Growth chart

2.  Growth chart is the visual display of child’s
physical growth and development
 Graphical representation of anthropometric
parameters
 Growth – increase in physical size

3.  0-2weeks
 3 to 8
 9 weeks to birth
 1st 4weeks
 Upto 12months
 upto 3YRS
 3 to 6yrs
 6 - 12yrs
 13 yrs and above
 0VUM
 EMBRYO
 FETUS
 NEWBORN
 INFANT
 TODDLER
 PRESCHOOL CHILDREN
 SCHOOL AGE CHILDREN
 ADOLESCENCE

4.  In 1940 data developed by MEREDITH at iowa,
used for growth assessment
 in 1960 nd 1970, two other datas were
designed HARDVARD GROWTH CURVES and
TANNER GROWTH CURVES
 IN 1956 nd 1965 ICMR undertook a nationwide
cross sectional study ,were INDAN
REFERENCE CHARTS are established

5.  In 1977 NCHS along with CDC developed
growth chart based on Fel’s longitudinal
study
 In 2000, CDC developed a growth curve
based on data from national health surveys
nd birth certificates in US

6.  Most preferred charts for under5 children all over the world
 Based upon MGRS – MULTICENTRE GROWTH
REFERENCE STUDY
 Constructed using BOX COX POWER EXPONENTIAL
METHOD ALONG WITH CURVE
 6 COUNTRIES BONGUI
1. BRAZIL
2. OMAN
3. NORWAY
4. GHANA
5. US
6. INDIA

7.  Access to health care
 Breast fed babies
 Full term babies
 No smoking during pregnancy
 Exclusive breast feeding >4months
 Began solids by 6 months
 Continued breastfeeding >12months
WHO supports Theory that
optimal nutrition + optimal environment + optimal
care= OPTIMAL GROWTH

8. 1. WEIGHT FOR AGE
2. WEIGHT FOR HEIGHT
3. HEIGHT FOR AGE
4. HC FOR AGE
5. MAC FOR AGE
6. SFT FOR AGE
7. BMI FOR AGE
8. MAJOR MOTOR MILESTONES
Separate charts for both gender for each parameters

9.  PERCENTILE BASED
 Z SCORE BASED/ SD BASED
Z SCORE= observed value – mean value
standard deviation

10.  WHO CHARTS for under5 ,
 beyond 5yrs Indian growth charts are
preferred , such as
1. INDIAN ACADEMY OF PAEDIATRIC
CHARTS
2. K.N. AGARWAL CHARTS
3. KHADILKAR CHARTS

11.  Combined IAP charts from birth to 18yrs
<5YRS IAP MODIFIED WHO charts
>5YRS IAP 2015 5 – 18 charts

12.  Prescriptive nature
 Breast feeding norm
 LMS method of
statistics
 Exclusion of obese +
 Prescriptive for BMI,
descriptive for other
aspects of growth
 Good nutition and
health
 LMS method
 Exclusion of obese +

13.  Name and DOB
 Single page – assess – ht,wt,HC
 Back side – wt for ht
 Only 4 lines ( percentiles)
 Expressed in both percentile and Zscore
 Vertically – 1 dark line – 15days
 Horizontally – 1 line represents 1cm or 1kg

16.  Enter name, dob
 X axis CHRONOLOGICAL AGE
 Y axis MEASURES (Ht,Wt,HC)
 Growth is markied with dots at point of
intersection of X & Y axis
 Each year is divided as 12months

17.  When you make subsequent measures on
same chart, joins the point by line
 Remind the parents of next growth
measurements and explain your findings

19.  TARGETED HEIGHT - ADJUSTED MID
PARENTAL HEIGHT
 Calculated as follows
BOY: (MHT+FHT+13)/2
GIRL: (MFT+FHT-13)/2
 This ht is plotted at 18YRS OF AGE

20.  MAC – SHAKIR’S TAPE
 3 zone- red, yellow,green
GREEN - >12.5CM – NORMAL
YELLOW – 11.5 -12.5CM – BORDERLINE
RED - < 11.5CM – MALNUTRITION
 S F T – HARPENDEN CALLIPERS
1. SUPRASCAPULAR
2. SUBSCAPULAR
3. BICEPS
4. TRICEPS

21.  CHEST CIRCUMFERENCE
AT BIRTH HC>CC
9mnths – 1yr HC=CC
After 1yr HC<CC
 BMI = WT in kg
HT in sq.mt

22. AGE WEIGHT HEIGHT HC
BIRTH 3 50 34
6MONTHS 6 65 43
1YR 9 75 46
2YRS 12 90 48
3YRS 15 95 49
4YRS 16 100 50

23. AGE
 0-2yr
 2-5 yr
 >5yrs
MEASUREMENT
 Ht,wt,HC 0,6,10,14 wks
 Ht,wt,HC every 6months
 Ht,wt,BMI every year

24.  CHILD GROWTH IS MONITERED TO
 Assess adequacy of nutrition
 weight status & possess obesity
 Screen for disease related to abnormal
growth

25.  GROWTH MONITORING
 DIAGNOSTIC TOOL
 PLANING AND POLICY MAKING
 EDUCATIONAL TOOL
 TOOL FOR ACTION
 EVALUATION
 TOOL FOR TEACHING

26.  Barometer of well being
 Important pillar of preventive care
 Help- reassure normalcy
 Helps- early identification of growth
disorders, nutritional disorders & systemic
disorders

27.  Feeding practice
 Racial and ethnic variation
 Sex
 Size at birth
 Parental stature
 Altitude