See How they Grow

All parents want their children to grow big and strong, but sometimes kids need a little help.

BY CECILIA CAPUZZI SIMON, Parents magazine, June 01, 2004 >>

How can you tell whether your child is growing properly? And is there anything you can do to help his growth along?

6 Factors That Affect Growth

1. Heredity Your child's genetic history is the number-one influence on her growth, says Lynne Levitsky, M.D., chief of the pediatric endocrine unit at Massachusetts General Hospital, in Boston. Look to Mom and Dad's height, shape, and rate of growth to predict how your child will turn out. Need proof of the power of genes? Studies show that identical twins grow to within an inch of each other in final height.

2. Nutrition "Without a good diet, kids won't grow normally," says Jo Anne Hattner, R.D., a pediatric specialist at the American Dietetic Association. Be vigilant about making sure your kids consume wholesome calories. Even well-meaning parents can derail a child's healthy diet. Common problems? Incorrectly mixed infant formula, not getting enough calories when you're breastfeeding or weaning, or even efforts to keep an infant from getting "fat." (Babies, no matter how plump, should never be put on diets.) Too much juice or soda can also can interfere with a child's appetite for nutritious foods.

3. Medical Conditions Some children are born with or develop serious medical conditions that can stunt growth if not treated. The most common: gastrointestinal disorders such as celiac disease; food allergies; thyroid problems; hormone deficiency; heart, kidney, or liver ailments; and certain chromosomal abnormalities. Medications for common childhood conditions should also be monitored closely. For instance, Ritalin and other stimulants prescribed for ADHD have been found to affect growth. The problem is often dose-related and is usually easily fixed, says Barry B. Bercu, M.D., head of endocrine, diabetes, and metabolism at All Children's Hospital, in St. Petersburg, Florida.

4. Exercise Regular physical activity promotes growth by strengthening bones and muscles. But beware of getting your child involved in high-impact sports such as gymnastics and running, which -- when done excessively -- can impede growth and even cause trauma to developing bones.

5. Sleep Make sure your child snoozes soundly each night. About 70 to 80 percent of growth hormone is secreted during sleep, says Paul Saenger, M.D., a pediatric endocrinologist at Children's Hospital at Montefiore Medical Center, in New York City.

6. Emotional Well-Being Kids reach their full growth potential when they're in a loving, nurturing, and supportive family environment, says Thomas Moshang, M.D., director of the growth center at Children's Hospital of Philadelphia. Emotional neglect and excessive tension or anxiety can interfere with growth. The condition -- called "psycho-social growth failure" by doctors -- is extremely rare, but its consequences are as real as malnutrition.

How to Read the Childhood Growth Chart

The most important tool in understanding and tracking your child's growth is a simple piece of paper: The childhood growth chart. There are charts for height, weight and head circumference for infants and for children. But how to decipher all those lines and numbers? And what is a percentile, anyway? To find out where your child falls on the chart for height, for example:

1. Find his measurement in inches on the left or right side of the chart, and his age along the top or bottom.

2. Move your fingers along those lines until they intersect.

3. Make a mark at that point.

4. Find the curve closest to this intersection. (Each curve represents a different percentile -- or the number of children out of 100 who would measure in at that height.)

5. Follow the curve up to the right to read which percentile it represents. (A 15-month-old boy who is 31 inches long would be in the 50th percentile, or exactly average in size.)
Rules for Good Measure

Careful tracking on the growth chart is critical to spotting problems and treating them quickly. Here's how to get the most from the childhood-growth grid.

* Be an advocate for your child. See that he is measured for height and weight at every doctor's visit and that each measurement is carefully plotted on the grid.

* Make sure your doctor has up-to-date charts. The latest growth charts from the Centers for Disease Control and Prevention make statistical adjustments for breastfed and formula-fed babies and for ethnic variations. They also include a body-mass index that flags weight problems.

