Keywords
Normal growth, Growth Charts
Health Maintenance Visit
The frequent office visits for health maintenance in the first 2 years of life are more than physicals . Although a somatic history and physical examination are important parts of each visit, many other issues are discussed, including nutrition, behavior, development, safety, and anticipatory guidance .
Disorders of growth and development are often associated with chronic or severe illness or may be the only symptom of parental neglect or abuse. Although normal growth and development does not eliminate a serious or chronic illness, in general, it supports a judgment that a child is healthy except for acute, often benign, illnesses that do not affect growth and development.
The processes of growth and development are intertwined. However, it is convenient to refer to growth as the increase in size and development as an increase in function of processes related to body and mind. Being familiar with normal patterns of growth and development allows those practitioners who care for children to recognize and manage abnormal variations.
The genetic makeup and the physical, emotional, and social environment of the individual determine how a child grows and develops throughout childhood. One goal of pediatrics is to help each child achieve his or her individual potential through periodically monitoring and screening for the normal progression or abnormalities of growth and development. The American Academy of Pediatrics recommends routine office visits in the first week of life (depending on timing of nursery discharge); at 2 weeks; at 1, 2, 4, 6, 9, 12, 15, and 18 months; at 2, 
, and 3 years; and then annually through adolescence/young adulthood (see Fig. 9.1 ; the Bright Futures’ “Recommendations for Preventive Pediatric Health Care” found at https://www.aap.org/en-us/documents/periodicity_schedule.pdf ).
Deviations in growth patterns may be nonspecific or may be important indicators of serious and chronic medical disorders. An accurate measurement of length/height, weight, and head circumference should be obtained at every health supervision visit and compared with statistical norms on growth charts. Table 5.1 summarizes several convenient benchmarks to evaluate normal growth. Serial measurements are much more useful than single measurements to detect deviations from a particular growth pattern even if the value remains within statistically defined normal limits (percentiles). Following the trend helps define whether growth is within acceptable limits or warrants further evaluation.
| WEIGHT |
| Weight loss in first few days: 5-10% of birthweight |
| Return to birthweight: 7-10 days of age |
| Double birthweight: 4-5 months |
| Triple birthweight: 1 year |
| Daily weight gain: |
| 20-30 g for first 3-4 months |
| 15-20 g for rest of the first year |
| HEIGHT |
| 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. |
| HEAD CIRCUMFERENCE (HC) |
| 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) |
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