Growth chart

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Sample growth chart for use with American boys from birth to age 36 months. CDC growth chart boys birth to 36 mths cj41c017.pdf
Sample growth chart for use with American boys from birth to age 36 months.

A growth chart is used by pediatricians and other health care providers to follow a child's growth over time. Growth charts have been constructed by observing the growth of large numbers of healthy children over time. The height, weight, and head circumference of a child can be compared to the expected parameters of children of the same age and sex to determine whether the child is growing appropriately. Growth charts can also be used to predict the expected adult height and weight of a child because, in general, children maintain a fairly constant growth curve. When a child deviates from his or her previously established growth curve, investigation into the cause is generally warranted. Parameters used to analyze growth charts include weight velocity (defined as rate of change in weight over time), height velocity (defined as rate of change in stature over time), and whether someone's growth chart crosses percentiles. For instance, endocrine disorders can be associated with a decrease in height velocity and preserved weight velocity while normal growth variants are associated with a decrease in height and weight velocity that are proportional to each other. It's important to note that other parameters are more commonly used such as waist circumference for assessing obesity and skin fold difference for assessing malnutrition. Growth charts can also be compiled with a portion of the population deemed to have been raised in more or less ideal environments, such as nutrition that conforms to pediatric guidelines, and no maternal smoking. Charts from these sources end up with slightly taller but thinner averages. [1]

Contents

Growth curve of a girl, compared to the 2006 WHO curves Growth Curve Girl (WHO).jpg
Growth curve of a girl, compared to the 2006 WHO curves

Growth charts are different for persons assigned male at birth and female at birth, due in part to pubertal differences and disparity in final adult height. In addition, children born prematurely and children with chromosomal abnormalities such as Down syndrome and Turner syndrome follow distinct growth curves which deviate significantly from children without these conditions. As such, growth charts have been created to describe the expected growth patterns of several developmental conditions. Since there are differences in normal growth rates between breastfed and formula-fed babies, [2] the World Health Organization growth charts, which better reflect the growth pattern of the healthy, breastfed infant, are considered the standard for U.S. children under age two. [3]

History and revisions to growth chart

The growth chart was first developed by the National Center for Health Statistics (NCHS) in 1977 to clinically analyze child development. The 1977 growth chart was subsequently used by the World Health Organization for dissemination to healthcare systems abroad. In order to accommodate for heterogenous populations internationally, the WHO made an effort to gather data from different regions in every continent. Data used to calculate the CDC's growth chart percentiles was accumulated periodically since the 1960s by the National Health and Nutrition Examination Survey. Updated and more comprehensive data was later used to revise the existing growth chart and construct the 2000 CDC growth charts. The revised growth charts include revision of the 14 existing charts as well as introduction of 2 new BMI-for-age charts. [4]

Quantitative definitions

Mid-parental height (MPH) is often used to predict the target height of an individual based on the heights of the two biological parents. It can be used to calculate the target height (TH) for children. MPH is given by (mother’s height + father’s height) divided by 2. MPH is unisex. Boys need an upward correction, girls need a downward correction. In view of an average height difference between adult men and women of 13 cm, TH for boys is usually given by MPH + 6.5cm, TH for girls by MPH - 6.5cm. Alternatively, TH can be expressed in standard deviation scores (SDS), with TH_SDS = (mother’s height_SDS + father’s height_SDS) / 2. Yet, this calculation is incorrect as it needs adjustment to mid-population height. It is suggested to use the conditional target height or cTH_SDS with a correction factor of 0.72. [5]

cTH_SDS = TH_SDS x 0.72

Velocity is another quantity that is used to quantify growth curves. It can be used for both height and weight. In the equation provided q is either weight or height, t represents time, and Δ represents change over a defined interval. Growth velocity is defined as follows. [6]

Body mass index (BMI) is a useful quantification that can gauge level of obesity. It is defined as follows with the given clinical ranges.

Bone age is another useful metric that complements a physician's use of a growth chart. It is particularly useful in working up growth abnormalities and can indicate a delay in onset of puberty.

Common variants of normal growth

Clinical significance

The combination of height and weight velocity can indicate underlying disease of genetic origin, endocrine cause, and/or delayed growth.

