Download to read offline
More Related Content
Similar to GROWTH CHAR..............TS prashanth.pptx
GROWTH CHAR..............TS prashanth.pptx
- 1. GROWTH CHARTS PRESENTER: DRPRASHANTH B N MODERATOR: DR SNEHA PATIL
- 2. Food for thought Highest growth velocity seen at ? Difference between failure to thrive and short stature ? What is growth failure ? What is the most important determinant for Birth weight? Weight at 2 years ? Final adult weight ? What is MPH and what does it signify
- 3. WHAT IS GROWTH? Growth is the sum of all cell replication and organ differenciation processes in the body. • Dynamic process • Increase in the physical size of the body • Growth is genetically predetermined. • Growth progresses orderly with individual variation. • Factors influencing growth and development Nutrition Family Emotional factors Socio cultural and community Physical factors Growth is an indicator of physical and mental well being of a child.
- 4. Growth and development . Growth Development Net increase in the size or mass of tissues Specifies maturation of functions Multiplication of cells Increase in intracellular substance Hypertrophy and expansion of cell size Maturation and myelination of nervous system Indicates acquisition of skills
- 5. Laws of growth Growth and development of children is a continuous and orderly process Growth pattern of every individual is unique Order of growth is cephalocaudal and distal to proximal (head neckarms legs and hands increase in size before arms )
- 6. Different tissuesgrow at different rates
- 7. Factors affecting growth Fetalgrowth Maternal factors : maternal malnutrition, comorbidities, age, obstetric complications, parity, acquired infections Placental factors Teratogens Fetal growth factors Fetal hormones Sex : males > females Genetic potential
- 8. Factors affecting growth Size at birth does not affect the infants genetic growth potential, in the first 2 years of life that infants gradually transition from their birth size to their own genetically determined height potential. Infants shift linear growth percentiles; 65% infants exhibit such shifts – moving up and down the growth charts. By 24 months these shifts are complete and children have entered a specific growth channel Birth weight is generally a poor indicator of the eventual growth pattern (except IUGR), most show catch up growth
- 9. Factors affecting growth Postnatal period Genetic factors IUGR Nutrition Hormonal influences : GH, Thyroid, Gonadal steroids, Glucocorticoids Sex Infections Chemical agents Trauma Socioeconomic factors Ethnicity and race Environment and stimulation Secular trend
- 11. PURPOSE OF GROWTHASSESMENT The purpose is to determine whether child is growing “normally” or Has “growth problem ” or trend towards a growth problem that should be addressed.
- 12. ASSESSMENT OF GROWTH The assessment of growth may be longitudinal or cross sectional. Longitudinal assessment involve measuring the same child at regular intervals. Cross sectional comparison involve measuring large number of children of same age. Basic growth assessment involves Measuring child’s weight and length or height. Comparing these measurements to growth standards.
- 13. When to assessnormal growth WELLNESS VISITS Immunization contacts : 6, 10, 14 weeks, 9 months, 15- 18 months Additional monitoring at 6 monthly intervals with opportunistic monitoring at illness visits is recommended. 4 to 8 years: height and weight 6 monthly and BMI, PL, SMR yearly from 6 years 9 to 18 years: height, weight, BMI, SMR should be assessed yearly
- 14. Red flag signs/criteria for referral Height <3rd or >97th HC <3rd or >97th Crossing 2 major percentile lines Below or above MPH range Absence of weight gain from 2 to 3 months between 6 to 11 months BMI > 23rd adult equivalent of IAP Growth velocity less than 5cm/year between 3 to 9 years Girls with axillary, pubic hair growth or breast budding before 8 years and boys with axillary, pubic hair growth or genital growth or testicular enlargement before 9 years
- 15. Red flag signs/criteria for referral Delayed puberty: girls without breast budding by 14yrs & no menarche by 15 yrs or boys with no signs of puberty till 16 yrs Arrest of puberty at some stage >2yrs Micropenis b/l or u/l undecended testis Atypical genitalia u/l or b/l gynecomastia in boys Hirsutism or menstrual irregularities in girls
- 16. WHAT ARE GROWTHCHARTS? Visible display of child’s physical growth and development. • “Road-to-health" charts. • First designed by David Morley, later modified by WHO. These growth charts are primarily designed for longitudinal follow-up of a child(growth monitoring),to interpret the changes over time.
