Many parents worry and have questions about the growth of their children so we asked our doctor for some answers:

What is normal growth?

Children grow very rapidly the first two years of life and during puberty. This is reflected by their rapid weight and height gain.

child-weight-gainWeight changes:

  • Loss of 5-10% of birth weight the first few days of life
  • Week 1 – 2 : Regain birth weight
  • 2 weeks – 3months : Gain 20 – 30g /day
  • 3 – 6 months : Gain 20g /day
  • 6 -12 months : Gain 12g /day
  • 12 -18 months : Gain 8 g /day

Generally, children double their birth weight by 5-6 months of age and triple their birth weight by 1 year.

Height gained:

    • 1st year: 25cm
    • 2nd year: 12cm
    • 3rd year onwards till puberty: 6 cm/y
    • Growth spurt during puberty ( usually of about 2 years duration) :

Girls 6-11 cm/ y
Boys 7-12 cm/y

What are the factors that influence a child’s growth?

The growth of a child is influenced by genetics, general health, nutrition, hormones and his psychosocial environment.

How can I monitor my child’s progress?

To track a child’s growth, you can plot her weight and height in the charts available on her health booklet. Joining these points over time, you will see a curve form on the chart. This gives an the indication of how the child compares with her peers.

For example, if a girl’s weight falls on the 25th centile line, it means that she is heavier than 25% of normal girls her age and lighter than 75% of normal girls. Between the age of 6-18 months, a child’s position on the chart may move up or down these centile lines. This may be normal as long as there is continued weight gain (never weight loss) and the child is in good health. After this age, most children should grow at a normal rate such that the growth curve appears parallel to the other lines on the chart i.e. their position remains constant relative to their peers.

When should I be concerned?

Children whose measurements fall under the 3rd centile may be completely healthy but should be assessed by their paediatrician to exclude any medical problems. This is especially so if they have chronic diarrhoea, vomiting, poor appetite or are not attaining normal milestones.

Another cause for concern is the child who is not gaining weight or height appropriately for age. She may start off at a higher centile and fall to a lower centile over time. This is reflected by a growth curve that cuts across the centile lines on the chart.

How can I optimize my child’s growth?

For a child to grow well, he needs a balanced diet. Chronic illnesses or hormone deficiencies need to be addressed and adequately treated. Last but not least, a loving and supportive home environment is important.

What does a growth assessment entail?

The doctor will ask many questions about the growth, general health, nutrition as well as the birth and development of your child. She will also take notes about family history and the heights of the parents and siblings. A thorough physical examination will be carried out. This includes looking at the weight, height measurements, pubertal stage and aims at detecting any relevant medical conditions.

Previous height and weight measurements of the child are useful in determining his growth rate. It is important to see if the child is keeping up with his peers and growing at a normal rate.

What kind of tests will my child need to undergo?

Depending on the findings in clinic, the doctor may recommend further tests which may include:

Bone age – This is an X-ray of the wrist and gives the doctor an indication of the skeletal maturity of your child. Some children may have bones younger or older than their chronological ages and this will have bearing on their height.

Karyotype – In the instance of short girls, the doctor may ask for an analysis of their chromosomes. This is to exclude a condition known as Turner syndrome. ( See below).

Growth hormone stimulation test – Random levels of growth hormone do not reflect the body’s true ability to produce growth hormone. In order to detect growth hormone deficiency, a growth hormone stimulation test is conducted. Not all patients require a growth hormone stimultation test and this is only carried out on after discussion with the doctor.

FAQ on Conditions Linked with Short Stature

What is Growth Hormone Deficiency (GHD)?

Children with GHD do not have normal production of growth hormone (GH). This is may be due to a developmental abnormality of the pituitary gland that is normally in charge of producing GH. In some children, the pituitary gland may have been destroyed by infection or tumours. In others, there is no structural abnormailty of the pituitary gland but it just fails to perform normally. Sometimes, GHD is associated with other hormone deficiencies as well.

Children with GHD fail to grow normally and do benefit from growth hormone treatment. This should however, first be assessed by and discussed with your doctor.

What is Turner syndrome?

This is a genetic condition that affects girls where there is a missing X chromosome. Girls generally have two copies of the X chromosomes in each of their cells. Turner syndrome occurs when there is only one X chromosome in some or all of the cells. Girls with Turner syndrome are short and may also have some other distinctive physical features. GH helps these girls grow better. Often, these girls also have problems of delayed puberty and require female hormone replacement.

I was told my child had Intrauterine Growth Retardation (IUGR) or was Small for Gestational Age ( SGA). What does this mean for him in the future?

Some babies grow suboptimally while in the womb. This may have been due to maternal health issues, a placenta that did not function well, the baby’s genes or other unknown factors. These children are small at birth compared to their peers of the same “incubation period”. For term babies, this is usually taken to be less than 2.5kg or less than 45cm on length. Most of these children, despite being born small, will catch up with their friends by 2-3 years of age. Those who do not catchup may benefit from GH treatment.

There is information that SGA children are at increased risk of high blood pressure, insulin resistance, lipid problems and metabolic syndrome in later adult life. These issues need to be discussed before a decision is made with regard growth and GH treatment.

What is Constitutional Delay of Growth and Development?

This is a term used to describe late-bloomers who enter puberty later than their peers. There is often a family history of similar pubertal delay in their parents and close relatives. As a result of their less mature skeletal system, they may appear shorter than their classmates initially. They start puberty late but may grow for a longer time and catch up with their peers. Because these are normal children, most of them will finish off within the normal height range as dictated by their genetic potential.

What is Idiopathic Short Stature?

Idiopathic is medical-ese for “unknown cause”. These are children who are very short but who appear to be healthy otherwise. They have normal hormone levels and are not GH deficient when tested. There is now evidence that some these children may have other genetic factors that contribute to their short stature. GH has been to shown to help improve the growth of some of these children.

Further Reading

The Magic Foundation, visit www.magicfoundation.org

The Hormone Foundation, visit www.hormone.org

dr-vera-ohDr Vera Oh
Paediatrician
Special Interest in Growth and Endocrinology
MBBS (S’pore), MMED Paediatrics (S’pore), MRCP (UK)

Dr Oh graduated from the National University of Singapore with a Bachelor of Medicine and Bachelor of Surgery degree in 1994. Her post-graduate qualifications include a Master of Medicine (Paediatrics), Singapore, and a Membership of the Royal College of Paediatrics and Child Health, United Kingdom.

Dr Oh is trained in paediatrics, with an interest in growth and endocrinology. She has over 15 years of medical experience and received her advanced training at Mount Sinai Medical Centre in U.S.A.

Common conditions managed by Dr Oh include:
a. Growth disorders
b. Thyroid disorders
c. Juvenile diabetes mellitus
d. Pubertal issues and other childhood hormone problems

Dr Oh is multi-lingual and can communicate in English, French, Mandarin, Cantonese and Hokkien.

sbccPractice Address :
SBCC Baby & Child Clinic
Growth & Endocrinology Centre
3 Mount Elizabeth
#12-14 Mount Elizabeth Medical Centre
Singapore 228510

For more information, visit SBCC Baby & Child Clinic