The document discusses growth monitoring and assessment in children. It provides information on different growth charts used internationally and in India, including the WHO growth standards. Key points covered include:
- Growth is determined by genetics and influenced by nutrition and environment. Growth charts track changes over time and compared to references.
- WHO growth standards from 2006 provide the norm for healthy growth in children up to 5 years old. CDC recommends their use along with CDC charts for ages 2-20.
- India has adopted WHO standards and developed a Mother and Child Protection Card to record growth and milestones. New affluent Indian references were produced in 2007-2008.
- Regular growth monitoring allows detection of growth faltering or
Weighing of the child at regular intervals, the plotting of that weight on a graph (called a growth chart) enabling one to see changes in weight, and giving advice to the mother based on this weight change is called ‘GROWTH MONITORING’
The growth chart or road to health chart was first designed by David Morley and later modified by WHO which is a visible display of a child's physical growth and development.
Growth charts in Neonates- Preterm and termSujit Shrestha
Growth charts in Newborn, Preterm and term neonates. All historically used charts in NICU are discussed here.
Presented by Dr Sujit, in Sir Ganga Ram Hospital
Service providers who receive high nutrition risk referrals, particularly Registered Dietitians, need to be knowledgeable about general and clinical pediatric nutrition as well as counselling skills for working with families and children.
This is the first of five self-directed training modules available in PowerPoint presentations that have been developed and evaluated to respond to this need
Weighing of the child at regular intervals, the plotting of that weight on a graph (called a growth chart) enabling one to see changes in weight, and giving advice to the mother based on this weight change is called ‘GROWTH MONITORING’
The growth chart or road to health chart was first designed by David Morley and later modified by WHO which is a visible display of a child's physical growth and development.
Growth charts in Neonates- Preterm and termSujit Shrestha
Growth charts in Newborn, Preterm and term neonates. All historically used charts in NICU are discussed here.
Presented by Dr Sujit, in Sir Ganga Ram Hospital
Service providers who receive high nutrition risk referrals, particularly Registered Dietitians, need to be knowledgeable about general and clinical pediatric nutrition as well as counselling skills for working with families and children.
This is the first of five self-directed training modules available in PowerPoint presentations that have been developed and evaluated to respond to this need
Aene project a medium city public students obesity studyCIRINEU COSTA
Identifying undernutrition and obesity on students and propose public policies of health are urgent issues. This paper presents a study with weight and stature from students collected by physical education teachers (PEF) in schools of a city near São Paulo. The PEF collected the data and they were inserted in a program especially developed for each school Department (AENE Project). The datas were analyzed by software and evaluation done based on a World Health Organization (WHO_2007) table, that develops health programs worldwide. The results evaluations were used to raise the students and family, teachers and responsibles for treatment search (when required).
1· The precise goal of the study or experiment· The populati.docxeugeniadean34240
1
· The precise goal of the study or experiment
· The population
· Your expected sample size
· How you will go about collecting your sample
· Exactly what statistical computations you expect to perform (hypothesis, null hypothesis, alternative hypothesis, type I and II error, significance level, critical value, P-value, etc.
· How you will present your results to the reader
· Itemized expected cost for your study in terms of time and money
Childhood Obesity among Pittsburgh School Students, Ages 6-12 Years
The hypothesis of if schools served healthier food and gave the children more time to eat as well as having more chances to be active, like recess and physical education, then child hood obesity rates would decrease drastically. This study will investigate effects of teaching obese children better habits of eating and exercise and improved habits and self-esteem. The children for the study will be drawn from the general school population (ages 6 to 12). Students (n = 20) will receive a brief intervention regarding nutrition, activity, and snacking. Students will serve as their own control. Each participant will be pre- and post-tested regarding eating behavior, activity, snacking behavior, and levels of self-esteem. The hypothesis will be tested through the application of quantitative analysis (one-way ANOVA) to the data collected
(Dotsch, Kokocinski, Knerr, Rascher, Rascher & Weigel, 2008).
The goal of this proposal is to study the prevalence of obesity among school children 6-12 years old in Pittsburgh Public Schools, and to identify any variation as per age, gender, place of residence, and type of school. Obesity is usually defined as more than 20 percent above ideal weight for a particular height and age ("Obesity,"). This proposal is addressed to meet the needs of children who have become obese due to environmental factors. If we can alter a few key and relatively simple areas in the lives of individuals, reinforce this within the schools and community, and re-evaluate the messages being sent in our culture, American school children will soon see an end to an excessive weight gain.
