Growth Assessment in Children

Initial Evaluation

• The Centers for Disease Control and Prevention (CDC) recommends plotting a child's measurements on CDC growth charts to determine if they fall below the 2nd percentile threshold, which indicates potential underlying pathologic conditions requiring evaluation, for children ≥24 months 3, 4
• The American Academy of Pediatrics suggests that growth velocity over serial measurements is more informative than a single measurement, and downward crossing of percentile lines indicates true growth faltering and warrants more urgent evaluation 1, 2

Essential Initial Laboratory Tests

• Thyroid function tests, including TSH and free T4, are essential because thyroid dysfunction directly affects growth velocity, according to the American Thyroid Association 5
• Celiac disease screening, including tissue transglutaminase (tTG) IgA antibodies with total serum IgA level, should be measured, as celiac disease commonly presents with poor growth as a primary symptom, recommends the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition 5
• A complete blood count (CBC) screens for anemia and other hematologic abnormalities, and identifies potential chronic inflammatory conditions affecting growth, suggests the American Society of Hematology 1
• A comprehensive metabolic panel (CMP) evaluates kidney function, liver function, and electrolyte balance, and screens for chronic kidney disease and metabolic disorders that impair growth, recommends the National Kidney Foundation 1

Additional Considerations

• The child's height should be compared to the mid-parental height to determine if it is consistent with genetic potential, suggests the American Academy of Pediatrics 1, 2
• If initial screening is normal but growth concerns persist, consider karyotype, inflammatory markers, or referral to pediatric endocrinology, recommends the Pediatric Endocrine Society 1, 2

Common Pitfalls to Avoid

• Do not delay evaluation if measurements fall below the 2nd percentile, even if the child appears healthy, warns the American Academy of Pediatrics 2
• Do not assume normal growth based on a single measurement without assessing growth velocity through serial measurements plotted over time, cautions the American Academy of Pediatrics 1, 2