Behind growth curve
A child whose measured height, weight, or head circumference falls below the expected percentile range for their age and sex on standardised growth charts.
Quick Facts
| Aspect | Details |
|---|---|
| Detection age | Any age; most commonly identified 0-5 years |
| Severity threshold | Below 2nd percentile or dropping 2+ percentile lines |
| Prevalence | 2-5% of children (varies by definition used) |
| Reversibility | Often treatable if cause identified early |
Measurement standards
- Growth charts — WHO charts (0-4 years), UK-WHO charts (2-18 years)
- Key metrics — Weight-for-age, length/height-for-age, head circumference (under 2s)
- Tracking required — Single measurement insufficient; pattern over time matters
- Centile lines — 0.4th, 2nd, 9th, 25th, 50th, 75th, 91st, 98th, 99.6th
- Red flags — Crossing two centile spaces downwards, measurements below 0.4th centile
Common causes
Inadequate nutrition
- Insufficient calorie intake (feeding difficulties, poverty, neglect)
- Poor absorption (coeliac disease, cystic fibrosis, cow's milk protein allergy)
Medical conditions
- Chronic illness (heart disease, kidney disease, severe asthma)
- Hormonal disorders (growth hormone deficiency, thyroid problems)
- Genetic syndromes (Turner syndrome, Down's syndrome)
Constitutional factors
- familial short stature (both parents short)
- constitutional delay (late bloomer, normal eventual height)
Assessment process
- Review growth history — Plot all available measurements on appropriate chart
- Calculate mid-parental height — Assess if child's trajectory matches genetic potential
- Health screening — Full examination, dietary history, developmental check
- Investigations — Blood tests (coeliac screen, thyroid, full blood count), bone age X-ray if indicated
- Specialist referral — Paediatric endocrinology if no obvious cause or severe deviation
Monitoring
- Frequency — Every 1-3 months initially, depending on severity
- Home tracking — Maintain feeding diary if nutritional concern
- School liaison — Inform staff if medical cause identified
- catch-up growth — Expected once underlying cause treated; rate varies by age
Note: General guidance only. Consult a healthcare provider for specific concerns.
See also
Growth charts interpretation [[failure to thrive]] Constitutional growth delay Growth hormone deficiency Nutritional assessment in children