The results of this survey are important for the development of evidence-based practice guidelines and the overall process will have an impact on the clinical practice, research and dietetic policy.
School children between 6-12 years old will be sampled using stratified random sampling (SRS) with cumulative population proportionate from each school (cluster) of four districts. A total of 20 clusters will be selected by systematic sampling. The clusters spread out geographically by schools, and then the sample starts at a random cluster and then takes every 10th cluster in the list. First, take a separate SRS in each stratum to allow separate conclusions about each stratum. Then, a stratified sample will have a smaller margin of error than an SRS of the same size. Data will be analyzed using Body Mass Index (BMI- CDC) calculator and/or a .
Running head PICOT STATEMENT 1PICOT STATEMENT 5.docxtoltonkendal
Running head: PICOT STATEMENT 1
PICOT STATEMENT 5
PICOT Statement: Childhood Obesity
P-I-C-O-T Statement
P- Patients who suffer from obesity (BMI of more than 30)
I- Undertaking nutritional education, diet, and exercise
C- Comparison to nutritional education, endoscopic bariatric surgical intervention
O- Improved health outcomes in terms of overall weight
T - A year’s time limit
PICOT Statement: Childhood Obesity
Introduction
Childhood obesity poses serious health problems in the US as the number of overweight and obese population increases at a rapid pace every year. The effects of this problem have arrested the attention of policymakers, societal members, and government agencies. This has resulted in ranking childhood obesity as a national health concern. The adverse impacts of this disease go beyond the health realms to include economic burden on both personal and national budgets. While there are numerous risk factors and various evidence-based interventions to address this challenge, no single approach is consistently efficacious in curbing the disease. Consequently, it is imperative that efficacious initiatives and policies be developed to address the never-ending problem of childhood obesity. Multidisciplinary approaches are often broad and cut across all dimensions of personal health problems. Instead of placing emphasis solely on biomedical models, health care professionals should also seek to promote behavior change among obesity patients and their family members. A PICOT statement can be utilized as an effective tool to seek interventions of addressing childhood obesity.
PICOT Statement
Population
In the US, obesity prevalence is highest among children aged from 6 to 11 years (Cheung et al. 2016). The disease has tripled among this age group from 4.2 percent to 15.3 percent from 1963 to 2012. In the last three decades, increased cases of obesity prevalence have been noted among children of all ages, although the differences in obesity prevalence have been recorded in terms of age, race, ethnicity, and gender (Cheung et al. 2016). In this respect, children from socioeconomically disadvantaged families and some racial and ethnic minorities experience the higher median score on obesity than the dominant white population. Higher obesity rates are often recorded among blacks and Hispanics compared to whites. For instance, a survey on girls in the Southwest revealed that the yearly cases of obesity stood at 4.5 percent among Blacks, 2 percent among Hispanics, and 0.7 percent among white girls aged from 13 to 17 years (Cheung et al. 2016). For low-income earners, American Indians rank highest at 6.3 percent, followed closely by Hispanics at 5.5 percent.
Intervention
Evidence-based interventions that seek to reduce childhood obesity incidences in the country should target two major areas: prevention and treatment. High-quality RCT has been proven as one of the most effective preventative ...
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. Growth is a dynamic process
as an increase in the physical size of the body as a whole or any of its parts
Associated with increase in cell number and/or cell size.
A normal healthy child grows at a genetically predetermined rate
Child development refers to the biological, psychological and
emotional changes that occur in human beings between birth and
the end of adolescence, as the individual progresses from
dependency to increasing autonomy.
Nutritional, family, emotional, sociocultural and community, as well as
physical, factors play a role in shaping the child’s psycho logic and
physiologic development
3. 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
comparing these measurements to growth standards.
4. The purpose is to determine whether a child is growing “normally”
or
has a growth problem or trend towards a growth problem that should
be addressed.
5. Consist of a series of percentile curves
that illustrate the distribution of selected
body measurements in the study
population
Used to track the growth of children from
infancy to adolescence
Indicates the state of the child's health,
nutrition and well being
Growth charts were popularised by David
Morley.
6. These growth charts are primariy designed for longitudinal follow up
of a child(growth monitoring), to interpret the changes over time[2].
NCHS 1977 growth charts
CDC 2000 growth charts
WHO Growth Charts (2006)
NEW 2007 AFFLUENT INDIAN GROWTH CHARTS
7. Primarily to identify children with growth deviation and
diseases and conditions that manifest through abnormal
growth.
