Version May 2024
INTRODUCTION — Normal growth is the progression of changes in height, weight, and head circumference that are compatible with established standards for a given population. The progression of growth is interpreted within the context of the genetic potential for a particular child [1]. Normal growth is a reflection of overall health and nutritional status. Understanding the normal patterns of growth enables the early detection of pathologic deviations (eg, poor weight gain due to a metabolic disorder, short stature due to inflammatory bowel disease) and can prevent the unnecessary evaluation of children with acceptable normal variations in growth.
A review of normal growth patterns during infancy and childhood will be provided below. Growth during puberty is discussed separately. (See "Normal puberty".)
DETERMINANTS OF NORMAL GROWTH — Somatic growth and biologic maturation are influenced by several factors that act independently and in concert to modify a child's genetic growth potential. The influence of maternal nutrition and intrauterine environment are reflected primarily in the growth parameters at the time of birth and during the first month of life, whereas genetic factors have a later influence [2]. The correlation coefficient between length and adult height is only 0.25 at birth but increases to 0.8 at two years of age [3,4].
Although primarily reflected in the growth parameters at birth, long-term influences of maternal nutrition and intrauterine environment on subsequent growth and pubertal development have been described [5,6]. Studies in various populations have demonstrated an association between catch-up growth or rapid growth in infancy or early childhood and subsequent obesity, suggesting that mechanisms that signal and regulate catch-up growth in the postnatal period may play a role in the development of obesity. (See "Definition, epidemiology, and etiology of obesity in children and adolescents", section on 'Metabolic programming'.)
NORMAL PATTERNS — Most healthy infants and children grow in a predictable fashion, following a typical pattern of progression in weight, length, and head circumference. Normal human growth is pulsatile; periods of rapid growth ("growth spurts") are separated by periods of no measurable growth [7-9]. Growth is also seasonal, with growth velocities increased during the spring and summer months [10].
Growth velocity — Growth velocity, the change in weight or height over time, is a more sensitive index of growth than is a single measurement. Current growth points should be compared with previous growth points, if possible, to determine the interval growth velocity.
After birth, the growth velocity of twins is increased compared with singletons [11]. Nonetheless, their weight, length, and body mass index (BMI) usually are less than those of singletons during the first 2.5 years of life, even after correcting for gestational age [11,12]. By age four years, the weight, height, and BMI of twins are comparable to those of their non-twin siblings [12].
Weight gain in children <2 years
Typical milestones — General guidelines regarding weight gain during infancy and childhood for infants with growth parameters that were appropriate for gestational age at birth include the following:
●Term neonates may lose up to 10 percent of their birth weight in the first few days of life and typically regain their birth weight by 10 to 14 days [13-16] (see "Overview of the routine management of the healthy newborn infant", section on 'Weight loss')
●Newborns gain approximately 30 g per day (1 oz per day) until three months of age
●Infants gain approximately 20 g per day (0.67 oz per day) between three and six months of age and approximately 10 g per day between 6 and 12 months
●Infants double their birth weight by four months of age and triple their birth weight by one year
The growth patterns of preterm infants, small-for-gestational-age infants, and large-for-gestational-age infants are discussed separately. (See "Growth management in preterm infants", section on 'Growth chart' and "Infants with fetal (intrauterine) growth restriction", section on 'Physical growth' and "Large for gestational age (LGA) newborn", section on 'Potential long-term effects'.)
Effects of feeding method — The pattern of weight gain during infancy varies depending upon the method of feeding [17-23]. Compared with formula-fed infants, breastfed infants gain weight relatively rapidly during the first three to four months of life and relatively slowly thereafter. The weights of breastfed and formula-fed infants are similar by 12 to 23 months of age.
In 2010, the Centers for Disease Control and Prevention (CDC) recommended that the World Health Organization (WHO) growth charts be used in the United States for infants and children <24 months of age, regardless of the method of feeding [24]. (See 'WHO growth charts' below.)
The WHO growth charts were derived from a population of breastfed infants [25]; when the growth of formula-fed infants is tracked on WHO growth charts, normal and appropriate weight gain may appear to be too slow in the first three months of life and too rapid thereafter (figure 1) [24]. Conversely, when exclusively breastfed infants are plotted on the CDC and Prevention National Center for Health Statistics (CDC/NCHS) growth charts (which are derived from a sample of predominantly formula-fed infants), their normal and appropriate weight gain may appear to be too rapid in the first three months of life and too slow thereafter [26,27].
