Growth monitoring
Assistant prof. Mayasah A. Sadiq FICMS-FM
Growth monitoring defintion
Refers to the process of tracking child
growth by regularly measuring the child
and comparing his or her growth (i.e.,
height or weight) to a standard, assessing
growth adequacy, and linking the growth
trend with a target action through tailored
counseling and referral.
and
the health worker
Child Growth = marker of health
and development
Quick, non-invasive techniques
Plotting serial measurements on
charts
Abnormal growth can indicate
underlying health or developmental
problems
Birth to 2 years
Weight to
nearest 10g
To nearest
0.1cm
purpose‘infantometer’ to
nearest 0.1cm
2 & 3 ½ years
Portable or
fixed
‘for purpose’
To 100g /
0.1cm
NCHS(National Center for Health
Statistics USA) or WHO charts
•Growth charts are established on large populations of
normal children living under near-optimal conditions and
therefore representing the range of normal growth for
children at different ages.
•NCHS : USA population, cross-sectional
•New growth standards have been developed by the
World Health Organization (WHO) based on the growth
of normal breast fed infants in various regions of the
world. International growth reference standard
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.
For the assessment WHO has
provided
charts for both boys and girls.
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
➢ HC(head circumference)-for-age
What are growth charts?
Growth charts are a series of percentile curves
that show the distribution of body
measurements in children over time.
Growth charts are not diagnostic instruments.
They are screening tools that help you form an
overall clinical impression for the child being
measured.
The positions of the individual points on the
graph are less important than the overall
trajectory of the growth curve over time.
How to use a growth chart
Accurately determine age .
Accurately measure weight and recumbent
length
Plot measurements on appropriate chart
Use the percentile lines to assess body size
and growth, and monitor growth over time
Gather additional history, exam as needed
Discuss growth pattern with parent and agree
on subsequent action if required
Obese 97th
Z-score graphs
• 0 correspond to the mean and median
•Z-scores or SD scores are used to describe
mathematically how far a measurement is from the
median (average).
• Z score=x` ± SD
•The mean (median) is the same in both types of
graph
After measurement, what next?
•Measurement does not improve growth
•Interpret the graph
•Action must follow:
Any child with Z score < -3
Any child crossing the lines
Weight/height discrepancy
Consider wasting
High concern :
Any sharp decline in growth line:
◼ This is a very significant change in the
child’s growth.
◼ A sharp decline in a normal or
undernourished child indicates a growth
disturbance.
◼ Changes in weight or length should be
investigated before a child crosses two
major percentile lines.
High concern :
A flat growth line:
◼ Child is not growing consistently.
◼ When growth rate is rapid during first six
months of life, even a one month flat line in
growth represents a possible concern.
High concern :
Any sharp incline in the growth line:
◼ This is a very significant change in the child’s growth.
◼ Changes in weight or length should be investigated
before a child crosses two major percentile lines.
◼ An unexplained sharp incline may signal a change in
feeding practices - may lead to overweight/obesity.
◼ A sharp incline in a previously ill or undernourished
child may be “catch-up” growth expected in the re-
feeding period.
Practice Scenario - Birth
Omar is a 1 day old breastfed male infant:
◼ Birth date: 15 APR 2022
◼ Birth weight: 3.41 kg
◼ Gestational age: 38 weeks
Plot the point and describe his weight-for-age percentile
Description: “weight-for-age is at
the 50th percentile”=0 Z score
Practice Scenario – Week 1 Visit
At Omar's first study visit his mother is concerned
that she does not have enough breast milk.
◼ Visit date: 24 APR 2022
◼ Visit weight: 3.21 kg
◼ Age: 9 days
Plot the point and describe his weight-for-age percentile
Is this expected?
What else would you do at this visit?
Z score
between -1 &-2
Practice Scenario – Month 1 visit
At the Month 1 visit, Omar has not yet regained his birth
weight:
◼ Visit date: 15 May 2022
◼ Visit weight: 3.35 kg
◼ Age: 1 month
Plot the point and describe his weight-for-age percentile
Is this expected?
What else would you do at this visit?
Description: “weight-for-age
is at the -3 z score
Practice Scenario – Interim visit 1
Omar returns for an interim weight check two weeks
after his Month 1 visit:
◼ Visit date: 30 May 2022
◼ Visit weight: 4.21 kg
◼ Age: 1.5 months
Plot the point and describe his weight-for-age percentile
Is this expected?
What else would you do at this visit?
Description: “weight-for-age
is at the -1 Zscore
Practice Scenario – Interim visit 2
Omar returns for an interim weight check one month
after his last interim visit:
◼ Visit date: 01 July 2022
◼ Visit weight: 5.23 kg
◼ Age: 2.5 months
Plot the point and describe his weight-for-age percentile
Is this expected?
What else would you do at this visit?
Description: “weight-for-age
is between the -1 Z score
Practice Scenario – Month 6 visit
Omar returns for his Month 6 visit:
◼ Visit date: 12 OCT 2022
◼ Visit weight: 7.26 kg
◼ Age: 6 months
Plot the point and describe his weight-for-age percentile
Is this expected?
What else would you do at this visit?
Description: “weight-for-
age is -1 Z score
