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Active Living
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Prehistoric Workout
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Childbirth
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Advice from the Maternity Clinic
Advice from the Maternity Clinic (Part 2)
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Building a Better Baby
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Support During Labour
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Introduction
Managing Your Pain
Movement Matters
Moving Forward
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Returning to Work
Understanding and Goal Setting
When Pain Doesn't End
Dental Health
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Baby Bottle Tooth Decay
Baby Teeth
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A Healthy Mouth
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The Smile You Want
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Smiling through the Senior Years
Teeth for Life
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Tobacco Risks to Oral Health
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Wisdom Teeth
Your Healthy Smile
DIABETES
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10,000 Steps
A1C Test
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Alchohol and Diabetes
A Diabetes Success Story
ABCs of Diabetes Management
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Artery Health
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Benefits of Insulin
Benefits of Breakfast
Blood Glucose Medications
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Blood Sugar Lows
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Canada Food Guide Revisited
Carbohydrate Counting
Catastrophic Drug Plan
CDA Guidelines for Diabetes
Celiac Disease and Diabetes
Celebrating Health
Childhood Diagnosis of Diabetes
Children and Type 2 Diabetes
Cholesterol-lowering Medications
Colds and Diabetes
Constipation
Continuous Blood Glucose Monitoring
Cutting Edge
Dangers of Uncontrolled High Blood Pressure
Debunking Diabetes Myths
Driving and Diabetes
Diabetes and Menopause
Diabetes and OTC Medications
Diabetes Care Team
Diabetes and Celiac
Diabetes and Depression
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Diabetes Eating on a Shoestring Budget
Diabetes Etiquette
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Diabetes in Cats
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Diabetes Management ABCs
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Diabetic Ketoacidosis
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Diet Tips for South Asians
Dining Out
Drinking and Diabetes
The Discovery of Insulin
Eating Disorders
Easing the Strain of Stress
Eating to Protect Your Kidneys
Eating Well During Shift Work
Eggs in a Diabetic Diet
Emotional Eating
Emotions of Diabetes Diagnosis
Erectile Dysfunction
Exercise Excuses
Why Fad Diets Fail
Fats
Fibre
Fill Your Day with Energy
Financial Support for Diabetes
Food Temptation
Foot Care
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Gastroparesis
Gestational Diabetes
Get Active
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Gift Ideas
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Going Green in the Kitchen
Grocery Shopping Tips
Guidelines for Diabetes Management
Holiday Party Survival Guide
Health Information on the 'Net
Healthy Happy Holidays
Healthy Beverage Choices
Health Benefits of Soy
Healthy Restaurant Meals
High Blood Pressure and Diabetes
High Blood Pressure
HbA1c Test
Healthy Eating for Active People
High Blood Lipids
Home from the Hospital
Home Alone and Sick
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Immunization & Diabetes
Incretins-a Hormone Treatment
Injecting Insulin
Insulin Discovery-The Story
Insulin
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Insulin - the Key to Energy Management
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Immunization and Diabetes
Internet Health Sites
Islet Cell Transplantation
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Kidney Disease - Reducing the Risk
Living with Diagnosis of Diabetes
Living Powerfully with Diabetes
Low Blood Glucose
Managing Diabetes
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Your Medication Expert
Medication Research Studies
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Microalbuminuria
New Diabetes Technologies
Natural Medicines and Diabetes
No Need for Insulin?
Not Snoozing
Over-the-Counter Medications
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Diabetes and OTC Medications
Pedicure Precautions
Peripheral Arterial Disease
Pet Diabetes
Planning for Pregnancy
Prebiotics and Probiotics
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Reducing Stress of Surgery
Safe and Successful Travel
Schizophrenia and Diabetes
Sensible Snacking
Setting Health Goals
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Sharps Disposal
Shorter Insulin Needles
Sleep - a Missing Link
Smart Snacking
Smart Summer Nutrition
Snack Bars
Snacking with Diabetes
Sodium
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Solving the Insurance Puzzle
Stress and Diabetes
Success in School
Supplements
Supporting Spouse with Diabetes
Sweeteners
Sugar, Carbs and Blood Glucose Control
Think Positive with Diabetes
Tiny Bites Equal Big Calories
Travelling with Diabetes
Tips for a Better You
Tobacco Use and Diabetes
Top 10 Reasons to Exercise
Treating Low Blood Glucose
Treating Hypoglycemia - Role of Glucagon
Tune up Your Diet
Type 1.5 Diabetes
Type 2 Diabetes
