Below Average Height? What Parents Need to Understand About Their Child’s Growth

Every parent in Singapore dreams of nurturing a child who exemplifies good health, strength, and excellence. When you notice your child is shorter than their classmates in school, it’s natural to feel concerned. But what exactly constitutes healthy growth for Singaporean children, and when should you consider consulting a pediatrician? Join us as we delve deeper into your child’s growth and development journey  

Understanding Your Child’s Normal Growth Patterns

Medical professionals use specialized growth charts to evaluate children’s physical development. These charts, developed by leading health organizations, help determine if a child’s growth falls within expected ranges for their age and gender.

Growth Milestones by Age Group

The World Health Organization (WHO) and Centers for Disease Control (CDC) have established growth charts that define healthy percentile ranges for children’s height and weight, taking into account both age and gender, as per the table below:

Age Group	Gender	Height (cm)	Weight (kg)	Notes
1 year	Male	71–79	8.9–11.8	Growth should typically range between the 5th and 95th percentiles during birth to 24 months
	Female	69–77	8.2–11.1
3 years	Male	91–100	12.7–16.8	Consistent growth within established percentiles indicates healthy development during toddler years (ages 2-5)
	Female	90–99	12.0–16.1
7 years	Male	115–128	18.2–26.2	Growth patterns diversify during elementary years (ages 5-12), but maintaining consistent percentiles remains important
	Female	114–127	17.5–25.6
15 years	Male	159–175	47.2–70.7	Puberty brings significant changes during teenage development (ages 12-18)
	Female	156–167	46.4–64.4

  If your child’s measurements fall below the 5th percentile on these growth charts, it’s advisable to consult with a pediatrician to determine if further evaluation is necessary.  

Identifying Growth Concerns

While variations in height are common, certain indicators deserve professional attention. Regular monitoring helps identify potential growth issues early.

Common Factors Affecting Height Development

There are several factors that can influence your child’s growth trajectory:

• Inherited Genetics: Family genetics play a significant role in determining height potential. Some children naturally develop more slowly due to inherited growth patterns or constitutional delay.^(1,2,3)-
• Dietary Considerations: Proper nutrition fundamentally affects growth. Selective eating habits may lead to crucial nutrient deficiencies, particularly in proteins, minerals, and vitamins essential for proper development. ^{(4, 5)}
• Lifestyle Influences: External factors such^{(9, 10, 11)} as
  • Quality of sleep
  • Physical activity levels
  • Environmental stressors
• Medical Conditions: Various health conditions can affect growth ^{(6, 7, 8)}, including
  • Thyroid dysfunction
  • Digestive disorders like celiac disease
  • Growth hormone insufficiency

  Parents can take several proactive steps to promote optimal growth:

1. Optimize Nutrition

Support your child’s development with nutritious meal choices that span all major food groups. Prioritize high-quality proteins, whole-grain products, colorful fruits and vegetables, and dairy foods. When dealing with picky eating habits, take a gentle approach by making new food introductions playful and pressure-free.

2. Transform Eating Habits

Picky eating habits that lead to inadequate nutrition, particularly a lack of protein, may require professional intervention from a pediatrician or dietitian to develop better eating strategies. Because protein provides crucial building blocks for muscle, bone, and tissue development, insufficient protein intake can impact your child’s growth trajectory. ^{(4, 5)} 

3. Promote Active Living

To promote growth hormone release and strengthen the musculoskeletal system, regular physical activity is key. Engaging in activities such as organized sports, swimming sessions, and bicycle riding can support active development. ^{(11, 12)} 

4. Prioritize Rest

Growth hormone is primarily released during sleep, making sufficient rest essential for your child’s growth and development. Younger children need about 10–12 hours of sleep per night, while older kids should aim for 8–10 hours. ^{(9, 10, 11)}

5. Regular Check-Ups

Regular pediatric check-ups are essential for tracking your child’s growth. If any concerns arise, the pediatrician may recommend a specialist for further assessment. 

