Background/Aims: Measurements of children's size have (1) provided a biosensor of health and well-being in their environment; (2) provided references for clinical assessment, and (3) informed public health efforts to ameliorate living conditions. Size-for-age measurements offer no information about the growth trajectories by which children achieve size, and growth trajectories offer no information on proximal mechanisms underlying growth biology. Increasing attention to the biological processes themselves, only estimated by anthropometric parameters and statistically based growth proxies, is needed. Methods: A literature overview of human growth measurement interpretations. Results: Aspects of study design, analysis and reliance on common conventions contribute to limitations in growth biology knowledge. Examples include conflating both the concepts of size and growth and incremental gains in either weight or length as manifestations of growth; nonuniformity in the use of growth trajectory-derived clinical categories, and conventional approaches to data collection and analysis. Conclusions: Intensive studies of individuals hold promise for expanding normal growth biology knowledge. Focusing on growth (not merely size), length (not weight alone) and individual growth patterns (not growth chart phenotypes) are important tactics. Benefits include clarification of mechanisms by which nutrition and metabolism influence growth, new solutions to abnormal growth states and improvements in long-term health consequences.

Tanner JM: A History of the Study of Human Growth. New York, Cambridge University Press, 1981.
Tanner JM, Whitehouse RH, Takaishi M: Standards from birth to maturity for height, weight, height velocity, and weight velocity: British children, 1965. II. Arch Dis Child 1966;41:613-635.
Hamill PV, Drizd TA, Johnson CL, Reed RB, Roche AF, Moore WM: Physical growth: National Center for Health Statistics percentiles. Am J Clin Nutr 1979;32:607-629.
de Onis M, Garza C, Victora CG, Onyango AW, Frongillo EA, Martines J: The WHO Multicentre Growth Reference Study: planning, study design, and methodology. Food Nutr Bull 2004;25:S15-S26.
WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development. Geneva, World Health Organization, 2006.
Martorell R, Young MF: Patterns of stunting and wasting: potential explanatory factors. Adv Nutr 2012;3:227-233.
Tanner JM: Growth as a measure of the nutritional and hygienic status of a population. Horm Res 1992;38:106-115.
Steward DK, Pridham KF: Growth patterns of extremely low-birth-weight hospitalized preterm infants. J Obstet Gynecol Neonatal Nurs 2002;31:57-65.
Roberfroid D, Pelto GH, Kolsteren P: Plot and see! Maternal comprehension of growth charts worldwide. Trop Med Int Health 2007;12:1074-1086.
de Onis M, Wijnhoven TMA, Onyango AW: Worldwide practices in child growth monitoring. J Pediatr 2004;144:461-465.
Lampl M, Thompson AL: Growth chart curves do not describe individual growth biology. Am J Hum Biol 2007;19:643-653.
WHO Multicentre Growth Reference Study Group: Assessment of differences in linear growth among populations in the WHO Multicentre Growth Reference Study. Acta Paediatr Suppl 2006;450:56-65.
Lampl M: Limitation of growth chart curves in terms of individual growth biology; in Preedy VR (ed): Handbook of Growth and Growth Monitoring in Health and Disease. New York, Springer, 2012, vol 3, pp 3013-3029.
Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, Singh GM, Gutierrez HR, Lu Y, Bahalim AN, Farzadfar F, Riley LM, Ezzati M: National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011;377:557-567.
Hall BK: Bones and Cartilage: Developmental and Evolutionary Skeletal Biology. New York, Elsevier, 2005.
Nilsson O, Baron J: Fundamental limits on longitudinal bone growth: growth plate senescence and epiphyseal fusion. Trends Endocrinolol Metab 2004;15:370-374.
O'Connor JE, Bogue C, Spence LD, Last J: A method to establish the relationship between chronological age and stage of union from radiographic assessment of epiphyseal fusion at the knee: an Irish population study. J Anat 2008;212:198-209.
