Nutrition plays a major role in both the physical and intellectual development of children. Monitoring growth and development is a cornerstone of pediatric care. Healthy infants and children typically follow a predictable pattern of development, which allows growth to serve as a sensitive marker for health and nutritional status. Growth can be affected by a variety of conditions, and alterations in growth can be the first sign of a pathologic condition. Marked deviations from a normal growth pattern, particularly during early life, have also been associated with an increased risk of comorbidities later in life. Delayed growth in childhood has been associated with decreased adult height and altered body composition, including increased abdominal fat mass, in adulthood. Further, a substantial body of research has demonstrated that malnutrition can lead to abnormal brain development, including tissue damage, disordered differentiation of neural cells, reduction in synapses and synaptic neurotransmitters, and delayed myelination. These can lead to lasting cognitive impairment, affecting attention, visual, auditory, memory, and executive function, and interfering with a child’s school performance and potential for achievement.

Clinical evaluation of a child’s growth should focus on key historical features, as well as accurate measurement of all growth parameters. The history should include a thorough dietary history, weight, length, and head circumference at birth, prenatal history, past medical and family history, and a complete review of systems for evidence of systemic disease. Body weight, length or height, head circumference, and weight-for-length or body mass index (BMI)-for-age are easily measured or calculated and can be compared with population standards using growth charts (Appendix A). Pediatric growth can be divided into three periods: infancy, childhood, and adolescence.