What are the typical growth spurts for children from infancy through adolescence?

Typical Growth Spurts in Children from Infancy Through Adolescence

Children experience two major growth spurts: the first and most dramatic occurs during infancy (particularly the first year of life with a 25 cm height increase), and the second occurs during puberty with boys achieving peak height velocity of 9.5 cm/year around age 13.5 years and girls reaching 8.3 cm/year around age 11.5 years. 1, 2

Infancy Growth Spurt (Birth to 3 Years)

The infancy-childhood (IC) spurt represents the maximum growth velocity of the entire human lifespan:

• During the first year of life, infants grow approximately 25 cm, representing a 1.5-fold increase in height—the greatest growth spurt humans ever experience 2
• The IC spurt begins between 6-12 months of age when growth hormone (GH) starts to significantly regulate growth 3
• This spurt is completed around age 3 years when the infancy component of growth virtually ceases 3
• Nutrition is the single greatest contributing factor to height growth during this period 2
• The IC spurt is absent in children with GH deficiency who receive no hormonal therapy 3

Early Childhood (Ages 2-6 Years)

Growth velocity decreases substantially but remains steady:

• Annual height velocity decreases to 8 cm/year from ages 2-4 years, then to 6 cm/year from ages 4-6 years 1
• A pre-school spurt occurs at approximately ages 4.8 years in boys and 4.6 years in girls 4
• Growth during this phase is characterized by cyclical patterns with regular accelerations and decelerations 4

Mid-Childhood (Ages 6-10 Years)

Growth continues at a steady but slower pace with identifiable mini-spurts:

• A mid-childhood spurt is clearly identified at age 7.0 years in boys and 6.7 years in girls, present in virtually all children 4
• Height velocity approaches a plateau of approximately 5.5 cm/year before puberty 1
• A late-childhood spurt occurs at ages 9.2 years in boys and 8.6 years in girls 4
• Growth follows a cyclical pattern with mean peak intervals of 2.2 years in boys and 2.1 years in girls 4
• Between ages 2-11 years, total body iron increases from 600 mg to 2300 mg, with blood volume expanding from 900 mL to 2600 mL 1

Adolescent/Pubertal Growth Spurt

This represents the second major growth acceleration, with significant sex differences in timing and magnitude:

Timing and Peak Velocity

• Boys: Peak height velocity (PHV) of 9.5 cm/year occurs at mean age 13.5 years 1
• Girls: PHV of 8.3 cm/year occurs at mean age 11.5 years 1
• The pubertal growth spurt (PGS) begins between ages 10-15 years in boys and 8-13 years in girls 5
• In children with average-to-late puberty onset, a prepubertal spurt occurs at ages 10.8 years in boys and 10.0 years in girls 4

Total Growth During Puberty

• Boys grow on average 28 cm (SD ±4 cm) from take-off to cessation of growth 1, 6
• Girls grow on average 25 cm (SD ±4 cm) during the same period 1, 6
• The adult sex difference in height is due much more to later take-off in boys than to a greater male adolescent spurt 6

Physiological Changes

• Blood volume increases dramatically: from 2600 mL (75 mL/kg) in an 11-year-old male to 4500 mL (70 mL/kg) in a 17-year-old male 1
• This expansion requires approximately 1000 mg of iron dedicated to erythropoiesis alone 1
• Growth during puberty depends on gonadal steroids (estrogen and testosterone) which stimulate IGF-1 production and induce GH secretion 1

Maturity-Related Variations

• Earlier maturers have higher PHV and total pubertal growth gain, but adult heights are similar across all maturity groups 5
• Very early maturers show height SDS values >+1 during pubertal years, while very late maturers show values >-1, but these differences disappear at adult height 5
• Lung growth lags behind height increase during the growth spurt, with height growth peaking approximately 1 year before weight and lung function growth rates in males 1

Important Clinical Considerations

Growth assessment requires understanding of these normal patterns:

• WHO growth charts are recommended for children under 24 months, while CDC charts should be used for children 24 months and older 1, 7
• Growth velocity over time is more informative than single measurements 7
• Values below the 2.3rd percentile (labeled as 2nd percentile) warrant evaluation for underlying causes 7
• The cyclical pattern of prepubertal growth with rapid changes in height velocity should be considered when assessing any child's growth or response to treatment 4
• During adolescence, lung growth appears to lag behind standing height increase, creating a temporary shift in the relationship between lung volume and height 1