12. Other definition
Change of growth that has crossed two
major growth percentiles (i.e. from above the
75th percentile to below the 25th).
13. Attained growth
Weight <3rd percentile on NCHS growth
chart
Weight for height <5th percentile on NCHS
growth chart
Weight 20% or more below ideal weight for
height
Triceps skinfold thickness < 5 mm
14. Rate of growth
Depressed rate of weight gain
<20 g/d from 0 to 3 months of age
<15 g/d from 3 to 6 months of age
Falloff from previously established growth curve
Downward crossing of >2 major percentiles on
NCHS growth chart
Documented weight loss
22. c)Unavailability of food
Inappropriate feeding technique
Insufficient/inadequate volume of food
Inappropriate food for age
Withholding of food (abuse, neglect)
41. Medical history
Prenatal care and complications (infection,
maternal nutrition, drug exposure)
Gestational age and growth parameters at birth
(SGA, prematurity)
Perinatal complications (infections, CNS
insults, anomalies)
42. Previous hospitalizations, illnesses, and surgery
Current medications
Review of systems (vomiting, stooling patterns,
mechanics of feeding/swallowing, anorexia,
distress/tiring with feeds)
43. Nutritional history
Caloric intake
Breast-fed: schedule and length of feeds; maternal
cues to prefeeding engorgement, milk let-down, and
drainage postfeeding; maternal diet, rest, stress, and
medications
Formula fed: type, method of preparation; feeding
schedule; amount offered and consumed
Mixed diet: 3-day diet history (food/beverage type,
method of preparation, quantity consumed)
44. Schedule and length of feedings
Daily feeding/mealtime environment
Location/positioning during feedings
Perceptions of suck, swallow, and grasp of nipple
Caregivers involved with feedings
45. Amount and type of mealtime
supervision
Behavior during feeding
History of progression to solid/table foods
Favorite/disliked foods
Parental knowledge/beliefs regarding
child/infant feeding
Family eating practices and beliefs
Financial constraints affecting food
availability
50. Observation of a feeding
Feeding environment (home observation)
Type and amount of food offered
Duration of feeding
Child's oromotor and fine motor skills
51. Laboratory studies
Diagnostic tests directed by positive findings
on history, physical, and review of growth
date
@complete blood count,
@serum electrolytes,
@serum creatinine, urinalysis (± culture),
total protein/albumin, bone age (if height
growth also poor)
52. Hospitalize if:
Evidence of physical abuse and/or severe
neglect
High risk for abuse and neglect, very disturbed
parent & child interaction, poor parent functioning,
and/or an extremely stressful environment
Severe malnutrition and/or medically unstable
Outpatient management failure
Editor's Notes
What do you notice about this curve? The child is decreasing in weight and height percentiles over time. However, for the last 1 year (3 points) the child remains stable on the 10%ile for weight. Sometimes children between 12 mos to 2 years have a period of growth decline where they trend downward to find “their curve”. Sometimes children are born on the 75%ile but don’t really belong there based on genetics and other factors, they may trend downward to find their own curve. The reassuring thing is the child is not losing weight nor staying the same weight. Also, she is stable now on the 10% and height is stable at 25%ile.
What do you notice in this growth chart?
The points are all very close to or below the 5%ile. However, the child has been following a predictable pattern of growth since birth. He never loses weight or stays the same weight. He is just a smaller child and has been this way since birth.
Making sense of the growth chart is easier when you take into account the weight for height. If the weight for height is low, this means that the child’s weight is not appropriate for their height. This is more concerning than simply if their weight for age is low.
This is the weight for height for the child Thomas whose growth chart we looked at before. Remember both his weight and height were low but his weight for height is NORMAL (10%ile). This shows Thomas weighs an appropriate amount for how tall he is.