Eveleth P, Tanner J: Worldwide Variation in Human Growth. Cambridge, Cambridge University Press, 1990.
Lampl M, Johnston FE: Problems in the aging of skeletal juveniles: perspectives from maturation assessments of living children. Am J Phys Anthropol 1996;101:345-355.
Nilsson A, Marino R, De Luca F, Phillip M, Baron J: Endocrine regulation of the growth plate. Horm Res 2005;64:157-165.
Snodgrass JJ: Human energetics; in Stinson S, Bogin B, O'Rourke D (eds): Human Biology: An Evolutionary and Biocultural Perspective. New York, Wiley-Blackwell, 2012, pp 325-384.
Lobstein T, Baur L, Uauy R, IASO International Obesity Task Force: Obesity in children and young people: a crisis in public health. Obes Rev 2004;5:4-104.
Eisenmann JC, Heelan KA, Welk GJ: Assessing body composition among 3- to 8-year-old children: anthropometry, BIA, and DXA. Obes Res 2004;12:1633-1640.
Parker L, Reilly JJ, Slater C, Wells JCK, Pitsiladis Y: Validity of six field and laboratory methods for measurement of body composition in boys. Obes Res 2003;11:852-858.
Hawkes CP, Hourihane JO, Kenny LC, Irvine AD, Kiely M, Murray DM: Gender- and gestational age-specific body fat percentage at birth. Pediatrics 2011;128:e645-e651.
Travison TG, Chiu GR, McKinlay JB, Araujo AB: Accounting for racial/ethnic variation in bone mineral content and density: the competing influences of socioeconomic factors, body composition, health and lifestyle, and circulating androgens and estrogens. Osteoporos Int 2011;22:2645-2654.
Demerath EW, Sun SS, Rogers N, Lee M, Reed D, Choh AC, Couch W, Czerwinski SA, Chumlea WC, Siervogel RM, Towne B: Anatomical patterning of visceral adipose tissue: race, sex, and age variation. Obesity (Silver Spring) 2007;15:2984-2993.
Florey CduV: The use and interpretation of ponderal index and other weight-height ratios in epidemiological studies. J Chronic Dis 1970;23:93-103.
Yajnik CS, Fall CHD, Coyaji KJ, Hirve SS, Rao S, Barker DJP, Joglekar C, Kellingray S: Neonatal anthropometry: the thin-fat Indian baby. The Pune Maternal Nutrition Study. Int J Obes Relat Metab Disord 2003;27:173-180.
Baumgartner RN, Heymsfield SB, Roche AF: Human body composition and the epidemiology of chronic disease. Obes Res 1995;3:73-95.
Huang TTK, Johnson MS, Figueroa-Colon R, Dwyer JH, Goran MI: Growth of visceral fat, subcutaneous abdominal fat, and total body fat in children. Obes Res 2001;9:283-289.
Karsenty G, Oury F: The central regulation of bone mass, the first link between bone remodeling and energy metabolism. J Clin Endocrinol Metab 2010;95:4795-4801.
Renault V, Thorne L-E, Eriksson P-O, Butler-Browne G, Mouly V: Regenerative potential of human skeletal muscle during aging. Aging Cell 2002;1:132-139.
Lang T, Streeper T, Cawthon P, Baldwin K, Taaffe DR, Harris TB: Sarcopenia: etiology, clinical consequences, interventions, and assessment. Osteoporosis Int 2010;21:543-559.
Butte NF, Wong WW, Garza C: Energy cost of growth during infancy. Proc Nutr Soc 1989;48:303-312.
Butte NF: Energy requirements of infants. Public Health Nutr 2005;8:953-967.
Lewis DS, Coelho AM Jr, Jackson EM: Maternal weight and sire group, not caloric intake, influence adipocyte volume in infant female baboons. Pediatr Res 1991;30:534-540.
Wolf G: Gut microbiota: a factor in energy regulation. Nutr Rev 2006;64:47-50.
