Growth charts: Is your baby growing normally?

Since birth, my daughter's head has measured in the 95th percentile, while her height and weight have been in the 50th and 25th, respectively. She seems fine developmentally. Should I be concerned that my baby is not growing normally?


Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

You have given me two very important pieces of information. One is that your daughter has had her head proportions about the same since birth. The other is that she seems developmentally appropriate. In other words, her trend has been consistent and normal over time. This is very reassuring.

It is not uncommon to have seemingly disproportionate body parts in the first year of life, but it is important to consult with her doctor to confirm how well she is developing.

The most common reason for a larger head compared to the body is inheritance. There are head size charts for adults too. So if there is any particular concern, you and the father can have your heads measured to see if there is a trend toward larger heads.

Remember, the 95th percentile, the 50th percentile, and the 5th percentile are all normal, so try not to put a whole lot of stock in the numbers if everything else is going well.

The growth of children, particularly infants, is of big concern to parents and pediatricians. There are many diseases and disorders which first manifest themselves by altering growth. Alterations may be in the form of a growth slow down, accelerated growth, or disproportionate growth. However, everybody is different, and so growth patterns are bound to be different as well. Therefore, there is a lot more to look at when evaluating how well your child is growing than just what her growth percentiles are.

Look at the Video, Not the Still Picture

A picture may say a thousand words, but it is often left up to different interpretations. A video or movie often tells the story in a more exact way.

Growth in children is much the same, in that seeing how a child got to her current growth percentiles is more important than the actual growth percentile at any given moment.

Children's growth is quite rapid in the first few months of life. Because of this, growth percentiles may jump around a bit especially in the first year of life. The weight percentile is the most common thing to wander. Although the infant should always be gaining weight, the rate at which she does may vary. The height percentile may also vary although this is usually more gradual than the weight. The head circumference percentile is the most consistent and therefore tends to stay around the same percentile with each visit to the doctor. Because of this movement in percentiles especially in the first two years of life, health care providers tend to put more emphasis in the trend of how growth is going rather than what the percentiles are on that particular visit.

A wise mom once told me, "Different people grow differently because they're different." This is a profound statement because while there are guidelines to help physicians track the growth patterns of patients, they are only guidelines.

Due to different family traits, little boys and girls may be built with different proportions but otherwise be happy and healthy. Following growth on growth charts allows physicians to screen for abnormalities that might be occurring. This screening is analogous to adult mammography screening. There are women who have mammography that show signs suspicious for cancer. Does this mean they have cancer? Of course not, but it means additional testing should be done to make sure it isn't cancer. The same is true for growth charts. When a child's growth differs from the "published norms," it doesn't necessarily mean she is abnormal, it just means it should be looked into further. This might entail just taking a better history, doing a more detailed physical exam or perhaps doing other tests.

Good luck to you.

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