Is your baby growing normally in the first years of life?

 

Is my child growing normally?

That is a fair concern!

All parents want (and worry about!) their child growing normally. That is why your doctor is monitoring the growth by measuring the weight, length or height, and head circumference.

Health and nutritional problems are likely to affect growth, so that is a relatively easy and good measure to assess.

What is even better is a repeated measure over time, so that you can assess the pattern of growth. That is why regular check up at the doctor are key!

Regular growth measures can help your doctor notice (and prevent) any health or nutritional problems.

Growth Chart

The first 12 months: exponential growth!

By your child’s first birthday, she/he will have tripled in size! Talk about rapid growth (don’t you just keep on buying bigger and longer clothes?!).

Just like during pregnancy, weight is the “best” indicator of adequate growth. Taking additional measures of length and head circumference can provide even more information on your child’s growth. It is not a perfect system but an easy one to screen for potentially more serious problems.

Infant growth measure like length, weight and head circumference are easy and accessible measure to screen for any health problems

 

Growth chart 101

 

What can influence your baby’s growth

In short, so many things!

Many factors can influence your child’s growth, from genetics to appetite!

 

Growth chart 101: what is that?

The growth charts (or curves) that are used by your doctor to track your child’s growth have been created by the World Health Organization by sampling a large number of children all over the world. These children were all healthy, breast fed, and from different ethic backgrounds. They represent the normative model for optimal growth and development. In other words, these growth curves suggest the range of weight and length an average healthy kid should gain over time.

Growth charts allow us to track the head circumference which represents brain growth, as well as the weight and length (before 2 years, otherwise called height) gain over time for your child, based on sex and age. Just to note, before 2 years of age, a child’s height is measured laying down and is therefore called length.

The example below shows a growth pattern of a baby boy over time. The top curve displays the body length, while the bottom curve is shows weight gain. The red dots indicate the measures taken at each doctor’s visit. Over time, repeated measure (ideally always using the same equipment and in the same manner, for example naked with a clean diaper) allows to track the growth and see emerging patterns of your child’s development.

Growth Chart

Growth charts allow us to capture the pattern of your child’s growth over time.

 

Growth chart 101: what is a percentile?

The growth charts display the “normal” length-for-age, weight-for-age, and head circumference-for-age based on thousands of kids’ growth from all over the world. The percentiles (from 3 to 97) represent the normal window of growth we can expect for children. The 50th percentile represent the average (where most children are), so that below 50th percentile is lower than the average (but still normal!) and above 50th percentile is above the average (but still normal). If your baby is on the 75th percentile for length, that means s/he is taller than 75% of the babies of the same age, and 25% shorter than the babies of the same age.

Now this is different than what we typically associate with average, and being above the average – this is not a math test. There is nothing to aim for, except to be within the average (between 3th and 97th percentile) and relatively constant over time (following a specific percentile).

Children typically follow the same percentile for length and weight. If your child is on the 15th percentile for weight, most of the time, he would also be at the 15th percentile on the length chart. These two measures would grow in parallel, but it is not uncommon or necessarily bad news if your kid changes percentiles in the first three years of life.

Your child is going to grow according to his/her genetic potential, reaching what is considered his/her natural weight and natural length. Genetics will win! After 3 years of age, the growth should be steady, without change in percentiles until your child reaches puberty.

The best comparator for your child is his/her own self: your child will grow according to his/her genetic potential

 

Growth chart 101: does it matter if my child is not on the 50th percentile?

It doesn’t matter. Bodies come in all shapes and forms. There is no “goal” to reach here. Your baby is born the way s/he is and it is perfect this way! Your child will reach his/her genetic potential, whatever that represents in percentile.

There is no “goal” to achieve besides ensuring your child is healthy and fed appropriately to support his/her natural growth!

 

Growth chart 101: is it better to be above or below the 50th percentile?

It doesn’t matter. Nothing is better. Even being on the 50th percentile is not “better”. What is important is that your child follows his/her own growth pattern, whatever the percentile is. We are concerned when there are sudden drops or spikes in percentiles, suggesting a potential health problem or inadequate food intake.

Bodies (even baby’s!) come in all shapes and forms – that is the beauty of it!

 

Growth chart 101: the right growth charts for your child

Different growth charts exist for preterm infants and infant with special health conditions. Tracking these children’s growth is just as important, but using the right growth chart and comparing them to similar children is key as their expected growth pattern will be unique.

If your baby was born prematurely or with special needs, tracking his/her growth is just as important. Specific growth charts have been created for these children.

