Pediatric Growth - An Overview

Introduction:

Nutritional, environmental, and genetic factors influence physical growth and development. It is vital to track the growth and development of children appropriate to their age and determine if any medical problems are withholding the expected growth of the child. These are tracked with the help of growth charts. Growth charts are early indicators of certain medical problems and are easy, inexpensive, quick, and noninvasive.

Why Is Growth Assessment Important?

Growth is the physical gain in body size and begins from the time a fetus develops in the womb and continues in an orderly pattern. Though genetics play a role in growth, nutritional, familial, sociocultural, emotional, and community factors also contribute to growth. The two rapid growth periods in humans are:

• Continuation of fetal growth to infancy.

• The rapid phase of growth during puberty.

Growth is bounded by time, and any issue faced during the initial growth phase may affect the final growth of children. Hence, monitoring appropriate growth is crucial to identify any deflection of the normal growth pattern.

How Were Growth Charts Developed?

Growth charts came into existence through information obtained by measuring and weighing almost thousands of children. From the obtained data, the national average height and weight for each gender and age were developed. The lines or curves on the growth charts explain how a majority of children weigh a particular amount at a particular age.

What Is the Purpose of Using Growth Charts by Doctors?

Growth charts are a usual part of a child’s check-up. The purpose of using growth charts is as follows:

• Compare the growth of the child with other children of the same age and gender.

• The pattern of the child’s height and weight gain over a period of time.

• To check if the growth is proportional.

Does a Different Pattern in the Growth Chart Indicate a Problem?

A different growth pattern inferred from the growth chart does not always necessarily mean a serious issue. The obtained information is compared with the overall well-being, genetic, and environmental background of the child. This includes whether the child can achieve the developmental milestones (behaviors or physical skills in infants as they grow), whether any unhealthy signs are present, comparison of height and weight with the child’s parents or siblings, whether the baby was born prematurely, and whether the kid attained puberty earlier or later than the expected average age.

Are There Different Growth Charts?

There are different charts for boys and girls, as their growth patterns and rates are different. A separate chart is used for babies from birth to 36 months. Another chart is allocated for kids and teens between 2 and 20 years of age. Special growth charts are available for kids with certain conditions, like premature babies.

What Do Growth Charts Measure?

During each check-up visit, the pediatrician (child specialist) will check for the following:

• The weight of the child is measured in grams and kilograms or ounces and pounds.

• The height of the child is measured while lying down in children under 3 years of age and while standing up in children over three years of age.

• Head circumference, in which the size of the head is measured by encircling a measuring tape around the back of the head just above the eyebrows.

From two years of age, the child’s body mass index (BMI- a measurement to evaluate the child’s body fat) is calculated based on height and weight. Each value measured is compared with the normal range for children of the same age and gender on the growth chart.

Why Measure Head Circumference in Babies?

Measuring head circumference in babies gives hints about brain development. A smaller or bigger head than those of other babies of the same age and gender or too rapid or a sudden stop in head growth can indicate an underlying health condition. For instance, an unusually large head may indicate a condition called hydrocephalus (accumulation of fluid in the brain), whereas a smaller head than average can be a sign that the brain is not developing normally or has stopped developing or growing.

What Are the Types of Growth Charts?

The two types of growth charts are:

• Growth Standards: The information obtained from these growth charts suggests how a population of kids should grow functionally with the best available nutrition and environment. For example, the WHO 2006 growth standard for children below five years of age provides the benefit of being able to compare with children from different ethnicities, races, and countries easily. These are prescriptive.

• Growth References: These growth charts are developed from values gathered from healthy children who belong to the same ethnicity and are known to have grown in an environment of sufficient care and nutrition. For example, revised Indian Academy of Pediatrics (IAP) growth charts (2015), and Agarwal growth charts (1994). These are descriptive.

What Are the Percentiles in Growth Charts?

Percentiles are nothing but measurements that convey where a child is when compared with other kids. The percentiles are depicted as lines drawn in curved patterns on the growth charts. The doctors view where the measurements land on the percentile line after they plot the child’s height and weight on the growth chart. The following is the inference from the chart:

• If the percentile number is higher, the child is bigger when compared with other children of the same age and sex, whether it is for weight or height.

• If the percentile number is small, the child is also small.

For instance, if a 5-year-old boy’s weight is in the 10th percentile, it means that 10 percent of the boys belonging to that age weigh less than the child, and 90 percent of boys of that age weigh more. This can be a cause of concern with respect to weight. Suppose the same child is in the 10th percentile for height; it means that 10 percent of children are shorter and weigh less than the child, while 90 percent are taller and weigh more. This shows that the child has a normal height but slightly weighs less than the average weight. This is usually not a problem if other factors are normal.

What Is Considered an Ideal Percentile?

There is no specific ideal percentile. A baby who is in the 10th percentile can be as hale and healthy as a baby in the 95th percentile. Some children can follow a definite growth pattern, growing proportionally in height and weight. If a 5-year-old girl on the 10th percentile line maintains to be on the same line, it can mean that the child is growing along the same definite pattern, which is a good indicator. Certain factors can also alter the percentile like:

• Mistakes in measurement can occur if the baby moves on the scale.

• One measurement is not the final result. For example, an infant may lose weight following diarrhea but may regain weight after the illness.

• There is a wide range of what is regarded as ‘normal’. A low percentile does not always mean that the child is sick, not having enough nutrition, or that breastmilk is insufficient for the baby.

• These measurements are not predictors of whether the baby will be tall, short, fat, or skinny when it grows as an adult.

When Can Growth Charts Signify a Problem?

Growth charts can signify a problem when:

• Deviation From the Normal Pattern: For example, if the height and weight of the child have been on the 70th percentile until the child is six years old, and then the height drops to the 40th percentile at seven years of age, it might indicate a problem in growth since the child is not following the normal growth pattern. This is not always a matter of concern since few kids show variations in growth at some point, and it differs with every child. Growth can be rapid at times and is normal during infancy and puberty.

• Height Not Proportional to Weight: If a boy’s height is in the 50th percentile and weight in the 90th percentile, it suggests that the child is 50 percent taller than the kids of their age but weighs more than 90 percent of the children of their age. This can indicate a problem. Suppose the boy is in the 85th percentile for both weight and height and follows this pattern over a period of time; it means that the child is healthy and slightly larger than average.

Other issues can be when the child’s measurements remain below the 10th percentile or above the 90th percentile of their age, if the growth of the head is too rapid or too slow when measured over a given period, and if vast variations in percentiles are observed when measured after a specific period.

Conclusion:

Since the world population is diverse, there are children belonging to different cultures, geography, and religions. Children belonging to different races may differ in status. Growth charts can be useful to assess stunted growth, underweight, or overweight in children.

Each child has their own growth pattern, and growth charts provide a general idea about the growth pattern in children.