Growth & Development Disorders

Growth is one of the most reliable signs of a child's overall health, and it is read as a trend instead of as a single number. Your child's measurements are plotted on a chart, and the useful information is the line they trace over months and years. A child who has always been on a lower centile and is growing steadily along it is usually a healthy small child. A child who was on a higher centile and is drifting downwards across the lines is the one who needs explaining.

There are many reasons a growth line can flatten. Not eating enough, or not absorbing what is eaten, is the commonest. Long-running illness of the gut, kidneys, heart or chest takes energy that would have gone into growing. Hormone problems, including an underactive thyroid, slow growth without necessarily causing other obvious symptoms. Some children are small because their parents are, and some are simply slow starters who grow later than their classmates and end up at a normal adult height.

Development runs on its own track, covering movement, hand skills, speech and understanding, and social behaviour. Children reach milestones across a range of ages, so the concern is not usually a single late milestone but a child who is behind across several areas, who has stopped making progress, or who has lost a skill they previously had. Puberty arriving unusually early or not arriving on time is assessed along the same lines.

The assessment begins with measurements taken properly and plotted against the earlier ones. Height is measured without shoes on a fixed stadiometer, weight on a calibrated scale, and head circumference in the younger years. Bring every previous record you have, including the immunisation card and school health checks, because an old measurement turns a single point into a line.

Your paediatrician measures both parents' heights to calculate the range your child would be expected to reach, then examines your child's body proportions, since some conditions affect the limbs and the trunk differently. The examination looks for signs of long-running illness: pallor, an enlarged abdomen, the state of the skin, hair and teeth, the thyroid in the neck, the heart and chest, and the stage of puberty where that is relevant.

For developmental concerns, your paediatrician observes your child directly at play, watches how they move, how they use their hands, how they respond to their name and to your voice, and how they communicate. Hearing and vision are checked early in any assessment of delayed speech, since a child who cannot hear cannot learn to talk. Expect detailed questions about the pregnancy, the delivery, the newborn period, family history and what your child's day actually looks like.

Growth is measured in months, and that sets the pace of everything. A growth rate cannot be calculated from two measurements taken close together, so your paediatrician will usually want four to six months between visits to know whether the line has changed direction. That interval is part of the assessment instead of a delay in it.

Where a cause is found and corrected, the response often shows as a period of faster growth in the following six to twelve months. Treating an underactive thyroid or a gut condition that was blocking absorption can produce a visible change on the chart within a year. Where hormone treatment is indicated, it is given daily over several years and reviewed at intervals throughout.

Developmental support works the same way. Speech therapy, physiotherapy and occupational therapy are measured in months of regular sessions, with most of the work happening at home between them. Progress is judged against your child's own starting point at each review.