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Boys_2-18_years_growth_chart.pdf
1.
Pre-puberty In Puberty
Completing Puberty (Tanner stage 1) (Tanner stages 2-3) (Tanner stages 4-5) If both of the following: If any of the following: If any of the following: High voice Slight deepening of the voice Voice fully broken No signs of pubertal Early pubic or armpit Moustache and early facial development hair growth hair growth Enlargement of testes or penis Adult size of penis with pubic and axillary hair Manufacture 4 Jan. 13 UK2-18A4B Issue 2 Harlow Printing Limited Tel: 0191 455 4286 www.healthforallchildren.co.uk Data Recording Recording Date Weight Length/Height Location Health worker name Measurement 1 Measurement 2 Recording Date Weight Length/Height Location Health worker name Recording Date Weight Length/Height Location Health worker name Measurement 3 Measurement 4 Recording Date Weight Length/Height Location Health worker name Recording Date Weight Length/Height Location Health worker name Measurement 5 Measurement 6 Recording Date Weight Length/Height Location Health worker name Recording Date Weight Length/Height Location Health worker name Measurement 7 Measurement 8 Recording Date Weight Length/Height Location Health worker name Recording Date Weight Length/Height Location Health worker name Measurement 9 Measurement 10 Recording Date Weight Length/Height Location Health worker name Very Overweight (Obese) Overweight 99.6 98 91 75 50 25 9 2 0.4 O y r ry e er V 5 7 1 9 8 9 6 . 9 9 e l i t n e C Ver ery ry y y rw rw rw e e l l le i i il t ti n nt ) e e) s se e es b O Ob ( (O t h ht i gh i ig e ei w r e er v O Ov t h ht g gh i ig g e ei w r e er v O Ov 9 2 9 2 9 9 ) ht ht (O (O wei eig ig er erw O il ile le O e O e w w e l g t gh gh t l e 6 . 9 9 2 9 5 2 0 5 5 7 1 9 8 9 B 4 . 0 2 9 5 2 0 5 C t h g i e W 9 2 4 . 0 t t n n nt e e en c c ce MI M MI B B BM 0 e l i t n e C t h g i e H MI MI c M M e 6 . 9 9 8 9 1 9 5 7 0 5 5 2 4 . 0 Adult Height Predictor This allows you to predict the child’s adult height based on their current height, but with a regression adjustment to allow for the tendency of very tall and short children to be less extreme in height as adults. Four boys out of five will have an adult height within ±6 cm of the predicted adult height. Instructions for use Plot the most recent height centile on the centile line on the Adult Height Predictor (on the flap to the right of the height centile chart) and read off the predicted adult height for this centile. Mid-Parental Centile The ‘mid-parental centile’ is the average adult height centile to be expected for all children of these parents. It incorporates a regression adjustment to allow for the tendency of very tall and short parents to have children with less extreme heights. Comparing this to the child’s current height centile can help assess whether the child’s growth is proceeding as expected. The larger the discrepancy between the two, the more likely it is that the child has some sort of growth disorder. Most children’s height centiles (nine out of ten) are within ±two centile spaces of the mid-parental centile, and only 1 percent will be more than three centile spaces below. Instructions for use The Mid-parental Centile Comparator is on the flap to the right of the height centile chart. If possible measure both parents’ heights, or else use reported heights. Plot their heights on the Mother’s and Father’s height scales. Join the two points with a line between them. The mid-parental centile is where this line crosses the centile line in the middle. Compare the mid-parental centile to the child’s current height centile, plotted on the adult height predictor centile scale. Mid-parental target height This can be obtained by plotting the mid-parental centile on the main chart at age 18 and reading off the corresponding height. Four boys out of five will have an adult height within ±7 cm of this target height. However the predicted adult height (above) is usually closer than mid-parental target height to the child’s final height. Please place sticker (if available) otherwise write in space provided. Name: ________________________________________ NHS/CHI No: Hospital No: Date of Birth: BOYS UK Growth chart 2-18 years Anyone who measures a child, plots or interprets charts should be suitably trained or supervised. For further information and training materials see fact sheet and presentation on www.growthcharts.rcpch.ac.uk This chart is mainly intended to assess the growth of school age boys. It combines data from the UK 1990 growth reference for children at birth and from 4 -18 years(1), with the WHO growth standard for children aged 2 years to 4 years(2). The growth of children under 2 years of age should be plotted on the more detailed UK-WHO 0-4 years growth charts. As well as simply using this chart for plotting growth data, it also includes a number of new features which you may wish to use to help interpret the growth data. • birth centile plotting scale • BMI look-up and plotting grid • scales to estimate adult height and mid-parental centile • guide to assessing puberty Plotting Plot each measurement by placing a small dot where a vertical line through the child’s age crosses a horizontal line through the measured value. The