Growth refers to the various physical and developmental milestones that most children reach during each age level. This includes increases in height and weight as well as development in cognitive, (cognitive skills include knowing how to perceive, think, recognize, and remember), language, and social skills. Hair grows; teeth come in, come out, and come in again; and eventually puberty (sexual development) starts. It's all part of the growth process.

There are many factors that influence a child’s growth, including their

• genetic potential (how tall their parents and other family members are)
• hormones such as the thyroid hormone, Growth hormone, Cortisol and sex hormones (estrogens in girls and testosterone in boys)
• underlying medical problems (such as congenital heart disease, Down syndrome, etc),
• overall nutritional status and
• environmental factors.

No child grows at a perfectly steady rate throughout this period of childhood, however. Weeks or months of slightly slower growth alternate with mini "growth spurts" in normal children. A normal child can have up to 60 days of no growth.

Around age 11 years in girls and 11.5 years in boys, children enter puberty. Puberty is the onset of sexual development, which includes the appearance of pubic and underarm hair, the growth and development of sex organs, and in girls, the onset of menstruation. This process continues for about 2 to 5 years.

A major growth spurt occurs at the time of puberty. Girls gain about 20 cms and boys gain about 25cms during this growth spurt.

Growth slows down after menstruation in girls and they may gain upto 3-9cms.
By the time girls reach age 15 and boys reach age 16 or 17, the growth associated with puberty will have ended for most teens and they will have reached physical maturity.
As the child grows, the skeletal maturity also increases. The growth plates fuse and growth of the child stops. Finally In certain situations where the skeletal maturity is delayed children may continue to grow till a later age.

When to suspect a growth problem in your child?

A growth problem is suspected

• If your baby is abnormally small at birth
• If your child’s height is below the lower limit of normal on a growth chart
• If the child’s height-gain is less than 4cms per year from the age of 6 years till onset of puberty and less than 6-7cms/year during puberty.
• If the child is crossing percentiles on the growth chart in the downward direction,
  it means that your child may not be growing normally and needs to be evaluated.

If your child’s height has never been measured, a growth problem may be suspected if:

• Your child is one of the shortest in his/her class
• Your child’s growth over a year has been insignificant
• The child is not outgrowing his/her clothes
• His/her shoe size is not changed for a long time

Importance of early identification of growth disorders

Early identification and intervention for growth disorders is very important. The earlier the problem is caught, better the results of treatment. Waiting for puberty may cause unnecessary delay and it may be too late to intervene.

The best way of identifying a growth problem is by regular measurement of height. Your child’s pediatrician or family physician can do this easily. The same person should preferably measure height with the same measuring device.

In summary, if your child’s height is significant shorter than his (her) peers and his genetic potential, it is worthy to have your child evaluated by his medical doctor in order to rule out some conditions which might be easily corrected.