Secondarily to discuss health promotion related to
feeding, hygiene, immunisation and other aspects ,
education of parents to allay their anxiety about their
childs growth also to sensitize health care workers to use
growth charts.
8. Individual level
Community level
National level
Scientists
Monitoring &documenting
growth
Comparison with
references std
To detect growth faltering
Monitoring health status
Performance of programs
Comparison over time
Identification of problem areas
National/international
comparisons
Research tool
9. First 2 years
2 –10 years
>10 years
Length/age
Weight/age
Weight /height
Head circumference/age
Height/age
Weight/age
BMI/age
Height/age
Weight/age
BMI/age
pubertal development
11. The deviation of the value for an individual from the median
value of the reference population, divided by the standard
Deviation for 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
12. The rank position of an individual on a given reference distribution,
stated in terms of what percentage of the group the individual
equals or exceeds .
Eg. A child of a given age whose weight falls in the 10th percentile
weighs the same or more than 10% of the reference population of
children of same age
Towards the extremes of the reference distribution there is little
change in percentile values, when there is infact substantial change
in weight or height
Commonly used -3,-2 and -1 Z scores are respectively the 0.13th ,
2.28th and 15.8th percentiles and the 1st ,3rd and 10th percentiles
correspond to, respectively, the -2.33,-1.88,and -1.29 Z scores.
14. Ratio of a measured value in the individual, for instance weight , to the
median value of the reference data for the same age or height, expressed
as a percentage.
Main disadvantage-
lack of exact correspondence with a fixed point of distribution across age
and wt status
Eg. Depending on the child’s age, 80% of the median weight for age might
be above or below -2Z score; in terms of health, it reflects in different
classification of risk.
Cut off points for percent of median are different for the different
anthropometric indices.
15. This distinction is important in the assessment of which growth chart is
the most appropriate to a given population
A growth reference describes the growth of a sample of individuals who
are representative of the general population, without making any
association with health(CDC charts)
Growth reference are descriptive and are prepared from a population
which is thought to be growing in the best possible state of nutrition and
health in a given community. They represent how children are growing
rather than how they should be growing.
A standard, on the other hand, describes the growth of a healthy
population and provides a reference to which all populations can
aspire.(WHO charts)
Growth standards are prescriptive and define how a population of
children should grow given the optimal nutrition and optimal health .
16. Advantages of growth standard is that children of all
countries, races, ethnicity can be compared against a
single standard thus assessment becomes more
objective and easy to compare. The disadvantage is
that these are likely to over diagnose underweight and
stunting in a large no. of children in developing
countries such as India.
Advantages of references is that they are true
representative of the existing growth pattern of children
and allow us to study the secular trend in terms of
height, weight and obesity. Disadvantages include
they need to be updated at least once in a decade and
in modern times likely to define overweight children as
normal
17. Reference data from Boston children’s hospital
Hospital based
Longitudinal study
Small sample size
Top fed babies
Still served the purpose of creating an
awareness re need for monitoring & growth
assessment
Used in Indian growth charts & for classification
of malnutrition since mid 1970s .
18. Banik Dutta et al: ICMR Technical report
series no. 18, 1972: Growth & Physical
development of Indian infants & children
Not affluent population, but mixed group
Community based
Criticised for method of sample selection &
data collection
19. Using longitudinal-data from the Fels Research Institute,
collected in Yellow Springs, Ohio between 1929 and 1975
The 1977 growth charts were developed by the National Center for
Health Statistics (NCHS) as a clinical tool for health professionals to
determine if the growth of a child is adequate. [1]
The 1977 charts were also adopted by the World Health
Organization for international use.
Its sample was acknowledged to be quite limited in geographic,
cultural, socioeconomic and genetic variability.
The 2000 CDC growth charts represent the revised version of the
1977 NCHS growth charts
20. The 2000 CDC growth charts represent
the revised version of the 1977 NCHS
growth charts
The revised growth charts consist of 16
charts (8 for boys and 8 for girls)
introduction of two new body mass index-
for-age (BMI-for-age) charts for boys and
for girls, ages 2 to 20 years.
21. Data collected from
1. National Health and Nutrition Examination
Surveys (NHANES),
2. National Natality Files
3. NatalityFiles in Wisconsin and-Missouri,
4. The CDC Pediatric Nutrition Surveillance
System,
5. The Fels Research Institute child growth study
The primary source of data for the infant
charts up to age 6 months was NHANES III.