- 17. BASICS OF GROWTHCHARTS Growth chart is characterized by various curves, each representing specific percentile/ SD. • Percentile curves represent frequency distribution curves. • Proportion charts use Z score lines
- 18. Z- SCORE ORSTANDARD DEVIATION SCORE It represents the deviation of the value for an individual from the median value of the reference population (Observed value) - (Median reference value) Z score = ------------------------------------------------------------------------ Standard deviation of reference population A fixed Z score interval implies a fixed height or weight difference for children of a given age . Advantage:- Allows mean and SD calculation for a group of Z score in population based applications
- 20. PERCENTILE The rankposition of an individual on a given reference distribution, stated in terms of what percentage of the group the individual equals or exceeds . Unable to calculate summary statistics with the use of percentiles. Towards extremes of the reference distribution-only little change in percentile value with substantial change in weight or height status
- 21. COMPARISON OF CHARACTERISTIC OFTHREE MEASURES OF SCALE
- 22. CORRELATION BETWEEN PERCENTILES ANDZ SCORES FOR WHO CHARTS
- 23. Evolution of growthcharts International growth charts Indian growth charts STUART/MEREDITH GROWTH CHARTS1946 TANNER GROWTH CHARTS 1965 NCHS GROWTH CURVES 1977 CDC GROWTH CHARTS 2000 WHO GROWTH STANDARDS 2006 AGARWAL ET AL., 1992 &1994 KHADILKAR GROWTH CHARTS 2007 REVISED IAP GROWTH CHARTS 2015
- 24. TYPES OF GROWTHCHARTS Reference growth charts – These charts are descriptive and shows how children grow. Health status of the reference population is not taken into consideration. Standard growth charts- Prescriptive- shows how children should grow. Reference population is selected on health grounds
- 25. Growth Standard VsReference , IAP growth charts
- 27. HISTORY OF INNOVATIONOF GROWTH CHARTS Published the first growth charts in his work “Histoire Naturelle”
- 28. GROWTH CHARTS EVOLUTION Since early 1900s variety of growth references were developed and used. Limitations : Infants and preschool children not covered properly Limited representation of ethnic, genetic, socioeconomic variability Stuart/Meredith growth charts (1946-1976) Parameters Measured: stature and weight Population: White children living near Iowa city, Iowa, Boston, Massachusetts, from 1930 to 1945. Limitations: Sample size were small/didn’t represent standard US population Percentile curves smoothened by hand Statistical curve fitting procedures were not used
- 29. TANNER GROWTH CHARTS In 1965 Tanner, Whitehouse and Takaishi made growth standards from birth to maturity in British children Growth charts made for height, weight, height velocity and weight velocity (Birth to 19 years). In 1973, Tanner and Whitehouse introduced new charts by enlarging birth to 5 years section of the previous weight and height charts • The new charts have enough space for accurate and repeated plotting in the first two years after birth
- 30.
- 31. NCHS GROWTH CURVES1977 National Academy of Sciences urged to develop new growth charts for infants and children by using current data. NCHS task force of experts was formed Developed mainly to assess nutritional disturbances in U.S. children Source of data: Fels Research Institute Health Examination Surveys of NCHS Disadvantages Triplets were excluded from study Twins and low birth weight not excluded National survey data were not available for birth to one year age group; Supplemented with Fels data. The infant charts were solely based on the Fels data
- 32. 1977 NCHS GROWTHCHARTS Weight for age Birth to 36 months 2 to 18 years Length for age Birth to 36 month Weight for Length Birth to 36 months Boys(49 to 103 cm) Girls(49 to 101cm) Head Circumference for age Birth to 36 months Stature for age 2 to 18 years Weight for stature Boys(90 to 145 cm) Girls(90 to 137 cm)
- 33. CDC GROWTH CHARTS2000 NCHS growth charts in use since 1977 were revised. As CDC Growth Charts: released in 2000 Recommended for use in clinical practice and research to assess size and growth in U.S. children. Two set of charts Infants, birth to 36 months of age Children and adolescents from ages 2 to 20 years. New body mass index-for-age (BMI-for-age) charts were created
- 35. CDC GROWTH CHARTS 2000 Data collected: National Health Examination Surveys II, III National Health And Nutritional Examination Surveys I,II&III and Supplemental data
- 36. CDC GROWTH CHARTS 2000 Exclusions: ▪ Data for all VLBW infants were excluded from infant growth charts ▪ Excludes data from NHANES III for ages >6 years ▪ Data from NHANES III for ages
- 37.
