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Child growth

Slow growth

  • Lachlan was born at 38 completed weeks of gestation weighing 2.6 kg and measuring 46.1 cm.  He has attended all routine health visits and is reaching all developmental milestones.  His weight and length measures are recorded in the table below.  His parent s report that he is feeding and sleeping well however they have frequently expressed concern regarding Lachlan's small size.  What is your assessment of his growth?  What advice have you been giving to Lachlan's parents?

    Age

    Weight   (kg)

    Length (cm)

    Birth

    2.6

    46.1

    1 month

    3.2

    50.9

    2 ½ months

    4.3

    56.1

    5 months

    5.9

    62.0

    7 months

    6.8

    65.0


    Case study questions and activities

    1. Plot Lachlan's growth Note: Born at 38 weeks gestation Lachlan is considered to have been born at term and his age does not require correcting when plotting his growth measurements. 

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    case4_c_length_boys.gif

  • 2. How would you describe Lachlan’s growth pattern?

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    Lachlan’s birth weight was just above the 3rd percentile.  His rate of weight gain appeared to be slow in the first 3 months of life with weight dropping below the 3rd percentile.  However in the second 3 months of life his weight has increased so that at 7 months he is back above the 3rd percentile.   His length has tracked along the 3rd percentile from birth.

    3. How would you interpret Lachlan’s growth?  Is Lachlan’s pattern of growth a cause for concern? 

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    Although Lachlan’s weight dipped below the 3rd percentile at 2½ months fluctuations around growth percentiles are considered normal.  As his length is on the 3rd percentile Lachlan’s growth is proportional and is currently not a cause for concern.  Infants with lower birth weight can be expected to grow at lower percentiles.  

    4. What additional considerations would you take into account when advising Lachlan’s parents?

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    Additional considerations could include but are not limited to:
    1. General health and development.
    2. Diet / feeding history.  
    3. Social history.
    4. Parental height.
    5. WHO growth pattern.

    Concern in one or more of these areas may influence your advice.

    5. What recommendations did you make to Lachlan’s parents when he attended at 2.5 months? Have your recommendations changed?

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    As Lachlan is reaching expected developmental milestones, feeding and sleeping well his parents were advised to continue current feeding practices.  It was recommended that he continue to attend for regular health checks.  It is not uncommon for healthy typically developing babies to have small dips in weight percentiles in the early months of life.   Many babies display a small dip in growth in the early months of life but will pick up again.  Review of growth at 5 and 7 months has shown this to be the case for Lachlan.  As he continues to feed well and has no other health concerns then there no indication to change your advice.

    Key Learnings from this case study

    1. Serial measurements are required for making growth assessment.
    2. Growth pattern is one indicator of health and well being.
    3. Small fluctuation around growth percentiles are considered normal at any percentile.
    4. Tracking of length and weight on similar percentiles indicates that the child is growing in proportion.