Normal Growth

My question concerns my daughter’s size and growth. Siobhan was born weighing 7 pounds, 6 ounces, which is average, as I understand. She is now 12 months old and only weighs 17.5 pounds. At every checkup, her height falls into the 75th percentile but her weight and head size are at around the 5th percentile. Is this something I should be concerned about? Both my husband and I are of average size and height. I spoke to my doctor’s office this morning and was able to get the following information:
* Birth: Height 20″, Weight 7 lbs 6.5 oz, Head Circumference 34 cm
* Five Weeks: Height 21.5″, Weight 9 lbs 7 oz, Head Circumference 36 cm
* Two Months: Height 23″, Weight 10 lbs, Head Circumference 37.5 cm
* Four Months: Height 24.7″, Weight 12 lbs 1 oz., Head Circumference 39.8 cm
* Six Months: Height 25.5″, Weight 14 lbs, Head Circumference 41.3 cm
* Nine Months: Height 27.5″, Weight 15 lbs 4 oz, Head Circumference 42.4 cm

I don’t have her one year measurements as our appointment is next week. My pediatrician hasn’t said too much about her small size except to ask if she eats well (she does, will eat anything but broccoli!)
Teri Anderson – Membership Care Coordinator – Palm Harbor, Florida

Normal Growth

Dr. Greene’s Answer:

Childhood is a magical time. What is the essence of childhood? Is it wonder? Innocence? Security? . . .

The essence of childhood is growth. Growth defines childhood for all species. Growth creates the magic and the wonder. Of course some adults retain a sense wonder — those who continue to flower and grow.

Since growing is the core task of childhood, assessing growth is an important part of pediatrics. One of the major reasons for those numerous well-child check ups is to carefully measure and follow growth over time. Each time a young child visits her doctor, her height, weight, and head circumference are measured and recorded on a growth chart.

These charts were created from data collected between 1963 and 1975 as part of the Fels Longitudinal Study conducted by Wright State University School of Medicine in Yellow Springs, Ohio. More than 20,000 healthy, well-nourished, American children were measured to determine normal growth rates. In 1979, the National Center for Health Statistics (NCHS) published these values as reference numbers for children in the U.S. The World Health Organization (WHO) later adopted these same numbers as the international standard for growth.

The NCHS growth charts are divided into seven percentile lines, ranging from the 5th to 95th percentile. If a girl, such as Siobhan, is at the 75th percentile in height, it does not mean that her height is 75 percent of normal. Rather it means that Siobhan is taller than 75 percent of the healthy, well-nourished girls her age in the Ohio Study between 1963 and 1975. The 50th percentile is the median, or standard value — the number above and below which half of the children fall.

Siobhan’s height, weight, and head circumference are all normal for her age. Numbers between the 5th and 95th percentiles are considered normal. The standard weight for a one-year-old girl is 21 pounds. Anyone weighing between 17 1/4 and 24 3/4 pounds will be between the 5th and 95th percentiles. Nevertheless, remember that, by definition, 5 percent of completely healthy, well-nourished girls will fall below the 5th percentile. Still, when a child measures below the 5th percentile, the likelihood that there is some type of growth problem increases.

The NCHS charts not only determine normal height, weight, and head circumference for age, but also provide values of appropriate weight for each given height, regardless of age. Since she was 2 months old, Siobhan’s weight for height has fallen between the 5th and 10th percentiles. Between five and 10 percent of healthy, well-nourished children of her height weigh less than she does. She is thin — but not abnormally thin.

So far we have been looking at where a child falls on the growth chart at any given moment — but growth is a process, not a moment in time. A girl at the fifth percentile in weight may be growing normally, may be experiencing growth failure, or may be having a growth spurt, depending on the trajectory of her growth curve. The first few points of a growth curve primarily reflect the in utero environment. Once a child is a few months old, however, the curves begin to reflect her own genetic tendencies, as well as the impact of her own nutrition and health. Rapid changes in percentile lines may signal a problem. If Siobahn’s weight and head circumference proceed to fall below the 5th percentile, it will be prudent to determine why.

Broadly speaking, children who are too small may be so for one of 5 reasons — congenital, familial, constitutional, hormonal, or nutritional:

  • Congenitally small children are born small, and the growth tapers off during infancy. The underlying problem might be a chromosomal abnormality (such as Down’s syndrome), a congenital infection (such as herpes), or a toxic exposure (such as alcohol or tobacco).
  • Children small for familial reasons have small parents.
  • In constitutional growth delay, children are born at an average size, drop to lower percentiles during infancy, and then follow these curves through childhood, with an extra growth spurt during adolescence. These children become normal size adults. This pattern may run in families (it does in mine).
  • Children with hormonal growth failure will have normal or increased weight for height. Their heights will decline before, or at the same time as, weights.
  • In nutritional problems, by contrast, the weight falls first (called wasting), perhaps followed eventually by the height (called stunting), and sometimes leading eventually to a decreasing head size (severe, chronic malnutrition). Nutritional problems can be the result of inadequate intake, increased caloric needs (heart disease, kidney disease), or the inability to use calories consumed (extreme social/emotional deprivation).