lettering on the charts (‘weight’, ‘length’ etc.) sits on the 50th centile to provide orientation. Birth centile plotting scale The chart starts at age 2 years, but there is a plotting scale on the left of the chart where for term infants, birth weight (and if measured, length) can be plotted to allow comparison of the birth centile with later growth. months months Centile terminology If the point is within 1/4 of a space of the line they are on the centile: e.g. 91st. If not they should be described as being between the two centiles: e.g. 75th–91st. A centile space is the distance between two of the centile lines, or equivalent distance if midway between centiles. Growth patterns before and during puberty Successive height measurements can show wide variation, because it is difficult to measure height accurately. If there are concerns it is useful to measure on a few occasions over time. Assessing growth during puberty is complex because the age when puberty starts varies. What does a height in the shaded area below the 0.4th centile mean? This chart provides some extra guidance about the lower limit (0.4th centile) for height in boys 9-14 years. If a plot falls within the shaded area on the height chart between 9 and 14 years, pubertal assessment will be required and mid-parental centile should be assessed. If they are In puberty or Completing puberty, they are below the 0.4th centile and should be referred. In most instances a Pre- pubertal boy plotted in this area is growing normally, but comparison with the mid-parental centile and growth trajectory will assist the assessment of whether further investigation is needed. Pubertal Assessment The puberty ‘phase’ may be ascertained through simple questions about the appearance of secondary sexual characteristics as well as by clinical examination. By history from parents, carers or young person Is the timing of puberty normal? The three vertical black lines (puberty lines) on the right hand page (9-18 years) of the chart indicate the normal age limits for the phases of puberty described above. • Boys with measurements plotted on the left page will usually be in the ‘Pre-puberty’ phase. Puberty before 9 years in boys is likely to be precocious and further assessment is necessary. • Between 9-14 years most boys will be either ‘Pre- puberty’ or ‘In puberty’. If there are no signs of puberty by 14 years, then puberty is delayed and further assessment is indicated. • From 14-17 years most boys will be either ‘In puberty’ or ‘Completing puberty’. • After 17 years boys will usually be ‘Completing puberty’. If this is not the case, maturation is delayed and further assessment may be needed. If weight is above the 75th centile or if weight and height centiles differ, the BMI centile should be calculated, as the BMI centile is the best indicator of thinness and fatness. The BMI look-up allows you to read off the BMI centile, accurate to a quarter of a centile space. There is a BMI centile grid at the top of the growth chart where the centiles for children with high or low values can be plotted. Instructions for use 1. Note the weight and height centiles from the growth chart. 2. Plot the weight centile against the height centile on the the BMI look-up. 3. If between centiles, read across in this position. 4. Read off the corresponding BMI centile from the blue slanting lines. 5. Plot the centile in the BMI grid at the top of the growth chart at the appropriate age. References 1. Freeman JV, Cole TJ, Chinn S, Jones PRM, White EM, Preece MA. Cross sectional stature and weight reference curves for the UK, 1990. Arch Dis Child 1995; 73:17-24. 2. www.who.int/childgrowth/en For further relevant references see fact sheet downloadable from www.growthcharts.RCPCH.ac.uk © Copyright RCPCH 2012 What does a high or low BMI mean? A BMI above the 91st centile suggests overweight. A child above the 98th centile is very overweight (clinically obese). BMI below the 2nd centile is unusual and may reflect undernutrition, but may simply reflect a small build. Body Mass Index (BMI) centile look-up When is further assessment required? If any of the following: • Where weight or height or BMI is below the 0.4th centile, unless already fully investigated at an earlier age. • If the height centile is more than 3 centile spaces below the mid-parental centile. • A drop in height centile position of more than 2 centile spaces, as long as measurement error has been excluded. • Smaller centile falls or discrepancies between child’s and mid-parental centile, if seen in combination, or if associated with possible underlying disease. • If there are any other concerns about the child’s growth. Measurement procedure Accurate measurement is essential and shoes must be removed for all measurements Height: Measure height recorded to the last millimetre. A correctly installed stadiometer or approved portable measuring device is the only equipment that can be reliably used (see illustration). If a child cannot stand, measure lying down, using an approved length measuring device and plot as for height. Frankfurt Plane Position head and feet as illustrated with child standing as straight as possible. Weight: Remove heavy clothing and shoes and weigh using class III clinical electronic scales in metric setting.