 

Growth chart 101: it is so hard to get a single measurement

Once you’ve visited the doctor for a checkup, you know that it can be challenging to measure accurately and precisely the weight, length and head circumference of your baby! They move, they wiggle, they cry and they don’t particularly like it…  That can influence the validity of the measure taken. On top of that, there is a difference between the best practice and what is done routinely in doctor’s office based on availability of equipment, time and cooperation of baby!

For babies under 2, the best way to measure length is to use a length board where the baby is laying down, head touching the board, legs extended and the footboard is moved towards the heel of the baby. That is called “recumbent length” and is measured laying down, as opposed to the standing height, measured standing using a stadiometer fixed to the wall, where the kid stands tall and the movable headboard is touching his/her to give the reading.

To measure weight, the best way is to use an infant scale where the baby can lay or sit down on the scale safely without assistance until the reading is done.

Despite best intentions from parents and health care practitioners, babies are challenging to measure!

 

Growth chart 101: the trend over time tells more than a single measure

Repeated measures, ideally taken in the same conditions over time is what we are really looking for. That is what tells us if your child is growing well. A single measure can tell us a bit, but really not much! But having several measurements allow us to see the growth pattern and trends. It also allow us to see if there is a decline or incline in the growth.

Surfing between percentile can be normal during the first three years; however, your doctor will judge when it is abnormal. For sure, a sharp incline or decline in growth (and jumping up or down percentiles) is suggestive of a health problem and warrants monitoring.

Ask your doctor to show you your child’s growth chart and review the pattern of growth together.

 

Infant growth: why and when to worry

The growth chart, in combination with a full health history and medical examination can help your doctor to screen for potential health problems.The clinical judgment of your doctor is important in assessing when is it time to worry and investigate further.

When to worry? Gaining too little

Growth can be altered due to inadequate food intake or a health problem.

In most situations, the weight will be affected first, while the length (height) will be affected later on.
If the problem persist or is severe, it can negatively impact your child’s length, where s/he will not growth as tall as her genetic potential.

Failure to thrive is the term used to describe when a child is not growing as expected. See this growth chart example. You can notice a decline in weight (bottom curve) and a subsequent decline in length (top curve).

Growth Chart

Several things could explain the flattening of the curve:

  • Is the child getting more active?
  • Is this child breastfed or formula fed?
  • Is the child eating less than usual?
  • Has the child been sick lately?
  • Has anything changed in the child’s routine?
  • Have any health problems occurred?

Most of the time it is due to inadequate food intake, and the good news is it can be reversed by tweaking the feeding approaches. The guidance of a registered dietitian can help parents.

We recommend regular visit at your doctor to monitor your child’s growth and to have the occasion to bring up any growth concerns you might have.

 

When to worry? Gaining too much

Should you worry is your baby is gaining too much weight? Not necessarily! See this example of a child who is starting to move up to a different percentile on the weight curve.

Growth Chart

This shows an incline in the weight (bottom curve) with a steady growth in length (top curve). Does that mean this baby is gaining too much weight? Not necessarily. Several avenues could be discussed with the parents:

  • Is the child eating more than usual?
  • Is the child less active than usual?
  • Has the child been sick lately?
  • Is this child breastfed or formula fed?
  • Has anything changed in the child’s routine?
  • Have any health problems occurred?

Just like when a child is not gaining enough, the doctor would monitor the growth and discuss with the parents of the general health of the child, the parents’ concerns and they would agree together of the next steps to take to ensure the child is growing to his/her potential.

Tracking weight and length gain over time ensure to detect in time any abnormalities or feeding problems that can be readjusted as needed.

In the end, don’t over stressed and don’t panic… as parents you’ve likely already noticed all the subtle changes in appetite, food intake, physical activity, mood and sleep pattern of your child. The growth charts just add one more piece to the story. It’s important to monitor growth so we can catch any problem early on. We want all kids to grow healthy and happily, and most of the times, readjusting our nutrition strategies can help them thrive.

REFERENCES

WHO Growth Charts – Dietitians of Canada

WHO. Measuring a child’s growth. World Health Organization. 2008.

Marchand, V. The toddler who is falling off the growth chart. Paediatr Child Health 2012;17(8):447

PEN The Global resource for nutrition practice. Growth monitoring of infants and children using the 2006 WHO child growth standards and 2007 WHO growth references [Internet]. 2013.

Dietitians of Canada and Canadian Paediatric Society. A Health Profressional’s Guide for using the WHO Growth Charts for Canada. 2014.

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