Parents, pediatricians, and nurses have been using growth charts since the late 1970’s to track growth in their infants and children. The charts were revised back in the year 2000 as the data for the first charts (from a small study in Ohio) that didn’t accurately reflect the cultural and ethnic diversity of our communities.
The hallmark of a well child check is the review of a child’s growth. Growth can be a reflection of a child’s overall health, nutrition, and/or tolerance of possible underlying medical conditions. So understanding what your doctor or nurse practitioner says about your child’s growth should be a priority.
Watch the video to learn more about interpreting growth charts.
If your doc doesn’t have a computer in the room, ask to see the chart (on paper) or on a computer in their office. It will not only inform you, I suspect it will delight you to see what your child has done since the last time they have been seen.
The human body really is a fine-tuned machine and growth is simply astounding if you really stop to think of it.
If you have a challenge understanding how your child is growing or how the growth chart is presented, demand clarification. It’s okay if you don’t understand the presentation of facts on these grids; have confidence to speak up and ask for the doctor or nurse practitioner to explain it.
Revisions to the growth charts in 2000
Understanding growth charts
Basic but essential information. I like this link too: https://www.cdc.gov/growthcharts/who_charts.htm
It describes the CDC adoption of the WHO charts for children under two years of age.
So if my baby grew like mad in the beginning but seems to be slowing down, should I be worried? He went dorm 50th percentile at birth to 90th at 2 months, and by his 6 month check up he was back down to 50-75 (height). Also… Why are the ranges so broad? There seems to be a pretty wide range of sizes for young babies, so I’d think they’d be able to pin it down a little more precisely than give or take 12%. I would be much less worried by 50 to 90 to 75 than 50, 90, 50. I guess I’ll just have to see where he falls at his 9 month…
Some of this might be due to human error, you could have them double check the percentile from his 6mo appt when you go back at 9mo. Our office uses paper graphs so it’s up to the nurses interpretation where they fall. Or, he could have been mis-weighed too. (From a fellow mom perspective) I wouldn’t sweat it to much, and like you said, see how it falls at 9 months. 🙂
Wendy Sue Swanson, MD says
First off, babies often “find their spot” on the curve — around 6-9 months, so many babies shift where thy are. Another reason it’s great to review w the pediatrician at the visit. Likely this is what you’re seeing. Talk w your child’s doc at the next visit.
I often say that after 6-9 months “genes take over” and your child lands more on the curve in their predicted spot (for length) based on parental height and genetic ore-disposition.
In regards to the range and span reflected on the curve— it reflects the variance of sizes for healthy infants and children in our population regardless of feeding (breast or formula) and ethnic background. Does that make sense or did I misunderstand your question?
So do genetics NOT have much to do with his size so far? I’m hoping he’ll be tall like his dad, not short like me. 🙂 I’m guessing he was mime assured at his 2 month… That would probably even everything else out and his weight has been pretty consistent.
My 8mo old has always been “above the 97th percentile” for height and weight, he’s gigantic (but happy and healthy). My 3yo followed the same trend and is now 50th in weight and 90th in height. It’s been remarkable to watch him grow from this giant-sized chubby baby to a lanky toddler who sometimes seems like he’s too skinny. It’ll be interesting to see how my littlest grows, but I feel a bit more relaxed about his percentiles being so high, knowing that his big brother had a similar pattern.
My son had problems with growth even before he was born and I was on bed rest for the last month of my pregnancy. He came on his due date but was 5 pound 7 oz. He followed a curve (always on the low end) but dropped off of it because he had tonsil/adenoid issues @ age 2, which were removed at 2-1/2 yrs (thanks Childrens!). He started to get back on the chart because he ate and slept a better but is still on the low end of low for height and weight. He is almost 5 and wears a 2T pant! At what point do we start to think about human growth hormone? What are the advantages/disadvantages and how is it determined if a kid is really a candidate or could benefit? If it only will buy him an inch I don’t see it being worth it but as a boy if he could maybe be 5’7″ or 8″ vs. being potentially 5’4″ I’d be interested in knowing more about it. My ped says it would be a long shot if they worked at all but interested in hearing your take.
Wendy Sue Swanson, MD says
You ask a very complex question and I certainly think you should review this again with your child’s doctor.
However, a couple of things. Growth hormone deficiency is rare. And in starting an evaluation for growth your pediatrician can evaluate a number of things prior to you seeing a endocrinologist.
1) More than the percentile or size of your child, the rate at which your child is growing is key to knowing if they have adequate growth and growth factors. So next time you’re at the clinic, have your doc explain and confirm your child’s growth rate (the amount of gain in height since the last visit divided by the number of months) is normal.
2) If concerns about delays, there are a few tests that can be completed to help gain insight into reasons for delayed growth rate, if there is one. Sometimes we do a bone age study. This involves an xray of wrist to determine if the “age” of the bones matches the chronological age of a child. Rarely children who are deficient in growth factors (or have other medical conditions) will prove to have delayed growth that is evidenced on the xray. In addition, your pediatrician may consider blood testing looking at growth factors and some other hormones (thyroid function, for example).
And know this, by and large the most common reasons for children to be on the shorter side is familial short stature (inherited shorter height) or constitutional growth delay (“late bloomer”). But always talk with your child’s doc if you remain concerned as I’ve certainly diagnosed growth delays in practice.
Thank you for your reply! I will definitely talk to my ped at my son’s next visit – which unless we have some other issue will be after his quickly approaching 5th birthday. It does comfort me that I am all of 5 foot on a good day (and in heels although my osteopenia might mean I’ll be under 5 foot permanently in the not too distant future.) My husband is 5’8″ so we aren’t overly tall to begin with. But thanks for the perspective and information. Nice to get it from a real doc and not Dr. Google!
I have three kids and I had IUGR with all of them. My daughter is 9 and wears a size 7 finally. She is the size of kids at least a year or two younger then her. My son is three and still in a 2T pant He was only 5 pounds 13 ounces on his due date also. My 19 month old is below the 5% too. My husband is 5’6 and I am 5’7 1/2. I was like my daughter and didn’t really grow until I was 16 then I shot up. We keep a very close eye on my son and as long as he is eating, sleeping and staying on his curve even if it’s just below the chart the docs don’t worry and we have been checked by multiple docs at children’s in the past year. I would try to remember how you grew as a child and how your husband grew and how much of his size is due to genetics. Hope that maybe helps.
As parents, we should all be aware of our child’s growth, which is an important indicator of overall health. Check out a newly launched site: MyGrowthCharts.com. It has growth charts from the WHO-World Health Organization, which pediatricians are now recommending -it’s free to the public and you can e-share your chart with your pediatrician, family or day care provider. Best Regards.