Weight gain in children ≥2 years — Children typically gain approximately 2 kg (4.4 pounds) per year between two years and puberty.
A prepubertal child whose weight velocity is <1 kg per year (<2.2 pounds per year) should be monitored closely for progressive nutritional deficits. (See "Poor weight gain in children older than two years in resource-abundant settings".)
Linear growth
Typical milestones — General guidelines regarding length or height gain during infancy and childhood include the following (figure 2):
●The average length at birth for a term infant is 20 inches (50 cm)
●Infants grow 10 inches (25 cm) during the first year of life
●Toddlers grow 4 inches (10 cm) between 12 and 24 months, 3 inches (7.5 cm) between 24 and 36 months, and 3 inches (7.5 cm) between 36 and 48 months
●Children reach one-half of their adult height by 24 to 30 months [1]
●Children grow 2 inches per year (5 cm per year) between age four years and puberty
●There is a normal deceleration of height velocity before the pubertal growth spurt (figure 3A-B)
The height percentile shifts during the first two years of life in nearly two-thirds of normal infants [28,29]. Approximately one-third of infants cross one major percentile line (eg, 10th, 25th, 50th, 75th, 90th), one-fourth cross two major percentile lines, and one-tenth cross three major percentile lines [28]. The shift may be an increase or decrease from the percentiles in the first six months, during which growth is influenced primarily by the intrauterine environment. After the period of shift, the child's height trajectory typically proceeds along the same channel between age two and nine years of age. This can be used to predict adult height. (See 'Predicted height' below.)
Prepubertal growth is a nonlinear process, consisting of growth spurts lasting an average of eight weeks, separated by periods of slow growth, which last an average of 18 days [9].
Height velocity — A period of at least six months is necessary for reliable calculation of height velocity in children older than two years. Average normal length or height velocities are as follows (figure 2):
●0 to 6 months – 1 inch (2.5 cm) per month
●7 to 12 months – 0.5 inches (1.25 cm) per month
●12 to 24 months – Usually >4 inches (10 cm) per year
●24 to 36 months – 3 inches (8 cm) per year
●36 to 48 months – 2.75 inches (7 cm) per year
●4 to 10 years – 2 to 2.4 inches (5 to 6 cm) per year
A prepubertal child whose height velocity is <2 inches per year (<5 cm per year) should be monitored closely. (See "Causes of short stature" and "Diagnostic approach to children and adolescents with short stature".)
Variants of normal — The two most common causes of short stature beyond the first year or two of life are variants of normal growth: familial short stature and delayed (constitutional) growth. Growth velocity is normal in each of these conditions, but there are other characteristic features (table 1). (See "Diagnostic approach to children and adolescents with short stature", section on 'Normal growth'.)
Predicted height — Adult height can be predicted by projecting the child's current growth channel to the value at 18 to 20 years or by calculating the midparental height.
●Projected height – The projected height for a child older than two years is determined by extrapolating the child's growth along the current channel to the 18- to 20-year mark (figure 4). The projected height can be compared with the calculated midparental height to determine if the child's growth is consistent with genetic potential.
For children with delayed or accelerated growth, using the skeletal age (bone age) rather than the chronologic age to determine the projected height channel provides more accurate assessment of projected height (figure 5). (See "Diagnostic approach to children and adolescents with short stature" and "The child with tall stature and/or abnormally rapid growth".)
Skeletal age generally is obtained by assessing the appearance and shape of the bones of the hand and wrist from a radiograph. The methods used most commonly for determining skeletal age are the Greulich and Pyle Atlas [30] and the Tanner-Whitehouse (TW2) methods [31]. (See "Diagnostic approach to children and adolescents with short stature", section on 'Bone age determination'.)
●Midparental height – Although the precise contribution of heredity cannot be quantitated, an estimate of a child's adult height potential can be obtained by calculation of the midparental height, adjusted for the sex of the child (calculator 1) [32]:
•For females, 13 cm is subtracted from the father's height and averaged with the mother's height. The 13 cm represents the average difference in height of adult males and females.
•For males, 13 cm is added to the mother's height and averaged with the father's height.
•For both females and males, 8.5 cm on either side of this calculated value (target height) represents the 3rd to 97th percentiles for anticipated adult height.
