Measurement of growth is one of the most important indicators of infant health. Deviations may provide an early indication of an underlying problem. Compare growth parameters with respect to normal values for age and sex, as well as prior readings on the same child, to assess trends. Confirm abnormalities in somatic growth by repeat measurement to account for potential measurement error.

Measure growth parameters carefully using consistent technique and, optimally, the same scales to measure height and weight.

The most important tools for assessing somatic growth are the growth charts which are published by the National Center for Health Statistics and also the World Health Organization. All charts include height, weight, and head circumference for children up to 36 months and height and weight for children 2 to 18 years. Charts plotting weight by length as well as BMI are also available. These growth charts have percentile lines indicating the percentage of normal children above and below the child's measurement by chronologic age. Special growth charts are available for use in infants born prematurely to correct for this result.

The AAP, NIH, and CDC now recommend that clinicians use the 2006 WHO International growth charts for children 0 to 23 months of age. CDC growth charts should be used in the United States to assess growth in children 2 to 19 years of age.

Length.

For children younger than age 2 years, measure body length by placing the child supine on a measuring board or in a measuring tray, as shown in Figure 1. Direct measurement of the infant using a tape measure is inaccurate unless an assistant holds the child still with hips and knees extended. Velocity growth curves are helpful for older children, especially those who are suspected of having endocrine disorders.

FIGURE 1. Accurate length measurement requires careful assistance.

Weight. 

Weigh infants directly with an infant scale. Infants should be weighed naked or be clothed only in a diaper.

Head Circumference. 

The head circumference should always be measured during the first 2 years of life, but measurement can be useful at any age to assess growth of the head (Fig. 2). The head circumference in infants reflects the rate of growth of the cranium and the brain.

FIGURE 2. Head circumference is a vital metric during early childhood.

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