- 38. WHO GROWTH CHARTS2006 NCHS/WHO growth reference, did not adequately represent early childhood growth and that new growth curves were necessary. World Health Assembly endorsed this recommendation in 1994. WHO undertook the Multicentre Growth Reference Study (MGRS) between 1997 and 2003 to generate new curves for assessing the growth and development of children UNDER THE AGE OF 5 YEARS OVER THE WORLD
- 39. The MGRScombined a longitudinal follow-up from birth to 24 months & a cross-sectional survey of children aged 18 to 71 months. Sample Size: 8440 healthy breastfed infants and young children 1743 for longitudinal component 6697 for cross sectional component Study Location Brazil, Ghana, India, Norway, Oman and USA. The study populations lived in • Socioeconomic conditions favourable to growth • Mobility was low • ≥20% of mothers followed WHO feeding recommendations and • Breastfeeding support was available The mothers were non smokers and breast feeding their children
- 40. Why MGRSis unique? – Growth standards produced by selecting healthy children living under conditions likely to favour achievement of their full genetic growth potential. MGRS data included Weight and head circumference at all ages, Recumbent length (longitudinal component), Height (cross-sectional component), Length and Height (between 18 to 30 months) Arm circumference, triceps and subscapular skinfold thickness (all children aged ≥3 months)
- 41. SALIENT FINDINGS INMGRS Striking similarity in linear growth across the diverse populations were studied. An evaluation of the differences in length of participants from birth to 2 yrs of age within and among the MGRS sites demonstrated 70% of the total variance in length was due to inter individual differences and only 3% was due to inter site differences Greater genetic variability resides within populations than among populations
- 43. WHO GROWTH CHARTS Charts developed • Weight for age • Length/height for age • Weight for length • Weight for height • Body Mass Index for age • Mid arm circumference for age • Head circumference for age • Triceps skin fold thickness for age • Sub scapular skin fold thickness for age • Growth velocity charts based on weight, height and head circumference • Windows of achievement in motor milestones WHO growth standards were produced with both Z score curves and percentile curves
- 44. Weight for age Age dependent factors
- 45.
- 46. Length/height for age Age dependent
- 47.
- 48. Weight for length/ height boys Age independent factors
- 49. BMI for age Age independent factors
- 50. BMI for age Age independent factors
- 51. Head circumference forage Age dependent factors
- 52. Mid arm circumferencefor age Age independent factors
- 53. Subscapular skinfold BMIis not a direct measurement of body fat Skinfold thickness indicates the status of fat deposits in the body. Measured using Harpenden calliper Measured over the triceps, subscapular, biceps and suprailiac area.
- 54. Triceps skinfold forage Normal skinfold thickness depends on age and sex Females > males >85th centile in age specific percentile charts are abnormal
- 55. FEATURES OF WHOGROWTH CHARTS Based on prescriptive approach Breastfeeding the biological “norm” and establishes the breastfed infant as the normative growth model Provides a truly international standard, that child populations grow similarly across the world’s major regions when their needs for health and care are met New innovative growth indicators: the skin fold thicknesses
- 56. Accompanying windowsof achievement for six key motor development milestones provides a unique link between physical growth and motor development.
- 57. AGARWAL GROWTH CHARTS1992 & 1994 Before Agarwal growth charts, there were not much nation wide studies to assess growth of Indian children. Agarwal et al., conducted two separate studies (published in 1992 and 1994) to assess the growth performance of Indian children aged birth to 18 years of age Developed Growth Charts for 2 age groups: Birth to 6 years and 5 to 18 years 50th percentile of height of Indian children from high socioeconomic groups corresponded to 30th – 40 th centiles in CDC charts. 50th centile of adult stature corresponded to the 10th – 20th centile in CDC charts
- 58. BIRTH TO6 YEARS Longitudinal study Children belonging to the affluent population segments (urban) in seven cities were selected: Bangalore, Bombay, Calcutta, Delhi, Kota, Ludhiana, and Varanasi. Years of Data collection: Two years (1985-1987) as two different cohorts. Cohort- I - birth to one year Cohort-II - one to six years of age. Sample size: Cohort-I - 418 boys and 332 girls Cohort –II - 1011 boys and 874 girls Parameters measured: Weight Height/length Circumferences of head, chest and mid arm.
