Proper Growth
My child does not seem to be growing well. How do I know if he is growing appropriately or not?
All children have spurts and slow periods of growth, just as their appetite changes. The best way to tell if a child is growing normally is to plot height and weight on a growth chart, which your doctor can provide. As long as your child is growing roughly along the same growth percentile, there is nothing to worry about.
I hear a lot of talk about growth charts. What are growth charts?
Growth charts are graphs that you can use to compare your child’s growth to that of many other normal children. They are used to determine whether children are growing too fast or too slowly, or whether they are too thin or too fat.
I am always confused when they say my baby is at the 20th percentile. What exactly does it mean?
When someone says your baby is at the 20th percentile for either height or weight, this is a way of relating your baby’s size to that of a normal population. A baby that is exactly average, would be at the 50th percentile. When someone says your baby is at the 20th percentile, it means that 20% of otherwise normal, healthy children are smaller, and 80% are larger than your child.
Where do these growth charts come from? Are they really representative of what my baby should be doing?
The growth charts come from measurements of large numbers of healthy, growing children. Because the information is pooled from large numbers of infants and represents group changes, it doesn’t always apply to individuals who can have some variations in growth patterns. Still, the growth charts are a very good measure of what growth you can expect from your child.
What about the factor of parents’ heights on growth. Shouldn’t that make a difference as to how tall the child would be?
The size of the parents and the sex of the child are the single biggest factors that determine how tall a person will be as an adult. By the time a child reaches school age, his height ordinarily will reflect the parents’ heights. Parents’ heights, however, are of less importance in determining the infant’s height. Your doctor can usually take into account the heights of a child’s parents and determine whether the current height is in the correct range.
What about race? I am black. Are these curves reflective of race?
Most growth charts used in the United States reflect the population of the United States, including both black and white children. There are some small differences in heights, but these differences are not big enough to cause problems using the growth curves.
I am Asian. Do these curves apply to my child at all?
The growth curves apply to Asians, too. Interestingly, most Asian children who are born and raised in the United States fall in the average range of height, even though the ancestors from their native countries are relatively smaller.
My baby has been crossing percentiles. That sounds a bit scary. Is he growing too fast?
Most children grow at a fairly steady rate and hence do not cross percentiles. Percentiles can be crossed in an upward or downward direction. Often this is a sign that the growth pattern could be abnormal. You should always discuss this with your physician. Sometimes it is just a temporary change, for instance, when the baby is sick and not feeding well.
There is one circumstance where crossing percentiles is normal during early childhood. This occurs when the child is born with a birth weight and size that are relatively small, but he has tall parents. To reach the genetic potential for height, the baby must cross percentiles. This occurs during the second year of life, after which time most children stay on their given percentile. The same circumstance can happen with a child who is large at birth but has small parents. In this case, the child’s height will correct to a lower percentile, usually during the second year of life.
My baby is always above the 90th percentile. Should that worry me?
One in 10 healthy babies by definition will be above the 90th percentile. The most important question is: Is your child’s growth continuing to accelerate and becoming further and further away from average height and weight? Your pediatrician or family doctor should be able to plot your baby’s heights and weights on the chart and determine whether a problem is present.
Big heads run in my husband’s family, and my baby’s head is also on the large side. Is that okay?
It is probably okay. Again, the size of parents’ heads tends to be reflected in the size of children’s heads. If your baby is developing normally and is otherwise healthy, there is little cause for alarm. It is critical to determine whether the problem of the large head is seeming to get greater over time or merely staying on the large side. This is done by your doctor’s making repeated measurements over time and plotting them on the graph. A head size that continues to increase faster than it should would be reason for futher examination.
Most of my kids seem to be long and lean. My youngest baby looks long and lean also. When do I start worrying about it?
A good indicator of whether your baby is healthy is to look at the change in length growth rather than the change in weight. Of course people always wonder if babies who are long and lean are getting adequate nourishment. If your baby’s height is in the normal range and he continues to grow in length normally, then he should be considered healthy. If your baby has problems with eating or with stool pattern, or if weight and height are affected, then I would bring this to the attention of your doctor.
I am breastfeeding my baby, and they tell me that breastfed infants are a bit smaller at some point. Is that true? And if so, should I worry?
There is a time early in life when the weights of breastfed babies tend to be a little less than those of bottle-fed babies. This seems actually to have little impact on their overall growth and development in the end, and therefore it appears that both breastfeeding and bottle-feeding produce healthy, normal children.
My baby’s head is small on the growth curve, but the rest of his body seems to fall inside the curves. Is that okay?
