Proper Use and Interpretation of Growth Charts

The growth charts shown in eFigure 23-1 online were revised by NCHS (2000) from surveys of generally well-nourished children representing a cross section of ethnic and economic groups in the United States. These graphs provide a normal range of weight and length or height for a given chronologic age. Recumbent length is recorded on the chart for children from birth to 36 months, and standing height is recorded on the chart for children from 2 to 18 years. Premature infants should have their chronologic age adjusted according to their degree of prematurity up to age 2 years, because most catch-up growth is complete by this time. Although a height or weight above the 95th percentile or below the 5th percentile should alert the physician to a possible problem, these can represent the outer fringe of the normal range.

Linear growth in infants has been shown to occur in incremental bursts rather than continuously (Lampl et al., 1992). A growth curve constructed by a series of heights and weights taken over time allows the physician to compare current growth with the child's previous pattern. The linear growth velocity, or rate of gain in height, decreases from 25 cm per year during the first year of life to a prepubertal rate of 5 to 6 cm/yr by age 6 or 7 years (Miller and Zimmerman, 2004). The rate accelerates during puberty. A child whose growth curve parallels the normal curve regardless of the child's absolute percentile has a normal rate of growth for that particular child. In comparison, a child whose height or weight crosses multiple percentile lines or whose linear growth rate drops below 4 cm/yr requires further evaluation for nutritional, psychosocial, or organic problems that could impede or accelerate growth (Lipsky and Horner, 1988). Children with genetic short stature have normal length and weight at birth, but their growth percentiles decline within the first 2 to 3 years of life as they reach their genetic potential (Halac and Zimmerman, 2004).

Although careful measuring and plotting of growth parameters is the most accurate method by which to follow a child's physical growth, approximate growth guidelines are helpful to the physician in remembering and forming an overall impression of the child's progress (Table 23-1).

Pregnancy And Childbirth

Pregnancy And Childbirth

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