The document discusses growth charts and child development scales. It provides background on the WHO growth chart, including that it was developed based on data from healthy breastfed children in diverse settings. The MGRS from 1997-2003 aimed to establish new growth curves. The WHO charts use 2nd and 98th percentiles to identify abnormal growth. In India, the WHO growth chart was incorporated into the "Mother and Child Protection Card" in 2009. The Trivandrum Developmental Screening Chart is also discussed as a tool to screen motor, mental, hearing and visual development in children under 2 years.

1. WHO GROWTH CHART &
TRIVANDRUM
DEVELOPMENT SCALE
DR. KRISHNA.D.S

2. GROWTH CHART
Growth charts are visible display of child’s physical growth
and development. Also called as “road-to-health" chart.
It was first designed by David Morley for growth assessment
and was later modified by WHO

3. NEED FOR ASSESSMENT
Child growth is monitored to:
Assess adequacy of nutrition
Identify weight status and potential for obesity
Screen for disease related to abnormal growth

4. HOW GROWTH IS ASSESSED??
• The assessment of growth may be longitudinal or cross sectional.
• Longitudinal assessment of growth entails measuring the same child
at regular intervals.
• Cross sectional comparisons involve large number of children of same
age.
• Basic growth assessment involves measuring a child’s weight and
length or height

5. HISTORY
• In 1940, data developed by Meredith at Iowa, used for growth
assessment.
• In 1960 and 1970, two other data sets were used, Harvard growth
curves and Tanner growth curves.
• In 1956 and 1965 ICMR undertook a nationwide cross sectional study
and established Indian reference charts.

6. HISTORY
• In 1977, National Centre for Health and Statistics along with CDC
developed growth curves based on Fel’s longitudinal study from 1929
to 1975.
• In 2000, CDC developed a growth curve based on data from national
health surveys and birth certificates in the U.S

7. BACKGROUND
In 1993 WHO undertook a comprehensive review of the uses and
interpretation of growth references
Did not adequately represent early childhood growth and that new
growth curves were necessary.
The World Health Assembly endorsed this recommendation in 1994.
In response WHO undertook the Multicentre Growth Reference Study
(MGRS) between 1997 and 2003 to generate new curves for assessing
the growth and development of children.

9. MGRS
• MGRS combined a longitudinal follow-up from birth to 24 months
and a cross-sectional survey of children aged 18 to 71 months.
• Data gathered from 8440 healthy breastfed infants and young children
from diverse ethnic backgrounds and cultural settings
• Aim- healthy children living under conditions that favour the
achievement of their full genetic growth potential

10. Criteria for Inclusion
• Access to health care and breastfeeding support
• Full term birth
• No smoking during pregnancy
• Exclusive or primarily breastfeeding > 4 months
• Began feeding solids by 6 months
• Continued breastfeeding > 12 months

11. The WHO charts support the theory that optimal nutrition +
optimal environment + optimal care = optimal growth
regardless of time, place or ethnicity.

12. Indicators
• For the assessment WHO has provided charts for both boys and girls (age of
5yrs)
• Growth indicators are used to assess growth,
length/height-for-age
weight-for-age
weight-for-length/height
BMI (body mass index)-for-age

13. WHO GROWTH CHART
x-axis:
• In WHO Growth chart, x-axes show age. Points plotted on vertical
lines corresponding to completed age (in months, or years)
y-axis:
• y-axes show length/height, weight, or BMI. Points plotted on or
between horizontal lines corresponding to length/height, weight or
BMI as precisely as possible

14. WHO GROWTH CHART
• Growth curves are constructed using Box Cox Power Exponential
Method (BCPE) along with curve smoothing by cubic splines.

18. Cut off values……
• WHO growth standards are based on healthy children living in optimal
conditions so more extreme cutoffs are used to identify nutrition
risk.
• WHO charts use 2nd and 98th percentiles as the outermost percentile
cutoff values indicating abnormal growth.
• CDC use 5th and 95th percentile as cut off values.

19. Interpretation of growth curves
Suspect Risk,
• A child’s growth line crosses a z-score line.
• There is a sharp incline or decline in the child’s growth line.
• The child’s growth line remains flat (stagnant); i.e. there is no gain in
weight or length/height.
Normal growth curve runs parallel to the median curve.

20. In India….
• India has adopted the new WHO Child Growth Standards (2006) in
February 2009
• These standards are available for both boys and girls below 5 years of
age.
• WHO growth chart has been incorporated with "Mother and Child
Protection Card"

23. Management
• Weight b/w curves 1 & 3-undernourished,require supplementary
feeding at home
• Weight below curve 3 - consult the doctor and follow his advice.
• Weight below curve 4 - hospitalized for treatment

24. USES
• Growth monitoring
• Diagnostic tool
• Planning and policy making
• Educational tool
• Tool for action
• Evaluation
• Tool for teaching

25. TRIVANDRUM DEVELOPMENT SCALE
• Screening tool to test the development delay in children under the age
of 2 yrs
• Developed by Child Development Centre, SAT, Trivandrum
• 17 test items, selected by trial and error from Bayley’s Scale of Infant
Development (Baroda norms).
• Helps to screen motor, mental, hearing and visual development.

27. How to use TDSC ??
• Left end of the horizontal line represents, the age at which 3% of
children passed the item and right end represents the age at which 97%
of the children passed that item.
• Vertical line is drawn from the chronological age
• Failure to achieve an item that falls short on the left hand side of
vertical line – developmental delay.

28. VALIDATION OF TDSC
• Done on the sample from coastal Neendakara Panchayath & Baby
Well clinic, SAT. (both in community and at hospital)
• Out of 1945 children screened 49 showed developmental delay.
• Denver Developmental Screening Test (DDST) was used as standard
for validation

29. TDSC has a sensitivity of 66.7% and specificity of 78.8%
Currently, used by Anganwadi workers in community field survey.
Can be interpreted by any person with minimal training.
Needs 5- 7 minutes

30. REFERENCES
• WHO. WHO child growth standards. Geneva(Switzerland):
WHO;2007
• World Health Organization. Training Course on Child Growth
Assessment. Geneva, WHO, 2008
• Park K. Textbook of Preventive and Social Medicine. 23rd edition
• AFMC Textbook of Public Health and Community Medicine – 1st
edition
• Trivandrum Developmental Screening Chart MKC Nair, B George, E
Philip

31. THANK YOU