Introduction
Growth is the increase in size (measured); development is the gain of skills (observed). Both follow a predictable sequence, and checking them is the core of every paediatric visit: a child who is not growing or developing is telling us something is wrong.
Growth in numbers
Growth charts and short stature
- Plot weight, length or height and head circumference on WHO charts (0–5 years) and national charts after; follow the child along a centile.
- Compare with mid-parental height (average of parents' heights, +6.5 cm for boys, −6.5 cm for girls).
- Short stature: below −2 SD (or the 2nd–3rd centile). Normal variants: familial (short parents, normal bone age, normal velocity) and constitutional delay (late puberty in a parent, delayed bone age, catches up). Abnormal: falling across centiles; growth hormone deficiency, hypothyroidism, Turner syndrome, coeliac disease, chronic illness, steroids, small for gestational age without catch-up.
- Bone age (X-ray of the left hand) shows how much growth is left.
- Failure to thrive: weight falling across two major centiles in an infant; most often from too little intake (feeding problems, neglect), less often malabsorption or chronic disease.