The Importance of Monitoring Growth

Tuesday, September 15, 2015
The Importance of Monitoring Growth

In commemoration of International Children’s Growth Awareness Day in September, the Lebanese Pediatric Society and Novo Nordisk are calling for improved routine monitoring and plotting of children’s growth, stressing that assessment of a child’s height and weight sheds light on their general health and well-being1.


It is especially important to measure and plot your child’s growth during every visit to the pediatrician, particularly if you feel they are small for their age or not growing as well as they should,” said Dr. Wissam Fayad, Coordinator of the Lebanese Pediatric Endocrinology Club at the Lebanese Pediatric Society. “Warning signs can include children not outgrowing their clothes year after year, or obvious height differences between them and their classmates.”


Growth monitoring has been part of preventive child health programs for more than a century2, and short stature or growth retardation is recognized as a relatively early sign of poor health2.


Indicative results announced in 2012 from a collaborative screening campaign conducted by the Lebanese Ministry of Education, the Lebanese Pediatric Society, and Novo Nordisk, found 4% of children attending KG-1 and Elementary levels 1 to 5 in public schools in North Lebanon have short stature as defined by 2 Standard Deviations (SD) or more below the established mean.


Over the last 25 years, there has been little improvement in the late age at which growth-related disorders are diagnosed3-5, meaning that signs of poor growth in children are often being missed by parents and healthcare professionals.


While poor growth is not always a cause for concern, in some children, changes to prior growth pattern could signal a problem, ranging from malnutrition to potentially serious health disorders6-8 that can be difficult to identify, because a child’s growth is often only monitored until the age of two.


“By securing an early diagnosis and beginning appropriate treatment as soon as possible, parents can give their children the best chance of living a healthy and normal life,” concluded Fayad.


The Lebanese Pediatric Society recommends the regular measurement of height and weight at least once a year. The measurements have to be plotted on a growth chart in order to detect any deviation, in which case the child needs to undergo clinical assessment, blood tests, bone age determination and other tests in order to properly diagnose and allocate adequate treatment.


Underlying Conditions of Growth Abnormalities:

Optimal growth depends on heredity, normal skeletal and endocrine function, nutrition, absence of chronic disease, and a nurturing environment. Fetal, infant, environmental, and maternal factors can interact to impair intra-uterine and post-natal growth. If a child is failing to grow due to an underlying medical problem, his or her visible growth failure means that other more serious things are going on inside the body. Height is simply an early signal for parents to take their child to the physician.


Normal height growth rates vary according to age. Children during the first year of life should grow 24 cm. During the second, growth slows to an average of 11 cm. During the third, growth averages 8 cm. From age four until puberty, growth should be at least 5-6 cm/year. Pubertal changes prompt a growth spurt of around 9 cm/year usually starting by the age of 10 for girls and 12 for boys.


Particular attention is required for children born Small for Gestational Age, or SGA - a largely under-diagnosed condition in Lebanon. They are those whose length, weight or both are lower than the normal range at birth. Most babies born SGA catch-up to their peers by age two without medical intervention, but about 10% of them do not. Such children are seven times more likely to be short as adults and are at risk for certain health problems throughout life.



  1. Health Technology Assessment 2011;15:11
  2. Grote et al. Arch Dis Child 2008;93:212–7
  3. Herber et al. Arch Dis Child 1986;61:110–2
  4. Lee PA, et al. Int J Pediatr Endocrinol 2012;2012:22.
  5. Ross, et al. Horm Res Pediatr 2011;76:392-9
  6. Child Growth Foundation. Growth hormone deficiency. Last accessed May 2015
  7. NORD. Turner syndrome. Last accessed May 2015.
  8. DPC Education Center. What are the symptoms associated with pediatric kidney disease? Last accessed May 2015.