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Normal growth patterns in infants and prepubertal children?AuthorJulie A Boom, MDSection EditorTeresa K Duryea, MDDeputy EditorMary M Torchia, MD?Last literature review version 18.2: mayo 2010 | This topic last updated: mayo 20, 2010 INTRODUCTION?—?Normal growth is the progression of changes in height, weight, and head circumference that are compatible with established standards for a given population. The progression of growth is interpreted within the context of the genetic potential for a particular child [ HYPERLINK "" \t "_blank" 1]. Normal growth is a reflection of overall health and nutritional status. Understanding the normal patterns of growth enables the early detection of pathologic deviations (eg, poor weight gain due to a metabolic disorder, short stature due to inflammatory bowel disease) and can prevent the unnecessary evaluation of children with acceptable normal variations in growth.A review of normal growth patterns during infancy and childhood will be provided below. Growth during puberty is discussed separately. (See "Normal puberty".)DETERMINANTS OF NORMAL GROWTH?—?Somatic growth and biologic maturation are influenced by several factors that act independently and in concert to modify a child's genetic growth potential. The influence of maternal nutrition and intrauterine environment are reflected primarily in the growth parameters at the time of birth, whereas genetic factors have a later influence. As an example, the correlation coefficient between length and adult height is only 0.25 at birth, but increases to 0.8 at two years of age [ HYPERLINK "" \t "_blank" 2,3].Although primarily reflected in the growth parameters at birth, long-term influences of maternal nutrition and intrauterine environment on subsequent growth and pubertal development have been described [ HYPERLINK "" \t "_blank" 4,5]. Studies in various populations have demonstrated an association between catch-up growth or rapid growth in infancy or early childhood and subsequent obesity, suggesting that mechanisms that signal and regulate catch-up growth in the postnatal period may play a role in the development of obesity. (See "Definition; epidemiology; and etiology of obesity in children and adolescents", section on 'Metabolic programming'.)NORMAL PATTERNS?—?Most healthy infants and children grow in a predictable fashion, following a typical pattern of progression in weight, length, and head circumference. Normal human growth is pulsatile; periods of rapid growth ("growth spurts") are separated by periods of no measurable growth [ HYPERLINK "" \t "_blank" 6-8]. Growth is also seasonal, with growth velocities increased during the spring and summer months [ HYPERLINK "" \t "_blank" 9].Growth velocity?—?Growth velocity, the change in growth over time, is a more sensitive index of growth than is a single measurement. Current growth points should be compared to previous growth points, if possible, to determine the interval growth velocity.Twins?—?After birth, the growth velocity of twins is increased compared to singletons [ HYPERLINK "" \t "_blank" 10]. Nonetheless, their weight, length, and body mass index (BMI) usually are less than those of singletons during the first 2.5 years of life, even after correcting for gestational age [ HYPERLINK "" \t "_blank" 10,11]. By age four years, the weight, height, and BMI of twins are comparable to those of their nontwin siblings [ HYPERLINK "" \t "_blank" 11].Weight gain?—?General guidelines regarding weight gain during infancy and childhood for infants with growth parameters that were appropriate for gestational age at birth include the following:Term neonates may lose up to 10 percent of their birth weight in the first few days of life and typically regain their birth weight by 10 to 14 days [ HYPERLINK "" \t "_blank" 12-14] Newborns gain approximately 30 g/day (1 oz/day) until three months of age Infants gain approximately 20 g/day (0.67 oz/day) between three and six months of age and approximately 10 g/day between 6 and 12 months Infants double their birth weight by four months of age and triple their birth weight by one year Children gain 2 kg/year (4.4 lbs/year) between two years and pubertyA prepubertal child whose weight velocity is <1 kg/year (<2.2 lbs/year) should be monitored closely for progressive nutritional deficits. (See "Etiology and evaluation of failure to thrive (undernutrition) in children younger than two years"?and "Poor weight gain in children older than two years of age".)The growth patterns of preterm infants, small-for-gestational-age infants, and large-for-gestational-age infants are discussed separately. (See "Management of growth of preterm neonatal intensive care unit graduates", section on 'Growth chart'?and "Small for gestational age infant", section on 'Physical growth'?and "Large for gestational age newborn", section on 'Relationship of high birth weight and adult obesity'.)Breastfed infants?