- 59. 5 TO 18YEARS Crosssectional study Study location: Data were collected from 23 schools North Zone(Delhi, Shimla, Dehradun and Nainital) West- South Zone(Bombay, Madras and Udaipur) Central Zone(Lucknow, Allahabad, Varanasi) East Zone(Dhanbad and Calcutta) Sample size: 12899 boys and 9951 girls studying in 1 to 12th std. Exclusion: Children with systemic diseases or with major surgeries Parameters measured: Weight Height, sitting height, Head and Chest circumference Biacromial and Bicristal diameters and Skinfold thickness (methods described by Tanner and Weiner and Lourie). Sexual growth(development of genitalia, breast, presence of auxillary and pubic hair(Graded according to Tanner)
- 60. KHADILKAR GROWTH CHARTS2009 WHO recommends that each country should update its growth references every decade New growth references were produced in 2009 by Khadilkar et al. Selection of sites: The IAP divides India into five zones Ten cities were selected from these zones Schools admitting children of socioeconomically well off families were selected (11 schools)
- 61. NEW IAP GROWTHCHARTS 2015 The need to revise IAP growth charts for 5- to 18-year-old Indian children and adolescents was felt as India is in nutrition transition and Previous IAP charts are based on data of two decades old. Studies performed on Indian children’s growth, nutritional assessment and anthropometry from upper and middle socioeconomic classes in last 10 years were identified Sample size: 87022 (5 to 18 years) • Data from 14 cities (Agartala, Ahmadabad, Chandigarh, Chennai, Delhi, Hyderabad, Kochi, Kolkata, Madurai, Mumbai, Mysore, Pune, Raipur and Surat) in India were collected. They found small increases in height in 50th and 97th centiles and striking differences in weight percentiles, inidicating secular trend and epidemic of obesity
- 62. SECULAR TREND INWEIGHT
- 63. SECULAR TREND INHEIGHT
- 66. Paediatrician friendly growthcharts User-friendly growth charts for Paediatrician’s everyday use. No calculations are involved while using these charts, neither for BMI nor for MPH MPH percentile lookup tool which was designed in such a way that by joining the father’s height on left to the mother’s height on the right (both in CM) gives the MPH percentile (on the middle line) for that specific gender A quick BMI screening tool based on weight for height that eliminates the need to calculate BMI will help to rapidly decide if a child is overweight, obese, normal or underweight. In a busy clinic, less calculations the pediatrician must perform the better.
- 67.
- 68.
- 69. For ex: fathersheight 178cm, mothers hight is 160cm MPH
- 70. Growth velocity Conclusion regardinggrowth velocity should be drawn after a minimum of 6 months of observation Preferably after a year. Growth occurs at different stages.
- 71. Growth velocity Periodof rapid growth: intrauterine Postnatal growth, highest in the postnatal period, gradually decreases upto the pre pubertal period followed by pubertal growth spurt. Girls Boys Pubertal growth spurt Early , 10-11years Later, 9-14 years Peak growth velocity 8-9cm/year 10.3cm /year After menarche growth velocity declines and stops 2 years after menarche. Higher peak growth velocity and longer period of growth results in taller stature
- 72. Height velocity inIndian children Height velocity percentiles as per age for Indian children and adolescents for 5-17 years The peak median height velocities were 6.6 cm at 10.5 years in girls and 6.8 cm at 13.5 years in boys Aim: assess height velocity and develop height velocity percentiles in 5-17-year-old apparently healthy Indian children from two centers from India (Pune and Delhi), and (ii) to study the magnitude and age at peak height velocity during adolescence in Indian children.
- 73. Upper segment andlower segment ratio The trunk is relatively longer than LS at birth ; US:LS = 1.7 In postnatal life, the growth velocity of LS is greater. 1.3 at 3 years 1 at 7 years 0.89 during puberty Rises to slightly below 1
- 74. US : LSratio growth charts - Indian
- 75. How to plotmid parental height Mid parental height is necessary to understand child’s genetic potential so that child’s current height percentile can be checked against MPH percentile. Involves a calculation and plotting at 18 years to know the mid parental percentile MPH = (fathers heigh + mothers height)/ 2 +/- 6.5 This value is plotted on charts, and gives an idea estimate of target height for the child and the percentile it is likely to follow Projected adult height = MPH +/- 8.5cm
- 76. How to plotmid parental height For ex: Fathers height 176cm Mothers height 168cm MPH = (176 + 168)/2 +6.5 = 178.5 Present height 9 years: 126cm
- 77. HA BA CAWA !!!??? Bone age is a measure of the degree of skeletal maturity of a child, i.e. how far the child has advanced in its development of the skeleton. Chronological age : it is the age of the child at present Height age : Height age is that age at which the childs present height would have been appropriate for age OR the age that corresponds to the childs height when plotted at the 50th percentile on a growth chart Weight age: the age that corresponds to the childs weight when plotted at the 50th percentile on a growth chart
- 78. How to plotheight age For ex: 8 year old girls height is 140cm Which corresponds to 10.5 years
- 79. Familial short statureBA = CA > HA
- 80. Constitutional delay ofgrowth BA < CA and BA = HA
- 81. A: constitutional delayof growth and adolescence BA < CA and BA = HA B : Familial short stature BA = CA > HA C : Acquired pathogenic growth failure BA < HA < CA D Precocius puberty BA > HA > CA D
- 82.
