For Healthcare Professional use

Toddler Factsheet 3.1

GROWTH AND
ITS MEASUREMENT
www.infantandtoddlerforum.org
LEARNING POINTS
1 Measuring the growth of infants, toddlers and children is
an important part of child health surveillance. It can help
to detect overweight and underweight, short stature and
faltering growth. It can also provide reassurance about
normality.
2 Healthcare professionals should consider measuring the
weight and length/height of toddlers if they or the parents
have concerns about the toddlers health, feeding pattern,
size or growth.
3 Healthcare professionals should be competent at taking
accurate anthropometric measurements (weight, length/height
and head circumference) and plotting them on growth charts.
4 Healthcare professionals whose role involves growth
monitoring should be appropriately trained.
5 Measuring equipment requires regular calibration and
maintenance for accuracy.
6 The UK has adopted WHO growth charts for the age range two
weeks to four years based on measurements of normal healthy
infants and toddlers who were breastfed during infancy.
7 Growth charts currently recommended for use in the
UK are the UK-WHO and the UK90 growth charts. They
come in a variety of formats and can be ordered from
www.healthforallchildren.co.uk.

8 Normal healthy toddlers usually grow steadily along centile

lines or parallel to them. Weight and length/height will not
necessarily be on or close to the same centile lines.
9 Weight measurements are likely to vary more than length/
height measurements in relation to centile lines. Small ups
and downs in weight may be seen with short-term illnesses
that affect food intake.
10 Most cases of growth faltering are caused by inadequate food
intake, which can have a number of causes, but can usually be
dealt with in primary care settings.
11 To assess if a toddler is overweight or obese, his or her Body
Mass Index (BMI) should be calculated and plotted on a BMI
centile chart.
12 When referring toddlers with growth concerns to a paediatrician
it is good practice to include both biological parents height
measurements and a mid-parental height calculation.Growth comprises two dimensions
weight and
length/height. The body grows most rapidly during
the first six months of life healthy newborn infants
double their birth weight by four to five months and
triple it by a year. By the age of two years a healthy
toddler is approximately half his or her adult height.
Gains in both weight and length/height slow down
throughout the toddler years as shown in the table
alongside.
Average growth rates of infants and toddlers
Age Weight Gain
(kg/yr)
Height Gain
(cm/yr)

0-12 months 6.6 25

1-2 years 2.4 12
2-3 years 2 8
GROWTH AND ITS assessment
Growth, development and health are inextricably
linked. Measuring the growth of infants, toddlers
and children is an important part of child health
surveillance. It can help to detect overweight and
underweight, short stature and faltering growth.
It can also provide reassurance about normality.
The linear (length/height) growth of toddlers (defined
as children aged one to three years of age) is largely
under the control of growth hormone (secreted by the
pituitary gland) and thyroxine (from the thyroid gland).
Food also plays a critical role, particularly in weight
growth. Genes, inherited from each parent, mainly
determine length/height.
Adequate nutrition will ensure that normal healthy
toddlers maintain their genetically determined
growth rate.
Inadequate or inappropriate food intakes can cause
growth faltering and in severe cases malnutrition.
Excessive intakes of food, particularly energy-rich
foods, will lead to overweight or obesity.
EXPECTED RATES OF GROWTH
02
When assessing the growth of a toddler both
weight and length/height should be measured.
Measurements of weight and length/height at

intervals of about three and six months respectively

are needed to provide meaningful information about
growth rate. Measurements should be plotted on a
growth chart.
ASSESSING
THE GROWTH
OF TODDLERS03
What is a centile line?
Take 1,000 toddlers of the same age say two years and
three months arranged in a queue in order of their
height. If this queue is divided into 100 equal small
queues of 10 toddlers each, then each division between
these small queues is called a centile. The 2nd centile
separates the 20 shortest toddlers from the other 980
toddlers. The 75th centile separates the 750 shortest
toddlers from the other 250 toddlers. The 50th centile
represents the median height for the group and divides
the 500 shorter toddlers from the 500 taller ones.
Centile lines describe the distribution of growth
measurements for all ages. The charts have nine centile
lines the 0.4th, 2nd, 9th, 25th, 50th, 75th, 91st, 98th
and 99.6th centiles. Centile lines are also applied to
weight growth charts. Indeed the growth of any part
of the body, such as head circumference or mid upper
arm circumference, can also be described using centile
charts, which are constructed in the same way.
A growth chart is a visual representation of the
normal distribution of the weights and length/heights
of healthy normal children.