—?The pattern of weight gain during infancy varies depending upon the method of feeding [ HYPERLINK "" \t "_blank" 15-21]. Compared to formula-fed infants, breastfed infants gain weight relatively rapidly during the first three to four months of life and relatively slowly thereafter. When exclusively breastfed infants are plotted on National Center for Health Statistics (NCHS) growth curves (which are derived from a sample of predominantly formula-fed infants), their normal and appropriate weight gain may appear to be too rapid in the first three months of life, and too slow thereafter [ HYPERLINK "" \t "_blank" 22-24].Although the weights of breastfed and formula-fed infants are similar by 12 to 23 months of age, the typical pattern of slowed weight gain after three to four months among breastfed infants may lead to early introduction of solid foods or cessation of breastfeeding if the slowed weight gain is perceived as lactational inadequacy [ HYPERLINK "" \t "_blank" 23,25]. The use of a weight curve derived from a population of breastfed infants may prevent this misperception. Such a curve has been developed for international use by the World Health Organization (WHO) [ HYPERLINK "" \t "_blank" 26]. (See 'WHO growth curves'?below.)Linear growth?—?General guidelines regarding length or height gain during infancy and childhood include the following (table 1):The average length at birth for a term infant is 20 inches (50 cm) Infants grow 10 inches (25 cm) during the first year of life Toddlers grow 4 inches (10 cm) between 12 and 24 months, 3 inches (7.5 cm) between 24 and 36 months, and 3 inches (7.5 cm) between 36 and 48 months Children reach one-half of their adult height by 24 to 30 months [ HYPERLINK "" \t "_blank" 1] Children grow 2 inches/year (5 cm/year) between age four years and puberty There is a normal deceleration of height velocity before the pubertal growth spurt (figure 1A-B)The linear growth rate shifts during the first two years of life in nearly two-thirds of normal infants [ HYPERLINK "" \t "_blank" 27,28]. Approximately one-third of infants cross one major percentile line (eg, 10th, 25th, 50th, 75th, 90th), one-fourth cross two major percentile lines, and one-tenth cross three major percentile lines [ HYPERLINK "" \t "_blank" 27]. The shift may be an increase or decrease from the growth rate of the first six months, during which growth is influenced primarily by the intrauterine environment. After the period of shift, the child's growth typically proceeds along the same channel of growth between two and nine years. This can be used to predict adult height. (See 'Predicted height'?below.)Prepubertal growth is a nonlinear process, comprised of growth spurts lasting an average of eight weeks, separated by periods of slow growth, which last an average of 18 days [ HYPERLINK "" \t "_blank" 8].Height velocity?—?A period of at least six months is necessary for reliable calculation of height velocity in children older than two years. Average normal length or height velocities are as follows (table 1):0 to 6 months — One inch (2.5 cm) per month 7 to 12 months — One-half inch (1.25 cm) per month 12 to 24 months — Usually >4 inches (10 cm) per year 24 to 36 months — 3 inches (8 cm) per year 36 to 48 months — 2.75 inches (7 cm) per year 4 to 10 years — 2 to 2.4 inches (5 to 6 cm) per yearA prepubertal child whose height velocity is <2 inches/year (<5 cm/year) should be monitored closely. (See "Causes of short stature"?and "Diagnostic approach to short stature".)Variants of normal?—?The two most common causes of short stature beyond the first year or two of life are variants of normal growth: familial short stature and delayed (constitutional) growth. Growth velocity is normal in each of these conditions, but there are other characteristic features (table 2). (See "Causes of short stature", section on 'Patterns of abnormal growth'.)Predicted height?—?Adult height can be predicted by projecting the child's current growth channel to the value at 18 to 20 years or by calculating the midparental height.Projected height — The projected height for a child older than two years is determined by extrapolating the child's growth along the current channel to the 18- to 20-year mark (figure 2). The projected height can be compared with the calculated midparental height to determine if the child's growth is consistent with genetic potential.For children with delayed or accelerated growth, using the skeletal age (bone age) rather than the chronologic age to determine the projected height channel provides more accurate assessment of projected height (figure 3). (See "Diagnostic approach to short stature"?and "The child with tall stature or abnormally rapid growth".)Skeletal age generally is obtained by assessing the appearance and shape of the bones of the hand and wrist from a radiograph. The methods used most commonly for determining skeletal age are the Greulich and Pyle Atlas [ HYPERLINK "" \t "_blank" 29]?and the Tanner-Whitehouse (TW2) method [ HYPERLINK "" \t "_blank" 30].Midparental height — Although the precise contribution of heredity cannot be quantitated, an estimate of a child's adult height potential can be obtained by calculation of the midparental height, adjusted for the sex of the child (calculator 1)?