Kids love to measure their height against anything — the door, the wall, the pool (“Look where I can stand now!”) and, of course, their parents. (“I’m up to here on you!”) As parents or caregivers, it’s natural to wonder if your child is growing as they should and if their development is on track.
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Healthcare providers check kids’ measurements against the child growth chart at every well visit and will let you know if they see any issues. But you may wonder whether those growth charts can predict whether your child will be short, tall or somewhere in between.
“Many factors influence a child’s growth,” says Andrea Mucci, MD. Dr. Mucci is a pediatric endocrinologist, a specialist in the hormone system of kids. Here, she provides insight into child growth and development for parents who are concerned or simply curious about their child’s height.
Understanding the child growth chart
Different countries use different growth charts. In the United States, healthcare providers typically rely on World Health Organization (WHO) charts for kids from birth to 2 years old. From 2 through adulthood, healthcare providers use Centers for Disease Control and Prevention charts.
When your pediatrician gives you the numbers, they may explain your child’s:
- Growth curve, their height and weight mapped out over time. The growth curve shows your child’s anticipated trajectory, or how they should grow over time based on their height and weight so far. If your child’s pediatrician sees a dramatic drop in your child’s growth curve compared with the trajectory, that can be a red flag.
- Percentile, a measurement of how your kid compares to other kids their age. The American Academy of Pediatrics considers a child short when their height is in the lower 3%, but it’s important to note that this can be “normal” for many kids.
What is a normal growth rate?
A normal growth rate is important for kids, says Dr. Mucci. A growth rate that’s too slow or too fast may be a sign of an underlying disease that could also affect the health of your child’s internal organs. Most health problems are associated with a growth curve that’s falling or plateauing (staying the same).
The average amount of growth you can expect to see in a year varies depending on the age:
- Toddlers: Children grow quickly between ages 1 and 3. That’s why you can’t keep them in the same size clothes for long at this stage, says Dr. Mucci. Toddlers grow 10 centimeters (about 4 inches) a year.
- Age 3 to puberty: At this stage, growth slows to around 5 to 6 centimeters (about 2 inches) per year. It’s normal for height to stall a bit before puberty, too, notes Dr. Mucci.
- Puberty: Growth takes off again during puberty, with an average of 8 to 9 centimeters (about 3 inches) a year. Girls typically start puberty one to two years earlier than boys and grow fastest before beginning menstruation (having a period). Girls usually enter puberty between 8 and 13 years, while for boys, puberty begins around ages 9 to 14. Growth gradually slows in the two years following the onset of puberty and stops once puberty ends.
If your child isn’t growing as expected, your provider may recommend getting bloodwork and/or an X-ray. If they’re still concerned, they may suggest seeing a pediatric endocrinologist, who’ll determine whether further testing is needed.
Growth hormone is made by your pituitary gland at the base of your brain and controls your body’s growth. If your child’s pediatric endocrinologist is concerned about the labs or growth pattern, they may suggest a specialized test called a “Growth Hormone Simulation test.” This test takes a number of hours and includes a series of blood tests to see if your child is producing the appropriate amount of growth hormone. If tests show an issue with growth hormone, your child’s pediatrician can discuss treatment options with you.
What influences a child’s growth?
Your child’s growth has to do with several factors, including:
These are the features passed down through your family. More than 700 genes can affect height, according to Dr. Mucci. If both parents are tall, it’s more likely their child will also be tall, as there are more tall genes in their genetic pool.
“It would be unusual to have a short child in this case,” states Dr. Mucci. “But if one of you had a short mom or grandma or someone in the extended family, then it wouldn’t be as surprising to have a kid on the shorter side.”
No specific vitamin, mineral or supplement has been scientifically proven to affect height. But for kids to properly grow, they need adequate nutrition. That may be difficult if your child is a picky eater who doesn’t eat enough healthy foods or if they have a condition that interferes with nutrient absorption.
“We usually suspect nutritional or gastrointestinal problems if the weight is dropping more than the height,” says Dr. Mucci. “Your child might not be getting enough energy for proper growth.”
Some medications may contribute to reduced growth in children, including:
- Steroids: When used long-term for various medical conditions, steroid use can stunt growth because it affects bone health. Usually, height can “catch up” if and when these medications are stopped.
- Chemotherapy or radiation: Having high doses of chemotherapy or radiation during childhood can cause a person to be shorter as an adult. They can interfere with hormones necessary for growth or directly with bones. If your child stops making enough hormones, these can sometimes be replaced under the guidance of an endocrinologist.
- Stimulants: Medications for attention-deficit/hyperactivity disorder (ADHD) may affect height, but there’s conflicting research. Some ADHD studies point to a slight decrease in final height, while others found no impact. Appetite suppression is a common side effect of ADHD medications, which may make it challenging for kids to get all the nutrients they need, says Dr. Mucci.
Conditions that affect your hormones or nutrient absorption or produce inflammation (swelling and irritation) can impact growth. These include chronic diseases, such as:
Some genetic conditions such as Down syndrome or Turner Syndrome are also known to be associated with shorter heights.
Small at birth
“About 10% of babies born very small remain short as adults,” Dr. Mucci reports. “But we have treatments that can make a difference in their growth, so it’s worth getting an evaluation.”
Can you calculate how tall your child will be?
Healthcare providers can predict a child’s height using a specialized calculation (sex-adjusted midparental height). It’s a weighted average between two biological parents’ heights and gives a rough estimation of how tall your kid will grow, explains Dr. Mucci. “But when there’s a big difference in the parents’ heights, that calculation may not be very accurate. The child could take after one or the other or fall somewhere in between.”
Do big feet mean your child will be tall?
Some people say that big feet indicate a child will be tall. But people of the same height often have different size feet.
But feet size can tell you one thing: When you notice your kiddo’s feet grow larger, it’s a sign they’re about to get taller. According to one study, foot growth happens before spinal growth. Shoe size gets bigger about one year before a girl’s height changes and about two-and-a-half years before a boy shoots up.
When do kids stop growing?
Children are done growing after puberty. That’s when their growth plates — the soft, growing tissue at the end of bones — harden and stop growing. For girls, puberty typically ends two to three years after their period (age 15 on average). The average boy reaches the end of puberty around 17 or 18. One predictor is what age the child’s parents stopped growing.
When to see a healthcare provider
If you’re concerned about your child’s growth, discuss it with your pediatrician. Your provider may refer you to an endocrinologist, a specialist in hormones (which spur growth).
Alternatively, your pediatrician may recommend watching your child’s growth more closely for the next six months or running tests, including:
- X-rays: A picture of the bones in your child’s left hand and wrist can tell you their “bone age” and looks at how open their growth plates are.
- Blood tests: Your provider may order blood tests to check for underlying medical conditions that could cause a slow growth rate.
“Parents should keep in mind that there are normal variations of growth with genetics,” says Dr. Mucci. “So, don’t think a child with tall parents has to be tall. Kids can also be early or late bloomers. Shorter adolescents often catch up with peers in high school or college if they start puberty later.”
Dr. Mucci also says the best thing you can do to stay on top of any potential height problems is to keep up with your child’s annual well visits to their pediatrician. Those height and weight checks are a big part of doing everything you can to keep your children healthy. Then, you can focus on having fun with your kids now and imagining all the adventures (big and small) that are yet to come.