Normal Growth And Development Stature

Although the process of physical maturation that occurs during adolescence, puberty, incorporates the final growth spurt and attainment of final adult height, we first need to consider the aspects of growth prior to this period. As in any aspect of development throughout life, there is normal variation in the development of stature. On top of this normal variation, chronic rheumatic illness can variably impact growth in the prepubertal years and can subsequently impact growth further during the pubertal process.

Growth data, provided in the form of growth reference charts, forms the basis for assessing the "normality" of stature. There are various growth reference charts available for this purpose derived from different populations at different times. Growth reference charts derived from longitudinal data, repeated measurements of the same children over time, more accurately reflect an individual's growth compared to those derived from cross-sectional data, measurements of different children at different ages (1). The normal range is often between the 3rd and 97th percentiles, but varies a little, for example, between the 2nd and 98th percentiles using U.K. 1990 standards (Figs. 1 and 2). Children and young people growing outside these limits may still be growing normally, however, and other factors need to be taken into consideration.

During the first one to two years of life most infant's length adjusts either upwards or downwards, reflecting a transition from intrauterine growth determinants (including maternal size and fetal nutrition) to their genetic (familial and ethnic) growth potential (1). During the childhood years (age 2-9 years) a child is expected to grow along the same percentile, as determined by their genetic growth potential. This is simply estimated (provided no parental growth pathology) by calculating the mid parental height range (MPHR) (2) as follows:

For a male child, MPHR

For a female child, MPHR

The MPHR is the 95% confidence interval for that family, indicating that 95% of the couple's sons/daughters are expected to attain final adult heights within the range (in the absence of pathology).

Changing percentiles during puberty reflects the wide normal variation in timing and rate of the pubertal growth spurt. Some growth charts provide percentiles for early and late developers, in addition to average developers (Figs. 1 and 2).

The early stages of growth failure are more readily apparent when height velocity (growth rate) is compared to recognized standards (2) (Figs. 3 and 4). The normal range is between the 25th and 75th percentiles. Height velocity is slowest just prior to the pubertal growth spurt.

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Figure 1 Male growth reference chart incorporating early, average, and late puberty-onset growth percentiles.

Figure 1 Male growth reference chart incorporating early, average, and late puberty-onset growth percentiles.

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