Normal growth deficiency

One of the most common growth disorders, a growth deficiency can be due to either familial short stature or constitutional growth delay (CGD). Familial short stature is indicative when one or both parents are of a short stature, and the height and weight percentiles are under the 5 percentile threshold. [7] The child will be concordant with the mean parental height, and the bone age should be normal. Constitutional growth delays are marked by low height and weight percentiles as early as the first 4–6 months following birth. [8]

Genetic syndromes

A variety of genetic syndromes can result growth chart patterns with a typical pattern. Genetic diseases such as Turner's syndrome, Prader Willi, and Noonan syndrome can be marked by a less than 5th percentile height and weight since birth. [9] [10] [11] Other genetic disorders such as Marfan's syndrome and Klinefelter's syndrome are typically indicated by a height above the 90th percentile. [12] [13]

Endocrine and metabolic disorders

A decrease of height velocity with retained or increased weight velocity can be indicative of endocrine disorders including hypothyroidism, growth hormone deficiency, and excess of glucocorticoids.

Variability in growth charts

The CDC's growth chart is utilized from a population that consists of a representative population in the USA. Charts based on a specific race or ethnicity are not useful because of the growth chart progression can be attributed to socioeconomic factors. [14] WHO launched a revised growth in 2006 chart using children from Ghana, Oman, Norway, Brazil, India and the USA that substantiated the fact that growth is highly dependent on environmental factors. [15]

See also

Related Research Articles

<span class="mw-page-title-main">Body mass index</span> Relative weight based on mass and height

Body mass index (BMI) is a value derived from the mass (weight) and height of a person. The BMI is defined as the body mass divided by the square of the body height, and is expressed in units of kg/m2, resulting from mass in kilograms (kg) and height in metres (m).

<span class="mw-page-title-main">Turner syndrome</span> Chromosomal disorder in which a female is partially or completely missing an X chromosome

Turner syndrome (TS), also known as 45,X, or 45,X0, is a genetic disorder in which a female has a single X chromosome, compared to the two sex chromosomes in most people. Signs and symptoms vary among those affected. Often, a short and webbed neck, low-set ears, low hairline at the back of the neck, short stature, and swollen hands and feet are seen at birth. Typically, those affected do not develop menstrual periods or breasts without hormone treatment and are unable to have children without reproductive technology. Heart defects, diabetes, and low thyroid hormone occur in the disorder more frequently than average. Most people with Turner syndrome have normal intelligence; however, many have problems with spatial visualization that may be needed in order to learn mathematics. Vision and hearing problems also occur more often than average.

<span class="mw-page-title-main">Obesity</span> Medical condition in which excess body fat harms health

Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it negatively affects health. People are classified as obese when their body mass index (BMI)—a person's weight divided by the square of the person's height—is over 30 kg/m2; the range 25–30 kg/m2 is defined as overweight. Some East Asian countries use lower values to calculate obesity. Obesity is a major cause of disability and is correlated with various diseases and conditions, particularly cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis.

<span class="mw-page-title-main">Dwarfism</span> Small size of an organism, caused by growth deficiency or genetic mutations

Dwarfism is a condition wherein an organism is exceptionally small, and mostly occurs in the animal kingdom. In humans, it is sometimes defined as an adult height of less than 147 centimetres, regardless of sex; the average adult height among people with dwarfism is 120 centimetres (4 ft). Disproportionate dwarfism is characterized by either short limbs or a short torso. In cases of proportionate dwarfism, both the limbs and torso are unusually small. Intelligence is usually normal, and most have a nearly normal life expectancy. People with dwarfism can usually bear children, though there are additional risks to the mother and child depending upon the underlying condition.

<span class="mw-page-title-main">Wasting</span> Loss of muscle and fat tissue

In medicine, wasting, also known as wasting syndrome, refers to the process by which a debilitating disease causes muscle and fat tissue to "waste" away. Wasting is sometimes referred to as "acute malnutrition" because it is believed that episodes of wasting have a short duration, in contrast to stunting, which is regarded as chronic malnutrition. An estimated 45 million children under 5 years of age were wasted in 2021. Prevalence is highest in Southern Asia, followed by Oceania and South-eastern Asia.

<span class="mw-page-title-main">Growth hormone deficiency</span> Medical condition

Growth hormone deficiency (GHD), or human growth hormone deficiency, is a medical condition resulting from not enough growth hormone (GH). Generally the most noticeable symptom is that an individual attains a short height. Newborns may also present low blood sugar or a small penis size. In adults there may be decreased muscle mass, high cholesterol levels, or poor bone density.

Delayed puberty is when a person lacks or has incomplete development of specific sexual characteristics past the usual age of onset of puberty. The person may have no physical or hormonal signs that puberty has begun. In the United States, girls are considered to have delayed puberty if they lack breast development by age 13 or have not started menstruating by age 15. Boys are considered to have delayed puberty if they lack enlargement of the testicles by age 14. Delayed puberty affects about 2% of adolescents.

