Child Growth Variations

Child growth variations is a common phenomenon in a child’s growth process.

The growth begins from the very moment of conception and continues till an infant attains its specific adult stature. Many inherent and external variables influence children's growth potential resulting in growth variations.

Significance of child growth variations

The knowledge of normal growth pattern is crucial to distinguish normal growth variations from disturbed growth process caused by the stumbling blocks in the long process of child growth.

  1. If any of the intrinsic or extrinsic influences on child growth is not as favorable as would be desired for optimal growth, they can hinder a child’s growth.

  2. Moreover, the normal values of growth are themselves highly variable, because a large number of factors influence the growth process in children.

  3. Childhood development is closely related to child growth process. Identifying delays
    and abnormalities in growth process therefore helps prevent permanent handicaps in children.

There are many forms of child growth variations. Many of them are attributable to individual genetic predisposition and circumstantial familial patterns.

Age specific discrepant percentile values

If a child's measurements fall in normal range for “weight for height”, then the child will fall under the category of "normal child growth variation".

Example: The age specific growth graphs of a child may show 60th percentile for weight, 40th percentile for height and 50th percentile for head circumference.
This is a discrepant percentile.
However, the observed values yet lie within the normal range of “weight for height”, and so would be considered as a normal child growth variation.

Familial short stature

The familial short stature simply means what the name suggests; runs in the family. Child inherits short stature representing genes from the parents.

These children have low weight and height, which follow at a lower percentile on the growth chart throughout the childhood.

Their head circumference could be large or small, but within the normal limits for the age.

Consequently, familial short stature children grow to be short adults. Their adult height corresponds to that of their parents. They are medically absolutely normal, get normal growth spurts and have normal transition through the puberty.

Percentile growth curve shift with growth disorders

Note: In the percentile growth graph given below shift of the curve (in red) is associated only with growth disorders.

Any such deviation noticed on child's growth chart should arouse concern.

Percentile Growth Curve Shift with Growth Disorders

Constitutional short stature/ Late Bloomers

Constitutional short stature affected children are commonly known as Late bloomers.

Familial disposition, often in both the parents, has been documented in this pattern of delay in growth.

A constitutional short stature child is actually a normal child, whose height is uniformly sustained at a lower percentile during early childhood.

However, they have delayed onset of puberty , and consequently, their pubertal growth spurt gets delayed; hence the name " late bloomers ".

As a result these children appear shorter and younger than their peer and have:

  1. Bone maturation age, couple of years less than their chronological age.
  2. Insulin like growth factor 1 (IGF-1) levels though low for the chronological age crrespond to bone maturation (bone age).
  3. Growth hormone provocative test with a poorer response.

Constitutional short stature children often fall victim to peer pranks. This could arouse psycho social issues with some of the affected teenagers. Most of these children finally attain normal adult height.

Late bloomers should be examined and followed closely for the abnormalities of pubertal development.

If a constitutional short stature girl does not develop some secondary sex characters by the age of 14 and start menstruation latest by 16 years of age, then it is a cause for concern.

Catch down growth variations

catch down growth is specifically seen in children who start off at high percentile in early infancy. It occurs because of their excellent prenatal and postnatal nurturing. They need to slow down to fall in norms of human stature.

So, in between 6 and 18 months of age these children show a fall on their percentile growth chart as child growth variations. Over a time they match their genetic programming and then they grow at this lower percentile, but along their genetic potential.

They have normal physical, psychological and behavioral development. However, a fall of more than 2 major percentiles warrants medical consultation.

Growth spurts

Growth spurts are short periods of fast growth and are seen as:

  • Early infancy

  • Puberty

  • Catch up growth:
    This form of accelerated growth is seen in children during recovery from growth retardation - For example; premature and low birth weight babies.

Can coffee/caffeine intake during childhood cause stunting of growth?

Caffeine in coffee is an addictive drug. It has many undesirable effects on child health. Coffee consumption during pregnancy jeopardizes the growth and development of fetus, infants and toddlers.

However, its role in stunted growth of childhood has recently been disproved by scientific studies.

Nevertheless prolonged and excessive consumption of caffeine in chocolates, coffee, tea etc. cause many other adverse effects in children. Therefore, the subsidiary beverages that contain caffeine, such as health drinks, have been banned in many schools.

Evaluation of child growth variations

Patterns

Less than fifth percentile for head, weight & height


Discrepant Percentiles



Falling percentile

Consider

IUGR
Familial & Constitutional short stature

Normal
Familial or constitutional variant
Hormonal disorder

Emotional deprivation
Nutrition disorder
Catch down growth

Look For

Mid-parental height
Prenatal growth records
Pubertal development


Mid-parental height
Pubertal development
Hormones evaluation:
Thyroid, Growth & other related hormones

Social history
Dietetic history
Chronic diseases

A final word on child growth variations

We need to be vigilant and maintain growth charts through out the childhood in order to distinguish sneaking growth disorders from normal child growth variations at the earliest.

Back To
Child Growth, an Indicator of Child Health

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