Two sets of growth charts are recommended for use

in the UK, depending upon the age and date of birth
of the child whose measurements are being plotted.
For children born before May 2009 the UK90 charts
are recommended. They were developed by the Child
Growth Foundation and are based on data obtained
from healthy, predominantly bottle-fed, Caucasian
children in the UK between 1978 and 1990.
New charts (UK-WHO growth charts), based on data
collected by the World Health Organisation and
formatted by the Royal College of Paediatrics and
Child Health, are now recommended for children
born from May 2009 onwards unless they are already
plotted on UK90 charts, in which case the existing
charts should be used.
The UK-WHO charts contain data from both the WHO,
for 2 weeks to 4 years, and from the UK, for birth data.
From 4 years of age onwards the UK90 charts should
continue to be used for all children.
WHAT IS A GROWTH CHART?
UK-WHO growth chart for girls 0-1 year
The UK-WHO charts are based on WHO data and are
a growth standard rather than a growth reference.
They represent optimal growth and are regarded
as the most appropriate standard against which to
measure the growth of all children, irrespective of
their ethnicity or how they are fed.
The main differences between the UK90 and UK-WHO
charts are:

1. UK-WHO charts have a separate preterm birth

section
2. UK-WHO charts cover 2 weeks to 4 years
3. UK-WHO charts have a disjunction at two years,
corresponding to a change in measurements from
supine length to standing height
4. The 0.4th and 2nd weight centiles at 4 years are
lower for UK-WHO than for UK90 - the 2nd UKWHO centile is only just above the 0.4th
centile on
the UK90 charts.
Specialist growth charts are available for certain
conditions in which patterns of growth differ from
normal e.g. Down Syndrome and Turner Syndrome.
head
length
weight
66cm
64
62
60
58
56
54
52
50
48
46
44cm
50cm
49

48
47
46
45
44
43
42
41
40
39
38
37
36
35
34
33
32
31cm
82cm
80
78
76
74
72
70
68
66
64
62

60
58cm
50cm
49
48
47
46
45
44
43
42
41
40cm
14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50
Age in weeks/ months
Age in weeks/ months
123
3
4
4
5
5
6
6
7
7
8
8
9

9
10
10
11
11
2 4 6 8 10 12 14 16 18 20 24 26 28 30 32 34 36 38 40 42 44 46 48 50 22
9 .6th
98th
91st
75th
50th
25th
9th
2nd
0.4th
99.6th
98th
91st
75th
50th
25th
9th
2nd
0.4th
9 .6th
98th
91st
75th
50th

25th
9th
2nd
0.4th
99.6th
98th
91st
75th
50th
25th
9th
2nd
0.4th
99.6th
98th
91st
75th
50th
25th
9th
2nd
0.4th
99.6th
98th
91st
75th
50th
25th
9th

2nd
0.4th 99.6th
98th
91st
75th
50th
25th
9th
2nd
0.4th
2nd
9th
25th
50th
75th
91st
98th
99.6th
0.4th
2nd
9th
0.4th
25th
50th
75th
91st
98th
99.6th
GIRLS

01 year
Some degree of weight
loss is common after birth.
Calculating the percentage
weight loss is a useful way
to identify babies who
need assessment.
52
52
14kg
13.5
13
12.5
12
11.5
11
10.5
10
9.5
9
8.5
8
7.5
7
6.5
6
5.5
5
4.5

4
3.5
3
2.5
2
1.5
1
0.5kg
0
11kg
10.5
10
9.5
9
8.5
8
7.5
7
6.5
6
5.5
5
4.5
4
3.5
3
2.5
2
1.5

1
0.5kg
Obtaining growth charts
Growth charts are included in the Personal Child
Health Record but can be obtained in a number
of other formats from:
www.healthforallchildren.co.uk
Three growth charts are used most commonly:
one for weight, one for length/height and one for
head circumference. There are separate growth
charts for boys and girls. BMI charts are also
available from the same website.27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10

9
8
7
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
BOY'S WEIGHT (kg)
1 - 5yrs
years
(monthly divisions)
years

(monthly divisions)
1
1
/2 2 2
1
/2 3 3
1
/2 4 4
1
/2
1
1
/2 2 2
1
/2 3 3
1
/2 4 4
1
/2
1/6991 NOITADNUOF HTWORG DLIHC
99.6th
98th
91st
75th
50th
25th
9th
2nd
0.4th