Understanding Diabetes
Understanding Diabetes Medications
Understanding Ketones
Used Sharps
Urinary Incontinence
Vacationing with Diabetes
Vegetarian Eating for Diabetes
Vitamin D
Walking
Wise Choices About Natural Medicines
Wonderful Water
Natural Medicines & Diabetes
World Diabetes Day
Your Medicine Cupboard
Zimbabwe Hand Jive
Family Medicine
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ADHD in Children
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Antibiotic Use
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Aspirin Every Day?
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Back Pain Myths
Back Pain - Lower
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Doctor Visit
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Modern Living
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Bisphenol A
Canada's New Blood System
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Patient Safety in the Hospital
Pets and Health Benefits
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Physiotherapy Visit
Planning for End of LIfe
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Schizophrenia
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Soy
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5 Tips to Manage Weight
10 Ways to Cut Down on Fat
Battle the Bulge
Boost Your Bone Strength
Body Image
Breakfast is Important
Bowel Health
Building Your Bones
Celiac Disease
Challenging the Milk Myth
Diet Reality Check
Drink Up!
Eating Smarter & Cheaper
Energy Drinks
Food Allergies
Food for Active Kids
Fast Food
Food Labels
Giving Up Gluten
Healthy Diet, Healthy Smile
Healthy Eating for Boomers and Zoomers
Healthy Eating for Seniors
Healthy Eating on Business Travel
Healthy Ethnic Meals
Fad Diets
Fruits & Veggies - 5-10 a Day
Fats
Fat Phobias
Fats & Cholesterol
Feeding Your Kids
Fibre
Food Chemistry 101
Food and Mood
Getting Kids to MOVE
Healthy Eating for Teens
Healthy Habits
Herbal Medicine and Nutrition
New Ingredients for Your Shopping Cart
Iron
Kid's Food
Liquid Candy
Meal Planning with Planned Overs
Mercury Levels in Fish
Night Snacking
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Nutrition on the Net
Nutrition Myths Busted
Nutrition Questions Top 5
Nutrition for Menopause
Essential Omega-3
Preventing Cancer Through Nutrition
Picky Eaters
Power of Fruits & Veggies
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PMS and Nutrition
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Probiotics
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Survive and Thrive
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Pharmacy Care
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After a Heart Attack
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New Anticoagulant Medications
Inhaled Asthma medications
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Blood Thinners
Calcium and Iron Supplements
Changing Role of the Pharmacist
Children's Cold Remedies
Child's Fever
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Diuretics and Potassium Supplements
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Expanding Role of Pharmacies
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Generic or Name Brand?
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Heart Health
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Medication Questions?
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Over-the-Counter Drugs and Pregnancy
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Pharmaceutical Studies
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Sports & Nutrition Supplements
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Your Best Shot
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Alcohol
Antibiotic Resistance
Backpack Pain
Bacteria Fight Back
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Caffeine
Cell Phones and Driving
Childhood Obesity
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Cold and Flu Season
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Distracted Driving
Farm Safety for City Kids
Foodborne Illness
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The Flu and You
Heading Home for a Visit
Health Tips for Snowbirds
Hearing Loss and Music Players
H1N1 Virus - Plan Ahead
Household Mould
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Live Actively!
Insect Repellant
Keys to Preventing Cancer
Kids' Mental Health
Live Actively!
Low Birth Weight
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Are Pesticides Safe?
Preventing Burns and Scalds
Preventing Cancer through Nutrition
Quit Smoking 101
Respiratory Infections
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Should You Immunize?
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15 Great Reasons to Breastfeed
Anemia
Approaching Menopause
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Breast Cancer - Genetic Risks
Breast Cancer Self-Exam
Breast Cancer Screening Guidelines Changes
Breast Health
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Estrogen's Effect on the Brain
Fear of Fracture
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Hirsutism - Unwanted Hair
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The IUD
Menopause - What Men Should Know
Menstrual Bleeding - Abnormal
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Menopause
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Third Generation Birth Control Pills
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Family Health Online / Pharmacy at Safeway
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Family Health Magazine - CHILDHOOD

