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.
Puberty is the process of physical maturation from child to adult. Adolescence defines an age group; puberty occurs during adolescence (see Physical Growth and Sexual Maturation of Adolescents Physical Growth and Sexual Maturation of Adolescents During adolescence (usually considered age 10 to the late teens or early 20s), boys and girls reach adult height and weight and undergo puberty. For boys, see Sexual Differentiation, Adrenarche... read more ). At puberty, a 2nd growth spurt occurs, affecting boys Sexual Differentiation, Adrenarche, and Puberty Male sexual development and hormonal function depend on a complex feedback circuit involving the hypothalamus-pituitary-testes modulated by the central nervous system. Male sexual dysfunction... read more and girls Puberty Hormonal interaction between the hypothalamus, anterior pituitary gland, and ovaries regulates the female reproductive system. The hypothalamus secretes a small peptide, gonadotropin-releasing... read more slightly differently.
From birth until age 2 years, it is recommended that all growth parameters be charted using standard growth charts from the World health Organization (WHO). After age 2, growth parameters are charted using growth charts from the Centers for Disease Control and Prevention (CDC) (1 Reference 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 ).
(See also Failure to Thrive Failure to Thrive (FTT) Failure to thrive is weight consistently below the 3rd to 5th percentile for age and sex, progressive decrease in weight to below the 3rd to 5th percentile, or a decrease in 2 major growth percentiles... read more and Health Supervision of the Well Child Health Supervision of the Well Child Well-child visits aim to do the following: Promote health Prevent disease through routine vaccinations and education Detect and treat disease early Guide parents to optimize the child’s emotional... read more .)
Reference
1. Grummer-Strawn LM, Reinold C, Krebs NF, Centers for Disease Control and Prevention (CDC): Use of World Health Organization and CDC growth charts for children aged 0–59 months in the United States. MMWR Recomm Rep 10(RR-9):1–15, 2010. Clarification and additional information. MMWR Recomm Rep 59(36):1184, 2010.
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 < 2.5 kg was termed... 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
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)... read more (see table Changes in Prevalence of Obesity According to NHANES Changes in Prevalence of Obesity According to NHANES 
) 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.
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. | |||||||
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 ), 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 
. Supernumerary teeth and congenital absence of teeth are probably normal variants.
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. | ||
† Molars are numbered from the front to the back of the mouth (see figure Identifying the teeth Identifying the teeth | ||
Identifying the teeth
The numbering system shown is the one most commonly used in the US.  |
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.
Growth charts from the WHO (birth until age 2 years)
Growth charts from the CDC (after age 2 years)
