Is my child’s growth normal?

Many factors influence the growth of a child, including: parental height, nutrition, exercise and significant or chronic illnesses.  The first step to understanding the child's growth is to ensure all measurements are as consistent and accurate as possible.

Consistent Measurements:

Measuring Weight:

Try to always use the same scale (or at least note which scale was used, to help understand discrepancies). Weigh your child in the same clothing or while undressed.  If weighing an infant, try to weigh him or her without a diaper on.  If this isn't an option, ensure there is a new (clean and dry) diaper on. Weight fluctuates significantly throughout the day and in relation to meals and bladder and bowel movements. To minimize the effect of these, try to measure weight on an empty stomach, bladder and bowels. Measuring at the same time of day (first thing in the morning, or just prior to bath time) can help minimize some of these variations.

Measuring Height:

When measuring height, it is sometimes difficult to obtain accurate measurements.

If measuring on a doorjamb or wall: Try to have your child stand without shoes on, with his or her back up against a vertical wall.  Use a thick book or similar object with 90° (square) corners to ensure you project the top of their head straight back to the wall.  Use a pencil to mark this height on the wall, and finally afterwards you can measure the distance from the floor to the mark with a cloth or metal measuring tape.  If you are planning on leaving the mark in place to help visualize growth, write the child's name and date(or age) beside the mark. Good objects to use to project the head height to the wall include:  hardcover books, 90° (T-square, Set-square) ruler, a level, or other perfectly squared rigid objects. Difficult objects include phone books, magazines, simple rulers, floppy paper-cover books, or simply guessing.
If measuring an infant lying on a table: If lying on a change table, position his or her heels up against the edge of the table.  Ensure the knees are straight, and the body is not bent to a side.  Once you are sure the body is as straight, either make a mark on the table projecting down from the very top of the head, or use a cloth measuring tape placed just under one side of their body to get as accurate a measurement as possible from the heels to the top of the head.

Measuring Head Circumference:

When measuring head circumference, use a cloth or paper measuring tape, and place it around their head at or slightly above the level of the eyebrows. Move the measuring tape up and down to try and find the location with the largest/longest circumference around their head. Note the measurement on the tape where it meets up with the line for zero at the beginning of the tape.

Once accuracy and measurement variability is accounted for: If your child's growth seems to be falling off, not following a growth curve, it may be important to follow-up with a certified child health professional (physician, pediatrician, dietitian, nurse practitioner, etc) to understand why this is happening.  If you notice a trend of decreasing growth, or multiple curves being crossed over multiple measurements, it is very important that you do see your child's health professional to look into the possible reasons for this.  This is important as many of the causes for this are able to be modified before the child's cognitive development or final stature are affected.

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