UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Normal growth patterns in infants and prepubertal children

Author
Julieana Nichols, MD, MPH
Section Editor
Teresa K Duryea, MD
Deputy Editor
Mary M Torchia, MD

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 [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 and during the first month of life, whereas genetic factors have a later influence [2]. The correlation coefficient between length and adult height is only 0.25 at birth, but increases to 0.8 at two years of age [3,4].

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 [5,6]. 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 [7-9]. Growth is also seasonal, with growth velocities increased during the spring and summer months [10].

                             

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu May 26 00:00:00 GMT 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Lifshitz F, Cervantes CD. Short stature. In: Pediatric Endocrinology, Lifshitz F (Ed), Marcel Dekker, New York 1996. p.3.
  2. Touwslager RN, Gielen M, Derom C, et al. Determinants of infant growth in four age windows: a twin study. J Pediatr 2011; 158:566.
  3. HEALY 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.
  4. Tanner JM. Fetus into Man: Physical Growth from Conception to Maturity, Harvard University Press, Cambridge 1989.
  5. 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.
  6. Adair LS. Size at birth predicts age at menarche. Pediatrics 2001; 107:E59.
  7. Lampl M, Johnson ML, Frongillo EA Jr. Mixed distribution analysis identifies saltation and stasis growth. Ann Hum Biol 2001; 28:403.
  8. Lampl M, Veldhuis JD, Johnson ML. Saltation and stasis: a model of human growth. Science 1992; 258:801.
  9. Thalange NK, Foster PJ, Gill MS, et al. Model of normal prepubertal growth. Arch Dis Child 1996; 75:427.
  10. Gelander L, Karlberg J, Albertsson-Wikland K. Seasonality in lower leg length velocity in prepubertal children. Acta Paediatr 1994; 83:1249.
  11. 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.
  12. 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.
  13. 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.
  14. 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.
  15. 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.
  16. 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.
  17. 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.
  18. 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.
  19. Kramer MS, Guo T, Platt RW, et al. Feeding effects on growth during infancy. J Pediatr 2004; 145:600.
  20. 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.
  21. Cole TJ, Paul AA, Whitehead RG. Weight reference charts for British long-term breastfed infants. Acta Paediatr 2002; 91:1296.
  22. Dewey KG. Growth patterns of breastfed infants and the current status of growth charts for infants. J Hum Lact 1998; 14:89.
  23. 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. van Dijk CE, Innis SM. Growth-curve standards and the assessment of early excess weight gain in infancy. Pediatrics 2009; 123:102.
  25. American Academy of Pediatrics Committee on Nutrition. Breastfeeding. In: Pediatric Nutrition, 7th, Kleinman RE, Greer FR. (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2014. p.41.
  26. Whitehead RG. The importance of diet-specific growth charts. Acta Paediatr 2003; 92:137.
  27. World Health Organization. The WHO child growth standards. Available at: www.who.int/childgrowth/standards/en/. (Accessed on February 21, 2008).
  28. Grummer-Strawn LM, Reinold C, Krebs NF, Centers for Disease Control and Prevention (CDC). Use of World Health Organization and CDC growth charts for children aged 0-59 months in the United States. MMWR Recomm Rep 2010; 59:1.
  29. 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.
  30. 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.
  31. Greulich WW, Pyle SI. Radiographic Atlas of Skeletal Development of the Hand and Wrist, Stanford University Press, Stanford 1950.
  32. Tanner JM, Whitehouse RH, Cameron N, et al. Assessment of Skeletal Maturity and Prediction of Adult Height (TW2 Method), Academic Press, London 1983.
  33. Tanner JM, Goldstein H, Whitehouse RH. Standards for children's height at ages 2-9 years allowing for heights of parents. Arch Dis Child 1970; 45:755.
  34. Swaiman, 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.