[ HYPERLINK "" \t "_blank" 31]:- For girls, 13 cm is subtracted from the father's height and averaged with the mother's height - For boys, 13 cm is added to the mother's height and averaged with the father's height. The 13 cm represents the average difference in height of men and women.For both girls and boys, 8.5 cm on either side of this calculated value (target height) represents the 3rd to 97th percentiles for anticipated adult height [ HYPERLINK "" \t "_blank" 31].Head growth?—?General guidelines regarding head growth, a reflection of brain growth, include the following [ HYPERLINK "" \t "_blank" 32-34]:The average head circumference at birth is 13.7 inches (35 cm) Head circumference usually is 0.4 to 0.8 inches (1 to 2 cm) larger than chest circumference at birth Head circumference increases approximately 0.4 inches/month (1 cm/month) during the first year of life, with the most rapid growth occurring during the first six months, with an increase of 0.8 inches (2 cm) in the first month and 2.7 inches (6 cm) in the first four months. Brain weight doubles by four to six months of age and triples by one year of age The majority of head growth is complete by four years of ageEVALUATION OF GROWTH?—?Evaluation of growth in children focuses on historical features related to growth, accurate measurement of growth parameters, determination of growth percentiles for age and sex (including assessment of proportionality), and assessment of the growth trajectory. The laboratory and radiologic evaluation of nutritional status and measurement of body composition in children are discussed separately. (See "Laboratory and radiologic evaluation of nutritional status in children"?and "Measurement of body composition in children".)The accurate measurement and charting of growth may prevent unnecessary evaluation or intervention in a child who has a normal pattern of growth (eg, a breastfed infant whose weight percentile declines after three months of age on the NCHS weight curve but remains stable on the WHO weight curve; a child whose length channel shifts toward the channel of the midparental height in the first 12 to 15 months; a child with familial short stature whose growth velocity is normal). (See 'Breastfed infants'?above and "Causes of short stature", section on 'Intrinsic shortness'.)History?—?The history should include:The weight, length, and head circumference at birth Prenatal history: maternal infection, intrauterine exposures (cigarettes, drugs, alcohol, and other toxins) Interval growth points Past medical history Dietary history (see "Dietary history and recommended dietary intake in children", section on 'Dietary history') Developmental history Review of systems for symptoms of systemic disease (particularly vomiting or diarrhea) Family history, including parental heights, parental growth patterns, and timing of pubertal onset in parentsMeasurement?—?The physical examination should include careful measurements of weight, length, and head circumference. (See "The pediatric physical examination: General principles and standard measurements", section on 'Standard measurements'.)Growth standards?—?To determine the child's growth percentiles, weight and length (or height) should be plotted on the appropriate growth curve at each well-child visit and as indicated at interval visits [ HYPERLINK "" \t "_blank" 35]. Head circumference and weight-for-length should be plotted between birth and two years of age, and BMI after two years of age [ HYPERLINK "" \t "_blank" 35]. When a growth point deviates from the normal percentile range or from the patient's growth trajectory, the clinician should repeat the measurement to verify its accuracy.NCHS growth curves?—?The growth curves used by most pediatric healthcare providers in the United States are published by the National Center for Health Statistics (NCHS) and were revised in 2000 to include a more ethnically diverse population and more breastfed infants. The NCHS curves were derived primarily from data from the National Health and Nutrition Examination Survey, which has periodically collected height, weight, and other health information on the United States population since the early 1960s.The NCHS growth curves are available at the Centers for Disease Control and Prevention (CDC) Web site ( HYPERLINK "" \t "_blank" growthcharts/). Those that are most commonly used in practice are reproduced here; the figures can be printed out for clinical use.For boys aged zero to two years:Weight-for-age (figure 4)(calculator 2) Length-for-age (figure 5)(calculator 3) Head circumference-for-age (figure 6)(calculator 4) Weight-for-length (figure 7)(calculator 5)For girls aged zero to two years:Weight-for-age (figure 8)(calculator 2) Length-for-age (figure 9)(calculator 3) Head circumference-for-age (figure 10)(calculator 4) Weight-for-length (figure 11)(calculator 5)For boys aged 2 to 20 years:Weight-for-age (figure 12) Height-for-age (figure 13)(calculator 6) Body mass index-for-age (figure 14)(calculator 7)For girls aged 2 to 20 years:Weight-for-age (figure 15) Height-for-age (figure 16)(calculator 8) Body mass index-for-age (figure 17)(calculator 9)WHO growth curves?