Concerned my child is too small and/or not growing

Concerned your child is too small and/or not growing?

There are many influencing factors and various stages of growth throughout childhood, but if you are concerned your baby or child is not growing as expected the following information will be important to consider:

Growth charts and growth rate

Growth charts are tools used by healthcare professionals to track and assess your child’s growth over time. These charts provide a visual representation of your child’s growth in terms of height, weight, and head circumference, comparing it with typical growth patterns of children of the same age and gender. 

Centiles, also known as percentiles, are lines on growth charts that show the distribution of measurements in a population of children. For example, the 50th centile represents the average measurement; half the children of a given age and gender will be above this line and half below. Centiles are important so your child’s growth can be tracked and any deviations from expected growth patterns can be detected. Children’s growth typically tracks along a centile. 

It’s important to remember that being above or below the 50th centile isn’t inherently good or bad. The key is that they continue to follow their growth curve (centile) over time. 

If a child’s growth pattern shows sudden changes or significant deviation from their centile line, healthcare professionals can investigate early and provide necessary interventions. An acute illness may result in weight loss and subsequent falls from centiles, but once recovered, a child would usually return to their normal centile.  

Depending on the age of your child, there could be differing advice of when to be concerned and who to approach for advice about your concerns. GPs are usually the first healthcare professional parents consult, but you could also approach your health visitor or child’s school nursing team. 

In infancy, your baby’s weight is measured more often than length. The healthcare professionals involved in taking these measurements should be alerted that further health assessments are needed, if the following growth patterns occur in infancy:

1. A fall across 1 or more weight centile space if birthweight was below the 9th centile.

2. A fall across 2 or more weight centile spaces, if birthweight was between 9th and and 91st centiles.

3. A fall across 3 or more weight centile spaces, if birth weight was above the 91st centile.

4. When current weight or length is below the 2nd centile, whatever the birthweight or age.

Head circumference/measurements

Head measurements are a key indicator of a child’s brain growth and development. In the first few years of life, the brain grows rapidly, and the skull must expand to accommodate this growth. Head circumference measurements help identify whether a child’s head is growing at a typical rate and within an expected range for them.

A baby’s head circumference is usually measured after birth, but if it is taken in the first 24 hours it can be unreliable due to the head becoming misshapen in the womb and through childbirth. It is also measured at the 8-week check and at any time after that if there are any worries about the child’s head growth, general health and/or development.

An infant’s head circumference centile may show some variation over time, but following the first weeks after birth, most babies’ measurements track within one centile space on the growth charts.

The following measurements could be a sign of an underlying problem and may require further assessment:

1. Head circumference measurements which show unusually slow or fast growth.

2. If there is a rise or fall through 2 or more centile spaces

3. Measurements which are below the 2nd centile on the growth charts.

Growth concerns after infancy 

Beyond the age of 2 years, height can be measured when standing and the relevance of parental heights in comparison to their child’s is given more consideration.  It’s important to remember that a small drop in height measurement can be expected when moving from measuring a length with your child lying down to measuring a height with them standing.  Growth charts allow for this adjustment. 

A child’s mid parental height (MPH) is used to work out a child’s target height range based on their genetic potential. You may also hear the term mid parental centile (MPC); this refers to one of the printed centiles on your child’s growth chart. 

To work out your child’s MPH you can follow the instructions on this short video: 

The MPH can be charted on a growth chart by plotting the measurement on the appropriate centile at age 18 years. This will give you the mid parental centile (MPC). Most children will grow to be within 2 centiles either side of their MPC, this is their target height range. 

If you are concerned about your child’s growth and/or their general health speak to a healthcare professional. The following growth measurements and patterns may warrant further investigation and monitoring: 

1. A child with a height more than 2-3 centile spaces below their mid parental centile. 

2. A drop in one height centile band. 

3. A child measuring below the 2nd height centile. 

Puberty and height growth

Puberty is a natural and essential part of growth and development, marked by a series of predictable physical and emotional changes. While the timing and progression can vary, it’s important to monitor these changes.

If your child experiences early puberty, they may have one or more early growth spurts, but going through puberty too early could mean your child is shorter as an adult than they might have otherwise been.

Early or delayed puberty can be caused by hormonal imbalances, underlying medical conditions, or genetic factors, so it’s important to seek medical advice if you have any concerns.

If you are concerned about early or late puberty it is recommended to seek medical advice if:

Girls – signs of puberty before the age of 8 years, or no signs at age 13 years.

Boys – signs of puberty before the age of 9 years, or no signs at age 14 years.