04
The weights and length/heights of most toddlers who
are growing and developing normally will be on or
between the 2nd and 98th centiles. As toddlers get
older and subsequent measurements of length/height
and weight are plotted, measurements are expected
to remain fairly close to the same centile. This is
called growing along a centile. In general, weight will
vary more around a centile line than does length/
height. Food intake can affect weight, but not length/
height except in prolonged malnutrition. Emotional
deprivation and some rare diseases can affect both
weight and length/height growth.
Toddlers will not necessarily be on the same centile
line for both length/height and weight.
The weights and length/heights of some toddlers will
lie on roughly the same corresponding centiles, while
others will have their height close to one centile line
and their weight near another centile line. For example
the length/height of a tall slim toddler might be on
the 91st centile and his weight on the 50th centile.
A toddler whose length/height is on the 25th centile
and weight on the 75th centile will be shorter and
chubbier than average. These differing builds of
normal healthy toddlers are partly determined by
their genetic makeup, as well as their diet.
Plotting measurements of weight and height on a
growth centile chart enables comparison of a toddlers
growth with expected growth, or with a reference

population of normal healthy children.

HOW ARE TODDLERS EXPECTED TO GROW?
130
125
120
115
110
105
100
95
90
85
80
75
70
65
130
125
120
115
110
105
100
95
90
85
80
75
70

65
BOY'S HEIGHT (cm)
1 - 5yrs
years
(monthly divisions)
years
(monthly divisions)
1
1
/2 2 2
1
/2 3 3
1
/2 4 4
1
/2
1
1
/2 2 2
1
/2 3 3
1
/2 4 4
1
/2
1/6991 NOITADNUOF HTWORG DLIHC
99.6th
98th
91st

75th
50th
25th
9th
2nd
0.4th
Growth charts illustrating a tall, slim, boy toddler05
Weight
Weight measurements during infancy should be taken
at birth, then at clinic attendances for immunisations
at two, three and four months, and in addition at eight
months
3
. Weight may be measured more frequently
if there are concerns about health and development,
but not more often than fortnightly
4
.
Toddlers should be measured next when they attend
for their immunisations at about 13 months but
thereafter not usually until school entry, unless there
are concerns.
Length/height
There has been no research to support the routine
measurement of length in the first two years of
life. However routine length measurements are
recommended for all toddlers who are very small
for gestational age at birth or have dysmorphic
features

4
. This is usually carried out during clinical and
developmental assessments.
Head circumference
Head circumference should be measured at birth
and at six to eight weeks. If there is a crossing of
centiles upward or downward or signs suggestive
of hydrocephalus or microcephaly then two further
measurements over a four-week period should be carried
out. Obviously if there are concerns about a toddlers
development then measuring head circumference
should be part of a full neurological examination.
WHEN TO MEASURE
Weight Length/Height Head circumference
Infants and toddlers
born at term
At birth, 5 and 10 days and at
2, 3, 4, 8 & 13 months
Additional weights may be
taken if there are health
concerns or parents request
reassurance however weight
should not be measured
more frequently than
fortnightly during infancy
When there are health
concerns or parents
request reassurance
At birth and 6-8 week

examination
Infants and toddlers

born

small for

gestational

age

birth

at

preterm,

or

noted to

be

with

very

dysmorphic

features

with health problems

At birth, 5 and 10 days

and at attendance for
immunisations and clinical
assessments
At birth, at 6-8 weeks
and when there are
specific indications or
parental concerns
At birth and 6-8 week
check and as part
of examinations for
hydrocephalus or
microcephaly
Toddlers with
developmental concerns
At clinical assessments At clinical assessments As part of neurological
examination
Summary chart of different measures and when it is recommended they be done
3,4
The Child Growth Foundation recommends measurements of weight and height also at two
and three years of age, and head circumference

