Growth Evaluation in Children

Introduction to Growth Charts

The Centers for Disease Control and Prevention (CDC) recommends using CDC growth charts to evaluate growth in children over 24 months, and WHO growth charts for children under 24 months, to ensure continuity in growth assessment 1
The CDC considers height and weight measurements between the 5th and 95th percentiles as within the normal range for children over 24 months, including a six-year-old child 1

Normal height typically falls between the 5th and 95th percentiles on CDC growth charts, and evaluation is warranted if height is below a certain percentile or when height velocity is below a certain percentile for age and sex 1
Height should be measured standing, and weight should be measured with minimal clothing, with measurements plotted on appropriate CDC growth charts to establish patterns 1

Detailed growth measurements should include:

Measurement	Description
Height/Length	Measure of child's height or length
Weight	Measure of child's weight
Weight-for-Height Ratio	Calculation of weight in relation to height
Growth Velocity	Calculation of growth rate over time

Children with normal growth should have height and weight measured at routine well-child visits, according to the CDC 1
Most children maintain relatively consistent growth percentiles over time, with minor fluctuations between percentile lines being common and usually normal, although crossing two major percentile lines may warrant further evaluation 1
Children with normal evaluation but persistent growth concerns should be monitored every 3-6 months, with the first year of life being the most sensitive period for growth suppression effects, as supported by the CDC and WHO growth charts 2, 1

Genetic factors, such as parental heights, and nutritional status, with adequate nutrition being essential for optimal growth, are important considerations in growth assessment 1
A comprehensive medical history should include birth history, feeding history, chronic illnesses, medications, family history of growth patterns, and parental heights, as recommended by the American Academy of Pediatrics 2

If a child shows concerning growth patterns, a review of comprehensive medical history should be conducted, including birth history, feeding patterns, chronic illnesses, and family growth patterns 1
Evaluation for low growth percentile is warranted when:
Initial screening tests for children with persistent growth failure should include a complete blood count, comprehensive metabolic panel, and inflammatory markers (ESR, CRP), with a strength of evidence supporting these tests 2
Bone age radiography of the left wrist may be used to assess growth potential in children with persistent growth failure, according to the American Academy of Pediatrics 2
Infants with height between 3rd-10th percentile and low velocity should be reassessed in 3 months, while infants below 3rd percentile should undergo a complete evaluation and reassessment in 3 months, as recommended by the American Academy of Pediatrics 2
Head circumference measurement is a critical screening tool for neurological conditions in the first year of life, and crossing two major percentile lines is considered clinically significant and warrants further evaluation, as recommended by the American Academy of Pediatrics 3, 1