—?The WHO growth curves are based upon data from the Multicentre Growth Reference Study, which combined longitudinal data from birth to 24 months and cross-sectional data from 18 to 71 months of age [ HYPERLINK "" \t "_blank" 26]. The study population included 8440 healthy breastfed infants and young children from diverse ethnic backgrounds and cultural settings (Brazil, Ghana, India, Norway, Oman, United States). The study population was chosen to reflect a standard for children living under optimal environmental conditions.The WHO growth curves are intended to be used for all children, regardless of ethnicity, socioeconomic status, and type of feeding. However, they may not be suitable for all populations [ HYPERLINK "" \t "_blank" 36,37]. The WHO curves may be more appropriate than the NCHS curves for plotting the growth of exclusively breastfed infants during the first year to two years of life, since the WHO curves were derived from a breastfed population. (See 'Breastfed infants'?above.)The WHO growth curves are available at the WHO Web site ( HYPERLINK "" \t "_blank" who.int/childgrowth/standards/en). The weight curves for boys and girls aged zero to two years are reproduced here; they can be printed out for use in clinical practice.WHO weight-for-age (boys aged zero to two years) (figure 18) WHO weight-for-age (girls aged zero to two years) (figure 19)The WHO growth curves for children from birth to four years of age have been adopted for use in the United Kingdom (UK-WHO growth charts). UK-WHO growth charts and supporting educational materials can be downloaded from HYPERLINK "" \t "_blank" growthcharts.rcpch.ac.uk?[ HYPERLINK "" \t "_blank" 38]. When using the UK-WHO growth charts for weight, fewer children will be less than the 2nd percentile, and more children will be greater than the 98th percentile after the age of six months than when using the former UK90 growth charts.NCHS versus WHO growth curves?—?A summary comparison between the NCHS and WHO growth curves is provided in the table (table 3). Data from the National Health and Nutrition Survey in the United States (1999 to 2004) were used to determine the prevalence of short stature, underweight, and overweight among children using the NCHS and WHO growth curves [ HYPERLINK "" \t "_blank" 23]. The prevalence of the conditions varied depending upon which growth curve and which cut-off values were used for interpretation.When using the appropriate cut-offs (ie, the 5th and 95th percentile for the NCHS curves and the 2.3rd and 97.7th percentiles for the WHO curves) the prevalence of shortness and overweight were similar for both curves (table 3). However, the prevalence of underweight (low weight-for-age or low weight-for-height) was lower when using the WHO curves than the NCHS curves (table 3). This discrepancy may reflect an overidentification of underweight when using the NCHS curves, a hypothesis supported by the observation that the percentage of underweight infants has increased since adoption of the revised NCHS curves in 2000 [ HYPERLINK "" \t "_blank" 39,40].Whether the WHO growth curves, or some of the WHO curves, should be adopted for use in the United States is an area of ongoing discussion [ HYPERLINK "" \t "_blank" 39]. The CDC and the American Academy of Pediatrics are collaborating to develop additional guidance for appropriate use of the WHO growth curves for children in the United States ( HYPERLINK "" \t "_blank" GROWTHCHARTS/who_standards.htm).Premature infants?—?Most clinicians use standard NCHS growth curves to monitor the growth of preterm infants after discharge from the neonatal intensive care unit. Corrections for gestational age should be made for weight through 24 months of age, for stature through 40 months of age, and for head circumference through 18 months of age [ HYPERLINK "" \t "_blank" 41]. (See "Management of growth of preterm neonatal intensive care unit graduates".)Other growth curves?—?Special growth curves have been developed for a variety of conditions that are associated with altered patterns of growth. As examples:Turner syndrome (see "Clinical manifestations and diagnosis of Turner syndrome (gonadal dysgenesis)") Down syndrome (see "Clinical features and diagnosis of Down syndrome") Williams syndrome (available at: HYPERLINK "" \t "_blank" pediatrics.cgi/content/full/107/5/1192) [ HYPERLINK "" \t "_blank" 42] Achondroplasia (available at HYPERLINK "" \t "_blank" pediatrics.cgi/content/full/116/3/771) [ HYPERLINK "" \t "_blank" 43]Proportionality?