6. Consider Nutritional Supplements

Consider nutritional supplements to address dietary gaps. When in doubt, consult professional advice and recommendations from a healthcare provider, such as a pediatrician or dietitian.

7. Foster Emotional Well-being

Encourage and support your child by celebrating their achievements and strengths, rather than placing emphasis solely on their height. This approach helps foster a positive self-image and promotes their overall well-being.  

When Should You See a Doctor?

Consider consulting a pediatrician if you observe any of these signs in your child:

• Measurements that significantly deviate from standard growth charts
• Not meeting expected developmental milestones on time
• Persistent tiredness without obvious cause
• Unexpected changes in weight

 

While each child grows at their own unique pace, creating the conditions for optimal development involves balanced nutrition, sufficient rest, regular physical activity, and routine medical check-ups.

Picky eating habits, especially those limiting protein intake, can affect growth. However, early professional intervention can effectively address these issues.

For guidance specific to your child’s growth and development, always seek personalized advice from healthcare professionals who can provide recommendations tailored to your child’s individual needs.

 

References

1. Aguilar D, Castano G. Constitutional Growth Delay. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK539780/
2. Mastromauro C, Chiarelli F. Novel Insights Into the Genetic Causes of Short Stature in Children. touchREV Endocrinol. 2022;18(1):49-57. doi:10.17925/EE.2022.18.1.49
3. Seattle Children’s. (n.d.). Short stature: Understanding causes and treatment options. Retrieved January 3, 2025, from https://www.seattlechildrens.org/healthcare-professionals/provider-news/short-stature/
4. Taylor CM, Northstone K, Wernimont SM, Emmett PM. Macro- and micronutrient intakes in picky eaters: a cause for concern?. Am J Clin Nutr. 2016;104(6):1647-1656. doi:10.3945/ajcn.116.137356
5. Endrinikapoulos A, Afifah DN, Mexitalia M, Andoyo R, Hatimah I, Nuryanto N. Study of the importance of protein needs for catch-up growth in Indonesian stunted children: a narrative review. SAGE Open Med. 2023;11:20503121231165562. Published 2023 Apr 17. doi:10.1177/20503121231165562
6. Almahmoud E, Alkazemi DUZ, Al-Qabandi W. Growth Stunting and Nutritional Deficiencies among Children and Adolescents with Celiac Disease in Kuwait: A Case–Control Study. Children. 2024; 11(9):1042. https://doi.org/10.3390/children11091042
7. Giovenale D, Meazza C, Cardinale GM, et al. The prevalence of growth hormone deficiency and celiac disease in short children. Clin Med Res. 2006;4(3):180-183. doi:10.3121/cmr.4.3.180
8. Cammisa I, Rigante D, Cipolla C. Growth Outcomes and Final Height in Children with Acquired Hypothyroidism: A Systematic Review. Children. 2024; 11(12):1510. https://doi.org/10.3390/children11121510
9. Hermes FN, Nunes EEM, Melo CM. Sleep, nutritional status and eating behavior in children: a review study. Rev Paul Pediatr. 2022;40:e2020479. Published 2022 Sep 9. doi:10.1590/1984-0462/2022/40/2020479IN 
10. Lampl, M., & Johnson, M. L. (2011). Infant growth in length follows prolonged sleep and increased naps. Sleep, 34(5), 641–650. https://doi.org/10.1093/sleep/34.5.641
11. Fonseca, A. P. L. M., de Azevedo, C. V. M., & Santos, R. M. R. (2021). Sleep and health-related physical fitness in children and adolescents: a systematic review. Sleep science (Sao Paulo, Brazil), 14(4), 357–365. https://doi.org/10.5935/1984-0063.20200125
12. Hanifah, L., Nasrulloh, N., & Sufyan, D. L. (2023). Sedentary Behavior and Lack of Physical Activity among Children in Indonesia. Children, 10(8), 1283. https://doi.org/10.3390/children10081283