  35. Fujimura M, Seryu JI. Velocity of head growth during the perinatal period. Arch Dis Child 1977; 52:105.
  36. Hall, JG, Froster-Iskenius, UG, Allanson, JE. Head circumference (occipitofrontal circumference, OFC). In: Handbook of Physical Measurements. Oxford University Press, New York 2007. p.72.
  37. Bright Futures/American Academy of Pediatrics. Recommendations for Preventive Pediatric Health Care - Periodicity Schedule. www.aap.org/en-us/professional-resources/practice-support/Pages/PeriodicitySchedule.aspx (Accessed on December 15, 2015).
  38. Canadian Task Force on Preventive Health Care. Recommendations for growth monitoring, and prevention and management of overweight and obesity in children and youth in primary care. CMAJ 2015; 187:411.
  39. de Onis M, Onyango A, Borghi E, et al. Worldwide implementation of the WHO Child Growth Standards. Public Health Nutr 2012; 15:1603.
  40. 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.
  41. 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.
  42. American Academy of Pediatrics Committee on Nutrition. Failure to thrive. In: Pediatric Nutrition, 7th ed, Kleinman RE, Greer FR (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2014. p.663.
  43. Casey PH. Growth of low birth weight preterm children. Semin Perinatol 2008; 32:20.
  44. Bithoney WG, Dubowitz H, Egan H. Failure to thrive/growth deficiency. Pediatr Rev 1992; 13:453.
  45. Frank D, Silva M, Needlman R. Failure to thrive: Mystery, myth and method. Contemp Pediatr 1993; 10:114.
  46. Wright CM, Williams AF, Elliman D, et al. Using the new UK-WHO growth charts. BMJ 2010; 340:c1140.
  47. Casey PH, Kraemer HC, Bernbaum J, et al. Growth status and growth rates of a varied sample of low birth weight, preterm infants: a longitudinal cohort from birth to three years of age. J Pediatr 1991; 119:599.
  48. Hack M, Schluchter M, Margevicius S, et al. Trajectory and correlates of growth of extremely-low-birth-weight adolescents. Pediatr Res 2014; 75:358.
  49. Karniski W, Blair C, Vitucci JS. The illusion of catch-up growth in premature infants. Use of the growth index and age correction. Am J Dis Child 1987; 141:520.
  50. Sherry B, Mei Z, Grummer-Strawn L, Dietz WH. Evaluation of and recommendations for growth references for very low birth weight (< or =1500 grams) infants in the United States. Pediatrics 2003; 111:750.
  51. Georgieff MK, Mills MM, Zempel CE, Chang PN. Catch-up growth, muscle and fat accretion, and body proportionality of infants one year after newborn intensive care. J Pediatr 1989; 114:288.
  52. Committee on Genetics. American Academy of Pediatrics: Health care supervision for children with Williams syndrome. Pediatrics 2001; 107:1192.
  53. 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.
  54. Phillips S, Edlbeck A, Kirby M, Goday P. Ideal body weight in children. Nutr Clin Pract 2007; 22:240.
  55. Olsen, 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.
  56. Hall, JG, Froster-Iskenius, UG, Allanson, JE. Proportional growth and normal variants. In: Handbook of Physical Measurements. Oxford University Press, New York 2007. p.13.
  57. Hall, JG, Froster-Iskenius, UG, Allanson, JE. Limbs. In: Handbook of Physical Measurements. Oxford University Press, New York 2007. p.240.
  58. Dimeglio, A. Biometric measurements. In: Lovell and Winter's Pediatric Orthopaedics, 6th ed, Morrissy, RT, Weinstein, SL (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.35.
  59. Jarzem PF, Gledhill RB. Predicting height from arm measurements. J Pediatr Orthop 1993; 13:761.
  60. Kanof ME, Lake AM, Bayless TM. Decreased height velocity in children and adolescents before the diagnosis of Crohn's disease. Gastroenterology 1988; 95:1523.
  61. Magiakou MA, Mastorakos G, Oldfield EH, et al. Cushing's syndrome in children and adolescents. Presentation, diagnosis, and therapy. N Engl J Med 1994; 331:629.
  62. Schlesinger S, MacGillivray MH, Munschauer RW. Acceleration of growth and bone maturation in childhood thyrotoxicosis. J Pediatr 1973; 83:233.
  63. Ben-Joseph EP, Dowshen SA, Izenberg N. Public understanding of growth charts: a review of the literature. Patient Educ Couns 2007; 65:288.
  64. Ben-Joseph EP, Dowshen SA, Izenberg N. Do parents understand growth charts? A national, Internet-based survey. Pediatrics 2009; 124:1100.
  65. Laraway KA, Birch LL, Shaffer ML, Paul IM. Parent perception of healthy infant and toddler growth. Clin Pediatr (Phila) 2010; 49:343.
Topic Outline

GRAPHICS

CALCULATORS