Assessment of abnormal growth curves

An important part of well-child care is the assessment of a child's growth. While growth in the vast majority of children falls within normal percentile ranges on standard growth curves, an occasional child demonstrates worrisome deviations in weight, height or head size. A single growth percentile value at any particular point in a child's life is only of limited usefulness to the physician. More important is the child's rate of growth. Children whose growth parameters are at the extremes of the growth curve but whose growth rates are normal are likely to be healthy. Conversely, accelerated or slowed growth rates are rarely normal and warrant further evaluation. This article addresses the initial steps to be taken when evaluating children with suspected growth abnormalities, the guiding principles that apply to all growth problems, and the most common growth curve deviations and approaches to their management.