Children Pediatric Growth Charts and Eating Disorders

How Child's Growth Charts Could Help Prevent an Eating Disorder

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Hopefully, at every well visit, your pediatrician documents your child’s growth on the CDC growth chart, which plots height, weight, and body mass index (BMI) against age-based averages. Why? Because the CDC growth chart is one of the best tools for early identification of eating disorders (and other problems).

Body Mass Index (BMI) is a dated, biased measure that doesn’t account for several factors, such as body composition, ethnicity, race, gender, and age. Despite being a flawed measure, BMI is widely used today in the medical community because it is an inexpensive and quick method for analyzing potential health status and outcomes.

Eating disorders most often begin during adolescence, and they can become severe quickly. Research shows that early intervention improves the chance for a full recovery.

Unfortunately, most pediatricians are not trained in the early detection of eating disorders. Furthermore, in the face of the current societal focus on obesity, doctors may be more sensitized to a patient's weight being over versus under what is expected and miss signs of restrictive eating disorders including anorexia nervosa. So parental vigilance can make a big difference. 

Contrary to what commercial diet companies promise and what the war on fat implies, not every individual is meant to be the average weight for their age and height.

Body weight and height are largely genetically determined. Consider foot size, where there is a normal distribution. While the average woman today has an 8 ½ shoe size, most do not — some will be size 5 and others will be size 10. And so it is with body weight. Not everyone is predestined to have a body weight in the 50thpercentile — some will be heavier and some lighter.

Checking a Child's Growth for Problems Throughout the Years

During the first year of life, the curve along which a child grows to a significant degree reflects environmental factors for the baby as well as in the mother during pregnancy.

By around the second year of life, a child starts to grow along a trend line that more accurately reflects his or her unique genetic growth potential. In healthy children height and weight each increase along a fairly constant growth curve. However, some children grow steadily along with the 25th percentile while other children grow steadily along with the 50th percentile and still others along with the 95th percentile.

Their height and weight percentages may be similar or different. This may all be normal for that child.

Annual measurement is recommended so there’s adequate information to determine whether a child is falling off a growth trajectory in a dangerous way. This is one of the reasons for yearly pediatric appointments. If you change pediatricians, it is a good idea to have the growth records transferred so that a complete record is maintained. 

Of note, many children and adolescents who develop anorexia nervosa do not experience actual weight loss. However, they are usually supposed to be growing at this age — it is common for children to gain 30 pounds as they go through puberty.

Failure to gain weight can be a sign of malnutrition and as dangerous as actual weight loss. Malnutrition during puberty can lead to weak bones and permanently stunted height. Failure to gain weight in a growing child should be a cause for concern. It can mean an eating disorder or a multitude of other health issues. When feeding issues are present in a child before the age of 6, it is categorized as a feeding disorder, rather than an eating disorder. Feeding disorders can potentially lead to dangerous medical consequences for the child, including failure to thrive, lack of growth, and malnutrition.

Growth curves are also used by professionals in establishing target weights for recovery, and research shows these curves are the best method for determining an individual’s treatment goal weight (more accurate than using BMI) when they are available.

They can help a professional to accurately estimate the weight at which females will resume menstrual periods following amenorrhea (loss of menstrual periods due to malnutrition). 

Falling off the growth chart trendline for either height or weight can indicate a potential problem. For example, if a child who has always tracked along the 75thpercentile for either height or weight suddenly starts tracking along the 40thpercentile, there is reason for curiosity and likely concern even if they are not technically underweight on a BMI chart. Sometimes children with anorexia fall off their height curves before they fall off their weight curves, which is why it is important to track both.

A recent study by Marion and colleagues reviewed the growth charts of 137 child and adolescent patients hospitalized in France. The findings showed that 48% of the patients exhibited deviations on their growth curves approximately 10 months before parents first noticed eating disorder symptoms. The researchers state their study "highlights the need for more meticulous analysis of growth charts to detect anorexia nervosa earlier in children and adolescents."

Parents can plot their child’s growth on the following charts, or obtain growth records from their child’s physician:

Parents can also plot growth curves electronically (for free) on My Growth Charts and can learn how to read a growth chart

A Word From Verywell

If you notice that your child has fallen off either his or her height or weight curves, ask your physician to conduct a careful history and physical. There are many possible explanations for a failure to grow and eating disorders are only one of them. Doctors may need to perform additional testing.

It is also important to note that not all patients with eating disorders will have weight loss or be at lower weights. Eating disorders may occur in people of all body sizes. ​

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  • Marion, M., Lacroix, S., Caquard, M. et al. Earlier diagnosis in anorexia nervosa: better watch growth charts!. J Eat Disord 8, 42 (2020).

  • Harrison, Megan E., Nicole Obeid, Maeghan CY Fu, and Mark L. Norris. 2013. “Growth Curves in Short Supply: A Descriptive Study of the Availability and Utility of Growth Curve Data in Adolescents with Eating Disorders.” BMC Family Practice 14 (September):134.

By Lauren Muhlheim, PsyD, CEDS
 Lauren Muhlheim, PsyD, is a certified eating disorders expert and clinical psychologist who provides cognitive behavioral psychotherapy.