10-14 days after birth

5
.
During the preschool years parents may seek reassurance that their toddler is growing
well and growth measurements
can be taken for this purpose. Healthcare professionals should consider measuring the
weight and length/height of
toddlers if they or the parents have any concerns about a toddlers health, feeding
pattern, size or growth
4
.Up until their second birthday, toddlers should be
weighed nude, without a nappy. Over this age they
should be weighed in light underwear without shoes
and socks. They should be weighed to the nearest
10g (1/100th of kg).
Toddlers who are unsettled or distracted can be held
by a parent and both weighed together. The parents
weight is then taken separately and subtracted from
the total weight. Alternatively the parent sits on the
scales, which are zeroed. The parent, while still on the
scales, holds the child and both are weighed together,
so the scales show the weight of the child only.
Equipment and calibration
Digital electronic scales that conform to European
regulations should be used. Measurements should be
made in kilograms (kg) and grams (g). Infant scales can
be used for toddlers of up to 10kg. Toddlers over 10kg
should be weighed on sitting or standing scales.
Scales should be checked daily to ensure they are
accurate by weighing a known weight, such as a bag

of pasta. It is the responsibility of the person using the

scales to make sure they are maintained and calibrated.
If many people use them then one person should be
responsible for calibration. Scales should be carefully
calibrated at least once a year
3,6
. The companies that sell
scales offer service agreements to do this. Care should
be taken when children are weighed in different settings
such as, at home, at the GP surgery or at a clinic, as
calibration may vary.
06
HOW TO MEASURE BODY WEIGHT
Sitting scales
Toddlers under two years
Up until a toddlers second birthday, length is
measured lying down and after that standing height
should be measured. The length of the toddler
should be measured without any clothing, including
the nappy, which can distort the hips and shorten
the length measurement. Two people are needed to
obtain an accurate length measurement. The toddler
should lie on his or her back with one person (ideally a
parent) holding the head against the headboard with
both hands. The corner of the toddlers eye should be
in a vertical line with the middle of the ear (known as
the Frankfort Plane). The second person should gently
flatten the knees and flex the ankles of the toddler
to 90 degrees and bring the footboard up to the flat

soles of the flexed feet. The length measurement is

then read off the scale, to the nearest
1
/2
cm.
Readings in a specialised unit by experienced staff
may be taken to the nearest millimetre
4
.
Equipment and calibration
A rollameter or a Holtain lying stadiometer is usually
used. Most equipment is either self calibrating or
comes with a one-metre standard measure with
which to calibrate before use.
European regulations state that scales should be
digital, electronic, metric weigh in kilograms
(kg) and grams (g) and self-zeroing
6
.
HOW TO MEASURE LENGTH/HEIGHT
Stadiometer for measuring length
Infant scalesHead circumference
should be measured
three times, to the nearest
millimetre, and the
average circumference
taken. The tape is placed
around the middle of
the forehead to make sure that it encircles the widest

diameter around the frontal and occipital bones.

Equipment
A non-stretch tape measure should be used, such as a
Lasso-o
TM
Child Growth Foundation tape, which needs
to be threaded.
07
Toddlers over two years
The toddler should be wearing light underwear, without
socks and shoes. He or she should stand upright with
heels, buttocks and shoulders touching the stadiometer
and look straight ahead with the corner of the eyes
horizontal with the middle of the ear. To maximise the
height, the head should be lifted slightly by placing
fingers below the toddlers jaw just below the ears at
the mastoid process.
Equipment and calibration
A Leicester Height Measure, a stadiometer with the
scale fixed to the footplate, is the ideal equipment
because when installed correctly, it is self-calibrating.
A stadiometer fixed to the wall must be installed
appropriately to be accurate and should always be
calibrated with a rule before use
4
.
Standing stadiometer
1. First calculate the age of the toddler and mark it
on the horizontal axis of the growth chart. Correct

the age of toddlers born prematurely.

2. Find the length/height or weight on the vertical
axis of the growth chart.
3. Put a dot on the chart to mark where a vertical
line from the age axis and a horizontal line from
the weight/length/height axis intersect. Do not
use a cross or a dot with a circle around it because
these symbols are difficult to read when plotted
closely together.
PLOTTING MEASUREMENTS
ON GROWTH CHARTS
Correcting the age of toddlers
born prematurely
It is important to correct for prematurity in the first
two years of life. A toddler under two years of age,
born at 31 weeks gestation, for instance, was born
nine weeks early (40 31 = 9 weeks). This childs
corrected age will always be nine weeks less than
his or her actual age since birth. When calculating
the corrected age, subtract nine weeks from the
actual age since birth date. For example, when the
child is one year and 26 weeks old the corrected age
will be one year and 17 weeks (26 9 = 17 weeks).
Mark the corrected age on the age axis of the chart.
HOW TO MEASURE HEAD CIRCUMFERENCE
Head circumference measurement using Lasso-o
TM
tape
frontal bone occiput08