22. Addition of BMI for age charts: 2 – 20
years
Addition of 85th centile on BMI for age & wt
for stature charts
Addition of 3rd & 97th centiles
Limits of length & stature extended on wt
for length & wt for stature charts
Smoothened percentile curves & Z scores
Correction of disjunction that occurred
between 24 & 36 months when switching
from length to stature in NCHS charts
23. Birth – 36 months
2 - 20 years
2-5 years
Length & weight for age
Head circumference for age
Weight for length
Stature & weight for age
BMI for age
Weight for stature
24.
25.
26.
27.
28.
29.
30.
31.
32. In 1993 the World Health Organization (WHO) undertook a
comprehensive review of the uses and interpretation of
anthropometric 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 the world over.
33. Participating countries include Brazil, Ghana, India,
Norway, Oman, and USA.
Data collected by trained staff using a common
protocol
Sample selected from communities where there
were no environmental constraints to growth.
The new growth reference is based on breastfeeding
as the biological norm.
Measurements include weight/age, height/age, and
weight/height. Data on BMI was generated for
children under 5 for the 1st time.
34. Between 1997 and 2003
longitudinal follow-up from birth to 24 months
+
cross-sectional survey of children aged 18 to 71 months
Primary growth data and related information were gathered from
8440 healthy breastfed infants and young children from widely
diverse ethnic backgrounds and cultural settings
35. The study includes
Healthy children
Living under conditions likely to favor the achievement of their full
genetic growth potential
Mothers engaged in fundamental health-promoting practices, namely
breastfeeding and not smoking[4].
The new standards show that growth can be achieved with
recommended feeding and health care (e.g. immunizations, care
during illness)
The standards can be used anywhere in the world
study also showed that children everywhere grow in similar patterns
when their nutrition, health, and care needs are met
36. For the assessment WHO has provided charts for both boys and girls.
Growth indicators are used to assess growth considering a child’s age
and measurements together.
length/height-for-age
weight-for-age
weight-for-length/height
BMI (body mass index)-for-age
Head circumference for age
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47. Consists of X axis which is usually in years
or months and y axis that changes
according to the reference e.g. cm, inches,
kg, kg/m2.
the x axis is usually divided into 12 equal
parts (months) for each year. Standard
growth chart has 7 percentile lines and
include 3,10,25,50,75, and 97 percentiles.
48. Z score Height for age Weight for age BMI for age
>3 May be abnormal May be abnormal obese
>2 Normal Use BMI Overweight
>1 Normal Use BMI Risk of
overweight
0 normal Use BMI normal
<-1 normal normal normal
<-2 stunted underweight wasted
<-3 Severely stunted Severely
underweight
Severe wasted
49. > 95th percentile
85th to < 95th
percentile
< 5th percentile
Overweight
Risk of overweight
Underweight
50.
51.
52.
53.
54.
55.
56.
57.
58. When interpreting growth charts, be alert for the following situations,
which may indicate a problem or suggest 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.
59. Seen as ‘gold standard’ of growth charts in terms of promoting good
health outcomes, including across cultures.
Establishes breastfeeding as the biological norm.
More suitable to the aboriginal population as the infants, especially in
remote communities, are predominantly brestfed
Have greater capacity to assist the early identification of
development of overweight
60. Do not reflect current feeding practices.
The rapid weight gain demonstrated in the breastfed infants first six
months may not be appropriate for all breastfed babies May
inadvertently discourage exclusive breastfeeding
Slower than expected growth rates may be interpreted as neglect
especially in aboriginal communities
61. Comparison WHO Growth Chart CDC Growth Chart
Studied
population
Breastfed
infants and toddlers
Breastfed and
formula fed infants
and toddlers
Growth pattern How healthy
children SHOULD
GROW in ideal
conditions
How certain groups
of children HAVE
GROWN in the past
Concept of
growth
A STANDARD by
which all children
should be
compared
A REFERENCE does
not imply that
pattern of growth is
optimal
62. CDC recommends that health care
providers:
Use the WHO growth charts
for infants and children 0 to 2 years of
age
Use the CDC growth charts
for children ages 2 to 20 years
Growth Chart Recommendations for Health
Care Providers
63. The WHO standards establish growth of the breastfed
infant as the norm for growth
The WHO standards provide a better description of
physiological growth in infancy
The WHO standards are based on a high-quality study
designed explicitly for creating growth charts.
