Growth is one of the key characteristics that differentiate children from adults. Children grow. In this article based on a group discussion handled by Dr Nwaoma Nwaogu, Consultant Paediatric Endocrinologist, you get to know what growth is, how to monitor growth of your children and what to do if your child is not growing appropriately.
What is Growth?
Simply put- Increase in size or number. It can be described as a positive change. In relation to health, we would say physical growth has happened when there is an increase in weight and height.
Why should we worry about growth and why should it be monitored?
Growth is a sign of progress. When a child does not grow, it invariably means there is danger. The brain and other organs are not receiving the adequate signals to increase in size and function, which would eventually lead to ill health.
Growth monitoring is a process of following the growth of a child compared with a standard by periodic, frequent anthropometric measurements and assessments.
The main purpose of growth monitoring is to assess growth adequacy and identify faltering at early stages before the child reaches the status of undernutrition.
There are genetic and familial factors affecting growth. For example, short parents are likely to have short children. Children born with certain conditions are already disadvantaged e.g. down syndrome, sickle cell anaemia etc…They grow at a different pace from the other children.
Should growth be monitored? YES.
How is growth monitored?
From the first day of life, parameters such as weight, length, circumference of the head are measured. These parameters are checked at every well visit, immunization visit and sick child visit. These parameters should be plotted on appropriate age and gender specific growth charts.
Tools for monitoring growth
Weighing scale and a stadiometer with a tape measure can be used in measuring these parameters. Another parameter of interest used in measuring growth is the mid upper arm circumference . This reflects the nutritional state of the child. All these parameters should be plotted on charts for clarity . These charts are found here : https://www.cdc.gov/growthcharts/index.html
What normal growth looks like:
In the first year of life, infants grow 10 inches (25 cm) in length and triple their birth weights.
After age 1, growth in length slows quite a bit. By age 2, growth in height usually continues at a fairly steady rate of about 2½ inches (6 cm per year until adolescence.
No child grows at a perfectly steady rate throughout this period of childhood, though. Weeks or months of slightly slower growth alternate with mini “growth spurts” in most children.
A major growth spurt happens at the time of puberty, usually between 8 to 13 years of age in girls and 10 to 15 years in boys. Puberty lasts about 2 to 5 years. This growth spurt is associated with sexual development, which includes the appearance of pubic and underarm hair, the growth and development of sex organs, and in girls, the start of menstruation.
By the time girls reach age 15 and boys reach age 16 or 17, the growth of puberty has ended for most and they will have reached physical maturity.
We can see that puberty comes with an increase in weight and height. Sleep and exercise are also factors that influence growth,
Factors affecting growth:
They include; hormonal deficiencies eg: thyroid or growth hormone; factors affecting growth from the mothers womb like maternal infections and medical conditions like hypertension, socio economic factors like teenage pregnancies, wars, famine, etc…
Evidences of no growth in children:
Loss of muscle mass, loosening of originally fitted clothes and accessories like belts, falling off the growth curve when parameters are consistently plotted on charts, no changes in weight parameters during clinic visit.
So what to do when a child is not growing?
See a paediatrician who will establish this fact by history taking, physical examination and investigating the cause of this poor growth. This investigation might lead to the invitation of other health care workers who will help in re establishing growth. These specialist include: nurse/ health educators, dieticians/nutritionist, subspecialists eg paediatric cardiologist if it is found that the reason for poor growth is a hole in the heart or paediatric nephrologist if the reason for poor growth is related to the kidney/bladder organs.
In summary, monitoring growth would enable every caregiver detect early childhood challenges (ill health) and would encourage early intervention, thus preventing morbidity and mortality.