Is Your Child Growing Normally?

Hundreds of medical issues can affect your child's growth. In fact, an abnormal growth pattern is often the earliest indication of an underlying medical condition. It is important to track your child's growth at home at least twice annually. If you think that your child is not growing properly, this is the perfect place to start. Early signs of abnormal growth include wearing our shoes before outgrowing them; fitting into the same clothes or coats for more than one year; younger siblings catching up or surpassing your child's height; gradually falling behind classmates. The opposite is sometimes present where your child is growing too fast. Maintaining a normal growth pattern is a good indicator of a child's overall good health. Growth is influenced by many factors such as heredity, genetic or congenital factors, illness and medications, nutrition, hormones, and psychosocial environment. More importantly than a child's actual or projected stature is whether or not they follow a normal growth pattern.

Online/automatic Growth Chart.

Simply plug in your child's information and a chart will be generated. If you are not familiar with getting accurate measurements or growth charts, we STRONGLY suggest you read the at home instructions.

Measurements of growth-height and weight on a growth chart is an inexpensive service that should be offered by all health care providers. 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 per year. Pubertal changes prompt a growth spurt of 2 ½  to 4 ½ inches per 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 to 5 inches per year. After pubertal changes are completed and bone ends fuse, no further growth is possible.

Measuring Your Child at Home

Getting accurate measurements about your child's height and weight is VERY important. Healthy children grow AT LEAST 2-2.5 inches each year (after age 2 and before puberty). So if your measurements are even slightly could indicate a problem when there is not one. Therefore, it is VERY important that you follow this guide carefully!

  • Get a hard book and a pencil
  • Go to a room with a hard floor (no carpet) and a flat wall.
  • Stand your child against the wall
    • Make sure to remove sox, shoes and bulky items (hair bows, coats, jackets)
    • Arms should be by their side.
    • Head face straight ahead, not tilted up nor down.
    • Heels should be touching the wall.
    • Feet flat, not standing on their toes!
  • Place the book on their head (see example on the right)
    • Make sure that the side of the book touching the wall is completely flat against the wall-not tilted at all.
  • Check one more time that the feet are flat on the floor
  • Mark the wall where your child’s head meets the book.
  • Ask your child to step away. This is important because you really need to measure the exact distance from the floor to that mark
  • Write down the exact distance from the floor to the mark on the wall.
  • Repeat this process to confirm that you have measured your child properly. Continue to repeat until your measurements are very close together.
  • After you get the height measurement, click the Proceed to Growth Charts page to reach our Automated Growth Chart, or to download printable charts. (It will plot the height and weight of your child (after the age of 2) on a form for you.)

Understanding Growth Charts

Growth Charts show you how your child compares to other children his/her age. The more recorded measurements you have the better! Seeing a "pattern" of growth over several years helps you understand how your child has progressed. Most Pediatric Endocrinologists (growth specialists) want at least 12 months (measuring at least twice in regular intervals) to establish a growth pattern.

IMPORTANT NOTE: If you get measurement records from other sources- you MUST be careful! If they measured your child incorrectly (with his/her shoes on, or with "items" in their hair, feet not totally flat or without making them stretch fully etc.)- it will make a big difference on their growth chart as it is plotted out. So don't panic if some items don't seem to line up correctly.

Understanding the Growth Chart (using height as the example)

A growth chart shows how a child's height compares to other children the exact same age and sex. After the age of 2, most children maintain fairly steady growth until they hit puberty. They generally follow close to the same percentile they had at the age of 2. Children over 2 years of age who move away (loosing or gaining more than 15 percentile points) from their established growth curve should be thoroughly evaluated and followed by a doctor, no matter how tall they are. Here is an example of a growth chart and an explanation about how to read/figure it out.

How do I figure out what percentile my child is in?

On each growth chart there is a series of lines swerving from the lower left and climbing up to the right side of the chart. These lines help people follow along (so to speak) so that you can see where your child falls on a growth curve.

Percentiles are the most commonly used markers to determine the size and growth patterns for children. Percentiles rank a child by showing what percent of kids would be smaller or taller than your child. If your child is in the 5th percentile, 95 out of 100 children the same sex and age, would be taller than your child. If you child is in the 70th percentile, he or she is taller than 70 out of 100 children the same age and sex.

Please keep in mind that your child's percentile doesn't necessarily indicate how well they are growing. A child at the 5th percentile can be growing just as well as a child at the 95th percentile. It is more important to look at your child's growth over time. If he/she has always been at the 5th percentile, then he/she is likely growing normally. It would be concerning if your child had previously been at the 50th or 75th percentile and had now fallen down to the 25th or lower percentile. 

It is not uncommon for children under the age of 2 to change percentiles. However, after the age of 2.5 to 3 years, children should follow their growth curves fairly closely. Again, discuss any concerns with your Pediatrician.

Keep in mind that many factors influence how children grow, including their genetic potential (how tall their parents and other family members are), underlying medical problems (such as congenital heart disease, kidney disease, syndromes, etc.), and their overall nutrition plays a big role in every child's growth and development.

If you are concerned about your child's height or weight, talk with your Pediatrician. Continue to watch the growth annually (or more frequently if you see your child falling below a normal pattern).  It is also important to make sure your child is not crossing percentiles in an upward swing because this too can represent a problem (see Precocious Puberty).

Growth Chart Example

Our imaginary child, Sally Sue, is 6 years old and stands 45.5 (115 cm) tall for this example.

If you look at the very bottom of the chart- you will see numbers starting with the number 2. Those numbers are the age of the child. In this example-we listed our sample girls as being 6 years old. Therefore, her growth is on that line on the bottom.

Next we found the mark on the left side of the page that matched her height 45.5 inches (115cm).

After we had her height and her age...we matched the two points and placed the blue dot where that information met.

Now.... see the curved lines going from the lower left side upwards towards the right side? Those lines have numbers too. If you enlarge the picture (or look at the growth chart generated from our automatic growth chart) you will see that the lowest line is the 3rd percentile and the top curved line is the 97th percentile. This chart shows that Sally Sue is on the 50th percentile. That means that out of 100 girls her same age- half are taller and half are smaller than she is. If she were on the 10th percentile, it would mean that she was taller than 10 girls and shorter than 90 girls her same age. At the 50th percentile (following the line to age 16 or so) you might GUESStimate that her final adult height would be somewhere between 63.5 and 64.5 inches tall. But that is true guess work! Genetics and many factors play a huge role in this process.

Growth Chart




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