Is my baby growing according to the rules - and is it gaining height and weight accordingly? Especially with a first-born child, parents are sometimes unsure whether everything is in order. This makes it all the more important that they are supported by their midwife at least during the mother's postnatal period (and beyond if necessary) and also have a paediatric practice they trust at their side.
I still remember Sabine well, who I looked after with her little Lea during her postnatal period. She and the baby were doing very well, the little one was developing like a textbook. So I was amazed when the very petite mum called me again a few months later and told me, rather unsettled, that she was worried about her little daughter. When I asked her what had happened, Mrs Sabine burst out: "At every check-up, the paediatrician criticises the fact that Lea's weight is very low. But my little one is a delicate little person - and yet wide awake, lively and curious! At seven months old, she is even crawling around the house and eating with a good appetite. Breastfeeding is still going well and she also likes her complementary food. I told the doctor all this, but somehow it went unheard. He just said that we had to keep a very, very close eye on her weight and always frowned. What am I doing wrong?"
I asked Sabine to give me some values from Lea's yellow Child examination booklet to name a few. I looked at the weight and length development over the last few months. After that I was able to reassure the mother. If a child is developing well overall and the weight values show a continuous upward curve and, as in Lea's case, are still within the normal range, there is rarely any cause for concern, even with small, lightweight children. If in doubt, parents can also seek a second opinion from another paediatric practice.
To be honest, I don't think it's very helpful for parents to be so unsettled in the way Sabine has described. From my point of view, it would be better to explain to them in detail in such cases why each It is important to carefully observe your baby's weight and height development, especially in the first two years of life. This can also provide clues as to whether there are any irregularities or indications of a possible illness.
For this reason, the measurement results for your child's height growth and weight gain, for example, are recorded in the "Yellow booklet" entered in diagrams. If this is done regularly, several of your child's development curves will emerge over time. In order to be able to better judge whether everything is in order, these individual curves are compared with those that have been determined for other children.
In the following, I would like to take a closer look at kilograms, centimetres, curves in diagrams and comparative values and explain what they are all about.
What does "percentile curve" mean?
On the back pages of the "Yellow Booklet" you will find diagrams in which various curves have already been drawn. They show the percentage distribution of how children in Germany develop in comparison to their peers, e.g. in terms of height growth or weight gain. These curves are growth curves of the normal population and are also called "percentile curves".
In Germany, we know how the weight and height growth of children develops at different ages. These values have been researched by the Robert Koch Institute in the "Study on the Health of Children and Adolescents" (KiGGS) over a very long period of time on a large number of children. These known average, standard and limit values are shown in the same percentile curves in the diagrams in the yellow booklet.
The measured values that your paediatrician determines for your child during the recurring check-ups (U-examination) are now also regularly entered here. Over the course of several entries, your child's personalised percentile curves will emerge. Both each individual curve and their comparison with each other and with the existing percentile curves provide the doctor with meaningful information about your child's individual development. This makes it easy to recognise whether everything is in the "green zone".
There are percentile curves
- for the Head circumference and
- separately for boys and girls for body length (in centimetres), body weight (in kilograms) and BMI (body mass index, which indicates the percentage of body fat).
Examples of weight and size curves
The diagrams in the yellow examination booklet also show some percentile curves as a guideline for the development of height and weight. The letter P stands for percentile and the following number indicates the percentage.
Let's take as an example the three most important percentile curves P3, P50 and P97, which are already given in the weight and height charts for boys and girls respectively.
The P3 curve marks the lowest limit of the standard range. If your child's weight or height were at the 3rd percentile (P3), this would mean that only 3 per cent of children of the same age (i.e. 3 out of 100 children) are even lighter or smaller than your child - and 97 per cent are heavier or taller.
The P50 curve shows the exact mean value (median) in the normal range. If your child's weight or height values are at the 50th percentile, you know: Exactly half (namely 50 per cent) of all children of the same age are lighter or smaller than your baby - and the other half are heavier or taller. So with P50, your child is exactly in the centre of the normal range.
The P97 curve in turn shows the upper limit of the normal range. This curve is the opposite of P3. If your child's weight or height values were at the 97th percentile, you can read from this: The vast majority of all children of the same age - namely 97 per cent - are lighter or shorter than your child, and only three per cent are heavier or taller than your child.
What is normal height and weight?
The vast majority of children therefore fall somewhere between the P3 and P97 curve in terms of length growth and weight development. This can also be P60 (= 60 per cent of children are lighter or shorter than your child and 40 per cent weigh more or are taller) or P25 (= 25 per cent of children are lighter or shorter than your child and 75 per cent are heavier or taller) or P40 and so on.
Every child has its "own" percentile curves, as its height and weight development also depends on its genetic make-up. If a child's parents are rather short, their baby may not be a "long lanky" - unless it takes after its grandfather, who measures a proud 1.92 metres ...
The personal percentile curves of a child's height and weight development can also differ slightly, e.g. P45 for weight and P55 for height growth. In some cases, these curves also differ significantly. Example: When comparing height, a child corresponds to the 45th percentile (= 45 per cent of their peers are shorter than the child in question and 55 per cent taller) - and when comparing weight, they are at the 85th percentile (= 85 per cent of their peers are lighter than the child in question and 15 per cent heavier).
The most important thing is: A child's individual growth or weight curve should always be between P3 and P97 and also run parallel to the predetermined P50 curve - regardless of whether it is below or above this.
What is noticeable in the development of height and weight?
If a child's curve approaches the 3rd percentile (i.e. only 3 per cent of children are lighter or smaller than this child) or the 97th percentile (i.e. only 3 per cent of children are heavier or taller than this child), some paediatricians become concerned. This was the case for Mrs S. - her Lea was continuously just above the P5 curve in terms of body weight. And yet everything was fine with her.
For example, if a child's length growth is under the value of the 3rd percentile, it belongs to the 3 per cent of the smallest in its age group and is considered to be of short stature. Conversely, it can also be about are above the 97th percentile. They are then taller than 97 per cent of all people of the same age and are considered tall.
Both deviations from the growth of the normal population are categorised as growth disorders. The paediatrician will then discuss this in detail with the parents and, if necessary, arrange various further examinations or treatments.
It can also be conspicuous if a child is continuously moving at a certain percentile or at least close to it - and suddenly leaves this developmental trajectory. Then their personal percentile curve no longer runs parallel to the specified P50, but changes significantly in comparison. Example: A child "starts" at P75, but their curve then stops rising and finally drops to P3. In such a case, a doctor will look for possible causes. This also applies to a reverse progression - i.e. if a child tends to develop in the lower range of the percentiles and suddenly leaves its curve upwards, e.g. suddenly grows from P25 to P85.
2 responses
Hello, my child was born with 3,450 g, at 3 months he slipped just below P3. He will soon be 10 months and we are at P49. Do I need to worry? In the worst case scenario, what could be the reason for this?