64. The ICMR undertook a nationwide cross sectional
study during 1956-1965 to establish indian referance
charts. Irrelevant now as they were done on lower
socio-economic class.
The growth charts compiled by Agarwal et al were
based on affluent urban children from all major
zones of India measured 1989-1991.the data is now
20 years old and irrelevant now.
In 2010-2011 Khadilkar et al have published the
growth charts on affluent children 5-18 years and
have also compared the growth of 2-5 years old
indian children with the new WHO growth charts.
These are the most modern national growth
references available now at present.
65. 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 [2].
A joint "Mother and Child Protection Card" has been developed which
provides space for recording [2]:
o family identification and registration
o Birth record
o Pregnancy record
o Institutional identification
o Care during pregnancy
o Preparation for delivery
o Registration under Janani Suraksha Yojana
o Details about immunization procedures
o Breast-feeding and introduction of supplementary food
o Milestones of the baby
66.
67. THE NEED FOR NEW CHARTS- previously available growth
reference curves in india are almost 2 decades old and WHO
recommends that each country should update its growth
references every decade and hence new growth references
were produced in 2009.
DATA COLLECTION-The IAP divides India into 5 zones-
north, south, east, west and central.the nutritionally well areas
were identified based on per capita income of cities.
The differences between zones were not significant
Data collection lasted from june 2007 to january 2008.
77. Birth to 3 years
Immunization contacts at birth, 6, 10 and 14
weeks, 9 months, 15-18 months and
thereafter every 6 months
4 to 8 years:
height and weight be measured 6 monthly
BMI, PL and SMR should be assessed yearly
from 6 years of age.
9-18 years:
height, weight, BMI and SMR be assessed
yearly
78. First three years
Length/height, weight or head circumference below 3rd
percentile or above 97th percentile on growth chart.
• Crossing of two major percentile lines (upward or
downward) e.g., going from above 75th percentile to below
50th percentile on height or weight chart.
• A child below or above mid parental range for height/length
(see calculation for target height range in Fig. 2)
• Weight loss or lack of weight gain for a month in the first 6
months.
• Absence of weight gain for 2-3 months from 6-12 months of
age.
• Micropenis.
79. • Unilateral or bilateral undescended testis.
• Ambiguous genitals.
Three to nine years
Length/Height below 3rd percentile or above 97th
percentile on growth chart.
• Crossing of two major percentile lines (upward or
downward) e.g., going from above 75th percentile to
below 50th percentile on height or weight chart.
• A child below or above mid parental range for height
• BMI over the 85th percentile at all ages.
• Rate of growth less than 5 cm/year.
80. • Girls with axillary, pubic hair growth or breast budding before
8 years and boys with axillary, pubic hair growth, genital
growth or and testicular enlargement before 9 years.
• Children with craniospinal irradiation or surgery for brain
tumors.
• Micropenis.
Nine to eighteen years
• Height below 3rd percentile or above 97th percentile on
growth chart.
• Crossing of two major percentile lines (upward or
downward) e.g., going from above 75th percentile to below
50th percentile on height or weight chart.
• A child below or above mid parental range for height
81. What are Tanner stages?
Tanner stages defines different levels of sexual maturity,
based on the development of primary (genitalia) and
secondary sex (pubic hair and breasts) characteristics.
These stages were first described by James
Mouilyan Tanner.
Sexual maturity rating is important in cases where
delayed or precocious puberty is suspected It provides a
means of documentation and standardization.
82. Stage 1 represents the
prepubertal breast in
which
there is elevation only of
the papilla.
stage 2, a "breast
bud"forms below the
areola
stage 3, there is further
enlargement and elevation
of both breast and areola
83. stage 4, the areola
forms a secondary
mound above the
contour of the breast
stage 5 breast is fully
mature, with
recession of the
secondary mound
and a smooth breast
contour.
84. Stage 1 describes
prepubertal genitalia.
stage 2, there is
enlargement of the testes
and scrotum, with
reddening and thinning of
the scrotum, but no
enlargement of the penis.
stage 3, the penis begins
to enlarge, first in length
and later in diameter.
85. stage 4, continued
lengthening of the
penis and
enlargement of the
glans.
Stage 5 represents
genitalia of adult
size and proportion
86. In the prepubertal stage
1, there may be fine
vellus hair that is no
different from that found
over the abdominal wall.
In stage 2, there is
growth of sparse straight
hair, primarily at the base
of the penis or along the
labia.
