- Growth is the increase in size of organs and body, and is assessed through physical anthropometry such as weight, height, head circumference, and mid-upper arm circumference. - Periodic growth assessment allows for early detection of growth faltering which can indicate undernutrition, infection, or disease. - Factors like genetics, nutrition, hormones, environment, and socioeconomic status can influence growth. - Growth charts are used to evaluate if a child's growth is normal based on weight for age, height for age, and BMI for age. - Deviations from normal growth patterns on charts may indicate malnutrition or underlying health conditions.

1. GROWTH ASSESSMENT
Dr. DODDABASAVA K.
JUNIOR RESIDENT
KSHEMA

3. Definition of Growth
•Growth is increase in size of organs and
body.
•It is quantitative change and refers to physical
maturation of the body.

4. Importance of growth assessment
• Growth is fundamental characteristic of
childhood.
• Normal growth is indicator of optimum
health.
• Deviation from the normal pattern is
indicative of pathological process.
• Periodic assessment facilitates early
detection of growth faltering, which may
be first manifestation of
undernutrition/infection/ disease.

5. Periods of growth
Terminology Period
Prenatal Period
Ovum Ovulation to 14 days
Embryo 15 days to 8 weeks
Foetus 9 weeks to birth
Perinatal Period 22 weeks of gestation to 7 days after birth
Postnatal Period
Newborn/Neonate First 28 days after birth
Infant First year
Toddler 1-3 years
Preschool child 3-6 years
School aged child 6-10 years(girls)
6-12 years(boys)

6. Adolescent
Prepubescent or late childhood 10-12 years (girls)
12-14 years(boys)
Pubescent 12-14 years(girls)
14-16 years(boys)
Postpubescent 14-19 years(girls)
16-20 years(boys)

7. Factors Affecting Growth
1. Genetic factors
a.Race
b.Sex
c.Chromosomal
2.Nutritional Factors
3.Hormonal-Thyroxine
GH
4.Environmental Factors
a.Infections
b.Trauma to growing bones
c.Chronic systemic illness

8. 5.Seasonal variation
6.Emotional factors
7.Social Factors
a) Socioeconomic class
b) Education of parents
c) Education of child

9. Laws Of Growth
1. Continuous and orderly process.
2. Growth pattern of every individual is unique.
3. Different tissues grow at different rates.
• General body growth – first two years of life.
• Brain growth – 3rd trimester and 1st year of
life.
• Lymphoid growth – Mid childhood

10. Rate of growth of different tissues

11. Growth can be measured in terms
of:
1. Physical anthropometry
2. Assessment of tissue growth
3. Bone age
4. Dental age

12. Physical anthropometry
Age dependent anthropometry-
1. Weight
2. Length or Height
3. Head circumference
4. Chest circumference

13. Age independent anthropometry
1. Midarm circumference(1-5 yrs)
2. Weight for height
3. Mid upper arm/height ratio
4. Midarm/Head circumference ratio
5. Quetlet’s index
6. Ponderal index
7. Dugdale’s index
8. Body mass index

14. WEIGHT
Measurement:
• Child should be naked or in minimal
clothing.
• Ideal is to use sliding beam balance scale
or electronic scale.
• Weighing scale is checked for zero, center
the infant on scale tray and older children is
weighed standing.

15. • beam type weighing scale
• detecto scale
• electronic scale
• bath room type scale
• Salter spring machine

17. Electronic Weighing Scale

19. Calculation of expected weight
Weech’s formula:
• 3-12 months
Expected weight (kg)=Age(months)+9
2
• 1-6 yrs
Expected weight (kg)=2y+8
• 7-12 yrs
Expected weight (kg)=7y – 5
2

20. Age weight
At birth 1x
5 months 2x
1 yr 3x
2 yr 4x
3 yr 5x
5 yr 6x
7 yr 7x
10 yr 10x

21. Age Weight gain
10 days- 3 months 30 g / day
3-6 months 20 g / day
6-9 months 15 g / day
9-12 months 12 g / day
1-3 yrs 3 kg / yr
4-12 yrs 2 kg / yr
>12 yrs 5-6 kg/yr