Head growth — General guidelines regarding head growth, a reflection of brain growth, include the following [33-35]:
●The average head circumference at birth is 13.7 inches (35 cm)
●Head circumference usually is 0.4 to 0.8 inches (1 to 2 cm) larger than chest circumference at birth
●Head circumference increases approximately 0.4 inches per month (1 cm per month) during the first year of life, with the most rapid growth occurring during the first six months, with an increase of 0.8 inches (2 cm) in the first month and 2.7 inches (6 cm) in the first four months
●Brain weight doubles by four to six months of age and triples by one year of age
●Most head growth is complete by four years of age
EVALUATION OF GROWTH — Evaluation of growth in children focuses on historical features related to growth, accurate measurement of growth parameters, determination of growth percentiles for age and sex (including assessment of proportionality), and assessment of the growth trajectory. The laboratory and radiologic evaluation of nutritional status and measurement of body composition in children are discussed separately. (See "Laboratory and radiologic evaluation of nutritional status in children" and "Measurement of body composition in children".)
History — The history should include:
●The weight, length, and head circumference at birth
●Prenatal history: maternal infection, intrauterine exposures (cigarettes, drugs, alcohol, and other toxins)
●Interval growth points
●Past medical history
●Dietary history (see "Dietary history and recommended dietary intake in children", section on 'Dietary history')
●Developmental history
●Review of systems for symptoms of systemic disease (particularly vomiting or diarrhea)
●Family history, including parental heights, parental growth patterns, and timing of pubertal onset in parents (delayed growth and/or puberty in a parent suggests constitutional delay of growth (table 1)) (see "Causes of short stature", section on 'Constitutional delay of growth and puberty')
Measurement — The physical examination should include careful measurements of weight, length, and head circumference. (See "The pediatric physical examination: General principles and standard measurements", section on 'Standard measurements'.)
The accurate measurement and charting of growth may prevent unnecessary evaluation or intervention in a child who has a normal pattern of growth (eg, a child whose length channel shifts toward the channel of the midparental height in the first 12 to 15 months) or who has a normal variant of growth (eg, a child with familial short stature whose growth velocity is normal). (See "Causes of short stature", section on 'Normal variants of growth'.)
Growth charts — To determine the child's growth percentiles, weight and length (or height) should be plotted on the appropriate growth chart at each well-child visit and as indicated at interval visits [36,37]. Weight-for-length should be plotted at well-child visits from birth through 18 months, and body mass index (BMI) should be plotted at well-child visits after two years of age. Head circumference should be plotted from birth through 24 months of age [36]. When a growth point deviates from the normal percentile range or from the patient's growth trajectory, the clinician should repeat the measurement to verify its accuracy.
In 2010, the Centers for Disease Control and Prevention (CDC) recommended that the WHO growth charts be used for children <24 months and the CDC and Prevention National Center for Health Statistics (CDC/NCHS) growth charts be used for children ages 2 through 19 years [24]. When using the World Health Organization (WHO) charts, fewer American children will be identified as underweight, but gaining weight more rapidly than is indicated on the WHO chart may be an early sign of being overweight. Additional differences between the WHO and CDC charts are discussed separately. (See "Measurement of growth in children", section on 'Recommended growth charts with calculators'.)
CDC growth charts — The growth charts traditionally used by most pediatric health care providers in the United States are published by the CDC based on data from the NCHS. The CDC/NCHS growth charts were revised in 2000 to include a more ethnically diverse population and more breastfed infants. The CDC/NCHS charts were derived primarily from data from the National Health and Nutrition Examination Survey, which has periodically collected height, weight, and other health information on the United States population since the early 1960s. As such, the CDC charts are reference charts, which describe the growth of children in the United States during an approximately 30-year period (1963 to 1994) [24].
The CDC recommends that the CDC/NCHS growth charts be used for children ages 2 through 19 years but that the WHO charts be used for children younger than two years [24]. The CDC charts for children older than two years are reproduced below; they can be printed out for clinical use.
For males aged 2 to 20 years:
●Weight-for-age (figure 6)
●Height-for-age (figure 7) (calculator 2)
Charts combining these curves are also available and may be most practical for clinical use:
•Weight-for-age and stature-for-age in males
●BMI-for-age (figure 8) (calculator 3)
For females aged 2 to 20 years:
●Weight-for-age (figure 9)
●Height-for-age (figure 10) (calculator 4)
Charts combining these curves are also available and may be most practical for clinical use:
•Weight-for-age and stature-for-age in females
●BMI-for-age (figure 11) (calculator 5)
WHO growth charts — The WHO growth charts are based upon data from the Multicentre Growth Reference Study, which combined longitudinal data from birth to 24 months and cross-sectional data from 18 to 71 months of age [25]. The study population included 8440 healthy breastfed infants and young children from six participating countries (Brazil, Ghana, India, Norway, Oman, United States). The study population was chosen to reflect a standard for children living under optimal environmental conditions.
