Caitlin Whyte (Host): This is Children's Health Checkup where we answer parents' most common questions about raising healthy and happy kids. I'm Caitlyn Whyte, and with me is Dr. Kelley Smith, a Pediatrician at Children's Health. In this episode, we'll dive into the fascinating topic of growth spurts. Now, doctor, what exactly is a growth spurt, from a medical perspective, and what's actually happening in a child's body during this time?

Kelley Smith, MD, FAAP: When we have you into the office, we will often pop up the growth curve where you can see, oh yes, over time your child has made progress, and it kind of makes it look like it's one long continuum. But really, it's probably happening more like a stair step process. You wear the same height for a little while and then you grew more rapidly and then you kind of plateaued for a minute and then you grew more rapidly.

This is the time where not only are kids getting taller, they may be getting more muscle mass. Shoe sizes are changing. Not only pant length, but sometimes pant waist may be changing and generally just progressing towards achieving your final adult height.

Host: And are there typical ages when kids go through these growth spurts, or does it really vary from child to child?

Kelley Smith, MD, FAAP: So I'm going to say it varies more from child to child, however, if you've seen the growth curve from the first about two years of life, you will see that they are rapidly growing. And if you've ever been around a newborn who was suddenly out of all the newborn clothing and now barely fit into the six month clothing, you know what I'm saying there. Then when we reach two years to puberty, it's really more slow, steady growth. On average, you're gaining about two to three inches of height per year. Now, some years, may be a little faster, some years, may be a little slower, but that's the average until you get your final growth spurt of puberty, which for girls, that can happen anywhere between eight to 16. For the boys can happen anywhere from 10 to 18. I'll occasionally see a few that will grow as late as 20, but they are the exception and I tell my patients that all the time, especially if I can point out, Hey, look, your last three visits, you were the same height. Congratulations. This seems to be your final adult height.

Host: All right, and we've all heard the term growing pains, but are they real? Can growth spurts actually cause physical discomfort for kids?

Kelley Smith, MD, FAAP: The short answer is yes. Well, let me give the long answer. So when we're medically talking about someone who's having growing pains, the story usually goes that someone was pretty active that day. Maybe even exceptionally active. You know, the class had a field trip to the zoo. Then that night, they're complaining of pains typically in the long bones of the legs.

So we're talking the thighs or the shins. It is not associated with swelling. It is not something that wakes them up in the middle of the night, although can delay their ability to fall asleep. And I like to say, if you've got pain, but you also have unexplained fevers, this is not your problem and something else is going on.

Now, if I've got a kid who's complaining of pain when they wake up in the morning, this is also not growing pain. Something else is going on here. But a few months at a time, especially if you were more active and kind of that middle part of either the upper leg or the lower leg. Very, very common.

Host: Now, sometimes kids hit a growth spurt earlier or later than their friends. What's the best way for parents to talk with their child about their development, especially if they feel self-conscious about being taller or shorter, are just developing at a different place?

Kelley Smith, MD, FAAP: Oh, this one is what I spend a lot of my preteen and teenage visits going over because I like to say, Hey, remember in this part of Texas, we have an unnaturally high number of exceedingly tall people. So sometimes I'll be showing people, Hey, worldwide, you're actually a little taller than it looks in your class at school, but let's talk when people go through what. I will say for the boys, they don't always mind going through puberty earlier because they get to be tall faster. It's usually the opposite complaint that I have that you know, when am I ever going to grow? And sometimes I'll need to look at families and say, is there a history?

Are there people in your family who are late bloomers? And if the answer is yes, I'll be able to say, okay, things are looking like you may be on that path also. Also when I'm doing a well visit, I will go over where in the pubertal development a child is. I like to start off with, Hey, there was this guy named Tanner and he staged out guys and girls.

One looks like a young boy or young girl, and five looks like a grownup. And you are stage. And then tell them where they've landed. Gives them an idea of, hey, have things even started off or we're almost done with puberty. If you're nearly complete, that means your time for growing is coming to an end.