I can’t possibly assess your daughter without having examined her. I can say, however, that a child with a growth pattern like your daughter’s might be growing completely normally, might have a constitutional growth delay, or might need some extra nutrition. A careful history and physical examination by her pediatrician, with particular attention to her overall development and nutritional status, should help illuminate the situation. Tell Siobhan happy birthday from me, and may we all grow in wonder this coming year!

Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. babita

    My baby 1 year old and head is 50.05 Cm. Please tell ime if this is correct or not, and what can I do.

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  2. Milano

    My son weighs 14 pounds 14 ounces at his 4 month check up his head circumference is 15 3/4 and he is 25.5 inches long is he at a normal height and weight?

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  3. Tahir mehmood

    hello my son is 18 months old he is very weak,weighs only 7 kg i m much worried about him plz do suggest me

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  4. danielle

    My daughter is 18 months she only weighs 21 pounds and is 29 inches. I’m only 5 ft. But her dad is over 6 ft. I know I was a peanut too, but with her dad being so tall I was kind of hoping she would at least be average. Doc says she’s below the 2nd percentile. It just keeps dropping and I’m not sure why. When she was born she weighed 7 lbs. 10.5 oz. And was 20 in. Long. As much as I would love to keep her this size forever I do want her to develop normally. Any suggestions?

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  5. Cerina Murrells

    My 9 week old son had a check up today. His weight is 11 lbs 10oz. His length is 58cm, but his head circumference is 41cm which I have been told is to be checked in 2 weeks time. Is the head circumference abnormal? Do I need to worry?

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  6. Tracy Garcia

    Hello, my son turned 2 years old on Dec 24th, 2014. At his two year well child check up, he measured 32″ and weight was 24.4 Lbs. I am concerned, he is at 4th % for height and 9% for weight. He was a normal 6 Lbs 4 oz and 18.5 in at birth, but he was 12 Lbs at 1 month. He doubled his birth weight in just 1 month. He was exclusively breastfed until 18 months. Is it normal to be at 4th percentile for his age? My height is 5″ 0′ and my husband 5″ 5′.

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  7. alicia

    My son was born at 32 weeks, weighting only 3lbs. He had a heart condition which was fixed. He had ng feeding daily 26mls 23hrs a day. Anyhow, now he is 13 months and weighs 12lbs, and height 66cm. He is not developing according to milestones and doesn’t like physical contact. Obviously I know this weight is not right for age, but do you have any ideas what could be wrong? He has 15 docs, but none helping him, just “we don’t know maybe 3m syndrome”?

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  8. Amit

    My Son is 22 months old and having a head circumference of 49 cm his weight is 13 kg. His frontal fontanel is 2.5 finger open. Is this a point to worry. Although he doesn’t show any symptoms of retarted growth behaviors as such.

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  9. IJAY

    My daughter was 4.25kg at birth. At 14weeks she weighed 6.3kg, at 6 months she weighed 7kg and at 9 months she weighed 7.1kg. She weighs a little over 8kg now and 27 inches in height, 18inches in head circumference.

    She eats very well, not picky at all! She is very cheerful, starting walking by 11months and is very strong and vibrant. She has a wide vocabulary for her age and has mastery of all her motor skills for her age. In summary she is doing excellently well, even ahead of her peers in so many things, except her weight and height!

    I am about 5ft 4inches, her dad is about 5ft 6inches. I am averagely built for a woman (size12). Her dad is a little below averagely built. Most of the women from his own father’s side are petite in stature, but my own side of the family we are big-boned.

    I live in Nigeria, and in my area we are not as detailed and observant in our health care system.

    Should I be worried? Should I be worried or is she fine and will pick up later?

    Any info would really be helpful! Thank you

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  10. jj

    Hello,

    My son will be 18 months in a few days. He has not grown since his 12 month visit which he was measured at 34 inches. The doctor has sent him for blood work all of which came back normal except for some fat in his stools. He was a very big baby and now is not gaining much weight and their is no height growth. He is a picky eater but I have been supplementing with pediasure complete nutrition. I will take him back to the doctor tomorrow but thus far she has had no answers for why he has not grown in 6 months. Can you please help me with this?

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  11. Carol M.

    My grandson was normal in all respects at birth. Was exclusively breast fed for 6 mos. His growth is not progressing. He is the size of a 9 mo old but is 18 mos. He has a long torso and spindly legs. His tummy is huge….like the size of a squished cantaloupe. He can barely bend over. He just learned to crawl. He is very picky about food and eats mostly oatmeal,some eggs, and drinks organic whole milk. His cognitive development seems to match his physical size. If he is catching up, it’s so slow , one can hardly tell.

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  12. samreen

    my daughter is 23 month old her height is 30 inches &weight is 10 kg i m worried about her height & weight .

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  13. mehwish

    Hi my 7 mos old son is having 38 cm head circumference.he had 31.5 at the time of birth ,now he has head lag ,neither rolled over nor sat ….other wise he is happy kid.can anyone tell me about head circumference ,which has not grown since 4 months.

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  14. liv

    hi, my son just turn 7 snd he is very short for his age, he is the shortest on his class and he is the same high as my daughter who is 15 months younger than him. As a new born baby he was very long and big, almost 5kg. he is my second out of three and he was the heaviest and longer out of the three. around 1 he had an operation to removed one of his testicle as it didn’t descended rather than that he is very sporty and healthy. what can I do? is the operation related to his height? thanks

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