Gonadarche refers to the earliest gonadal changes of puberty. In response to pituitary gonadotropins, the ovaries in females and the testes in males begin to grow and increase the production of the sex steroids, especially estradiol and testosterone. The ovary and testis have receptors, follicle cells and leydig cells, respectively, where gonadotropins bind to stimulate the maturation of the gonads and secretion of estrogen and testosterone. Certain disorders can result in changes to timing or nature of these processes.

<span class="mw-page-title-main">Bone age</span> Degree of a persons skeletal development

Bone age is the degree of a person's skeletal development. In children, bone age serves as a measure of physiological maturity and aids in the diagnosis of growth abnormalities, endocrine disorders, and other medical conditions. As a person grows from fetal life through childhood, puberty, and finishes growth as a young adult, the bones of the skeleton change in size and shape. These changes can be seen by x-ray and other imaging techniques. A comparison between the appearance of a patient's bones to a standard set of bone images known to be representative of the average bone shape and size for a given age can be used to assign a "bone age" to the patient.

<span class="mw-page-title-main">Fetal alcohol spectrum disorder</span> Group of conditions resulting from maternal alcohol consumption during pregnancy

Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person who is exposed to alcohol as a result of their mother drinking during pregnancy. Symptoms can include an abnormal appearance, short height, low body weight, small head size, poor coordination, behavioral problems, learning difficulties, and problems with hearing and sight. Those affected are more likely to have trouble with school, the legal system, alcohol, other drugs, and other areas of high risk. The several forms of the condition are: fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (pFAS), alcohol-related birth defects (ARBD), static encephalopathy, alcohol-related neurodevelopmental disorder (ARND) and neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE). As of 2016, the Swedish Agency for Health Technology Assessment and Assessment of Social Services accepted only FAS as a diagnosis, seeing the evidence as inconclusive with respect to other types.

<span class="mw-page-title-main">Failure to thrive</span> Condition of children whose current weight or rate of weight gain is much lower than expected

Failure to thrive (FTT), also known as weight faltering or faltering growth, indicates insufficient weight gain or absence of appropriate physical growth in children. FTT is usually defined in terms of weight, and can be evaluated either by a low weight for the child's age, or by a low rate of increase in the weight.

Short stature refers to a height of a human which is below typical. Whether a person is considered short depends on the context. Because of the lack of preciseness, there is often disagreement about the degree of shortness that should be called short. Dwarfism is the condition of being very short, often caused by a medical condition.

<span class="mw-page-title-main">Childhood obesity</span> Obesity in children

Childhood obesity is a condition where excess body fat negatively affects a child's health or well-being. As methods to determine body fat directly are difficult, the diagnosis of obesity is often based on BMI. Due to the rising prevalence of obesity in children and its many adverse health effects it is being recognized as a serious public health concern. The term 'overweight' rather than 'obese' is often used when discussing childhood obesity, as it is less stigmatizing, although the term 'overweight' can also refer to a different BMI category. The prevalence of childhood obesity is known to differ by sex and gender.

<span class="mw-page-title-main">Alström syndrome</span> Rare genetic disorder involving childhood obesity and multiple organ dysfunction

Alström syndrome (AS), also called Alström–Hallgren syndrome, is a very rare autosomal recessive genetic disorder characterised by childhood obesity and multiple organ dysfunction. Symptoms include early-onset type 2 diabetes, cone-rod dystrophy resulting in blindness, sensorineural hearing loss and dilated cardiomyopathy. Endocrine disorders typically also occur, such as hypergonadotrophic hypogonadism and hypothyroidism, as well as acanthosis nigricans resulting from hyperinsulinemia. Developmental delay is seen in almost half of people with Alström syndrome.

<span class="mw-page-title-main">Obesity in the United States</span> Overview of obesity in the United States of America

Obesity is common in the United States and is a major health issue associated with numerous diseases, specifically an increased risk of certain types of cancer, coronary artery disease, type 2 diabetes, stroke, and cardiovascular disease, as well as significant increases in early mortality and economic costs.

<span class="mw-page-title-main">Classification of obesity</span> Overview of the classification of the condition of obesity

Obesity classification is a ranking of obesity, the medical condition in which excess body fat has accumulated to the extent that it has an adverse effect on health. The World Health Organization (WHO) classifies obesity by body mass index (BMI). BMI is further evaluated in terms of fat distribution via the waist–hip ratio and total cardiovascular risk factors. In children, a healthy weight varies with age and sex, and obesity determination is in relation to a historical normal group.