Interpreting plots on growth charts

Single plots of weight will indicate where a child is

in relation to the general population, i.e. heavier or
lighter than average. Similarly for height, a single plot
will indicate if a toddler is of average height or taller or
shorter than average.
Measurements of both weights and heights should
both be considered when interpreting either. Plots
between the 2nd and 98th centiles are generally
regarded as normal. Plots outside this range should
be considered carefully.
A toddler with a length or height below the 0.4th
centile should be referred to a paediatrician for
investigation of short stature
4.Mid-parental height should be calculated if the
toddlers height growth appears out of step with the
adult heights of his or her biological parents. The
results should be discussed with a GP or paediatrician
to consider whether the child should be investigated
4.Toddlers who have length or height measurements
between the 0.4th and 2nd centiles or between the
98th and 99.6th centiles should be measured again
in three months time to check that they are growing
parallel to the centile lines. If so their growth should
be considered normal.
If the weight is more than two centile lines above the
centile for height then BMI should be calculated to
check for overweight or obesity (see below).

Mid-parental height can be calculated by

obtaining the heights (in cm) of both parents.
These are added together and divided by two.
Then for boys 7cm is added to, and for girls 7cm
is subtracted from, this figure to give the midparental height. Mid-parental centile and
range
can then be determined.
Interpreting growth with two or more plots
of length/height and weight
It is more important to know whether a child is
following a centile line than to simply know what his or
her weight or length/height is at a single point in time.
Two plots taken at different ages give a measure of a
childs rate and pattern of growth. While changes in
weight centiles can be attributed to short-term health
problems, such as a bout of gastroenteritis, changes in
height growth can indicate longer-term concerns.
Factors to consider when interpreting
the pattern of growth
Measurement error: when a toddler crosses
centiles, first check that both weight and
length/height measurements are correct many
instances of growth concern arise from a gross
error of measurement for instance the scales are
not accurate or are incorrectly calibrated.
Toddlers genetic potential: A toddler with short
parents is also likely to be short, but a child who is
short and has very tall parents may not be achieving
his or her appropriate genetically expected height.
Weight and height are both on low centiles:

A toddler who follows the lower centiles of the

chart for both weight and length/height, and who
has always followed these centile lines, is likely to be
growing appropriately both weight and length/
height are proportional. Because the centile lines
describe the growth of the normal population, there
will always be some toddlers whose weights and
length/heights lie around the lower centiles and,
similarly, some toddlers whose weights and length/
heights lie around the upper centiles. Parents may
need reassurance that their short toddler is growing
as expected. As discussed above, there will be a few
toddlers who have short stature height/length
<0.4th centile. In some cases this will be normal
for that toddler, but in other toddlers it may be
due to an underlying medical condition (growth
hormone deficiency for instance). All toddlers with
length/height <0.4th centile should be referred
to a paediatrician for investigation.
Single plots of weight, height or length
Example of a mid-parental height calculation for a girl
175
170
165
160
155
150
(h)
2nd

9th
25th
50th
75th
91st
98th
Range
Mothers Height (MH) 156cm
Fathers Height (FH) 186cm
MPH = (MH + FH)
- 7cm
2
MPH = (156 + 186)
- 7cm
2
MPH = 164cm (50th)
Range = 164 8.5cm
In boys MPH = (MH + FH)
+ 7cm

2
(+/- 10cm for range)
Mid-parental height (MPH) - girls Weight measurement is on a much lower centile
than length/height measurement: Some children
are thin compared to others of their age, but if they
have always been thin, and their height continues
to follow the usual centile line for that child, then
it is unlikely that there is a problem. However a
toddler whose weight crosses centiles downwards

over time has growth faltering and may be failing

to thrive. There are a number of possible causes of
this growth pattern, which include insufficient food
intake, certain diseases, and other social, domestic
and environmental problems.

see Factsheet 3.2

Weight centile is more than two centile lines
above that of the length/height centile OR the
weight has crossed centile lines upwards:
A toddler with either of these growth patterns
may be overweight or obese or becoming so. This
should be assessed by calculating the BMI and
plotting it on a BMI centile chart. There is one for
boys and one for girls. A BMI over the 91st centile
indicates overweight, and above the 98th centile is
defined as obesity.

see Factsheet 3.3

09
Growth charts simply describe the rates and
patterns of growth of normal healthy children.
The plots on them can raise concerns about
growth, health and development, and they can
suggest causes of impaired growth, but they are
not diagnostic.
Factsheet 3.2 discusses the diagnosis and
treatment of undernutrition, failure to thrive and
growth faltering.

