Normal growth patterns have spurts and plateaus, so some shifting on percentile graphs can be expected. Large shifts in percentiles warrant attention, as do large discrepancies in height, weight, and head circumference percentiles. When caloric intake is inadequate, the weight percentile falls first, then the height, and the head circumference is last. Caloric intake may be poor as a result of inadequate feeding or because the child is not receiving adequate attention and stimulation (nonorganic failure to thrive [see Chapter 21]).
Caloric intake also may be inadequate because of increased caloric needs. Children with chronic illnesses, such as heart failure or cystic fibrosis, may require a significantly higher caloric intake to sustain growth. An increasing weight percentile in the face of a falling height percentile suggests hypothyroidism. Head circumference may be disproportionately
Weight loss in first few days: 5%–10% of birth weight Return to birth weight: 7–10 days of age Double birth weight: 4–5 months Triple birth weight: 1 year Daily weight gain: 20–30 g for first 3–4 months 15–20 g for rest of the first year
Average length: 20 in. at birth, 30 in. at 1 year At age 4 years, the average child is double birth length or 40 in.
Average HC: 35 cm at birth (13.5 in.)
HC increases: 1 cm per month for first year (2 cm per month for first 3 months, then slower)
Birth to 24 months: Boys Length-for-age and Weight-for-age percentiles
Figure 5-1 Length-by-age and weight-by-age percentiles for boys, birth to 2 years of age. Developed by the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion. (From Centers for Disease Control and Prevention: WHO Child Growth Standards, Atlanta, Ga, 2009. Available at http://www.cdc.gov/growthcharts/who_charts.htm
Figure 5-2 Head circumference and weight-by-length percentiles for boys, birth to 2 years of age. Developed by the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion. (From Centers for Disease Control and Prevention: WHO Child Growth Standards, Atlanta, Ga, 2009. Available at http://www.cdc.gov/growthcharts/who_charts.htm 2to20 years: Girls StatureWeight-for-age percentiles
Figure 5-3 Stature-for-age and weight-for-age percentiles for girls, 2 to 20 years of age. Developed by the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion. (From Centers for Disease Control and Prevention, Atlanta, Ga, 2001. Available at http://www.cdc.gov/ 2to20years:Girls Body mass index-for-agepercentiles
Figure 5-4 Body mass index–for-age percentiles for girls, 2 to  20 years of age. Developed by the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion. (From Centers for Disease Control and Prevention Atlanta, Ga, 2001. Available at http://www.cdc.gov/ large when there is familial megalocephaly, hydrocephalus, or merely catch-up growth in a neurologically normal premature infant. A child is considered microcephalic if the head circumference is less than the third percentile, even if length and weight measurements also are proportionately low. Serial measurements of head circumference are crucial during infancy, a period of rapid brain development, and should be plotted regularly until the child is 2 years of age. Any suspicion of abnormal growth warrants at least a close follow-up, further evaluation, or both.
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