The WHO growth charts are growth standards that describe how healthy children should grow under optimal conditions [24]. They are intended to be used for all children, regardless of ethnicity, socioeconomic status, and type of feeding. However, they may not be suitable for all populations [38,39].
In 2010, the CDC recommended that the WHO growth charts be used for children younger than 24 months [24]. The WHO growth charts are available at the CDC website and the WHO website. The weight, length, head circumference, and weight-for-length charts for males and females aged zero to two years are reproduced here; they can be printed out for use in clinical practice.
For males aged zero to two years:
●Weight-for-age (figure 12) (calculator 6)
●Length-for-age (figure 13) (calculator 7)
●Head circumference-for-age (figure 14) (calculator 8)
●Weight-for-length (figure 15) (calculator 9)
Charts combining these curves are also available and may be most practical for clinical use:
•Weight-for-age and length-for-age in males
•Weight-for-length and head circumference-for-age in males
For females aged zero to two years:
●Weight-for-age (figure 16) (calculator 6)
●Length-for-age (figure 17) (calculator 7)
●Head circumference-for-age (figure 18) (calculator 8)
●Weight-for-length (figure 19) (calculator 9)
Charts combining these curves are also available and may be most practical for clinical use:
•Weight-for-age and length-for-age in females
•Weight-for-length and head-circumference-for-age in females
The WHO growth charts show a faster rate of growth for the first three months of life than the CDC growth charts [24]. When plotted on the WHO growth charts, formula-fed infants typically appear to have slow weight gain during this time period (figure 1). (See 'Effects of feeding method' above.)
CDC versus WHO growth charts — A comparison of the CDC/NCHS and WHO growth charts is presented separately. (See "Measurement of growth in children", section on 'Commonly used growth charts'.)
Correcting for prematurity — Most clinicians use standard growth charts to monitor the growth of preterm infants after discharge from the neonatal intensive care unit. It is important to correct growth parameters for gestational age (by subtracting the number of weeks the child was preterm from the child's postnatal age at the time of evaluation) [40]. However, there is no consensus about how long to continue such correction. Studies that provide definitive guidance are lacking [41,42]. The rate and duration of "catch-up growth" may vary depending upon gestational age, birth weight, race/ethnicity, and other factors.
A traditional approach has been to correct for weight through 24 months of age, for stature through 40 months of age, and for head circumference through 18 months of age [43]. However, the 2009 United Kingdom-WHO growth charts suggest correction of all three parameters until age two years for children born before 32 weeks' gestation, and at least until age 12 months for children born between 32 and 36 weeks' gestation [44]. Even with correction, children with birthweight ≤1500 g may remain smaller and shorter than children born at term beyond two years of age [45,46]. When assessing the growth of children born preterm, it may be better to focus on the growth rate, which should approximate that of a term infant of the same corrected age [45,47]; or the weight-for-length, which should be similar to the reference standard [48,49]. (See "Growth management in preterm infants".)
Growth charts for special populations — Special growth charts have been developed for a variety of conditions that are associated with altered patterns of growth. As examples:
●Down syndrome (see "Down syndrome: Management", section on 'Growth')
●Turner syndrome (see "Clinical manifestations and diagnosis of Turner syndrome", section on 'Short stature and skeletal anomalies')
●Williams syndrome (see "Williams syndrome", section on 'Initial evaluation')
●Achondroplasia (see "Achondroplasia", section on 'Management')
●Prader-Willi syndrome (see "Prader-Willi syndrome: Management", section on 'Children and adults')
Proportionality — Proportionality is the degree to which individual growth parameters correlate with each other. Measures of proportionality are useful as screens of nutritional status, to diagnose overweight and obesity, and in generating a differential diagnosis for short or tall stature. Assessment of proportionality is particularly useful when growth parameters are abnormal. (See 'Abnormal patterns of growth' below.)