22. Interpretation of WHO Charts
Z score
(percentile)
Length/height for
age
Weight for age BMI for age
>3(99) May be abnormal Use BMI Obese
>2(97) Normal Use BMI Overweight
>1(85) Normal Use BMI Risk of overweight
0(50) Normal Use BMI Normal
<-1(15) Normal Normal Normal
<-2(3) Stunted Underweight Wasted

23. Growth Chart- Weight for Age

24. IAP Classification
Nutritional Status Weight for age(%) for 50th pecentile of
Harvard Standard
Normal >80
Grade I 71-80
Grade II 61-70
Grade III 51-60
Grade IV <50

25. Gomez Classifaction
Nutritional Status Weight for age(%) for 50th pecentile of
Harvard Standard
Normal >90
Grade I 76-90
Grade II 60-75
Grade III <60

26. Wellcome Trust
Weight for age Edema Present Edema Absent
60-80% Kwashirkor Undernutrition
<60% Marasmic Kwashiorkor Marasmus

27. Length/Height
• Lenght - < 2yrs - Infantometer
• Height - > 2yrs - Stadiometer

28. Height/length
• <2 yrs infantometer
• Two people required
• Head against fixed vertical head board
• Firmly press knee together
• Nearest 0.5 cms
• 0-85 cms

29. • >2yrs-stadiometer
• Bare footed with feet parallel
• Heels , buttocks , shoulders & occiput
touching the wall
• Head erect with eyes aligned horizontally
• Nearest 0.5cms

30. Infantometer

31. Stadiometer

33. Approximate gain in stature between
0 and 12 years of age
Age Rate of increase in stature
Birth to 3 months 3.5 cm/month
3-6 months 2.0 cm/month
6-9 months 1.5 cm/month
9-12 months 1.3 cm/month
2-5 yrs 6-8 cm/yr
5-12 yrs 5cm/yr

34. Growth Chart-Height for Age

35. Head circumference
• Birth – 18 yrs
• Non stretchable fiber glass tape
• Should encircle most prominent part of
occiput & supra orbital frontal area
• Accuracy of 0.1 cms
• Infant : length (cm ) + 9.5 +/- 2.5
2

36. Head Circumference

38. Expected head circumference in
children
Age Head Circumference (cm)
At birth 35
2 months 38
3 months 40
4 months 41
6 months 42-43
1 yr 45-46
2 yr 47-48
5 yr 50-51

39. Approximate gain in head
circumference between 0 and 5 yrs
Age Growth velocity of head circumference
0-3 months 2 cm/month
3-6 months 1 cm/month
7-12 months 0.5 cm/month
1-3 yrs 1 cm/6 months
3-5 yrs 1 cm/yr

40. Chest Circumference
• Measured at the level of nipples on mid
inspiration.
• < 5 yrs – Lying down position
• > 5 yrs – Standing position
• At birth – HC is 3cm more than CC
• At 1 year – HC = CC
• After 1 year – CC > HC

41. Chest Circumference

42. US:LS
• Length between vertex and pubic symphysis is
upper segment.
• Length between pubic symohisis and the heel
is lower segment.
• Ratio is decreased in rickets.