How Children Grow
What to expect and when to be concerned

All parents take great pride in watching their children develop. Although it is a complex process, growth seems so natural that it is often taken for granted. Sometimes, the pattern of a child’s growth may alert a doctor or nurse to an illness or medical problem that parents may not suspect. By understanding key stages of growth in children, parents may be more able to know if and when they should be concerned.

growth chartNormal growth

Apart from the nine months of growth before birth, children grow most rapidly during the first year of life. At birth, girls and boys are usually 46 to 54 centimetres (18 to 21 inches) in length. Most full-term girls weigh 2.6 to 4.1 kilograms (5.7 to 9.0 pounds), and boys 2.4 to 4.4 kilograms (5.3 to 9.7 pounds).

Healthy babies may lose up to 10 per cent of their birth weight in the first few days of life, but usually regain it after 10 to 14 days. They double their birth weight by five months and triple it by the first birthday.

The average rate of growth throughout childhood and adolescence is shown in Figure 1 above. The period of most rapid growth is during the first two years, then gradually slows until the start of the adolescent growth spurt. From age three until the beginning of puberty, most children grow at least five centimetres (two inches) a year. At puberty girls have an earlier and slightly smaller growth spurt than boys.

Puberty in girls is usually marked by the appearance of small breasts at age 10, but this can range from age seven to 13 years. Early pubic hair appears about six months later. Typically, menstruation begins a month or two before age 13, but the range is from 10 to 15 years. Early menstrual cycles are often quite irregular and unpredictable.

The first sign of puberty in boys is gradual enlargement of the testicles around age 12, although this can appear from nine to 14 years. Genital enlargement and appearance of pubic hair follow. Normally, girls reach adult height at 16 years, two to three years after menstruation starts. Boys normally reach adult height at age 18.

Factors influencing growth

Many things decide how a child will grow. Events that occur before birth may be important. Other factors include heredity (growth patterns of other family members), nutrition, and various childhood illnesses. Several chemicals (hormones) in the body play an important role in growth.

Events before birth: The health of the mother during pregnancy has an important effect on the size of her baby at birth. Infants born to mothers who smoke heavily or consume alcohol during pregnancy are often small at birth. They may also grow poorly after delivery. Mothers who are ill or poorly nourished during pregnancy may have babies with a low birth weight.

Most premature babies grow rapidly after delivery and are of normal size by the age of two. This is also true of babies whose development was disrupted in the last three months of the pregnancy. On the other hand, serious illness during the first three months of pregnancy may result in a baby who is not only small at birth, but remains small throughout life.

Heredity: The height of the parents is important to consider when assessing a child’s growth. During the first three years of childhood, babies whose parents are tall may grow faster than babies of short parents. If accurate measurements of the genetic parents’ heights as young adults are available, we can estimate the child’s ‘target’ height as an adult.

For girls, take the average of the parents’ height in inches (height of the mother plus the height of the father divided by two) and subtract 2.5 inches. For boys, take the average of the parents’ height in inches and add 2.5 inches. For instance, the target height for a girl with a 5’7” mother and 5’11” father would be 5’6.5”. The target height for a boy with the same parents would be 5’11.5”.

Nutrition: A healthy diet appropriate to the age of the child is essential for normal growth. Include enough calories for energy, with proper amounts of carbohydrate, fat, protein, vitamins and minerals. A child who eats a well-balanced diet does not need vitamin, mineral or other supplements. Indeed, some may suffer harmful effects if these are used unwisely. If in doubt, ask your doctor or a registered dietitian for advice.

General health: During acute (short-term) illness, a child may lose or fail to gain weight. This is temporary and will not cause permanent growth problems. However, chronic (long-lasting) illness may interfere with a child’s growth. If not corrected, there may be permanent loss of some growth potential.

Hormones: Hormones are chemical messengers produced by endocrine glands in the body and released into the bloodstream. They affect the function of cells throughout the body. The thyroid hormone, thyroxin, helps control the metabolism of various body tissues. Too little thyroxin (hypothyroidism) results in poor growth and excess weight gain. Too much (hyperthyroidism) can mean unexplained weight loss, even in children who are eating well.

The liver and other tissues change the growth hormone produced by the pituitary gland into a hormone called insulin-like growth factor 1 (IGF-1). This hormone affects bone growth throughout the body. Too little growth hormone or IGF-1 is an uncommon but important cause of failure to grow during childhood.