Weight-for-length — Weight-for-length should be plotted in children between zero and two years of age (figure 15 and figure 19) (calculator 9) [36]. A weight-for-length between the 2.3rd and 97.7th percentile reflects normal variation, whereas a weight-for-length less than the 2.3rd percentile or greater than the 97.7th percentile may indicate undernutrition or obesity, respectively [24]. (See "Clinical evaluation of the child or adolescent with obesity" and "Poor weight gain in children younger than two years in resource-abundant settings: Etiology and evaluation", section on 'Definitions'.)
The weight-for-length (or weight-for-height) typically is normal in children who have constitutional growth delay or familial short stature. (See 'Variants of normal' above.)
Body mass index — The BMI characterizes the relative proportion between the child's weight and the height squared. The BMI should be calculated for children older than two years (calculator 3 and calculator 5) [36]. The BMI percentile can be used as a screening tool for undernutrition and to diagnose overweight and obesity (figure 8 and figure 11). (See "Measurement of growth in children", section on 'Body mass index'.)
●A child with a BMI less than the 15th percentile is "at risk" for undernutrition. (See "Poor weight gain in children older than two years in resource-abundant settings", section on 'Growth parameters'.)
●A child with a BMI between the 85th percentile and <95th percentile is overweight, and a child with BMI ≥95th percentile is obese.
Severe (class II) obesity is defined as >120 percent of the 95th percentile value, or a BMI >35 kg/m2. For children with severe obesity, special BMI growth charts for with curves above the 97th percentile (for males (figure 20) and females (figure 21)) or extended BMI growth charts from the CDC are useful for clinical evaluation and monitoring. (See "Definition, epidemiology, and etiology of obesity in children and adolescents" and "Clinical evaluation of the child or adolescent with obesity".)
At the extremes (>97th percentile or <3rd percentile), small differences in percentiles represent clinically important differences in BMI. At these extremes, the z-score is a more precise reflection of how far the measurement deviates from the mean and is a useful tool for tracking changes (calculator 3 and calculator 5).
Ideal body weight — The percent of ideal body weight (IBW) is another method to assess proportionality and nutritional status. There are several methods by which to calculate IBW, each of which provides similar results for children younger than eight years [50]. One method is to plot the child's height on the height curve; draw a horizontal line from the height to the 50 percent height line, then draw a vertical line from the intersection to the 50 percent weight line; the intersection with the 50 percent weight line is the IBW [51]. Another method is to determine the weight percentile that is proportionate to the height percentile for chronologic age using standard growth charts (figure 22).
Percent IBW = actual weight divided by IBW x 100.
The assessment of nutritional status according to percent IBW is as follows:
●>120 – Obese
●110 to 120 – Overweight
●90 to 110 – Normal variation
●80 to 90 – Mild wasting
●70 to 80 – Moderate wasting
●<70 – Severe wasting
Body proportions — The proportions of the body change during fetal and postnatal growth [52]. The most commonly used descriptors of body proportions are the ratio of the upper body segment to the lower body segment and the ratio of arm span to height.
Upper segment to lower segment — The upper segment to lower segment ratio (US/LS ratio) is helpful in distinguishing among causes of short or tall stature and in distinguishing disproportionate growth from immaturity [53].
The lower segment is measured from the top of the symphysis pubis to the plantar surface of the foot. The upper segment is calculated by subtracting the lower segment from the child's height. Approximate normal ratios are as follows [52]:
●Birth – 1.7
●3 years – 1.33
●5 years – 1.17
●10 years – 1.0
●>10 years – <1.0
The US/LS ratio is increased in children with rickets, achondroplasia, and Turner syndrome (because of decreased limb length) and decreased in those with Marfan syndrome (because of increased limb length). (See "Overview of rickets in children" and "Achondroplasia" and "Clinical manifestations and diagnosis of Turner syndrome" and "Genetics, clinical features, and diagnosis of Marfan syndrome and related disorders".)
Arm span to height — The arm span is the distance between the tips of the middle fingers when the arms are raised to a horizontal position [54]. At birth, the arm span is typically less than length (by at least 2.5 cm) [52]. By approximately 10 years of age in males and 12 years of age in females, the arm span exceeds height [52,54]. Arm span is 0 to 5 cm greater than height in approximately three-fourths of healthy children, 5 to 10 cm greater in approximately one-fourth, and ≥10 cm greater in approximately 1 percent [55].
