Look at any class picture and you’ll see kids from different backgrounds, genders and all shapes and sizes. But despite some classmates being a head taller than their peers, the children are in the same grade and around the same age. So, how do parents know what’s “normal” as children grow up?
Pediatricians like Dr. Kaylan Edwards at Novant Health Pediatrics Brunswick are able to monitor this by tracking growth on a curve, known as the growth chart, to see if a child is developing proportionally. Some may be shorter or heavier than others, but what’s most important is that they follow a smooth, consistent curve. It drives home the importance of an annual physical, even when a child is doing well.
Health care providers also use the growth chart to compare development in children of the same age and gender. It’s been a standard in pediatrics since the 1970s and still today, plays a critical role in catching early signs of disease and preventing future health problems.
“It’s one of the only ways we can identify a problem early on,” Edwards said. “For example, we may see a child’s weight gain is dropping off around the four to six-month mark. This can help us catch metabolic issues, as well as different inherited syndromes that have no other symptoms.”
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Birth to two years
Pediatricians look for inconsistencies in growth from birth to 18 years, but Edwards said children are most closely tracked the first one to two years of life. During this time, Novant Health uses the World Health Organization pediatric growth chart to track weight, length and head circumference.
A common question Edwards gets from parents is related to head circumference. If the growth curve is inconsistent, it could point to intracranial problems, such as swelling of the brain, which would trigger a visit with a neurosurgeon. Alternatively, if an infant isn’t gaining enough weight, Edwards will discuss feeding with the parent.
“For younger children, I ask questions like ‘How much are you feeding? How are you mixing the formula? What type of formula are you using? Where do you get it from?’” Edwards said. “I understand that formula is expensive, but I find that some parents try to dilute it to stretch it out longer. On the flip side, if a child is gaining too much weight, I’ll make sure they’re not making the formula too concentrated, which would add extra calories.”
Edwards said diluted formula puts a child at risk for electrolyte abnormalities, which can cause development issues or even swelling in the brain. Signs a child may be lacking electrolytes include vomiting, drowsiness or a change in demeanor. She described it as a child “not acting like themselves.”
However, when children are healthy, Edwards said the growth chart can provide a level of comfort for parents.
“I have some parents who see the little rolls down their children’s side or their belly, and they come to me and say, ‘Are they overweight? My mom thinks they’re fat.’ It often makes them feel better when we look at the growth curve and they get a comparison to other children their age. It’s reassuring,” Edwards said.
Once a child is 2, Edwards said Novant Health transitions to the Center for Disease Control growth curve, which compares children nationwide. It’s also at this age that girls and boys are measured on different charts. That’s because they grow at different rates and in different patterns.
In addition to height and weight measurements, pediatricians begin tracking body mass index (BMI) – a measure of fat based on height and weight – at age 3. Edwards said BMI is an important indicator of healthy growth and development.
Into early adulthood
Pediatricians also use the growth chart to diagnose kids at risk for obesity. Children above 3 years old who are in the 85th BMI percentile or higher for their gender are considered overweight. Edwards said this can set a child up for “a lot of medical issues” at a very young age – including high blood pressure, high cholesterol, diabetes, heart disease and sleep apnea (a sleep disorder that causes breathing to stop and start).
If children are overweight, Edwards discusses what the child is eating and how often. Fast food and calories consumed from sugary beverages are often a culprit.
“On the other end, sometimes I see teenagers who are losing weight. That puts the antenna up for me. I begin a discussion to learn if the child is trying to lose weight. Maybe they’re fasting. We talk through it. The goal here is to make sure it’s not an eating disorder,” Edwards said.
As far as percentages go, some children are in the 10th percentile and others the 80th, but there is no one ideal number. Healthy children come in all shapes and sizes.