Adrenal glands sit on top of each kidney. Cortisol released from these glands has metabolic effects throughout the body. Too much may result in poor growth and excess weight gain. This is often seen in children who receive high-dose corticosteroids for a variety of medical conditions. These include severe – asthma, leukemia, arthritis, and inflammatory bowel disease.

At puberty, sex hormones have a strong affect on growth and maturation. In girls, estrogen is released by the ovaries. In boys, testosterone is released by the testicles. Both hormones stimulate growth and are partly responsible for the adolescent growth spurt.

If puberty is delayed, a child may grow more slowly than others of the same age. On the other hand, early puberty in a very young child can cause more rapid growth than expected. Even if they are very tall as children, boys and girls who experience puberty too early may be short as adults since the growth plates at the end of the long bones close too quickly. Once growth plates close, it is not possible to grow taller.

Evaluating growth

growth chartsHelp make certain that your child is growing normally by scheduling regular visits with your family doctor or pediatrician (children’s doctor) on a regular basis. Healthy children should be seen every three months during the first year of life, every six months during the second year, then once a year afterward. The doctor should plot the child’s height and weight on a growth chart like the ones shown in Figure 2.

A child on the fiftieth percentile is of average size, meaning 50 per cent of children of the same age and sex are smaller and 50 per cent are taller. Normal, healthy children will usually be between the third and ninety-seventh percentiles. After three years of age, a child’s height and weight should follow the same percentile curve.

If a child’s height or weight is below the third or above the ninety-seventh percentile, or if height or weight is not following the percentile curves, see a doctor. Although most of these children are healthy, the doctor may find a problem that needs further testing or treatment.

What if there is a growth problem?

When growth problems are discovered, the doctor will take a careful medical history of the child and the family. Details on diet, current and previous illnesses, medications, injuries and stays in hospital are important. The heights, weights and growth patterns of parents, and brothers and sisters are also relevant. Sometimes, even details about aunts, uncles and grandparents are considered.

The child’s height and weight are measured, and a general physical examination is done to look for problems. Lab tests, including blood and urine tests, may be recommended to rule out various medical conditions. A special x-ray of the hand and wrist, called a bone age, can help to assess the maturity of the bones and skeleton. This x-ray is particularly helpful in estimating a child’s growth potential. Short children whose bone age is significantly younger than their actual age may be able to catch up in terms of growth.

Occasionally, a doctor may refer the child to a specialist for further assessment. In certain cases, a test of growth hormone secretion may be recommended. These tests are not done on all short children. They are used if growth seems abnormal and other causes have been ruled out.

Growth hormone levels normally vary widely throughout the day. Aerobic exercise, deep sleep and several medications can stimulate secretion by the pituitary gland. Blood samples are normally taken every 20 to 30 minutes for two to three hours to determine whether the hormone is being released normally. If a child cannot produce growth hormone normally, a synthetic form of the hormone may be given. This may help restore normal growth. Additional tests, CT or MRI scans may be done to find out why a child is not making growth hormone normally.

In Canada, growth hormone is approved for use only by children who have growth hormone deficiency, chronic kidney disease before a kidney transplant, or Turner Syndrome. Very recently it has been approved for use by low birth weight babies. These are not babies who are premature. Rather, they are born small for their age based on the number of weeks from the beginning of the pregnancy.

Support for the child

When growth problems are present, specific treatment can help correct the cause. Even if children have normal variations of childhood growth patterns, it is essential to provide lots of emotional support. Children who are taller or shorter than their peers are often teased. Parents, teachers and others need to have expectations of children based on their age and stage of development, not on their physical size.

Children who are shorter or taller than others should be encouraged to participate in sports and other activities that they can enjoy regardless of size. Small children may do well in swimming, gymnastics, diving, martial arts, skiing, snow boarding, mountain biking, long distance running, dancing, horseback riding, art or music. Tall children may prefer basketball, volleyball, football, or hockey.

Try to keep your relationship with your child open so that emotional problems or concerns can be recognized early and discussed freely. Help is available if professional counselling is needed. Finally, if you have questions about the growth of your child, talk to your family doctor, pediatrician or public health nurse. They are excellent resources and very willing to help.

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FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written
with the assistance of
The College of Family Physicans of Canada
Alberta College of Family Physicians
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