"Is My Child Growing Normally?" Facts from the Experts

If your child is racing up the growth charts, or she's rooted in the front row of every class picture with the smaller kids, you may wonder if she's on the right track. Here's when to worry, and when not to, at every stage.

Birth to 1

From birth to age one, your little cherub triples in weight and gains about 10 in (25 cm) in length or height. An average-sized baby is 20 in (50 cm) long at birth and grows to about 30 in (76 cm) by age one. Boys tend to be slightly taller than girls and, according to Dietitians of Canada, breastfed babies tend to grow more quickly than formula-fed babies in the first six months, and then more slowly in the second six months of life.

What to expect at checkups: Your baby’s doctor will monitor weight, length and head circumference every month for the first six, then every two months until age one, to make sure her growth is on track. “If the weight, length and head all fit in the same parameter, that’s the pattern of the child,” says Fabian Gorodzinsky, an associate professor of paediatrics at the University of Western Ontario in London. “For example, a child who’s on the bottom of the growth chart for all three is a small child, and one who’s on the top end is a big child, but they are both normal.”

Troubleshooting: If any one measurement falls off, doctors do get concerned. “That’s one of the most important indicators that there’s something wrong with the child, such as a chronic infection or something more serious like a heart problem,” says Gorodzinsky. “Usually, the weight is affected first and the height is affected much later — for the child to not grow in height, the event has to be far more chronic and severe.”

That was the case with Sarah Kirmani’s baby, Alina, whose growth slowed at five months. “We decided to investigate rather than assume she was just a small baby,” says Kirmani, who lives in Markham, Ont. A paediatric cardiologist discovered that Alina had a heart condition that was hogging her little body’s supply of energy. After heart surgery at age one to correct the problem, Alina is now growing normally.

Growing really tall during the first year is usually no cause for worry, says Gorodzinsky. In extremely rare cases, a really big child could have a genetic or endocrine condition, such as gigantism, due to an excess of growth hormone. When the growth of a child’s head circumference is slow compared to the weight and length, it may suggest a problem with brain growth, and if the head grows too fast, it could be due to excess fluid in the brain. Talk to your child’s paediatrician if you have concerns.

Ages 1 to 3

During the toddler years, the growth rate slows to a steady pace and your baby’s adorably chubby arms, legs and belly slim down. Between one and three, boys and girls who fall in the middle of the growth chart will spring up from 29 to 37 in (74 to 94 cm) and will weigh 30 lb (14 kg).

What to expect at checkups: By this age, your child’s doctor has a good idea of the growth track he’s on. She’ll check height, weight and head circumference every three months from 12 to 18 months, then six months later at age two, and after that on an annual basis. The head measurements become less important at age two when the doctor will start to calculate your child’s BMI (body mass index) to see if his weight makes sense for his height.

Troubleshooting: If your child is smaller than expected, in rare cases, it could be due to an underlying medical condition. “But the most common problem we’re worried about at this stage is their weight going up because they’re eating too much junk food and not enough healthy food,” says Mylène Dandavino, a pediatrician at The Montreal Children’s Hospital.
Parents of super-tall kids may be concerned their child is sprouting up too quickly. That was the case with my daughter Sophie, now six. By age two, she was already three-foot-one (94 cm), skimming the top of the growth chart for height and towering over every toddler in her playgroup. It turns out Sophie was growing just like I had. “Kids often follow the same growth track as their parents,” says Dandavino. “So ask your own parents how you grew as a child.”

Ages 4 to 9

Height and weight continue to increase steadily, with boys and girls gaining about 2 to 3 in (5 to 7.5 cm) a year. So a four-year-old child in the middle of the chart would be about a foot taller by age nine, measuring 52 in (132 cm). Girls who start puberty early, at age eight or nine, may begin their big growth spurt (see “Ages 10 to 14+,” below).

What to expect at checkups: Your child’s doctor will continue to check her height and weight, and calculate her BMI, annually.

Troubleshooting: Slow growth in school-aged kids is most likely due to an endocrine problem, such as a malfunctioning pituitary gland, says Gorodzinsky. That’s what happened to Samantha Brinks* who stopped growing around age six. “She was always one of the tallest girls in class, but then I noticed her clothing sizes had stopped going up from year to year and she’d gone down from the 75th percentile for height on the growth chart to the third,” recalls her mom, Rachel.

Through blood tests, an endocrinologist found that Samantha’s pituitary gland wasn’t producing enough growth hormone. Injections corrected the problem.

Dandavino emphasizes that growth hormone injections are used only when medically necessary, as in Samantha’s case. But injections won’t boost the height of a child who’s genetically programmed to be shorter, and they may cause side effects.

Ages 10 to 14+

Puberty is the second big growth spurt in a child’s life, with the largest height gains between ages nine and 11 for Canadian girls. Expect to see your daughter grow about 9 to 11 in (23 to 28 cm). Once she gets her period, the growth plates in the bones close and she reaches her adult height, averaging 5 ft, 4 in (163 cm). Boys do most of their growing between ages 11 and 16. During adolescence, they gain about 10 to 11 in (26 to 28 cm), reaching an average adult height of 5 ft, 9 in (175 cm). For both sexes, arms, legs and feet grow faster than the torso, which can give preteens an awkward, gangly appearance. Since girls’ puberty growth spurts happen earlier, they may tower over the boys for a few years.

What to expect at checkups: Your child’s doctor will continue to check her height and weight.

Troubleshooting: If your child seems to have stopped growing, mention it to your doctor. Kids who are short and overweight may have a thyroid problem, which can be checked with a simple blood test. “But a thyroid problem in a child is uncommon; usually kids who are short and overweight eat too much and don’t get enough exercise,” says Dandavino.
Growing too fast sometimes creates health issues. Around her 11th birthday, Shelby Francis had a growth spurt, but lost 10 pounds in the process and ended up on the brink of anemia. “I felt terrible,” says Shelby’s mom, Julie. After a few months of whole milk and full-fat cheese, Shelby’s weight caught up to her height.

Kids who grow quickly may feel aches in the bones of their legs — often called growing pains. They are not harmful, but can be uncomfortable; massaging the legs may provide some relief. Some kids also experience growing pains as an acute, sudden chest pain, says Gorodzinksy. “That’s because the cartilage, the elastic band that joins the rib with the sternum, may not be growing at the same speed as the bones, so there’s a pull that feels like a sharp pain.”



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