Growth Assessment
Growth is a dynamic process defined as an increase in the
physical size of the body as a whole or any of its part
associated with increase in cell number and/or cell size.
It is simply a quantitative change in the child’s body.
The growth of a child occurs in four phases— Fetal ,
Infantile, Juvenile and Adolescent.
Definitions
1.Embryo = fertilized ovum to 12 weeks,
2.Fetus =12 weeks to delivery,
3.Newborn =newly delivered,
4. Neonate =1st 28 days,
5.Infant =from 28 days to end of 1st year,
6.Toddler =1-3 years, 7.Preschool =3-5 years,
8.School age =5-10 years,
9. Early childhood= 1st 6 years,
10.Later childhood=6-12 years ,
11. Early adolescent=9-13,
12.Middle adolescent= 13-16 years,
13. Late adolescent=16-18 years.
Types of growth:
Physical growth (Ht, Wt, head & chest circumference)
Physiological growth (vital signs …)
Growth Patterns
The child’s pattern of growth is in a head-to-toe direction, or
cephalocaudal, and in an inward to outward pattern called
proximodistal.
Don’t progress at the same rate (↑ periods of GR in early childhood
and adolescents & ↓ periods of GR in middle childhood)
Not all body parts grow in the same rate at the same time.
Each child grows in his/her own unique way.
Analysis of growth
1 –for infant, size in 1st 2years= reflect intrauterine life,
size more than 2years= midparental
2- In infant, the linear growth was taken by measuring board(supine)or
horizontal stadiometer, older(2 years and above)by vertical
stadiometer.
3- WT for HT, <5th centile remain the single best indicator for acute
under nutrition, while it is normal in chronic malnutrition.
4- Chronic and severe malnutrition in 1st year of life may limit the
head growth( ominous sign of late cognitive disability).
Growth chart
The most powerful tool in assessing of growth, each chart contain 7 or
8 percentile. there is separated chart for male and female and
according to age. Growth chart to be significant , need serial reading
not only single reading
Types of growth chart 
WT for age, HT(length, stature) for age, OFC for age, WT for HT,
BMI. There are special chart for premature baby(catch up growth),
Down syndrome, Klinfelter syndrome.
The weight(WT)
Birth wt 2.500-3.750 gram, decreasing in about 5- 10% in 1st 10-14
day of life, as result of :
1.Withdrawal of hormones from mother.
2.Loss of excessive extra cellular fluid.
3.Passage of meconium (feces) and urine.
4.Limited food intake.
then gained in about 20-30 g/day in the remaining 1st month, then
750 gram/month in the next 2month.
3-12month= age in month+9/2
1-6years= age in years x2+8
6-12 years=age in years x7-5/2
The above equations give idea about the rough ideal body wt.
The birth wt was doubled at the age of 6month ,and tripled at the age
of 12month, quadruple at 24months.
WT gain in 2nd year 0.25g/month while after 2nd year till adolescence
annual increment 2-3Kg.
Body wt less than 5th centile =underweight
Body wt more than 95th centile =overweight
Weight for age percentile
25 percentile
e.g.: if the 9-mo age line
intersects the 25th percentile
curve at 8kg, indicating that
25% of the 9-mo-old girls in
the growth chart sample
weigh less than 8 kg (75%
weigh more).
The height (HT)
Supine=length(less than 2year)
Standing=stature(more than 2year)
At birth =50 cm
At the end of 1st year=75cm
2-12 year=age (in years)x7+66cm
At age of 2year, in BOY, final adult HT=HT at this age x2
At age of 18month, in GIRLS, final adult HT= HT at this age x2
The birth HT doubled at the age of 4years and tripled at the age of 13
years. In 2nd year increase 12 cm/year while after 2nd year till
adolescence increase 5cm/year The best predictor of child eventual
adult HT is MID parntal HT
For Boys=mother HT+13cm +father HT/2
For Girls=father HT -13cm +mother HT /2
This is give approximately +/-5cm of final adult HT
HT less than 5th centile=SHORT stature
HT more than 95th centile =TALL stature
Weight for Height percentile
3rd percentile
e.g.: if a girl of 74cm length has 8kg weight. Then
she intersects the 3rd percentile, indicating
that 3% of the girls with such length have
weight below 8kg in the growth chart sample.
(regardless the age)
occcipitofrontal circumference (OFC)
OFC indicate brain growth but not intelligence:
The measurement should be taken with a device that cannot be
stretched, such as a flexible metal tape measure. Wrap the tape around
the widest possible circumference - from the most prominent part of
the forehead (often 1-2 fingers above the eyebrow) around to the
widest part of the back of the head. Try to find the widest way around
the head. measure 3 times, and take the largest one.
At birth =35 cm +/- 2cm 
In 1st 3months= increase 2cm/month 
In the next 3 months= increase 1cm/month 
In the next 6months= increase 0.5cm/month 
At the end of 1st year =47cm,at 2nd year=49

At the end of 4th year=51cm, 8th year=53 
At 12 years 55cm 
OFC less than 5th centile=microcephaly

OFC more than 95th centile =macrocephaly
Body Mass Index(BMI)
Wt(KG)/ht(M2)
Measure the adipose tissue in the body 
BMI for age < 5th centile=underweight 
BMI for age between 5th-85th percentile=healthy 
BMI for age between 85th-95th percentile= risk of overweight 
BMI for age >95th percentile=overweight(obese)
BMI Categories:
Underweight = <18.5 
Normal weight = 18.5–24.9 
Overweight = 25–29.9 
Obesity = BMI of 30 or greater 
CLASS I OBESITY=30-34 
CLASS II OBESIY= 35-39


CLASS III OBESITY=>40 
Others indictor of growth
1 . Body proportion 
Upper body segment/Lower body segment(U/L) 
At birth=1.7, 3years=1.3, more than 7years=1 or 0.9 
Increase U/L= short limb, rickets, achondroplasia, hypothyrodism

Decrease U/L =Marfan syndrome, scoliosis, spinal deformity
2 . Bone age
Measure the somatic growth (skeletal maturation), radiograph of the
hand and wrist.
A . delayed bone age but with normal HT age(age at which the HT on
50th centile)=constitutional growth delay.
B . marked delayed bone age (to chronological and HT
age)=endocrinopathy
3.Dental Development
Mineralization started in the 2nd trimester and go

Eruption started in 5-6 months postnatal , central then lateral,
mandibular then maxillary, delayed if no any tooth more than 13
months of age. Exfoliation (6 years).
Teething by itself if used alone , is poor indicator.
4- arm span (from 2 finger tips across the shoulder which equal to HT
at 3-4 years.