—?Proportionality is the degree to which individual growth parameters correlate with each other. Measures of proportionality are useful as screens of nutritional status, to diagnose overweight and obesity, and in generating a differential diagnosis for short or tall stature. Assessment of proportionality is particularly useful when growth parameters are abnormal. (See 'Abnormal patterns of growth'?below.)Weight-for-length?—?Weight-for-length should be plotted in children between zero and two years of age (figure 7?and figure 11)(calculator 5)?[ HYPERLINK "" \t "_blank" 35]. A weight-for-length between the 5th and 95th percentile reflects normal variation, whereas a weight-for-length less than the 5th percentile or greater than the 95th percentile may indicate undernutrition or obesity, respectively. Rapid increases in weight-for-length from zero to six months of age are associated with an increased risk of obesity at age three years [ HYPERLINK "" \t "_blank" 44]. (See "Etiology and evaluation of failure to thrive (undernutrition) in children younger than two years"?and "Clinical evaluation of the obese child and adolescent".)The weight-for-length (or weight-for-height) typically is normal in children who have constitutional growth delay or familial short stature. (See 'Variants of normal'?above.)BMI?—?The body mass index (BMI) characterizes the relative proportion between the child's weight and the height squared. The BMI should be calculated for children older than two years (calculator 7?and calculator 9)?[ HYPERLINK "" \t "_blank" 35]. BMI is a valid predictor of adiposity and the best clinical standard for defining obesity. The BMI percentile can be used as a screening tool for undernutrition and to diagnose overweight and obesity (figure 14?and figure 17). (See "Measurement of growth in children", section on 'Body mass index (BMI)',).A child with a BMI less than the 15th percentile is "at risk" for undernutrition. (See "Poor weight gain in children older than two years of age".) A child with BMI between the 85th and 95th percentiles is overweight, and a child with BMI ≥95th percentile is obese. (See "Definition; epidemiology; and etiology of obesity in children and adolescents"?and "Clinical evaluation of the obese child and adolescent".)At the extremes (>97th percentile or <3rd percentile), small differences in percentiles represent clinically important differences in BMI. At these extremes, the z-score is a more precise reflection of how far the measurement deviates from the mean and is a useful tool for tracking changes (calculator 7?and calculator 9).Ideal body weight?—?The percent of ideal body weight (IBW) is another method to assess proportionality and nutritional status. There are several methods by which to calculate IBW, each of which provides similar results for children younger than eight years [ HYPERLINK "" \t "_blank" 45]. One method is to plot the child's height on the height curve; draw a horizontal line from the height to the 50 percent height line, then draw a vertical line to the 50 percent weight line; the intersection with the 50 percent weight line is the IBW [ HYPERLINK "" \t "_blank" 46]. Another method is to determine the weight percentile that is proportionate to the height percentile for chronologic age using standard growth curves (figure 20).??Percent IBW = actual weight divided by IBW x 100.The assessment of nutritional status according to percent IBW is as follows:>120 — Obese 110 to 120 — Overweight 90 to 110 — Normal variation 80 to 90 — Mild wasting 70 to 80 — Moderate wasting <70 — Severe wastingBody proportions?—?The proportions of the body change during fetal and postnatal growth [ HYPERLINK "" \t "_blank" 47]. The most commonly used descriptors of body proportions are the ratio of the upper body segment to the lower body segment and the ratio of arm span to height.Upper segment to lower segment?—?The upper segment to lower segment ratio (US/LS ratio) is helpful in distinguishing among causes of short or tall stature and in distinguishing disproportionate growth from immaturity [ HYPERLINK "" \t "_blank" 48].The lower segment is measured from the top of the symphysis pubis to the plantar surface of the foot. The upper segment is calculated by subtracting the lower segment from the child's height. Approximate normal ratios are as follows [ HYPERLINK "" \t "_blank" 47]:Birth — 1.7 3 years — 1.33 5 years — 1.17 10 years — 1.0 >10 years — <1.0The US/LS ratio is increased in children with rickets, achondroplasia, and Turner syndrome (because of decreased limb length) and decreased in those with Marfan syndrome (because of increased limb length). (See "Overview of rickets in children"?and "Clinical manifestations and diagnosis of Turner syndrome (gonadal dysgenesis)"?and "Genetics, clinical features, and diagnosis of Marfan syndrome and related disorders".)Arm span to height?