2.
99.6th 98th 91st 75th 50th 25th 9th 2nd 0.4th 200cm 195 190 185 180 175 170 165 160 155 150 145 140 135 130 125 120 115 110cm 80kg 75 70 65 60 55 50 45 40 35 30 25 20 15 10kg weight height 200cm 195 190 185 180 175 170 165 160 155 150 145 140 135cm 105kg 100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10kg height weight BOYS 10 11 12
13 14 15 16 17 Age in years 9-18 years 10 11 12 13 15 16 Puberty starting before 9 years is precocious Puberty starting before 9 years is precocious Puberty is delayed if no signs are present by 14 years Puberty completing after 17 years is delayed 99.6th 98th 91st 75th 50th 25th 9th 2nd 0.4th Pre-puberty 0.4th 99.6th 98th 91st 75th 50th 25th 9th 2nd 0.4th 99.6th 98th 91st 75th 50th 25th 9th 2nd 0.4th 155cm 150 145 140 135 130 125 120 115 110 105 100 95 90 85 80 75cm 20kg 15 10 5 0kg 155cm 150 145 140 135 130 125 120 115 110 105cm 50kg 45 40 35 30 25 20 15 10 5 0kg BOYS 2 1 /2 3 1 /2 4 1 /2 5 1 /2 6 1 /2 7 1 /2 8 8 1 /2 3 2 4 5 6 7 Age in years 3 4 5 6 7 2 1 / 2 3 1 / 2 4 1 / 2 5 1 / 2 6 1 / 2 7 1 / 2 2-9 years 9 8 9 8 1 / 2 98th 91st 75th 50th 25th 9th 2nd 0.4th 99.6th 98th 91st 75th 50th 25th 9th 2nd 0.4th Birth centiles Length Weight 99.6th 9th months 2nd 0.4th 25th 75th 50th 98th 91st 2 58 56 54 52 50 48 46 44cm 99.6th 0.4th months months 2nd 25th 9th 75th 50th 98th 91st 5 4.5 4 3.5 3 2.5 2kg 1 Puberty is delayed if no signs are present by 14 years Puberty completing after 17 years is delayed 99.6th 98th 91st 75th 50th 25th 9th 2nd 0.4th 99.6th 9 8 t h 91st 75th 50th 25th 9th 2nd 0.4th 99.6th 99.6th 98th 91st 75th 50th 25th 9th 2nd 0.4th Parent Height Comparator Adult Height Predictor ft/in 6’3” 6’2” 6’1” 6’0” 5’11” 5’10” 5’9” 5’8” 5’7” 5’6” 5’5” 5’4” 5’3” 190 185 180 175 170 165 160 192 cm 99.6th 98th 91st 75th 50th 25th 9th 2nd 0.4th ft/in cm 6’1” 6’ 5’11” 5’10” 5’9” 5’8” 5’7” 5’6” 5’5” 5’4” 5’3” 5’2” 5’1” 5’ 4’11” 4’10” 4’9” Mother’s height 185 180 175 170 165 160 155 150 145 ft/in cm 6’7” 6’6” 6’5" 6’4” 6’3" 6’2" 6’1" 6’ 5’11” 5’10” 5’9” 5’8” 5’7” 5’6” 5’5” 5’4” 5’3” 5’2” 5’1” 200 195 190 185 180 175 170 165 160 155 Father’s height Mid-parental centile 91st 75th 50th 25th 9th Predicted Adult Height • Plot the most recent height centile on the relevant centile line and • Read off the predicted adult height for this centile. • Four out of five children will be within ±6 cm of this value. Father’s height: ____________ Mother’s height: ___________ Mid-parental Centile • Plot the the Mother’s and Father’s heights on their respective scales and join the two points with a line. The mid-parental centile is where this line crosses the centile line in the middle. • Compare the mid-parental centile to the child’s current height centile, plotted on the adult height predictor centile scale. • Nine out of ten children’s height centiles are within ±two centile spaces of the mid-parental centile. For all Children plotted in this shaded area see instructions. 99.6th 98th 91st 75th 50th 25th 9th 2nd 0.4th 99.6th 98th 91st 75th 50th 25th 9th 2nd 0.4th BMI CENTILE FROM LOOKUP OVERLEAF Very Overweight (obese) Overweight 99.6th 98th 91st 75th 50th 25th 9th 2nd 0.4th BMI CENTILE FROM LOOKUP OVERLEAF Very Overweight (obese) Overweight 17 14 Transit point from UK-WHO to UK90 data. 18 9 18
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