- 83. Neonatal growth charts Optimal post natal growth Growth standards versus references Intrauterine and Postnatal preterm growth charts Customized growth charts Correlation of growth charts with outcomes
- 84. WHY DO WENEED NEONATAL GROWTH CHARTS? To identify SGA and LGA babies To monitor the growth over a period of time ( reflects illness and nutritional status) To identify babies with EUGR at 36 weeks gestation ( neurodevelopmental impairment, final short height) SGA- Asphyxia, hypothermia, hypoglycemia, hypocalcemia, polycythemia, sepsis, death LGA- Birth trauma, Asphyxia, hypoglycemia, hypocalcemia, polycythemia
- 85. NEONATAL GROWTH CHARTS INTRAUTERINEGROWTH CHARTS 1) Lubchenco(1967) 2) Usher and McLean (1969) 3) Brenner (1976) 4) Arbuckle(1993) 5) Alexander( 1996) 6) Kramer (2001) 7) Fenton (2003 and 2013) 8) Olsen (2010) POST NATAL GROWTH CHARTS 1) Dancis 2) Wright 3) Shaffer 4) Berry et. Al(1997) 5) Ehrenkranz (1999) 6) CDC 2000 7) WHO MGRS 2006 8) Fenton (2003 and 2013) 9) Intergrowth 21 (2014)
- 86. PRETERM GROWTH CHARTS Babson and Benda published fetal- infant growth graph in 1976 An extended intrauterine growth chart Widely used in NICUs before 2003 Limitations: ✓ X axis begins at 26 weeks – Not able to plot younger preterm infants ✓ Y axis made in 500 gram increments – Difficult to plot precisely ✓ Sample size very small – only 45 infants. ✓ Data 15 years old at the time of publication The dotted line is Babson and Benda 1976 growth chart
- 87. REVISED FENTON GROWTHCHARTS 2013 In 2003, Fenton produced updated version of Babson and Benda charts. In 2013, revision of 2003 charts was done by Fenton and Kim. Aim to harmonize the preterm growth chart with the new WHO growth Standard Features of revised charts: ✓ Based on the recommended growth goal for preterm infants, fetus and term infant. ✓ Sex specific charts. ✓ Equivalent to WHO charts at 50 weeks gestational age( 10 weeks post term age) ✓ Large sample size of 4 million preterm infants ✓ Recent population based surveys collected between 1991 to 2007 ✓ Data from developed countries ✓ Enables plotting as infants are measured, not as completed weeks ✓ Exact Z score and percentile calculator available. ✓ Growth references not standards
- 89. INTERGROWTH- 21 CHARTS(2015) Series of projects conducted following the WHO prescriptive approach (Brazil, Italy, Oman, United Kingdom, United States, China, India and Kenya) Aim: provide international data irrespective of racial/ethnic origin
- 90. INTERGROWTH- 21 CHARTS(2015)
- 91. Inter growthcharts
- 92. SIZE -AT -BIRTH CHARTS POST NATAL FOLLOW UP CHARTS
- 94. POSTNATAL GROWTH *POSTNATALDIP in weight- attributed to extracellular fluid losses. *Most preterm also do not grow in length or head circumference in the first week of life, so all 3 growth parameters often cross percentiles downwards on growth charts. *Grow approximately parallel to growth chart curves once adequate nutrition is established and morbidities addressed Depends on genetic potential, internal and external factors Infancy (Nutrition) Childhood (Growth hormones) Puberty (Growth hormones + Sex Steroids)
- 95. APPROPRIATE PATTERNS OFPOSTNATAL GROWTH AGA with normal growth pattern AGA with EUGR AGA with upward crossing due to genetic potential after IUGR
- 96. LGA with goodgrowth due to genetic potential LGA returning to normal growth (infant of diabetic mother)
- 97. SGA with growthparallel to curve SGA regaining birth weight centile
- 98. TYPES OF FOETALAND NEONATAL GROWTH CHARTS Foetal growth charts-Foetal anthropometry estimation curves based on USG measurements Birth Weight for Gestational Age Charts Neonatal growth charts 1. Postnatal longitudinal growth charts for preterm infants 2. Postnatal growth charts for infants born at term
- 99.