—?The arm span is the distance between the tips of the middle fingers when the arms are raised to a horizontal position [ HYPERLINK "" \t "_blank" 49]. At birth, the arm span is typically less than length (by at least 2.5 cm) [ HYPERLINK "" \t "_blank" 47]. By approximately 10 years of age in boys and 12 years of age in girls, the arm span exceeds height [ HYPERLINK "" \t "_blank" 47,50]. Arm span is 0 to 5 cm greater than height in approximately three-fourths of healthy children, 5 to 10 cm greater in approximately one-fourth, and ≥10 cm greater in approximately 1 percent [ HYPERLINK "" \t "_blank" 49].The arm span-to height ratio is helpful in identifying conditions with a disproportion between the limbs and the trunk (eg, Marfan syndrome, in which the arm span usually exceeds height by at least 5 cm) [ HYPERLINK "" \t "_blank" 49]. (See "Genetics, clinical features, and diagnosis of Marfan syndrome and related disorders".)ABNORMAL PATTERNS OF GROWTH?—?Growth can be slowed or accelerated by a variety of conditions. Changes in growth may be the first sign of a pathologic condition (eg, inflammatory bowel disease, hypercortisolism, thyroid dysfunction) [ HYPERLINK "" \t "_blank" 51-53]. The evaluation and management of abnormal growth patterns in children are discussed separately:Poor weight gain (see "Etiology and evaluation of failure to thrive (undernutrition) in children younger than two years"?and "Management of failure to thrive (undernutrition) in children younger than two years"?and "Poor weight gain in children older than two years of age"?and "Malnutrition in developing countries: Clinical assessment"). Obesity (see "Definition; epidemiology; and etiology of obesity in children and adolescents"?and "Clinical evaluation of the obese child and adolescent"?and "Comorbidities and complications of obesity in children and adolescents"). Short stature (see "Causes of short stature"?and "Diagnostic approach to short stature"). Tall stature (see "The child with tall stature or abnormally rapid growth"). Microcephaly and macrocephaly (see "Etiology and evaluation of microcephaly in infants and children"?and "Etiology and evaluation of macrocephaly in infants and children").COMMUNICATING WITH PARENTS ABOUT GROWTH CURVES?—?Although some parents may appreciate viewing their child's growth and hearing their healthcare provider's interpretation of the graphic information, the usefulness of the growth curve as an education tool for parents is questionable. The general population may not easily understand growth curve data, as illustrated below [ HYPERLINK "" \t "_blank" 54-56]:In a survey of 1000 parents (demographically representative of the United States population), nearly two-thirds responded that it was important to see their child's growth chart [ HYPERLINK "" \t "_blank" 55]. However, 36 percent incorrectly determined a child's weight when shown a point plotted on a growth curve, 32 percent incorrectly identified the percentile associated with a plotted point, and up to 77 percent inaccurately interpreted data plotted on combined height and weight graphs. In another survey of 279 parents who were asked to rank six growth curves, almost one-half selected the curve with consistent growth along the 10th percentile as "least healthy" and 29 percent chose growth patterns along the 90th percentile or trending upward to the 90th percentile as the "healthiest" [ HYPERLINK "" \t "_blank" 56].Pediatric healthcare providers who choose to share growth curve information with parents must recognize the limitations of using growth charts as an educational tool.SUMMARYNormal human growth is pulsatile. Periods of rapid growth are separated by periods of no measurable growth. Growth is also seasonal, with growth velocities increased during the spring and summer months. (See 'Normal patterns'?above.) Growth velocity, the change in growth over time, is a more sensitive index of growth than is a single measurement. (See 'Growth velocity'?above.) Compared to formula-fed infants, breastfed infants gain weight relatively rapidly during the first three to four months of life and relatively slowly thereafter. (See 'Breastfed infants'?above.) Weight and height should be plotted on the appropriate growth curve at each well-child visit. Head circumference and weight-for-length should be plotted for children younger than two years of age and body mass index for children older than two years. The accurate charting of growth may prevent the unnecessary evaluation or intervention of a child who has a normal pattern of growth. (See 'Growth standards'?above.) The World Health Organization growth curves may be better than the National Center for Health Statistics (NCHS) growth curves for exclusively breastfed infants during the first year to two years of life. (See 'WHO growth curves'?above.) The growth of premature infants can be plotted on the NCHS growth curves. However, corrections for gestational age should be made for weight through 24 months of age, for stature through 40 months of age, and for head circumference through 18 months of age. (See 'Premature infants'?above.) Assessment of proportionality is useful as