<span class="mw-page-title-main">Weight management</span> Techniques for maintaining body weight

Weight management refers to behaviors, techniques, and physiological processes that contribute to a person's ability to attain and maintain a healthy weight. Most weight management techniques encompass long-term lifestyle strategies that promote healthy eating and daily physical activity. Moreover, weight management involves developing meaningful ways to track weight over time and to identify ideal body weights for different individuals.

Hypergonadotropic hypogonadism (HH), also known as primary or peripheral/gonadal hypogonadism or primary gonadal failure, is a condition which is characterized by hypogonadism which is due to an impaired response of the gonads to the gonadotropins, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), and in turn a lack of sex steroid production. As compensation and the lack of negative feedback, gonadotropin levels are elevated. Individuals with HH have an intact and functioning hypothalamus and pituitary glands so they are still able to produce FSH and LH. HH may present as either congenital or acquired, but the majority of cases are of the former nature. HH can be treated with hormone replacement therapy.

<span class="mw-page-title-main">Early Childhood Development</span> Rapid physical, psychological and social growth

Early childhood development is the period of rapid physical, psychological and social growth and change that begins before birth and extends into early childhood. While early childhood is not well defined, one source asserts that the early years begin in utero and last until 3 years of age.

References

  1. "WHO Child Growth Standards" (PDF). World Health Organization.
  2. Dewey, KG; Peerson, JM; Brown, KH; Krebs, NF; Michaelsen, KF; Persson, LA; Salmenpera, L; Whitehead, RG; Yeung, DL (1995). "Growth of breast-fed infants deviates from current reference data: A pooled analysis of US, Canadian, and European data sets. World Health Organization Working Group on Infant Growth". Pediatrics. 96 (3 Pt 1): 495–503. doi:10.1542/peds.96.3.497. PMID   7651784. S2CID   20425748.
  3. "Use of World Health Organization and CDC Growth Charts for Children Aged 0–59 Months in the United States" (PDF). Centers for Disease Control.
  4. Centers for Disease Control (11 January 2019). "CDC Growth Charts: United States".{{cite web}}: CS1 maint: url-status (link)
  5. Hermanussen, M; Cole, M. (2003). "The calculation of target height reconsidered". Hormone Research. 59 (4): 180–183.
  6. Bozzola, Mauro; Meazza, Cristina (2012), Preedy, Victor R. (ed.), "Growth Velocity Curves: What They Are and How to Use Them", Handbook of Growth and Growth Monitoring in Health and Disease, New York, NY: Springer New York, pp. 2999–3011, doi:10.1007/978-1-4419-1795-9_180, ISBN   978-1-4419-1794-2 , retrieved 2021-09-13
  7. "Constitutional Growth Delay: Practice Essentials, Pathophysiology, Epidemiology". 2020-01-15.{{cite journal}}: Cite journal requires |journal= (help)
  8. "Constitutional Growth Delay". Pediatric Endocrine Society. Retrieved 2021-09-13.
  9. "Turner syndrome - Symptoms and causes". Mayo Clinic. Retrieved 2021-09-13.
  10. "Prader-Willi Syndrome". NORD (National Organization for Rare Disorders). Retrieved 2021-09-13.
  11. "Noonan syndrome - Symptoms and causes". Mayo Clinic. Retrieved 2021-09-13.
  12. Hulse, J A (October 1988). "Special growth charts". Archives of Disease in Childhood. 63 (10): 1179–1180. doi:10.1136/adc.63.10.1179. ISSN   0003-9888. PMC   1779032 . PMID   3058044.
  13. Kwun, Younghee; Kim, Su Jin; Lee, Jieun; Isojima, Tsuyoshi; Choi, Doo-Seok; Kim, Duk-Kyung; Huh, June; Kang, I.-Seok; Chang, MiSun; Cho, Sung Yoon; Sohn, Young Bae (July 2015). "Disease-specific Growth Charts of Marfan Syndrome Patients in Korea". Journal of Korean Medical Science. 30 (7): 911–916. doi:10.3346/jkms.2015.30.7.911. ISSN   1598-6357. PMC   4479945 . PMID   26130954.
  14. "Reference Population | Overview CDC Growth Charts | Growth Chart Training | NUtrition | DNPAO | CDC". www.cdc.gov. 2019-01-23. Retrieved 2021-09-20.
  15. "Growth Charts". Center for Adoption Medicine. Retrieved 2021-09-20.