It is often said that maintaining a normal growth pattern is a good indicator of a child's overall good health. Failure to grow at least 2 inches each year can be natures early warning sign that something underlying (unseen) is abnormal and needs medical evaluation. Growth is influenced by many factors such as heredity, genetic or congenital, illness and medications, nutrition, hormones, and psychosocial environment. Measurements of growth-height and weight - are a very inexpensive service that should be offered by all health care providers rendering care to children. Additionally it is also important that these be done correctly and included as a part of sick visits as well as "well child" check-ups.
Normal height growth rates vary according to age. Children during the first year of life should grow 7-10 inches. During the second year growth slows to an average of 5 inches /year. During the third year growth averages 3 inches/year. From age 4 years until puberty, growth should be at least 2 inches/year. Pubertal changes prompt a growth spurt of 2 ½ -4 ½ inches/year for girls usually starting by 10 years. However, boys experience both puberty and this growth spurt later - usually starting by 12 years and averaging 3 - 5 inches/year. After pubertal changes are completed and bone ends fuse, no further growth is possible.
What Causes Children to Grow Poorly?
Heredity: Children are a reflection of their parents growth patterns and height. Parents who were late bloomers and experienced slow growth and late pubertal development may see the same pattern in their children. The final height these children achieve is usually normal. Parents who have short stature usually have children whose adult height potential is in the shorter range. Conversely tall parents usually have tall children. As a general rule, a child’s potential adult height ranges between the average of the parents heights toward that of the parent who is the same sex as the child.
Congenital (those present at birth) causes for growth failure include intrauterine growth retardation, skeletal abnormalities and chromosome changes. Intrauterine growth retardation may result from maternal infections, smoking or alcohol/drug use while pregnant. Skeletal causes, such as short limbed dwarfism, result from abnormal production of new bone and cartilage. These children usually have unusual trunk /limb proportions. Chromosome variations causing short stature can include Turner syndrome in girls and Down’s syndrome.
Illnesses and Medications: Conditions which are considered chronic can reduce growth because they interfere with the body’s ability to use nutrients properly. Diseases which involve the kidneys, digestive tract, heart or lungs are examples of such conditions that may influence growth. Some medications that are used in large doses or for long periods of time may affect growth. If you are concerned about the effects of medications on a regular basis, you should discuss this with the physician who prescribed them.
Nutritional problems can influence growth in two ways. More commonly the problem is a poor diet with inadequate nutrients, not enough calories or the wrong food groups. Secondly, diseases that interfere with the absorption of food from the bowel will prevent the body from using those nutrients for growth. In these cases symptoms may include nausea, vomiting, excessive gas, diarrhea or constipation, poor weight gain or being underweight for height. After diagnosis, these problems usually improve with a special diet and or medications. With proper correction of these disorders, growth will also improve.
Psychosocial: Children in situations where home life is disrupted or unhappy, or where there is a lack of love, of consistency or of emotional support, experience severe stress. This stress can precipitate growth failure. Growth resumes when the problems are relieved and the stress is gone.
Hormones are produced in several glands in the body. After being released from the glands into the blood, the hormones have their efffects on many different locations. The most common ones that affect growth are discussed next.
There are also other signs that indicate excessive cortisol such as muscle wasting and weakness, weight gain, easy bruising and thinning of the skin. Treatment depends on the cause of the problem.
Children who are above the 95% in height or are growing unusually fast for their age may need to be evaluated by their physician. Most commonly, tall children come from tall families, are growing at the normal rate for age and show no signs of ill health. For those children in whom this is not the case, a physical examination and history may reveal the cause. Causes of rapid growth that may be abnormal include excessive growth hormone production, some congenital growth hormone production, some congenital genetic conditions or early puberty. Signals of these problems may include unusual body proportions, breast growth, enlargement of the genitals and axillary and pubic hair growth.
What Can You Do?
All children should have records of growth kept with measurements every 3-6 months for infants and yearly for children over 2 years of age. This is usually done at your child’s doctor’s office but you can keep your own records at home.
The best height measurement is done by having the child stand in bare feet against a wall without a baseboard with knees straight, and hips and shoulders touching the wall. Head would be level facing straight ahead. Using a flat object held against the top of the head and touching the wall, you can mark the height of the wall and measure it. Use this method at home and you can suggest that your doctor’s office do the same. This can be done with a device called a "stadiometer" and is more accurate than the measuring device attached to upright scales. Children under 2 years should be measured lying on their backs on a flat surface with a measuring device that has adjustable ends. Each end of the measuring device should fit against the top of the head and soles of feet with legs extended. It is acceptable to see a decrease in height when switching from lying to standing measurements (approximately ½ - 1 inch).
Ask your child’s doctor to record the measurements on a growth chart. These charts have the normal ranges for U. S. children for height and weight for each age and sex and are divided into percentile patterns. For example, if your child is on the 10th percentile (%), he/she is taller than 10 percent of U.S. children of the same age and sex and shorter than the remaining 90%. The usual range is between the 5 - 95%.
If your child is below the 5% or above the 95% or if your child is not in the appropriate range based on his/her potential from the parents heights, your doctor should be concerned and may order other tests. Also, a growth rate that has previously been following along a certain % line and begins to move away either up or down toward another % curve may be cause for more investigation. Typically after age 2 years, a child establishes a set growth pattern along one of the % curves and follows it until growth is completed. Growing away from this percentile may signal a health problem.
Contributing Medical Specialists
Diane Teague, RN
Jennifer L. Najar, M.D.