a screen of nutritional status, to diagnose overweight and obesity, and in generating a differential diagnosis for short or tall stature. Assessment of proportionality is particularly useful when growth parameters are abnormal. (See 'Proportionality'?above.)Use of UpToDate is subject to the HYPERLINK "" \t "_blank" Subscription and License Agreement. REFERENCES 1Lifshitz, F, Cervantes, CD. Short stature. In: Pediatric Endocrinology, Lifshitz, F (Ed), Marcel Dekker, New York 1996. p.3.2Healy, MJ, Lockhart, RD, Mackenzie, JD, et al. Aberdeen growth study. I. The prediction of adult body measurements from measurements taken each year from birth to 5 years. Arch Dis Child 1956; 31:372.3Tanner, JM. Fetus into Man: Physical Growth from Conception to Maturity. Harvard University Press, Cambridge, MA 1989.4 HYPERLINK "" \t "_blank" Ong, KK, Ahmed, ML, Emmett, PM, et al. Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. BMJ 2000; 320:967. 5 HYPERLINK "" \t "_blank" Adair, LS. Size at birth predicts age at menarche. Pediatrics 2001; 107:E59. 6 HYPERLINK "" \t "_blank" Lampl, M, Johnson, ML, Frongillo, EA Jr. Mixed distribution analysis identifies saltation and stasis growth. Ann Hum Biol 2001; 28:403. 7 HYPERLINK "" \t "_blank" Lampl, M, Veldhuis, JD, Johnson, ML. Saltation and stasis: a model of human growth. Science 1992; 258:801. 8 HYPERLINK "" \t "_blank" Thalange, NK, Foster, PJ, Gill, MS, et al. Model of normal prepubertal growth. Arch Dis Child 1996; 75:427. 9 HYPERLINK "" \t "_blank" Gelander, L, Karlberg, J, Albertsson-Wikland, K. Seasonality in lower leg length velocity in prepubertal children. Acta Paediatr 1994; 83:1249. 10 HYPERLINK "" \t "_blank" van Dommelen, P, de Gunst, M, van der, Vaart A, et al. Growth references for height, weight and body mass index of twins aged 0-2.5 years. Acta Paediatr 2008; 97:1099. 11 HYPERLINK "" \t "_blank" Estourgie-van Burk, GF, Bartels, M, Boomsma, DI, Delemarre-van de, Waal HA. Body size of twins compared with siblings and the general population: from birth to late adolescence. J Pediatr 2010; 156:586. 12 HYPERLINK "" \t "_blank" Crossland, DS, Richmond, S, Hudson, M, et al. Weight change in the term baby in the first 2 weeks of life. Acta Paediatr 2008; 97:425. 13 HYPERLINK "" \t "_blank" Macdonald, PD, Ross, SR, Grant, L, Young, D. Neonatal weight loss in breast and formula fed infants. Arch Dis Child Fetal Neonatal Ed 2003; 88:F472. 14 HYPERLINK "" \t "_blank" Wright, CM, Parkinson, KN. Postnatal weight loss in term infants: what is normal and do growth charts allow for it?. Arch Dis Child Fetal Neonatal Ed 2004; 89:F254. 15 HYPERLINK "" \t "_blank" Whitehead, RG, Paul, AA. Growth charts and the assessment of infant feeding practices in the western world and in developing countries. Early Hum Dev 1984; 9:187. 16 HYPERLINK "" \t "_blank" Dewey, KG, Heinig, MJ, Nommsen, LA, et al. Growth of breast-fed and formula-fed infants from 0 to 18 months: the DARLING Study. Pediatrics 1992; 89:1035. 17 HYPERLINK "" \t "_blank" Hediger, ML, Overpeck, MD, Ruan, WJ, Troendle, JF. Early infant feeding and growth status of US-born infants and children aged 4-71 mo: analyses from the third National Health and Nutrition Examination Survey, 1988-1994. Am J Clin Nutr 2000; 72:159. 18 HYPERLINK "" \t "_blank" Kramer, MS, Guo, T, Platt, RW, et al. Feeding effects on growth during infancy. J Pediatr 2004; 145:600. 19 HYPERLINK "" \t "_blank" Dewey, KG, Peerson, JM, Brown, KH, et al. Growth of breast-fed infants deviates from current reference data: a pooled analysis of US, Canadian, and European data sets. World Health Organization Working Group on Infant Growth. Pediatrics 1995; 96:495. 20 HYPERLINK "" \t "_blank" Cole, TJ, Paul, AA, Whitehead, RG. Weight reference charts for British long-term breastfed infants. Acta Paediatr 2002; 91:1296. 21 HYPERLINK "" \t "_blank" Dewey, KG. Growth patterns of breastfed infants and the current status of growth charts for infants. J Hum Lact 1998; 14:89. 22Committee on Nutrition American Academy of Pediatrics. Breastfeeding. In: Pediatric Nutrition Handbook, 6th ed, Kleinman, RE (Ed), American Academy of Pediatrics, Elk Grove Village, IL 2009. p.29.23 HYPERLINK "" \t "_blank" Mei, Z, Ogden, CL, Flegal, KM, Grummer-Strawn, LM. Comparison of the prevalence of shortness, underweight, and overweight among US children aged 0 to 59 months by using the CDC 2000 and the WHO 2006 growth charts. J Pediatr 2008; 153:622. 24 HYPERLINK "" \t "_blank" van Dijk, CE, Innis, SM. Growth-curve standards and the assessment of early excess weight gain in infancy. Pediatrics 2009; 123:102. 25Whitehead, RG. The importance of diet-specific growth charts. Acta Paediatr 2003; 92:137.26World Health Organization. The WHO child growth standards. Available at: HYPERLINK "" \t "_blank" who.int/childgrowth/standards/en/. (Accessed on February 21, 2008).27 HYPERLINK "" \t "_blank" Smith, DW, Truog, W, Rogers, JE, et al. Shifting linear growth during infancy: illustration of genetic factors in growth from fetal life through infancy. J Pediatr 1976; 89:225. 