The arm span-to height ratio is helpful in identifying conditions with a disproportion between the limbs and the trunk (eg, Marfan syndrome, in which the arm span usually exceeds height by at least 5 cm) [55]. (See "Genetics, clinical features, and diagnosis of Marfan syndrome and related disorders".)
ABNORMAL PATTERNS OF GROWTH — Growth can be slowed or accelerated by a variety of conditions. Changes in growth may be the first sign of a pathologic condition (eg, inflammatory bowel disease, hypercortisolism, thyroid dysfunction) [56-58]. The evaluation and management of abnormal growth patterns in children are discussed separately:
●Poor weight gain (see "Malnutrition in children in resource-limited settings: Clinical assessment" and "Poor weight gain in children older than two years in resource-abundant settings", section on 'Definition' and "Poor weight gain in children younger than two years in resource-abundant settings: Etiology and evaluation", section on 'Growth trajectory and proportionality' and "Poor weight gain in children younger than two years in resource-abundant settings: Management", section on 'Initial management')
●Obesity (see "Definition, epidemiology, and etiology of obesity in children and adolescents" and "Clinical evaluation of the child or adolescent with obesity" and "Overview of the health consequences of obesity in children and adolescents")
●Short stature (see "Causes of short stature" and "Diagnostic approach to children and adolescents with short stature")
●Tall stature (see "The child with tall stature and/or abnormally rapid growth")
●Microcephaly and macrocephaly (see "Microcephaly in infants and children: Etiology and evaluation" and "Macrocephaly in infants and children: Etiology and evaluation", section on 'Etiology')
COMMUNICATING WITH CAREGIVERS ABOUT GROWTH CHARTS — Although some caregivers may appreciate viewing their child's growth and hearing their health care provider's interpretation of the graphic information, the usefulness of the growth curve as an education tool for caregivers is questionable. The general population may not easily understand growth chart data, as illustrated below [59-61]:
●In a survey of 1000 caregivers (demographically representative of the United States population), nearly two-thirds responded that it was important to see their child's growth chart [60]. However, 36 percent incorrectly determined a child's weight when shown a point plotted on a growth chart, 32 percent incorrectly identified the percentile associated with a plotted point, and up to 77 percent inaccurately interpreted data plotted on combined height and weight graphs.
●In another survey of 279 caregivers who were asked to rank six growth charts, almost one-half selected the curve with consistent growth along the 10th percentile as "least healthy" and 29 percent chose growth patterns along the 90th percentile or trending upward to the 90th percentile as the "healthiest" [61].
Pediatric health care providers who choose to share growth chart information with caregivers must recognize the limitations of using growth charts as an educational tool.
SUMMARY
●Normal patterns of growth
•Normal human growth is pulsatile. Periods of rapid growth are separated by periods of no measurable growth. Growth is also seasonal, with growth velocities increased during the spring and summer months. (See 'Normal patterns' above.)
•Growth velocity, the change in growth over time, is a more sensitive index of growth than is a single measurement. (See 'Growth velocity' above.)
•Compared with formula-fed infants, breastfed infants gain weight relatively rapidly during the first three to four months of life and relatively slowly thereafter. (See 'Effects of feeding method' above.)
●Use of growth charts
•Weight and height should be plotted on the appropriate growth chart at each well-child visit. Head circumference and weight-for-length should be plotted for children younger than two years of age and body mass index (BMI) for children older than two years. The accurate charting of growth may prevent the unnecessary evaluation or intervention of a child who has a normal pattern of growth. (See 'Growth charts' above.)
•The World Health Organization growth charts should be used for infants and children <24 months of age, regardless of method of feeding. (See 'WHO growth charts' above.)
•The growth of preterm infants can be plotted on the standard growth charts after correcting growth parameters for gestational age (by subtracting the number of weeks the child was preterm from the child's postnatal age at the time of evaluation). However, there is no consensus about how long to continue such correction. The rate and duration of "catch-up growth" may vary depending upon gestational age, birth weight, race/ethnicity, and other factors. (See 'Correcting for prematurity' above.)
●Evaluation of proportionality – Assessment of proportionality (usually as weight-for-length or BMI) is useful as a screen of nutritional status, to diagnose overweight and obesity, and in generating a differential diagnosis for short or tall stature. Assessment of proportionality is particularly useful when growth parameters are abnormal. (See 'Proportionality' above.)
ACKNOWLEDGMENT — The UpToDate editorial staff acknowledges Julie A Boom, MD, who contributed to an earlier version of this topic review.
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