II. Precautions

  1. Defining whether a child's growth is normal is difficult due to conflicting guidelines and growth curves
  2. Diagnosis relies on accurately recorded weight and height on growth chart over time

III. Evaluation: Initial Criteria (expect false positives)

  1. Weight for age <5th percentile for gender (or BMI for age <5th percentile, or weight/length <5th percentile)
  2. Weight deceleration that crosses 2 or more major percentile lines

IV. Evaluation: Re-evaluate growth in relation to normal modifiers of growth pattern

  1. Growth may be adequate for genetic predisposition or Breast Feeding versus Bottle Feeding
    1. See Resources under Weight Measurement in Children (particular attention to WHO growth curves)
  2. Interpret trends (3rd percentile may be normal if always following 3rd percentile)
  3. Consider using modified growth charts
    1. Prematurity
    2. Ethnicity
    3. Down's Syndrome
    4. Turner's Syndrome

V. Evaluation: Further evaluate with most specific indicators of abnormal growth

  1. Weight <75% of median Weight for Length
  2. Weight Velocity <5th percentile

VI. Resources

  1. CDC Growth Charts (includes WHO charts for under age 2 years)
    1. http://www.cdc.gov/growthcharts/

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