28 HYPERLINK "" \t "_blank" Mei, Z, Grummer-Strawn, LM, Thompson, D, Dietz, WH. Shifts in percentiles of growth during early childhood: analysis of longitudinal data from the California Child Health and Development Study. Pediatrics 2004; 113:e617. 29Greulich, WW, Pyle, SI. Radiographic Atlas of Skeletal Development of the Hand and Wrist. Stanford University Press, Stanford, CA 1950.30Tanner, JM, Whitehouse, RH, Cameron, N, et al. Assessment of Skeletal Maturity and Prediction of Adult Height (TW2 Method). Academic Press, London 1983.31Tanner, JM, Goldstein, H, Whitehouse, RH. Standards for children's heights at ages 2 to 9 years allowing for height of parents. Arch Dis Child 1970; 45:755.32Swaiman, KF. Neurologic examination of the term and preterm infant. In: Pediatric Neurology: Principles and Practice, 4th ed, Swaiman, KF, Ashwal, S, Ferriero, DM (Eds), Mosby, St. Louis 2006. p.48.33 HYPERLINK "" \t "_blank" Fujimura, M, Seryu, JI. Velocity of head growth during the perinatal period. Arch Dis Child 1977; 52:105. 34Hall, JG, Froster-Iskenius, UG, Allanson, JE. Head circumference (occipitofrontal circumference, OFC). In: Handbook of Physical Measurements. Oxford University Press, New York 2007. p.72.35Recommendations for preventive pediatric health care. Pediatrics 2007; 120:1376.36 HYPERLINK "" \t "_blank" Hui, LL, Schooling, CM, Cowling, BJ, et al. Are universal standards for optimal infant growth appropriate? Evidence from a Hong Kong Chinese birth cohort. Arch Dis Child 2008; 93:561. 37 HYPERLINK "" \t "_blank" Wright, C, Lakshman, R, Emmett, P, Ong, KK. Implications of adopting the WHO 2006 Child Growth Standard in the UK: two prospective cohort studies. Arch Dis Child 2008; 93:566. 38Wright, CM, Williams, AF, Elliman, D, et al. Using the new UK-WHO growth charts. BMJ 2010; 340:c1140.39Greer, FR. Time to step up to the plate: adopting the WHO 2006 growth curves for US infants. J Pediatr 2008; 153:592.40 HYPERLINK "" \t "_blank" Ogden, CL, Kuczmarski, RJ, Flegal, KM, Mei, Z. Centers for disease control and prevention 2000 growth charts for the United States: improvements to the 1977 national center for health statistics version. Pediatrics 2002; 109:45. 41Committee on Nutrition American Academy of Pediatrics. Failure to thrive. In: Pediatric Nutrition Handbook, 6th ed, Kleinman, RE (Ed), American Academy of Pediatrics, Elk Grove Village, IL 2009. p.601.42 HYPERLINK "" \t "_blank" American Academy of Pediatrics: Health care supervision for children with Williams syndrome. Pediatrics 2001; 107:1192. 43 HYPERLINK "" \t "_blank" Trotter, TL, Hall, JG. Health supervision for children with achondroplasia. Pediatrics 2005; 116:771. 44 HYPERLINK "" \t "_blank" Taveras, EM, Rifas-Shiman, SL, Belfort, MB, et al. Weight status in the first 6 months of life and obesity at 3 years of age. Pediatrics 2009; 123:1177. 45 HYPERLINK "" \t "_blank" Phillips, S, Edlbeck, A, Kirby, M, Goday, P. Ideal body weight in children. Nutr Clin Pract 2007; 22:240. 46Olsen, IE, Mascarenhas, MR, Stallings, VA. Clinical assessment of nutritional status. In: Nutrition in Pediatrics Basic Science and Clinical Applications, 3rd ed, Walker, WA, Watkins, JB, Duggan, C (Eds), BC Decker Inc, Hamilton, Ontario 2003. p.6.47Hall, JG, Froster-Iskenius, UG, Allanson, JE. Proportional growth and normal variants. In: Handbook of Physical Measurements. Oxford University Press, New York 2007. p.13.48Hall, JG, Froster-Iskenius, UG, Allanson, JE. Limbs. In: Handbook of Physical Measurements. Oxford University Press, New York 2007. p.240.49Dimeglio, A. Biometric measurements. In: Lovell and Winter's Pediatric Orthopaedics, 6th ed, Morrissy, RT, Weinstein, SL (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.35.50 HYPERLINK "" \t "_blank" Jarzem, PF, Gledhill, RB. Predicting height from arm measurements. J Pediatr Orthop 1993; 13:761. 51 HYPERLINK "" \t "_blank" Kanof, ME, Lake, AM, Bayles, TM. Decreased height velocity in children and adolescents before the diagnosis of Crohn's disease. Gastroenterology 1988; 95:1523. 52 HYPERLINK "" \t "_blank" Magiakou, MA, Mastorakos, G, Oldfield, EH, et al. Cushing syndrome in children and adolescence: Presentation, diagnosis and therapy. N Engl J Med 1994; 331:629. 53Schlesinger, S, MacGillivray, MH, Munschauer, RW. Acceleration of growth and bone maturation in childhood thyrotoxicosis. J Pediatr 1973; 83:233.54 HYPERLINK "" \t "_blank" Ben-Joseph, EP, Dowshen, SA, Izenberg, N. Public understanding of growth charts: a review of the literature. Patient Educ Couns 2007; 65:288. 55 HYPERLINK "" \t "_blank" Ben-Joseph, EP, Dowshen, SA, Izenberg, N. Do parents understand growth charts? A national, internet-based survey. Pediatrics 2009; 124:1100. 56 HYPERLINK "" \t "_blank" Laraway, KA, Birch, LL, Shaffer, ML, Paul, IM. Parent perception of healthy infant and toddler growth. Clin Pediatr (Phila) 2010; 49:343. ?2010 UpToDate? ? 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