Factsheet 3.3 discusses the identification and

management of overweight and obesity.
Open Book On Growth
An interactive, web-based, learning programme
designed to teach the principles and practice
of growth assessment, including how to
measure accurately, use equipment, plot
measurements on growth charts, interpret
them and take appropriate action.
See www.infantandtoddlerforum.org.
References and Further Reading
1. WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards based
on length/height, weight and age. Acta Pdiatrica 2006;Suppl 450:76-85.
2. 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, Switzerland: World Health Organization, 2006.
3. NICE. Maternal and Child
o=MaternalandChildNutritionMain

Nutrition

(In

Press)

www.nice.org.uk/page.aspx?

4. Hall D, Elliman D. (eds). Health for all children, 4th edition. Oxford University Press,
Oxford. 2003
5. Child Growth Foundation. www.childgrowthfoundation.org
6. Council Directive 90/384/EEC on the harmonization of the laws of the Member States
relating to non-automatic weighing instruments. 20 June 1990.
7. Cole TJ, Flegal KM, Nicholls D, Jackson AA. Body mass index cut offs to define thinness
in children and adolescents: international survey. BMJ. 2007; 335:194.
Example of a girls BMI centile chart
BMI is defined as weight in kilograms divided by
height in meters squared (BMI=Wt/(Ht)
2
). A toddler
with a BMI below the 2nd centile is classified as very
thin

7
. The cause should be considered. The lower thick
black line defines the boundary between normality
and overweight, and the upper black line defines the
boundary between overweight and obesity, according
to the International Obesity Task Force.
Additional
copies
of
this
www.infantandtoddlerforum.org

Factsheet

can

be

downloaded

from

The information contained within this Factsheet represents the independent views of the
members of the Forum and copyright rests with the Forum members.
Growth charts reproduced with the permission of the Child Growth Foundation. Supplies
and further information from www.healthforallchildren.co.uk.
BMI CENTILE CHARTS
Body Mass Index (BMI) is the WHO agreed measure of
thinness and fatness although it is not a measure of
body fat.Page suitable for photocopying for healthcare professionals to give to parents
GROWTH AND ITS MeasureMENT
GUIDANCE & TIPS FOR PARENTS
Growth measurements can help to monitor
your childs health and development and
reassure you that your child is growing
normally. They can also identify:
toddlers who are likely to become
overweight or underweight
toddlers who are growing too slowly
toddlers who are very short or very tall
and who may have a health problem
Toddlers grow more slowly than they did in
their first year.
On average toddlers gain about 2.5kg

(5 pounds) and grow about 12cm (4

inches) in length between their first
and second birthdays.
On average toddlers gain about 2kg
(4 pounds) and grow about 8cm (3
inches) in height between their second
and third birthdays.
If you have no concerns about your
toddlers health or development then
there is no need for them to be weighed
and measured except at clinical or
developmental assessments. However
if you do have worries then ask your
health visitor to carry out measurements.
These will be plotted on a growth chart
to determine if your childs growth is as
expected for his or her age.
Children of tall parents tend to be taller
than children of the same age whose
parents are short.
Toddlers under two years old should be
weighed and measured with no clothes,
nappy or shoes and socks on. They will
have their length measured while lying
down. You may be asked to hold your
toddlers head while his or her length is
being measured.
Toddlers over two years old will be
measured in light underwear with no shoes

or socks on. They will have their height

measured when standing up.
At least two consecutive measurements
of weight and length/height over time
are needed to give a picture of a toddlers
growth rate.
If your child is growing normally then his or
her weight or height will steadily rise along,
or be parallel to, the centile lines marked on
the growth chart.
Your toddlers weight and length/height will
not necessarily be on the same centile.
Toddlers whose length or height is below
the 0.4th centile or drops from a higher to
a lower centile may have a health problem.
This may require referral to a paediatrician
for assessment.
Toddlers on a much higher centile for weight
than height may be overweight or obese.
This can be checked on a BMI centile chart.
The head circumference of toddlers is
usually only measured when there are
concerns about their development.