In stage 3, hair increases
in quantity and is darker
and Curlier.
87. Stage 4 is characterized
by pubic hair that
resembles adult pubic
hair, although the
escutcheon covers a
smaller are than seen in
adults.
stage 5, pubic hair has
increased further in
volume, spread onto the
medial thighs,and taken
on characteristic male or
female configuration.
88. Stage
Female Male
Age range
(years)
Breast
growth
Pubic hair
growth
Other
changes
Age range
(years)
Testes
growth
Penis
growth
Pubic hair
growth
Other
changes
I 0–15 Pre-
adolescent
None Pre-
adolescent
0–15 Pre-
adolescent
testes
(≤2.5 cm)
Pre-
adolescent
None Pre-
adolescent
II 8–15 Breast
budding
(thelarche)
; areolar
hyperplasi
a with
small
amount of
breast
tissue
Long
downy
pubic hair
near the
labia, often
appearing
with breast
budding or
several
weeks or
months
later
Peak
growth
velocity
often
occurs
soon after
stage II
10–15 Enlargeme
nt of
testes;
pigmentati
on of
scrotal sac
Minimal or
no
enlargeme
nt
Long
downy
hair, often
appearing
several
months
after
testicular
growth;
variable
pattern
noted with
pubarche
Not
applicable
III 10–15 Further
enlargeme
nt of
breast
tissue and
areola,
with no
separation
of their
contours
Increase in
amount
and
pigmentati
on of hair
Menarche
occurs in
2% of girls
late in
stage III
1½–16.5 Further
enlargeme
nt
Significant
enlargeme
nt,
especially
in diameter
Increase in
amount;
curling
Not
applicable
89. IV 10–17 Separation
of
contours;
areola and
nipple
form
secondary
mound
above
breasts
tissue
Adult in
type but
not in
distribution
Menarche
occurs in
most girls
in stage
IV, 1–3
years after
thelarche
Variable:
12–17
Further
enlargeme
nt
Further
enlargeme
nt,
especially
in
diameter
Adult in
type but
not in
distribution
Developm
ent of
axillary
hair and
some
facial hair
V 12.5–18 Large
breast with
single
contour
Adult in
distribution
Menarche
occurs in
10% of
girls in
stage V.
13–18 Adult in
size
Adult in
size
Adult in
distribution
(medial
aspects of
thighs;
linea alba)
Body hair
continues
to grow
and
muscles
continue
to
increase in
size for
several
months to
years;
20% of
boys
reach
peak
growth
velocity
during this
period
90. The Fenton growth chart for preterm
infants has been revised to
accommodate the World Health
Organization Growth Standard and
reflect actual age instead of completed
weeks, in order to improve preterm
infant growth monitoring.”
91.
92.
93. Mid-parental Centile
Plot the the Mother’s and Father’s
heights on their respective scales and
join the two points with a line. The mid-
parental centile is where this line crosses
the centile line in the middle.
Compare the mid-parental centile to
the child’s current height centile, plotted
on the adult height predictor centile
scale.
Nine out of ten children’s height
centiles are within ±two centile spaces of
the mid-parental centile.
94. Plot the most recent
height centile on the
relevant centile line
Read off the predicted
adult height for this
centile.
Four out of five children
will be within ±6 cm of
this value.
Predicted Adult Height
95.
96. [1] Rakel. Textbook of Family Medicine. 7th ed. Philadelphia: Saunders;
2007. P. 555.(Growth and development; chap 31).
[2] Park K. Textbook of Preventive and Social Medicine. 21st ed.
Jabalpur(India): Banarsidas Bhanot Publishers; 2011. P.502.
[3]Srilakshmi B. Nutrition Science. 2nd ed. New Delhi: New Age International
(P) Ltd.; 2006.
[4] WHO. WHO child growth standards. Geneva(Switzerland): WHO;2007
[5] World Health Organization. Training Course on Child Growth Assessment.
Geneva, WHO, 2008.
[6]Ghai OP. Ghai Essential Pediatrics: CBS Publishers & Distributors pvt Ltd;
2006
[7] Rosen, D. Physiologic Growth and Development During Adolescence.
Pediatrics in Review. 2004;25:194-200.
97. Plot on fenton chart
Preterm, male child at 30 wks Total length
41 cms, HC 28 cms, wt 1.18 kg
At 32 wks total length 42.1,HC 28.9 , HC
1.26 kg