Your Child's Growth Chart Percentile: When to Worry & When Not To

doctor measuring girl

Your child's first doctor's appointment is an exciting (if not bleary-eyed) one, but it's also the moment we become acquainted with the ever-present growth chart -- the graph by which your little bundle will be compared for the rest of his or her young life. It can be kind of intimidating.


As your children grow, you're more than likely keeping your own keen eye on their height and weight, comparing their size to that of their peers. What might seem like an "average" height and weight to you just by looking at your kiddo may translate to something very different on the growth chart. So how much stock should we really put into that often-confusing table of numbers and percentages?

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"The growth chart is one of the best tools that pediatricians and parents have to quickly assess the health of a child," says Dr. Natasha Burgert, MD, FAAP, a pediatrician in Kansas City, Missouri. "Following growth trends over time provides us reassurance that the body is functioning well."

Burgert says it's not the percentile itself that counts -- it's whether or not that percentile changes much from doctor visit to doctor visit.

"One percentile value is an isolated measure and is not very helpful," she says. "What is important is how kids are growing over time, regardless of the percentile being high or low."

Oftentimes parents just want to know whether or not they should worry over growth chart results. Just like grown-ups, kids come in all shapes and sizes, so what constitutes a time to worry and a time to breathe deeply and go with the flow?

If your child falls in the 1st or 99th percentiles...

Chances are all is well health-wise if they show a consistent growth velocity within those percentiles. "Percentiles are not a math test. You don't get need to get a 100 percent to pass, and 1 percent is not a failing grade," says Dr. Burgert.

Instead, your doctor looks to see if your child follows a growth pattern consistent with the curve on the chart. "If children are not on the growth curve, then we look for other causes as to why this growth may be occurring," she explains. "Premature babies, for example, may be off the curve, but still gaining and growing nicely. An 8-year-old, however, who is still not on the curve may need additional evaluation to ensure this is healthy."

If your kid isn't on the grid...

"If a child 'isn't on the grid' then it certainly needs a little more investigation than if the child is just below the third percentile," says Dr. David Mathison, MD, MB, FAAP, regional medical director for PM Pediatrics. "If a parent is concerned, the best thing to do is discuss with their pediatrician. Assembling growth trends for the child and other family members (siblings in particular) may be helpful, as is a complete history. This is often a problem for foster children where family history and trending weights/heights are incomplete."

Looking at the growth trends or proportions of family members is helpful in that it can be an indicator of whether or not the child's measurements are, perhaps, hereditary. If they're not, maybe it's a sign of some other cause.

For example, says Mathison, "I remember as a resident following a family whose child always had a 'big head.' There's rarely anything to do about this, especially if Dad has a big head and the child is developmentally normal, but at some point when it's too big it needs a little investigation with imaging. In this case it was, of course, normal. But if a child has a normal head circumference and then all of a sudden jumps up the curves, this is very worrisome for an intracranial process such as hydrocephalus (too much water in the brain) or a brain tumor."

If your child jumps or plummets in percentile between office visits...

"Weight and height can shift in percentiles either up or down and must be taken into a greater context with information about history of growth, parental size, and even diet," says Dr. Nimali Fernando, MD, MPH, FAAP, of Yum Pediatrics in Spotsylvania, Virginia. "An experienced pediatrician should be able to tell you if a change in percentiles is worrisome or not. Body mass index (a calculation that takes into account weight for height) should also be considered when interpreting weight and height percentile. BMI can tell if a child is underweight (less than 5th percentile) versus overweight (85-95th percentile) or obese (greater than 95th percentile)."

A doctor may look at whether or not the dramatic change in percentile has to do with poor food choices or being sedentary.

Burgert says the next step would be to give these children some extra attention.

"Most children with growth concerns need more specific guidance in nutrition and calorie goals. We often see these children more frequently to monitor their progress," she says. "Rarely do these children need additional lab or specialty evaluation, but partnering with a pediatrician to share this decision is best."

If at any point you have any concerns over your child's growth, be open and honest with your pediatrician, who can offer up the best recommendations specific to your child.

"I would ask your pediatrician to help you understand your child's growth curve in the context of their overall growth history and health," says Dr. Fernando. "Ask if there is a cause for concern. In some cases specialists (like a pediatric endocrinologist) may be needed to help find an underlying reason for an abnormal growth pattern, or experts like a dietitian may offer specialized help in helping your child to gain or lose weight and get to a healthy range."


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