Since all measurements are related to averages, there are going to be some normal healthy babies who tend to fall on the small side of all our growth charts, whether they be for weight, height, or head size. A very small head can be an indication that there is a problem with growth of the brain, but it could be a variation on the normal as well. One critical question is whether your child’s development is normal, and whether the head continues to enlarge at a relative rate. All babies’ heads should continue to grow and increase in size. If growth is stopped, then this is a definite reason for examination by your baby’s doctor.
What about the measurements? How reliable are the measurements using paper tapes?
Measurements in length need to be made against a flat surface to be accurate. Paper tape measurements are considered reasonable if done carefully. The growth curves on body length are based on children’s being measured either lying or standing against a flat surface.
How about the scales? I thought there was a great variation in scales. Wouldn’t there be a possibility of error? Should I buy my own scale?
Moderately priced scales that are properly adjusted actually don’t have very much variation. Unless your child has a particular problem that necessitates frequent weighing, it is not really necessary to have your own scale. Sometimes it may make you unnecessarily nervous to see small insignificant increases or decreases each day in weight. Your pediatrician or family doctor can monitor your baby’s growth easily through routine office visits.
What if my baby ate just before being weighed. Wouldn’t that affect his weight right away?
Yes, if a baby eats 4 oz. of formula just prior to being weighed, he will weigh 4 oz. more. Therefore, for very young children, physicians try to weigh them at a constant time during the day in relationship to their feeding. Nonetheless, there is some day-to-day variation that will be a result of eating and elimination patterns which make drawing conclusions from weights taken too closely together in time somewhat difficult. Over time, these errors tend to balance each other out and make interpreting growth over a longer period possible.
They tell me that some people have heavy bones. How do I know if it is bone or fat that makes my baby weigh a lot?
There certainly are different body shapes, some people being endowed with more muscle, others being more delicate. In general, fat tends to accumulate in some predictable places (You know where these are!). This is probably a pretty good indicator whether your baby has too much fat.
My baby has a double chin. Is that okay?
Lots of babies have double chins. Whether your baby’s weight is okay for the height can be determined by a special kind of growth chart that plots weight for height, and will determine whether your baby is of average physique or not.
I hear that the right thing to do is have enough growth in muscle but not in fat. How can I distinguish that?
It is actually not always so easy to tell growth in muscle from that of fat. The major question I would have is: Is your baby healthy and vigorous and doing all the normal activities according to his age? If the answer is yes, then your baby probably has enough muscle for his needs.
I am very worried about the growth of my baby. He seems so fragile. Should I talk to dietitians, so that they can advise me on the right nutrition for my baby?
I am certain that a dietitian can give you good advice on nutrition for your baby, and can reassure you that what you are doing is absolutely right.
Providing good nutrition for your growing child is one of the most important things you can do for your baby. In terms of whether to be worried about your baby’s growth, the best thing to do is to examine your baby’s growth curve on one of the charts that we have described above. This will be a good indicator of whether your baby is growing normally or not.
At what point should I see a specialist in growth disorders?
A specialist in growth disorders should be consulted when your baby’s growth is abnormal, that is, he is either growing too fast or too slowly compared to other children the same age, or under circumstances where your child’s size either greatly exceeds or is very small compared to what would be expected based on the height of his parents.
In general, under these circumstances, your doctor or pediatrician should examine your child and determine if any obvious explanation for the abnormal growth pattern is at hand. If not, the specialist might be consulted to determine whether there is a disease present that is producing the abnormal growth pattern. In most cases, using specific tests, a growth specialist can arrive at an explanation for your child’s growth pattern. Many disorders of growth are treatable, and the best results of treatment usually occur when the diagnosis is made at a young age.
How would my baby be fed?
Not only are specialized milks needed, but also your infant may be too immature to be able to suck and swallow and/or coordinate these with breathing. Therefore, the infant must be fed by a tube in the stomach; we call this orogastric (if the tube goes from mouth to stomach) or nasogastric (if the tube goes from nose to stomach) tube-feeding. Infants may be fed continuously by this method or every 2 or 3 hours depending on their condition. The ability to coordinate sucking, swallowing, and breathing usually is achieved when the infant reaches 34 to 35 weeks. Therefore, if your infant was born at 26 weeks’ gestation, it might take 6 to 7 weeks before he is able to feed orally either at the bottle or the breast. So, as the infant develops, oral feeding will be introduced slowly.
Generally, by the time premature infants are discharged from the hospital, they are able to orally obtain the necessary milk intake either at the bottle or breast and are gaining weight. Usually, after hospital discharge, the infant will no longer need either specialized formulas added to breast milk or specially designed formula. At discharge, the doctors generally recommend exclusive breastfeeding or a routine infant formula with iron for use at home.
Occasionally, if all the nutrient needs have not been satisfied during the hospitalization, the specialized formulas will be necessary when your infant goes home. Your infant’s doctor will make this decision.
|