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Physical Growth of Infants and Children

By

Evan G. Graber

, DO, Sydney Kimmel Medical College

Last full review/revision Apr 2021| Content last modified Apr 2021
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Topic Resources

Physical growth includes attainment of full height and appropriate weight and an increase in size of all organs (except lymphatic tissue, which decreases in size). Growth from birth to adolescence occurs in 2 distinct phases:

  • Phase 1 (from birth to about age 1 to 2 years): This phase is one of rapid growth, although the rate of growth decreases over that period.

  • Phase 2 (from about 2 years to the onset of puberty): In this phase, growth occurs in relatively constant annual increments.

Reference

Length

Length is measured in children too young to stand; height is measured once the child can stand. In general, length in normal-term infants increases about 30% by 5 months and > 50% by 12 months; infants grow about 25 cm during the first year, and height at 5 years is about double the birth length. In most boys, half the adult height is attained by about age 2; in most girls, height at 19 months is about half the adult height.

Rate of change in height (height velocity) is a more sensitive measure of growth than time-specific height measures. In general, healthy term infants and children grow about 2.5 cm/month between birth and 6 months, 1.3 cm/month from 7 to 12 months, and about 7.6 cm/year between 12 months and 10 years.

Before 12 months, height velocity varies and is due in part to perinatal factors (eg, prematurity Premature Infants An infant born before 37 weeks gestation is considered premature. Prematurity is defined by the gestational age at which infants are born. Previously, any infant weighing read more ). After 12 months, height is mostly genetically determined, and height velocity stays nearly constant until puberty; a child’s height relative to peers tends to remain the same.

Some small-for-gestational-age infants Small-for-Gestational-Age (SGA) Infant Infants whose weight is the 10th percentile for gestational age are classified as small for gestational age. Complications include perinatal asphyxia, meconium aspiration, polycythemia, and... read more tend to be shorter throughout life than infants whose size is appropriate for their gestational age. Boys and girls show little difference in height and growth rate during infancy and childhood.

Extremities grow faster than the trunk, leading to a gradual change in relative proportions; the crown-to-pubis/pubis-to-heel ratio is 1.7 at birth, 1.5 at 12 months, 1.2 at 5 years, and 1.0 after 7 years.

Weight for Length/Height Percentile Calculators

Weight

Weight follows a similar pattern. Normal-term neonates generally lose 5 to 8% of birth weight in the days after delivery but regain their birth weight within 2 weeks. They then gain 14 to 28 g/day until 3 months, then 4000 g between 3 and 12 months, doubling their birth weight by 5 months, tripling it by 12 months, and almost quadrupling it by 2 years. Between age 2 years and puberty, weight increases 2 kg/year. The recent epidemic of childhood obesity Children Obesity is excess body weight, defined as a body mass index (BMI) of ≥ 30 kg/m2. Complications include cardiovascular disorders (particularly in people with excess abdominal fat), diabetes mellitus... read more (see table Changes in Prevalence of Obesity According to NHANES Changes in Prevalence of Obesity According to NHANES Obesity is excess body weight, defined as a body mass index (BMI) of ≥ 30 kg/m2. Complications include cardiovascular disorders (particularly in people with excess abdominal fat), diabetes mellitus... read more ) has involved markedly greater weight gain, even among very young children. In general, boys are heavier and taller than girls when growth is complete because boys have a longer prepubertal growth period, increased peak velocity during the pubertal growth spurt, and a longer adolescent growth spurt.

Table

Changes in Prevalence of Obesity According to NHANES

Age Group

1976–1980

2003–2004

2007–2008

2009–2010

2011-2012

2013–2014

2015–2016

2–5 years

5%

13.9%

10.1%

12.1%

8.4%

9.4%

13.9%

6–11 years

6.5%

18.8%

19.6%

18.0%

17.7%

17.4%

18.4%

12–19 years

5%

17.4%

18.1%

18.4%

20.5%

20.6%

20.6%

20–74 years

15%

32.9%

33.7%

35.7%

34.9%

37.7%

39.6%

Hales CM, Fryar CD, Carroll MD, et al: Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007-2008 to 2015-2016. JAMA 319 (16):1723–1725, 2018. doi:10.1001/jama.2018.3060

NHANES = National Health and Nutrition Examination Surveys.

