If your child visits a pediatrician or other health care provider regularly, you’re probably familiar with the routine – your child’s height and weight are measured. Infants will be weighed and their length determines; they will also have their head circumference measured. Those measurements let us see how much our children have grown since their last visit. Babies’ and children’s growth follows a relatively predictable pattern; deviations from that pattern can be a warning sign.
Once your child’s height and weight are measured, the measurements are compared to growth curves – graphs that show growth patterns of children by age. There is no single perfect growth rate so growth charts are set up using percentiles. Your child’s height (or length), weight, and head circumference (for infants) are graphed and reported as a percentile. For example, if your 6 year old son’s height is at the 50th percentile, that means that 50% of 6 year old boys are taller than your son and 50% are shorter. In the same way, if your 4 year old daughter is at the 25th percentile for weight, a quarter of 4 year olds are lighter than she is and three-quarters are heavier.
A wide range of growth percentiles are considered “normal.” A child at the 10th percentile for weight or the 95th percentile for height is still considered to be within the healthy range. You don’t get extra points for higher or lower percentiles. However, if your baby or young child is below the 2nd or above the 98th percentile for weight or head circumference (or below the 2nd percentile for length), your health care provider will try to find out why this is and if intervention is needed. In addition, children don’t usually make large jumps – like from the 75th to the 25th percentile – so if this happens, the reason for this faltering is investigated. Older children (age 2 and older) are assessed using slightly different standards. Older children’s’ body mass index (BMI) is calculated using their weight and height. If BMI for age or weight for height is above the 95th percentile, the child is evaluated as being overweight. If BMI for age is between the 85th and 95th percentile, the child is “at risk of overweight.” If BMI for age is below the 5th percentile, the child is considered underweight and further evaluation may be needed.
Of course, when any child is evaluated, factors such as the size of the parents and whether or not the child was born prematurely or if there are health issues are taken into consideration.
Up until a few years ago, vegetarians whose babies were breastfed were justly suspicious of growth charts. Before 2006 growth charts for infants were mainly based on the growth of babies fed infant formula. Babies who are breastfed tend to gain weight more slowly before their first birthday than do bottle-fed babies. Growth charts based on formula-fed infants may make it seem that breastfed infants are not growing well.
In 2006, the World Health Organization (WHO) released growth charts that were developed based on infants’ growth in Brazil, Ghana, India, Norway, Oman, and Davis, California. Despite geographic and ethnic diversity, infants grew at similar rates. Infants were from economically secure households, had access to clean water, and were breastfed for at least 12 months. The growth charts that were developed based on the growth of these infants reflect our best knowledge of what normal growth should look like. These growth charts are called the WHO growth charts and should be used to assess growth of children less than 2 years of age. The CDC growth charts are used to monitor growth of children 2 years and older in the United States.
It is important that your health care provider is using the proper growth chart to monitor your child’s growth. You can ask which growth chart is being used. Remember, if your child is under 2 years, the WHO growth chart is what is recommended. Older children are monitored with the CDC chart.
It is also important that your child’s height/length and weight are measured and recorded accurately. One of my daughters apparently lost an inch of height from one doctor visit to the next – I suspected she had not been measured correctly. Since measurements are assessed based on your child’s age, the age should be calculated. It’s not enough to say your child is 3 years old – a 3 -1/4 year old is different from a 3-3/4 year old.
Your child’s height may seem inconsistent around age 2. Before age 2, children’s length is measured when they are lying down. After age 2, height is measured. Length measurements are about 1/4 inch greater than height measurements. In addition, your child’s growth percentiles may change slightly when the child moves from the WHO charts to the CDC charts. As always, it is important for the health care provider to take into consideration your child’s growth pattern in the past.
Growth charts, used properly, can be a useful tool in assessing the growth of vegan children.
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