43. Normal upper segment/ lower
segment ratio in children
Age Upper segment/lower segment ratio
At birth 1.7:1
6 months 1.6:1
1 yr 1.5:1
2 yr 1.4:1
3 yr 1.3:1
4 yr 1.2:1
7 yr 1.1:1
10 yr 1:1
18 yr 0.9:1

44. Arm span
• Distance between tips of middle fingers of
both the arms when out stretched at right
angles.
• In < 5yrs of age arm span is 1-2cm less than
height.
• By 10-12 yrs both become equal.
• After 12 yrs arm span exceeds height (but
difference is <3cm)

45. Midarm Circumference
• Measured on left upper arm midway b/w
acromion and olecranon process with arm
hanging by side of body.
• Shakir tape
• Bangle test
• At birth: 9-11 cm
• 1-5years: 16-17 cm

46. Mid Arm Circumference

47. Shakir Tape
MUAC (cm) Inference
>13.5 Normal
12.5-13.5 Borderline
<12.5 Under nutrition

48. Bangle Test
• Used for quick assessment.
• Fibre glass ring of internal diameter
of 4cm is slipped up arm.
• If it passes above elbow , suggests
MAC <12.5 cm and child
malnourished.

49. QUAC STICK
• Quakers arm circumference stick
• Consists of rod with 2 sets of markings
height
MAC corresponding to ht
• If ht > ht for expected MAC – child is
malnourished
• Modified quack stick – colored rod

50. Quack Stick

51. Weight for height
Calculated as:
weight of child(kg) X100
Expected weight for a healthy
child of same height

52. Waterlow’s classification
Classification Height for Age
(% of expected)
Normal >95
First degree stunting 90-95
Second degree stunting 85-89
Third degree stunting <85

53. Classification Weight for height
(% expected of expected)
Normal >90
Mild wasting 80-90
Moderate wasting 70-79
Severe wasting <70

54. WHO Classification
Weight for Height Inference
Z- score < -2
(70-79% of expected)
Moderate wastimg
Z- score < -3
(<70% of expected)
Severe wasting
Height for age Inference
Z- score < -2
(85-89% of expected)
Moderate stunting
Z - score < -3
(<85% of expected)
Severe stunting
Edema +/-

55. Quetlet Index
• Calculated as:
weight(kg) X 100
{ Height(cm)}2
• Normal:0.14-0.16
• <0.14 indicate malnutrition

56. Rao and Singh’s Index
• Calculated as:
weight(kg) X 100
{ Height(cm)}2
• Normal:0.15-0.16
• <0.14 indicate malnutrition

57. Ponderal Index
Calculated as:
weight(g) X 100
height(cm)3
Ponderal Index Significance in newborn
>2.5 Term,AGA baby
<2 Asymmetrical IUGR
(Severe PEM)
>2 Symmetrical IUGR

58. Body Mass Index
•Calculated as:
weight(kg) X 100
[Height(m)]2
•Nutritional intervention is required if BMI
<15 or less then 5th percentile in children.

59. Growth Chart - BMI

60. Dugdale’s Index
• Calculated as
Weight(kg) x 100
Height(cm)1.6
Normal Value-0.88- 0.97
Malnutrition - <0.79

61. Kanawati Index
• Calculated as MAC(cm)
HC(cm)
Grades of Malnutrition Kanawathi Index
Mild 0.28-0.32
Moerate 0.25-0.28
Severe <0.25

62. Assessment of Tissue Growth
1. Triceps skin fold thickness
2. Biceps skin fold thickness
• Skin fold thickness gives estimation of fat.
• Can be measured by Lange’s of Harpenden’s
Skin fold calipers.

63. Bone Age
• For 1-8 yrs, bone age is determined by
examining carpal bones in X-ray of left wrist.
• No. of osification centres in wrist = Age(yrs)+1
Age X-ray
New born Knee, Ankle
3-9 months Shoulder
3 yrs Wrist
12-16 yrs Elbow, Hip

64. Dental Age
Age Eruption
At birth Nil
6-8 months Central incisors
10 months Lateral incisors
12-15 months 1st molar
15-21 months Canine
21-24 months 2nd molar
The teeth in the upper jaw erupt earlier than the lower jaw
except lower central incisors

65. Permanent Teeth
Age Eruption
6 1st molar
7-8 Central and lateral incisors
9 First premolar
10-11 2nd Premolar
11-12 Canines
12-13 2nd molars
17-22 3rd molars

66. THANK YOU