UNDERSTANDING GROWTH PERCENTILES

Since the growth charts compact a lot of information into a small space, they can be a little confusing to use and I often get requests for help from parents who don't understand how to plot their child on the charts.

This guide, and the picture below, should provide you with all of the information you need to use the growth charts to follow how well your child is growing. The first step is to find the right growth chart. In our example, we are going to find the percentile for a 2 year old boy who weighs 30 pounds, so we will use the growth chart for Boys from Birth to 36 Months. Next, (step A on the chart below) find your child's age at the bottom of the chart and draw a vertical line (a straight line up and down) on the growth chart. In our example, we drew a line through 24 months or 2 years.

Now find your child's weight on the right hand side of the chart, 30 pounds in our example, and draw a horizontal line (a straight line from side to side). This is step B in our example. Keep in mind that you don't have to really physically draw a line on the growth charts. If you really do that each time, your growth chart will look very messy and will be hard to read. Instead, just imagine where the line should be or draw a light line with a pencil that you can later erase.

Step C involves finding the spot where these two lines intersect or cross each other. Find the curve that is closest to this spot and follow it up and to the right until you find the number that corresponds to your child's percentile (step D).

In our example, you can see that a two year old boy who is 30 pounds is at the 75th percentile for his weight. What does that mean? It means that he weighs more than about 75% of boys his age. It also means that 25% of 2 year old boys weigh more than he does. Is that normal? Sure, if that is where he has always been on the growth charts.

Finding your child's percentile is a little harder if a curve doesn't actually pass through the spot where your child's age and weight come together. For example, what would you do if the boy in our example actually weighed 31 pounds? You would use all of the same steps and would have to imagine a curve that is somewhere between the 75th and 90th percentiles and figure that he was at about the 80th-85th percentile. If your child is above the 95th or below the 5th percentile, then you will also not be able to find an exact percentile, except to say that he is above or below the growth chart. You can use the same steps to plot your child's height and body mass index. Here are some more examples (try them before looking at the answers below):

A. B. C. D. E.

What is What is the What is the What is the What is the

the percentile for a 2 year old boy who is 2 feet 10 1/2 inches (34 1/2 inches)? percentile for a 13 year old girl who is 80 pounds? percentile for a 16 year old girl who is 5 foot 4 inches (64 inches)? percentile for a 9 year old who has a body mass index of 18? percentile for a 6 month old girl who is 14 pounds?

It is also important to understand that the growth charts are best used to follow your child's growth over time or to find a pattern of his growth. Plotting your child's weight and height at different ages and seeing if he follows a growth curve is more important than where he is at any one time. Even if your child is at the 5th percentile for his weight, which means that 95% of kids his age weigh more than he does, if he has always been at the 5th percentile, then he is likely growing normally. It would be concerning and it might mean there was a problem with his growth if he had previously been at the 50th or 75th percentile and had now fallen down to the 5th percentile.

Also remember that children between the ages of 6 and 18 months can normally move up or down on their percentiles, but older children should follow their growth curve fairly closely.

Answers to examples: A) 50th percentile, B) 10th percentile, C) 50th percentile, D) 75th percentile, E) about the 15th percentile

HOW TO DETERMINE YOUR GROWTH PERCENTILE CORRECTLY

Height And Growth Charts For Your Growth Percentile

What Do the Percentiles Mean? When you look at a growth chart, you will see seven curves that follow the same pattern. Each one represents a different percentile: 5th, 10th, 25th, 50th, 75th, 90th, and 95th. The 50th percentile line represents the average value for age. (There are also charts that show 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles. Doctors sometimes use these when they plot measurements that fall to the very outer edges of one or more growth curves). Your child's growth measurements will be plotted among these percentile curves. To better understand how to interpret those readings, consider these examples. An infant whose head circumference falls in the 90th percentile will be plotted right on the second curve from the top of the chart (the 90th percentile curve). Being in the 90th percentile means the child's head measurement is greater than or equal to the measurements of 90% of children that age in the country. The remaining 10% of infants that age have head measurements that exceed that child's. If a 4-year-old's weight at a checkup falls in the 20th percentile, that reading will be plotted between the curves for the 10th and 25th percentiles. That

means 80% of children that age weigh more and 20% weigh less than that child. Now, you shouldn't assume that a high or low reading means there's a problem. A baby whose head circumference is in the 90th percentile might also fall in the 90th percentile for weight and length - he's just a normal kid who's large overall. (He could be the son of a 6-foot, 8-inch former linebacker!) The child whose weight falls in the 20th percentile may have parents who are a bit below average for height and weight. For him, being in the 20th percentile is an entirely normal reading. Sometimes, however, a child's measurement increases or falls sharply, or is at one extreme of the growth chart. For example, children who fall below the 5th percentile on the weight for stature (height) chart are considered underweight; children at or above the 85th percentile on this chart are considered overweight (and at risk for obesity); and those at or above the 95th percentile are considered to be obese. Generally, if a measurement exceeds the 95th percentile or crosses two percentile curves (such as climbing from the 40th percentile to the 75th percentile, thereby crossing the 50th and 75th percentile curves), there may be some cause for concern. On the other hand, if a measurement falls below the 5th percentile or crosses two percentile curves (dropping from the 50th to the 20th percentile, for instance), the doctor will also consider the possibility of a health problem affecting the child's growth. What Can the Charts Tell Me About My Child's Growth? Although growth charts are valuable tools, both doctors and parents must be careful not to focus too much on any one reading. Instead, the numbers should be viewed as a trend. Any measurement, taken out of context of the others, might give you the wrong impression of your child's growth. For example, a child's height measurement might place him at the 5th percentile, but this usually doesn't indicate a growth problem if his subsequent measurements continue to track along that percentile curve (as might be the case for a child who has inherited "short genes" from his parents). If the doctor and parents fixate on that one measurement, however, they might wrongly worry about the child's growth. When growth chart readings are examined over time, they reveal a pattern of development. That pattern lets you know how your child is growing in relation to other children his age and also shows you how he has progressed from previous measurements. This information is a much more useful indicator of whether a child is growing normally than any single

measurement.

Notes on percentiles:

Percentiles are the most commonly used clinical indicator to assess the size and growth patterns of individual children in the United States. Percentiles rank the position of an individual by indicating what percent of the reference population the individual would equal or exceed. For example, on the weight-for-age growth charts, a 2year-old girl whose weight is at the 25th percentile, weighs the same or more than 25 percent of the reference population of 5-year-old girls, and weighs less than 75 percent of the 2-year-old girls in the reference population.

Please keep in mind that your child's percentile doesn't really indicate how well they are growing. A child at the 5th percentile can be growing just as well as a child at the 95th percentile. It is more important to look at your child's growth over time. If you are concerned about your child's growth, talk with your Pediatrician.