Tiraby C, Langin D: Conversion from white to brown adipocytes: a strategy for the control of fat mass? Trends Endocrinol Metab 2003;14:439-441.
Ibrahim MM: Subcutaneous and visceral adipose tissue: structural and functional differences. Obes Rev 2010;11:11-18.
Rosen ED, Spiegelman BM: Molecular regulation of adipogenesis. Annu Rev Cell Dev Biol 2000;16:145-171.
Barker DJP: Fetal origins of coronary heart disease. BMJ 1995;311:171-174.
Whincup PH, Kaye SJ, Owen CG, Huxley R, Cook DG, Anazawa S, Barrett-Connor E, Bhargava SK, Birgisdottir BSE, Carlsson S, et al: Birth weight and risk of type 2 diabetes: a systematic review. JAMA 2008;300:2886-2897.
Gluckman PD, Hanson MA, Cooper C, Thornburg KL: Effect of in utero and early-life conditions on adult health and disease. N Engl J Med 2008;359:61-73.
Levi S: The history of ultrasound in gynecology 1950-1980. Ultrasound Med Biol 1997;23:481-552.
Drooger JC, Troe JWM, Borsboom GJJM, Hofman A, Mackenbach JP, Moll HA, Snijders RJM, Verhulst FC, Witteman JCM, Steegers EAP, Joung IMA: Ethnic differences in prenatal growth and the association with maternal and fetal characteristics. Ultrasound Obstet Gynecol 2005;26:115-122.
Lampl M, Gotsch F, Kusanovic JP, Gomez R, Nien JK, Frongillo EA, Romero R: Sex differences in fetal growth responses to maternal height and weight. Am J Hum Biol 2010;22:431-443.
Lampl M, Lee W, Koo W, Frongillo EA, Barker DJ, Romero R: Ethnic differences in the accumulation of fat and lean mass in late gestation. Am J Hum Biol 2012;24:640-647.
Lampl M, Kuzawa CW, Jeanty P: Growth patterns of the heart and kidney suggest inter-organ collaboration in facultative fetal growth. Am J Hum Biol 2005;17:178-194.
Lampl M, Gotsch F, Kusanovic J, Espinoza J, Gonçalves L, Gomez R, Nien J, Frongillo E, Romero R: Downward percentile crossing as an indicator of an adverse prenatal environment. Ann Hum Biol 2008;35:462-474.
Lampl M, Kusanovic JP, Erez O, Gotsch F, Espinoza J, Goncalves L, Lee W, Gomez R, Nien JK, Frongillo EA, Romero R: Growth perturbations in a phenotype with rapid fetal growth preceding preterm labor and term birth. Am J Hum Biol 2009;21:782-792.
Lampl M, Kusanovic JP, Erez O, Espinoza J, Gotsch F, Goncalves L, Hassan S, Gomez R, Nien JK, Frongillo EA, Romero R: Early rapid growth, early birth: accelerated fetal growth and spontaneous late preterm birth. Am J Hum Biol 2009;21:141-150.
Lampl M, Kuzawa CW, Jeanty P: Prenatal smoke exposure alters growth in limb proportions and head shape in the midgestation human fetus. Am J Hum Biol 2003;15:533-546.
Lampl M, Kuzawa CW, Jeanty P: Infants thinner at birth exhibit smaller kidneys for their size in late gestation in a sample of fetuses with appropriate growth. Am J Hum Biol 2002;14:398-406.
Smith DW, Trugg W, Rogers JE, Greitzer LJ, Skinner AL, McCann JJ, Harvey MA: Shifting linear growth during infancy: illustration of genetic factors in growth from fetal life through infancy. J Pediatr 1976;89:225-230.
Taveras EM, Rifas-Shiman SL, Sherry B, Oken E, Haines J, Kleinman K, Rich-Edwards JW, Gillman MW: Crossing growth percentiles in infancy and risk of obesity in childhood. Arch Pediatr Adolesc Med 2011;165:993-998.