If you've not started yet, then I will look over at them and I'll say, Hey, congratulations. I can promise you'll be taller. I can't yet promise you'll be tall. I can just promise you'll be taller. Now, the earlier development, that tends to be something that can be particularly difficult for the girls because now they're taller than everyone in their class, including the boys.

They may be starting periods, they may be having to wear bras. All of the things that, you know, their peers may not be doing. For that, I try to encourage folks, you know, Hey, let's know what healthy periods look like. Also, let's make sure that, you know, we, we celebrate, Hey, it's good to be tall and people are going to be catching up with you.

So, give it a year or two, sometimes three, and then generally talk about body positivity and speaking to, yes, yes, this happened for you earlier, but it will happen for everyone eventually.

Host: And is it true that kids can become a little clumsier during a growth spurt? If so, is there any increased risk of injury that parents should be aware of?

Kelley Smith, MD, FAAP: That one, it kind of depends on how much growth the person has had. If we're talking, someone went up about an inch, maybe slightly more clumsy until they figure out what to do with their arms and legs. But really not extra risk of injury. If you're having a bigger growth spurt, typically the last one of puberty gets you more like four to six inches at a time or in one year.

That's when some of my sports do find that they are at higher risk of injury. So that might be a sport-based question. For example, my gymnasts, as they're learning to now navigate a much longer body through some of the apparatuses or thinking some of my field sports, again, much more mass to try to say, get over the pole vault or the high jump.

As far as things like the more common sports, soccer, running, football, not really found a significant difference. So I would say if your child is complaining that they just don't feel as coordinated or that things are taking more effort, might be worth seeing if their coach is noticing anything and might also be worth a trip to us to see if there is some other issue going on besides, Hey, you just need to figure out how to maneuver this now larger body.

Host: And when should parents be concerned about their child's growth, either if it seems like it's happening too fast or not fast enough?

Kelley Smith, MD, FAAP: When you're coming in for your annual checkup, part of the reason that as I like to say we look under the underwear is we are seeing, hey, has puberty started? And I have had the discussion over a few years, things are developing here too early for this child. We need to see if the, any of the labs are out of their parameters and potentially talk to the endocrinologist because too early can be a problem. It cuts off your ability to grow later. For girls, once they've had their periods for about two years, most of them have stopped growing. I'd say for guys, there is a Tanner stage in which I can tell you they stopped growing, but most parents are not looking under the underwear of their teenage boys.

So I would say if you've noticed the shoe size hasn't moved in about a year, but your child is not that tall, you might want to be talking to your doctor if they've not already mentioned, Hey, things seem to be starting off too early. Now as far as too little growth goes, Okay, so then we're looking at the folks who are growing less than two inches in a year.

Then we're looking at the folks who are not starting to have signs of puberty. For girls, you've got till age 14 for what we call secondary sexual characteristics to show up. For boys, you've got till age 16. So if I'm not seeing things firing off like they should be, I will be saying to them, Hey, we need to get labs, and then we might need to see a specialist. Also, I will say, because we are a part of the country that loves the sports, I will get a lot of questions about that.

So sometimes if I've got a parent concerned that their child is not growing properly, not only will I do the workup for someone who is of short stature, I will happily refer over to my specialist colleagues. I just warn families, hey, it may take several months to get in. Good news, someone will see and make sure that your child is going to gain their full height potential. Bad news, it's the same group of people that are also taking care of say, my Type 1 diabetics. And you can understand growth while important, not a potentially life-threatening illness like, Type 1 diabetes.

Host: Thank you, Dr. Smith for joining us again on the show. And if you're in North Texas, Children's Health Pediatric Primary Care offers trusted care close to home- from newborn checkups to care for common illnesses and more. Find a location near you at children's.com/primarycare. Thank you for listening to Children's Health Checkup. If you found this podcast helpful, please rate and review or share the episode and follow Children's Health on your social channels.