October 26, 2023

Is Your Child’s Growth on Target?

As long as your child is trending upward, even just slightly, there’s usually little reason to worry

Parent measures child's growth by marking the wall they stand against.

Your newborn quickly morphed into The Hulk by 6 months. (Those cheeks!) Yet by age 2 he’d fallen from the 90th percentile to the 30th, and you were back to shopping in the 18-month clothing section.

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Why the roller coaster? And is this yet another thing you should lose sleep over? Pediatrician Minh-Y Canh, DO, explains.

Growth and development: What’s ideal?

“In the first two years of life, it’s hard to predict what a child’s growth chart will look like,” says Dr. Canh. “Babies hit many growth spurts. After age 2, we have a better sense of how they are trending in their growth and where they may eventually settle.”

Dr. Canh says pediatricians typically look for an upward trajectory after age 2 (whether it’s slight or steep is kid-dependent). Mapping growth is a key reason there are so many well-child appointments in the first two years: “We keep close tabs on whether your child is growing appropriately since so much development and growth goes on in those first few years,” she says.

How to know if your child’s height chart is A-OK

Pediatricians will monitor your child’s weight at every well-child check. They are looking for things like growing too quickly, too slowly or not at all. Basically, as long as your child is trending upward, even just slightly, there’s often little reason to worry.

Pediatricians look at the big picture. There are times when kids just don’t grow as quickly. Or they may hit puberty later, at which point they’ll reach their full potential.

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After age 4, children typically continue to grow around 2 inches per year until they hit puberty. Following puberty, the bones will fuse and growth will stop — providers expect a growth flatline from this point forward.

Your child’s weight chart: It’s relative

“A baby’s weight is on my mind from the beginning. It’s a variable we have a bit more control over,” says Dr. Canh. “We get concerned when weight continues to decrease or increase over time because it probably means a child is getting too few or too many calories. We then look for the factors that may be causing this.”

For infants: A baby can overeat with both breastfeeding (chestfeeding) and formula. If you breastfeed and the milk supply is abundant, your baby might overeat. It’s harder for them to regulate how much they eat (especially if they suck for comfort).

The same thing can happen with formula fed babies if you make a larger formula bottle then needed. This can also be true with under eating if the milk supply is limited or if you make the formula bottles too small. “We may offer tips for how to decrease or increase the amount of milk or formula you offer your baby,” says Dr. Canh.

For toddlers: After the first two years, your child’s pediatrician will look for incremental weight gain and weight that’s relative to height. If there’s a weight concern, your doctor may suggest:

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  • Encouraging them to eat healthier foods.
  • Adjusting portion sizes.
  • Increasing physical activity in fun ways.

Does your kid have a growth disorder? (Spoiler: Probably not)

“If you’re worried, then reach out to your child’s pediatrician,” advises Dr. Canh. “We can explore whether there are conditions that may be causing or contributing to the problem.”

Possible reasons for height or weight growth problems include:

  • A growth hormone deficiency: Their pituitary gland doesn’t make enough growth hormone.
  • A thyroid disorder: Too much or too little thyroid hormone can affect metabolism and digestive function.
  • A constitutional growth delay: “Late-blooming” kids have delayed growth compared to their peers but will “catch up” eventually.
  • Familial short stature: Vertically challenged parents may hope for a hidden gene to give their kids height, but kids will typically reach the height of their parents.

If necessary, your child’s pediatrician may involve other healthcare providers to assess growth, provide education or offer treatments. Specialists may include:

  • A dietitian or nutritionist to provide healthy-eating advice.
  • A psychologist to work with your child or family on how they think about food or help your child cope with a growth delay.
  • An endocrinologist to discuss and treat any hormonal issues that may be impacting weight or height.

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