Prader A, Tanner JM, von Harnack GA: Catch-up growth following illness or starvation: an example of developmental canalization in man. J Pediatr 1963;62:646-659.
Albertsson-Wikland K, Karlberg J: Natural growth in children born small for gestational age with and without catch-up growth. Acta Paediatr Suppl 1994;399:64-70.
Ong KKL, Ahmed ML, Emmett PM, Preece MA, Dunger DB: Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. BMJ 2000;320:967-971.
Eriksson JG, Forsen T, Tuomilehto J, Winter PD, Osmond C, Barker DJP: Catch-up growth in childhood and death from coronary heart disease: longitudinal study. BMJ 1999;318:427.
Rabner M, Meurling J, Ahleberg C, Lorch SA: The impact of growth curve changes in assessing premature infant growth. J Perinatol 2014;34:49-53.
Nash A, Secker D, Corey M, Dunn M, O'Connor DL: Field testing of the 2006 World Health Organization growth charts from birth to 2 years: assessment of hospital undernutrition and overnutrition rates and the usefulness of BMI. JPEN J Parenter Enteral Nutr 2008;32:145-153.
Olsen EM: Failure to thrive: still a problem of definition. Clin Pediatr 2006;45:1-6.
Agency for Healthcare Research and Quality: Criteria for Determining Disability in Infants and Children Summary: Failure to Thrive. Evidence Report/Technology Assessment, No 72. Rockville, Agency for Healthcare Research and Quality, 2003.
Olsen EM, Petersen J, Skovgaard AM, Weile B, Jørgensen T, Wright CM: Failure to thrive: the prevalence and concurrence of anthropometric criteria in a general infant population. Arch Dis Child 2007;92:109-114.
Goldstein H: Multilevel Statistical Models, ed 4. Hoboken, Wiley, 2011.
Lampl M: Perspectives on modeling human growth: mathematical models and growth biology. Ann Hum Biol 2012;39:342-351.
Lampl M, Veldhuis JD, Johnson ML: Saltation and stasis: a model of human growth. Science 1992;258:801-803.
Lampl M, Johnson ML: Infant head circumference growth is saltatory and coupled to length growth. Early Hum Dev 2011;87:361-368.
Wood PA, Bove K, You S, Chambers A, Hrushesky WJM: Cancer growth and spread are saltatory and phase-locked to the reproductive cycle through mediators of angiogenesis. Mol Cancer Ther 2005;4:1065-1075.
Dirks MS, Butman JA, Kim HJ, Wu T, Morgan K, Tran AP, Lonser RR, Asthagiri AR: Long-term natural history of neurofibromatosis type 2-associated intracranial tumors. J Neurosurg 2012;117:109-117.
Lee NK, Sowa H, Hinoi E, Ferron M, Ahn JD, Confavreux C, et al: Endocrine regulation of energy metabolism by the skeleton. Cell 2007;130:456-469.
Lampl M, Thompson AL, Frongillo EA: Sex differences in the relationships among weight gain, subcutaneous skinfold tissue and saltatory length growth spurts in infancy. Pediatr Res 2005;58:1238-1242.
Lampl M, Johnson ML: Infant growth in length follows prolonged sleep and increased naps. Sleep 2011;34:641-650.
Tinetti ME, Fried TR, Boyd CM: Designing health care for the most common chronic condition - multimorbidity. JAMA 2012;307:2493-2494.
Freedman DS, Kettel Khan L, Serdula MK, Ogden CL, Dietz WH: Racial and ethnic differences in secular trends for childhood BMI, weight, and height. Obesity 2006;14:301-308.
Adair LS, Fall CH, Osmond C, Stein AD, Martorell R, Ramirez-Zea M, Sachdev HS, Dahly DL, Bas I, Norris SA, Micklesfield L, Hallal P, Victora CG; COHORTS Group: Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies. Lancet 2013;362:525-534.
WHO: Countdown to 2015: Building a Future for Women and Children: The 2012 Report. Washington, WHO & UNICEF, 2012.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.