About growth and Monitoring

1. GROWTH
CHARTS
AND
GROWTH
MONITORING
Shelvin Prasad

2. WHAT IS GROWTH?
•A net increase in the size or mass of tissue.
•Occurs because of two factors: - Multiplication of cells
-Increase of intracellular substance

3. FACTORS THAT AFFECT
PSYCHOLOGICAL AND
PHYSIOLOGICAL
DEVELOPMENT Nutrition
Family
Emotion
Physical Factors
Sociocultural and community

4. WHAT IS GROWTH
MONITORING?-a screening tool used to diagnose nutritional, chronic systemic and endocrine
disease at an early stage.
•Determine whether child’s growth is normal in comparison to standards given.
Aims of Growth Monitoring:
Primary:
To identify children with under/over nutrition
To identify diseases and conditions that manifest through abnormal growth.
Secondary:
 To discuss health promotion related to feeding, hygiene,immunization and other
aspects of the childs health and behavior.
Sensitive to use growth charts.

5. STEPS IN GROWTH
MONITORING
1.) Determining correct age of the child.
2.) Accurate weighing of the child.
3.) Plotting the weight accuracy on a growth chart of appropriate
gender.
4.) Interpreting the direction of the growth curve and recognizing if
the child is growing properly.
5.) Discussing the child’s growth and follow-up action needed with
the mother

6. HOW GROWTH IS ASSESSED
The assessment of growth may be by the following ways:
LONGITUDINAL: measuring an individual child at regular intervals.
CROSS-SECTIONAL: involve large no. of children at the same age.
BASIC: measurement of childs height, weight and length.
NUTRITIONAL: is a comprehensive evaluation carried out by a
registered dietician for defining nutritional status of a child. (direct,
indirect, anthropometry)

7. NUTRITIONAL ASSESSMENT
IN 6 MAJOR WAYS:
1. Nursing history
2. Physical Examination
3. Calculating percentage of weight loss
4. Dietary history
5. Anthropometric measurements
- skin fold measurement
- mid-arm circuference (MAC)
- mid-arm muscle circumference (MAMC)
6. Lab data
-Albumin, prealbumin, 24hr urinary urea nitrogen, urinary creatinine, Hb level
% weight loss = usual weight – current weight
x 100
Usual weight
MAMC (cm) = MAC(cm) – 3.143 TSF (mm)
10

8. INSTRUMENTS USED IN
GROWTH MONITORING

13. SCALES OF MEASUREMENTS
1. Z scores: deviation of the value of an individual from the median
value of reference population, divided by the standard deviation for the
reference population
*Fixed Z score interval  fixed ht or wght difference for children of
given age

14. 2. Percentile: rank position of an individual on given reference distribution,
stating what percentage of the group will the individual be equivalent to or
will exceed
3. Percent of Median: ratio of a measured value in the individual. E.g. weight
to the median value of the reference data for the same age/ height =
expressed as a percentage
Comparison Between The Characteristics of the 3 Measures of ScalesCharacteristic Z score Percentile Percent of Median
Adherence to ref.
population
Yes Yes No
Summary statistics
possible
Yes No Yes
Uniform criteria
across indices
Yes Yes No
Useful for detecting
changes at extreme
distribution
Yes No Yes

15. MALNUTRITION…
 Acute
- very low weight for height (below -
3z scores of the median WHO
growth standards).
-visible wasting & presence of
nutritional pitting edema
Chronic
-failure to grow at full genetic
potential mentally & physically
-stunted growth

16. Interpretation of different indicators
Indicator Acute Malnutrition Chronic Malnutrition
Weight-for-age
Height-for-age Normal
Weight-for-height Normal
1.Waterlow’s Classification (protein-energy malnutritio
H/A
W/H
>m- 2 SD < m – 2 SD
> m – 2 SD Normal Wasted
< m – 2 SD Stunted Wasted &
stunted
Grade Weight-for-age
Normal nutritional
status
Btw 90 & 110%
1st*, mild malnutrition Btw 75 & 89%
2nd*, moderate
malnutrition
Btw 60 & 74%
3rd, severe
malnutrition
Under 60%

17. 2. GOMEZ’S CLASSIFICATION
 basis of weight retardation
”normal” ref. child is in the 50th
centile of Boston standards
Nutritional
Status
Stunting
(% of
height/age)
Wasting
(% of
weight/height)
Normal >95 >90
Mildly impaired 87.5 – 95 80-90
Moderately
impaired
80- 87.5 70-80
Severely
impaired
<80 <70

18. 3.WELCOME TRUST
CLASSIFICATION-based on deficit in body weight for age & presence/absence of edema
*weight btw 60-80% of expected for age with edema = kwashiorkor
*weighing btw 60-80% of expected without edema = undernutrition
*without edema and weigh< 60% of expected weight for age= marasmus
Age Independent Anthropometric Indeces
Method Name of index Normal (severely
malnourished)
Dugdale’s index 0.88 – 0.97 (<0.79)
Rao’s index 0.15 – 0.16 (<0.14)
Kanawati 0.32-0.33 (≤0.25)

19. WHAT IS A GROWTH CHART
•Growth charts consist of a series of percentile curves that illustrate
the distribution of selected body measurements in children.
•The most powerful tool in growth assessment is the growth chart
used in combination with accurate measurements of height, weight,
head circumference, and calculation of the body mass index (BMI).
• Not intended to be used as a sole diagnostic instrument but
contribute to forming an overall clinical impression for the child being
measured.
TYPES:
CDC Growth Chart
WHO Growth Chart

20. STEPS IN PLOTTING
GROWTH CHART.
Step 1-Obtain Accurate Measurements.
Weight-kg/pounds.
Length- For children <2yrs the Frankfurt Plane is used. Older children
are measured by erect height.
For infant and toddlers head circumference should also be included.

21. STEPS IN PLOTTING
GROWTH CHART
Step 2-Select the appropriate growth chart.
Based on the age and sex of the child being weighed and measured.
Birth up to 2 years of
age.
2 to 19 years
WHO weight for age CDC Weight for age
WHO weight for length CDC Stature for age
WHO length for age CDC BMI for age

22. STEPS IN PLOTTING
GROWTH CHART.
Step 3- Record Data.
Includes Parents stature, Gestational age in weeks, Weight, length and
stature, Notable comments [Breastfeeding, non cooperative]
BMI for more than 2 years old.
Plot Measurements.

23. WHO GROWTH CHART
X-axis: shows age. Points plotted on vertical lines corresponding to
completed age(in months or years)
Y-axis: show length/height, weight or BMI. Should be precise as
possible.

28. INTERPRETATION OF
GROWTH CHART

29. REMEDIAL ACTIONS CAN BE:
 Counselling of the mother
Counselling of the mother aided by a growth chart
Nutritional supplements
Treatment of concurrent disease such as diarrhea
Referral to a specialist for investigation and diagnosis
Professional health worker or social support