With a newborn baby come visits to the pediatrician’s office and the use of growth charts to track length and weight. A local pediatric health professional broke down how to read a growth curve and what it can tell you about your child.
Charles Rinn, known to patients as Bo, is a pediatric nurse practitioner with Madison Irving Pediatrics in Syracuse. He cares for children from birth through age 21. Rinn earned his degree at SUNY Upstate Medical University and has been in practice for 15 years. He is married and lives in Baldwinsville with his wife and two children, Kate and Jacob, ages 8 and 11. (This interview has been edited and condensed.)
Family Times: What was your personal experience with growth charts?
Bo Rinn: When Jacob was a newborn he was born at just about 37 weeks and he was on the very bottom of the growth chart—at what we call the fifth percentile—and as he grew the next two months he ate more breast milk than any baby could ever possibly eat and he grew to the 95th percentile.
FT: When do newborns come in for well-child visits?
BR: We schedule visits for newborns at about 5 days of age, then about 2 weeks of age, and then at 1 month of age. After that the babies are seen according to the American Academy of Pediatrics guidelines for care.
FT: What happens when a newborn comes in for a well-child visit?
BR: The first part of the well-child visit is when the baby is triaged. The nurse does the vital signs that are appropriate for the child’s age. In a baby it’s usually their temperature, their heart rate and their respiratory rate. Another vital sign is weight, and length and head circumference. These measurements on a baby are a sign of health and how they’re growing.
FT: Is it difficult to record accurate lengths and weights?
BR: With some children, it can be. You sometimes have concerns with scales so we always have our scales checked. But when you have a fighting 18-month-old and they’re afraid to stand or sit on a scale and he’s thrashing when we’re trying to measure his height, it can be more difficult. That’s part of the art of medicine.
FT: What does this mean for the ability to record a child’s growth?
BR: A single point on a growth curve is really not that valuable; a growth curve is really best over time. And I think that goes back to what I was saying about my son. If he kept growing at the rate he was growing during the first two months of life, he would now be 10 feet tall and 400 pounds. But once he reached what was his optimal size, then he maintained that size.
FT: And what do the percentiles mean?
BR: It is averages of all types of people. If we went and found 100 kids who were all born on the same day and we put them all in one room, 50 percent of those kids would be in the middle of the height, weight and size category. And that means that 50 kids are not in the middle and those kids are going to be distributed higher and lower.
FT: What health problems can a growth chart help predict?
BR: I guess everything is related to the growth chart. A child’s growth is a major indicator of health.
FT: There have been stories in recent years about a baby’s “failure to thrive.” Can you explain what that means?
BR: Failure to thrive is when a child’s growth is significantly behind that expected as it’s seen on a growth curve. Failure to thrive can be a variety of factors. It can be a metabolic syndrome, illness, feeding issues and sometimes parental neglect.
FT: If a child is failing to thrive, what’s the next course of action?
BR: We want to look at their medical and dietary history. If their parent is providing them with all the nutrition that he needs, but he isn’t eating it, there’s a reason he isn’t eating it. If the baby is taking the right amount of food but he’s still not growing, there’s a reason he’s not absorbing the food. Our first rule is to figure out why he is not getting the nutrition that his body needs.
FT: So if the baby is not growing, what can parents do?
BR: First have a long discussion with a pediatric health care provider and find the cause. If it’s nutritional intake, then following the advice of the health care provider in regards to providing proper nutrition to her child.
FT: What factors go into how a child grows and develops?
BR: Well, of course, nutrition as we’re talking about, and having love and attention and being cared for in a warm home is a major part of a child’s development.
FT: Is a baby’s size connected at all to when he or she can sleep through the night without feeding?
BR: In one way, yes. If a baby around 4 months of age has not reached their predisposed weight, they will likely need additional calories in order to grow to that spot. In my son’s case he had to eat so many calories to get to that predisposed 95th percentile that he had to eat at night. The growth curve usually depicts a person’s genetic predisposition for size. When we do an interview with the parents, we will often get their weight and height in order to help us determine if a child is appropriate on the growth curve.