Weight for Age/Height/Length Percentile Calculators

Head Circumference

Head circumference reflects brain size and is routinely measured up to 36 months. At birth, the brain is 25% of adult size, and head circumference averages 35 cm. Head circumference increases an average 1 cm/month during the first year; growth is more rapid in the first 8 months, and by 12 months, the brain has completed half its postnatal growth and is 75% of adult size. Head circumference increases 3.5 cm over the next 2 years; the brain is 80% of adult size by age 3 years and 90% by age 7 years.

Body Composition

Body composition (proportions of body fat and water) changes and affects drug volume of distribution Distribution Pharmacokinetics refers to the processes of drug absorption, distribution, metabolism, and elimination. There are important age-related variations in pharmacokinetics. Absorption from the gastrointestinal... read more . Proportion of fat increases rapidly from 13% at birth to 20 to 25% by 12 months, accounting for the chubby appearance of most infants. Subsequently, a slow fall occurs until preadolescence, when body fat returns to about 13%. There is a slow rise again until the onset of puberty, when body fat may again fall, especially in boys. After puberty, the percentage generally stays stable in girls, whereas in boys there tends to be a slight decline.

Body water measured as a percentage of body weight is 70% at birth, dropping to 61% at 12 months (about equal to the adult percentage). This change is fundamentally due to a decrease in extracellular fluid from 45% to 28% of body weight. Intracellular fluid stays relatively constant. After age 12 months, there is a slow and variable fall in extracellular fluid to adult levels of about 20% and a rise in intracellular fluid to adult levels of about 40%. The relatively larger amount of body water, its high turnover rate, and the comparatively high surface losses (due to a proportionately large surface area) make infants more susceptible to fluid deprivation than older children and adults.

Tooth Eruption

Tooth eruption is variable (see table Tooth Eruption Times Tooth Eruption Times Physical growth includes attainment of full height and appropriate weight and an increase in size of all organs (except lymphatic tissue, which decreases in size). Growth from birth to adolescence... read more ), primarily because of genetic factors. On average, normal infants should have 6 teeth by 12 months, 12 teeth by 18 months, 16 teeth by 2 years, and all teeth (20) by 2½ years; deciduous teeth are replaced by permanent teeth between the ages of 5 years and 13 years. Eruption of deciduous teeth is similar in both sexes; permanent teeth tend to appear earlier in girls. Tooth eruption may be delayed by familial patterns or by conditions such as rickets Hypophosphatemic Rickets Hypophosphatemic rickets is a disorder characterized by hypophosphatemia, defective intestinal absorption of calcium, and rickets or osteomalacia unresponsive to vitamin D. It is usually hereditary... read more , hypopituitarism Growth Hormone Deficiency in Children Growth hormone deficiency is the most common pituitary hormone deficiency in children and can be isolated or accompanied by deficiency of other pituitary hormones. Growth hormone deficiency... read more , hypothyroidism Hypothyroidism in Infants and Children Hypothyroidism is thyroid hormone deficiency. Symptoms in infants include poor feeding and growth failure; symptoms in older children and adolescents are similar to those of adults but also... read more , or Down syndrome Down Syndrome (Trisomy 21) Down syndrome is an anomaly of chromosome 21 that can cause intellectual disability, microcephaly, short stature, and characteristic facies. Diagnosis is suggested by physical anomalies and... read more Down Syndrome (Trisomy 21) . Supernumerary teeth and congenital absence of teeth are probably normal variants.

Table

Tooth Eruption Times

Teeth

Number

Age at Eruption*

Deciduous (20 total)

Lower central incisors

2

5–9 months

Upper central incisors

2

8–12 months

Upper lateral incisors

2

10–12 months

Lower lateral incisors

2

12–15 months

1st molars†

4

10–16 months

Canines

4

16–20 months

2nd molars†

4

20–30 months

Permanent (32 total)

1st molars†

4

5–7 years

Incisors

8

6–8 years

Bicuspids

8

9–12 years

Canines

4

10–13 years

2nd molars†

4

11–13 years

3rd molars†

4

17–25 years

* Varies greatly.

Identifying the teeth

The numbering system shown is the one most commonly used in the US.

Identifying the teeth

More Information

The following are some English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

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