Background: Growth monitoring (GM) is the process of following the growth rate of a child in comparison with standards using periodic anthropometric measurements. It has positive effects on child growth outcomes by assessing growth and allowing for the early detection of growth faltering before the child reaches the condition of undernutrition. Despite the use of growth monitoring as an effective preventative and diagnostic method, its actual application is poor and inconsistent. Hence, the current study aimed to assess the growth monitoring practice and factors associated with GM at public health facilities in Adama City. Methods: An institutional-based cross-sectional study with both quantitative and qualitative designs was conducted from February 16 to March 20, 2023. The study was carried out among 378 health professionals from eight public health centers and one government hospital. For the qualitative part, observation and in-depth interviews with a few public health center medical directors were used to get the information using a checklist and semi-structured interview guide. A pretested, structured questionnaire was used to collect the data, which was entered into Epi info 7, and analyzed using SPSS 25 software. For all statistical significance tests, binary and multiple logistic regression were explanatory factors. Result: In the study, growth monitoring practices were (49.2%), with a response rate of 92.2%. Healthcare workers with over ten years of work experience (AOR =4.937, 95% CI: 2.741, 8.890), those with good knowledge (AOR = 2.129, 95% CI: 1.137, 3.98), who received supportive supervision on GM (AOR = 1.789, 95% CI: 1.041, 3.077), who had access to growth monitoring apparatus (AOR =2.08, 95% CI: 1.161, 3.508) and those Health professionals who see ≤ 25 children per day(AOR =2.26; 95% CI: 1.412, 3.625) were more growth monitoring. Conclusion: Growth monitoring practices among health workers at Adama public health facility were poor. Health professionals had limitations in plotting and interpreting growth charts. Several factors affect growth-monitoring practice. In addition to availing growth monitoring apparatus, supportive supervision is recommended to improve GM practice. Keywords: growth monitoring, health workers, public health facility, Adama town