* Compare growth from one visit to the next. Make sure your child is measured in the same way at each visit. For height, your child should be standing erect with her shoes off. Babies and toddlers up to age 3 should be measured for length while lying down and should be weighed without diapers or clothing.

* Keep your own records. Ask your doctor for a copy of the chart, or print one of your own right now: Growth Chart for Boys or Growth Chart for Girls.

* Don't read measurements out of context. Doctors don't worry about occasional blips on the chart; instead, they look for trends over time. Bouts of flu or other illnesses may set your child back at a checkup. "Seasonal growth" (kids sometimes grow three times faster in the spring months) and age-related growth spurts could briefly bump them ahead. And don't get hung up on numbers. As long as your child grows at a steady rate and stays within the range of his established percentile -- regardless of his size -- he's growing well.

* Know the warning signs. You should be concerned if your child crosses two or more percentile curves, say from the 50th to the 10th, or if he moves into extremes -- either below the 5th or above the 95th. A child whose weight is in the 95th percentile is considered obese. A score below the 5th percentile might mean your child has a chronic illness.

Can I Make My Short Child Taller?

If your child is below the 5th percentile in height, he could be deficient in growth hormone (GH). Doctors can prescribe a synthetic version to promote growth in children whose bodies don't produce enough of the hormone naturally or who suffer from certain diseases that impede growth. GH won't make basketball stars out of short kids, but it can help an abnormally small child gain some height.

What if a child is short but otherwise healthy? Most doctors won't prescribe GH to kids who are not hormone deficient, but new research suggests it could add up to two inches to a healthy child's final height. The growth comes at a high price, however. GH involves daily injections and can cost about $20,000 a year. Side effects in healthy kids are still unknown.

Baby Myth, Predictions, Expectations

Big Baby Myth
Q: Does a baby's size at birth offer any clues into what he'll look like as an adult?
A. No. In utero size is determined by how well the mom eats, as well as by the health of the placenta. That's why a petite woman can give birth to a ten-pound infant.
But once those babies are out of the womb, all bets are off. Big newborns who defied genetic odds will likely drop a couple of curves on the growth chart -- say from the 75th to the 25th percentile. It's also not unusual for small or average-size babies whose parents are big to grow rapidly and gain percentiles in the first two years of life. To get a fix on your how big your child will be, look at the pattern he establishes after he turns 2.

How to Predict Adult Height
* In boys: Add five inches to the mother's height, and keep the father's height constant. For example, a boy born to a mother who is 5'3" and a father who is 6'2" will likely grow to between 5'8" and 6'2".
* In girls: Subtract five inches from the father's height and keep the mother's height constant. The daughter of the couple above would grow to between 5'3" and 5'9".

Growth Spurts

Children grow in fits and starts. Here's a look at what to expect.
* 0-12 Mos. Most moms notice times when their babies just can't seem to get enough to eat. Increased hunger is the usual sign of a growth spurt. During the first year, there are plenty of them. Expect a lot of growth at 10 days to 3 weeks, 6 weeks, 3 months, and 6 months. By age 1, a typical baby will have tripled her birth weight and grown ten inches.
* 1 Year Growth slows a bit, but your baby will add an average of four to five inches and gain about a half pound per month.
* 2 Years Expect your toddler to grow three to four inches and gain three to four pounds. By the time they turn 3, most kids have grown to about 50 percent of their ultimate adult height. But soon the rapid pace of growth will slow down and become more subdued until puberty.
* 3 Years By the end of this year, your child will add another two to three inches, doubling his birth length.
* 4-10 Years Your child should grow about two inches and gain about six pounds per year. Some kids may experience a small spurt between 6 and 8 years.
* Puberty Puberty in girls usually begins between ages 8 and 13. She'll grow two to ten inches and gain 15 to 55 pounds before reaching her final adult size. Puberty in boys starts between ages 10 and 15. He'll grow anywhere from four to 12 inches and gain 15 to 65 pounds.

"Make sure your child snoozes soundly each night. About 70 to 80 percent of growth hormone is secreted during sleep."