- 100. WHAT ARE CUSTOMIZEDGROWTH CHARTS? Adjusted to reflect maternal constitutional variation. Optimized, by presenting a standard free from pathological factors such as diabetes and smoking; and Based on fetal weight curves derived from normal pregnancies, rather than neonatal weight curves which include pathological preterm deliveries.
- 101. Intra uterine growthcharts
- 102. SPECIAL GROWTH CHARTS Down syndrome Turner syndrome Achondroplasia William syndrome Cerebral palsy
- 103. CDC DSGS GROWTHCHARTS Children with Down syndrome have a different growth pattern compared to other children The Down Syndrome Growing Up Study (DSGS) enrolled a convenience sample of children with DS up to 20 years of age and followed them longitudinally. When compared to previous U.S. growth charts for children with Down syndrome There are clear improvements in weight gain during the first three years of life. Males (aged 2-20 years) are taller
- 104. GROWTH CHART FORTURNER SYNDROME
- 105. WEIGHT FOR AGECHARTS FOR ACHONDROPLASIA
- 106.
- 107. Uses of growthchart 1.Growth monitoring 2. Diagnostic tool: for identifying "high-risk“ children. For example, malnutrition can be detected long before signs and symptoms of it become apparent 3. Planning and policy making: by grading malnutrition, it provides an objective basis for planning and policy making in relation to child health care at the local and central levels 4. Educational tool: because of its visual character, the mother can be educated in the care of her own child· and encourage her to participate more actively in growth monitoring
- 108. Uses of growthchart 5. Tool for action: it helps the health worker on the type of intervention that is needed; it will help to make referrals easier 6. Evaluation: it provides a good method to evaluate the effectiveness of corrective measures and the impact of a programme or of special interventions for improving child growth and development. 7. Tool for teaching: it can also be used for teaching, for example, the importance of adequate feeding; the deleterious effects of diarrhoea. 8.Reassurance:It provides reassurance about child’s health and prevents parental anxiety.
- 110. Answers Highest growthvelocity seen at ? Prenatal 66cm/yr > postnatal 25cm/yr Difference between failure to thrive and short stature ? FTT- poor wt gain in infants and young children and Short stature – subnormal linear growth in childhood and adolescence What is growth failure ? Subnormal rate of growth; sustained height velocity <25th centile or <-1.5SD What is the most important determinant for Birth weight? – maternal and placental factors Weight at 2 years ? – gradual transition from birth size to genetic potential Final adult weight ? – genetic potential What is MPH and what does it signify – avg of both parents height after correcting for sex, childs genetic potential
- 111. Take home points We must get into the habit of regularly plotting these anthropometric data on the appropriate growth chart until the age of 18 years, and this will help in picking up the reason for failure to thrive early and thereby help to reduce expensive investigations.
- 112. References Nelson textbookof paediatrics Nelson Paediatric symptom based diagnosis OP GHAI textbook of essential paediatrics Paediatric Endocrine Disorders by Meena P Desai IAP textbook of Endocrinology ILLINGWORTHs development of the infant and young child WHO IAP Height Velocity Percentiles in Indian Children Aged 5-17 Years VAMANKHADILKAR1, ANURADHAKHADILKAR1, ARCHANA ARYA2, VEENA EKBOTE1, NEHAKAJALE1, LAVANYA PARTHASARATHY1, VIVEK PATWARDHAN1, SUPRIYA PHANSE1 AND SHASHICHIPLONKAR1 Khadilkar V, Yadav S, Agrawal KK, Tamboli S, Banerjee M, Cherian A, Goyal JP, Khadilkar A, Kumaravel V, Mohan V, Narayanappa D. Revised IAP growth charts for height, weight and body mass index for 5-to 18-year-old Indian children. Indian pediatrics. 2015 Jan 1;52(1):47-55.
- 113.