Spinal growth is a mixture of hierarchy, synchronisation, and harmony among more than 130 growth plates; the slightest error can lead to a complex malformation. Growth starts around the third month of intrauterine life and ends during the second decade of life. The anterior and posterior part of each vertebra, as well as cervical, thoracic, and lumbar spine regions, grow at a different rate. In particular, the thoracic region, the posterior components of the thoracic spine, grow at a faster pace than their anterior counterparts, while the opposite occurs in the lumbar spine. Careful weight assessment is an important part of the orthopaedic evaluation. Weight is another useful parameter for assessing growth, as most children with severe progressive scoliosis exhibit a deficit in weight. Lung growth is a process involving different pulmonary structures growing at different paces. Puberty is a turning point in children with idiopathic scoliosis, as the pubertal growth spurt increases the risk of deformity progression.