Growth monitoring is a screening tool used to assess physical growth and detect nutritional, chronic, or endocrine issues in children. It involves regularly measuring height, weight, and other growth indicators and plotting them on growth charts to monitor trends. The aims are to identify growth deviations from normal and diagnose any underlying conditions early. Key aspects include recommended intervals for monitoring, parameters to assess, growth chart use, and referral criteria. National programs in India incorporate growth monitoring to promote child health and nutrition.

1. GROWTH MONITORING,
SCREENING, & SURVILLENCE
1
Rakesh Kumar Verma

2. Refences
 Ghai Essential Pediatrics
 Nelson
 IAP Guideline
 IAP guideline new 2014
 Park Community Medicine
 Bulletin of the World Health Organization 2009;87:116-122. doi:
10.2471/BLT.08.051789
 Growth monitoring manual NIPCCD
 Indian Pediatrics: Revised IAP Growth Charts for Height,
Weight and Body Mass Index for 5- to 18-year-old Indian
Children
 Growth monitoring in children (Review) Panpanich R, Garner
P: Cochrane review
2

3. Over View
Definition
Aims
Importance of growth monitoring
Assessment of physical growth
Growth indices
Growth charts:-
Schedules
IAP recommendation for interval and
parameters
3

4. Definition
Growth denotes a net increase in
the size or mass of tissue
Occurring because of two factors:-
- Multiplication of cells
- Increase of intra cellular substance
4

5. Growth monitoring is a screening tool to
diagnose nutritional, chronic systemic and
endocrine disease at an early stage.
5

6.  Growth monitoring is widely accepted and
strongly supported by health professionals,
and is a standard component of community
Paediatric services throughout the world
 Experience in Tamilnadu, Maharashtra and
other states in India indicates that individual
growth monitoring of children is both feasible
and extremely useful.
6

7. A significant impact on mortality…
even in the absence of nutrition
supplementation or education”
(Gwatkin et al 1980).
7

8. AIMS OF
GROWTH MONITORING
8

9. 9Primary aims:
1. To identify children with growth deviation i.e.,
under nutrition and over nutrition
2. To identify diseases and conditions that
manifest through abnormal growth.
Secondary aims:
1. To discuss health promotion related to feeding,
hygiene, immunization and other aspects of the
child’s health and behavior.
2. Sensitize to use growth charts
Ultimately, the aim of growth monitoring is to minimise
illness and avoid unnecessary child death

10. Importance of growth monitoring
10

11. Growth monitoring helps
detect three main problems:
1. Feeding difficulties, particularly in the younger child;
2. Chronic ill health from whatever cause, including
respiratory infection, malaria, tuberculosis, and
growth hormone deficiency;
3. Social deprivation, where poverty and home
circumstances are such that one outcome is poor
nutrition;
11

12. Remedial actions can be:
a) counselling of the mother;
b) counselling of the mother, aided by the growth chart;
c) nutritional supplement;
d) treatment of concurrent disease, such as diarrhoea;
e) investigation for disease by the practitioner;
f) referral to a specialist for investigation and diagnosis;
g) professional health worker or social support.
12

13. Utility in health programs
Growth monitoring is viewed in most programs
as an activity for
 weighing children regularly and plotting weight on
growth charts to identify undernutrition,
 for feeding programs
 to provide data on nutritional status.
13

14. GROWTH MONITORING COMPRISES
PACKAGES OF ACTIVITIES:
1. Regularly anthropometry of children;
2. Plotting the information on a growth chart to make
pattern of growth visible;
3. If growth is abnormal (usually faltering), appropriate
measures, in concert with the mother;
4. As a result of these actions, the child’s nutrition improves,
the child receives appropriate social or medical support,
or doctors are able to diagnose early serious disease.
14

15. STEPS IN GROWTH
MONITORING
Growth Monitoring involves five steps
Step 1: Determining correct age of the child
Step 2: Accurate weighing of the child
Step 3: Plotting the weight accurately on a growth chart of
appropriate gender
Step 4: Interpreting the direction of the growth curve and
recognising if the child is growing properly
Step 5: Discussing the child’s growth and follow-up action
needed, with the mother
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16. ASSESSEMENT
OF
PHYSICAL GROWTH
16

17. Age dependent Age Independent
-Weight -MAC
-Height -BMI
-HC -Rao’s Index
-Chest circumference -Kanawatis index
17By two types of parameters

18. Other Growth indices 18
Body proportion:-US:LS ratio
Skeletal maturation
Dental development

19. 19
Many bio physiologic and psychosocial problems
can adversely affect growth, and aberrant growth
may be the first sign of an underlying problem.
The most powerful tool in growth assessment is the
GROWTH CHARTS

20. 20
In 2006 the World Health Organization released
growth charts based on the Multicenter Growth
Reference Study (MGRS).
Six study sites representing 5 continents were
included: USA, Brazil, Norway, Ghana, Oman, and
India.

21. 21
The data are presented in 5 standard
gender-specific charts:
(1) weight for age;
(2) height (length and stature) for age;
(3) head circumference for age;
(4) weight for height (length and
stature) for infants; and
(5) BMI for age for children

22. All the points on the growth chart should be marked
only as dots and not circles around the dot.
The height and weight should be recorded (and head
circumference till 3 years) and plotted on the chart. At
all subsequent visits join the dot up to the previous dot.
Remind parents of the time for the next measurement.
22

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29. 29
In a study, substantial discrepancies in underweight prevalence
estimates when using IAP versus WHO Child Growth Standards were
found. This could be explained by the fact that the new WHO standards
are based on data from predominantly breastfed infants of a
heterogeneous sample of children from developing and developed
countries, whereas IAP standards were based on Harvard unisex tables
of height and weight for age derived from predominantly formula-fed
infants of North European descent.
..recommend that professional bodies such as the IAP, the Indian
Association of Preventive and Social Medicine, the Indian Public Health
Association and the Indian Medical Association endorse the use of the
new WHO Child Growth Standards for the monitoring of the growth and
development of children in clinical and public health practice in India
IAP versus WHO Child Growth Standards
Pilot testing of WHO Child Growth Standards in Chandigarh: implications
for India’s child health programmes. Bulletin of the World Health
Organization 2009;87:116-122.

30. 30
IAP
GROWTH
CHART

31. 31

32. 32
Age Growth status Indicator/ Parameter Percentile
0-5 years Underweight Weight for age < 3rd
Severe underweight Weight for age < 0.1st
Stunting Length /Height for age < 3rd
Severe stunting Length /Height for age < 0.1st
Wasting Weight for height < 3rd
Severe wasting Weight for height < 0.1st
5 -18 years Underweight BMI for age < 3rd
Stunted Height for age < 3rd
Overweight BMI for age > 23rd adult
equivalent line
Obese BMI for age > 27th adult
equivalent line
IAP Growth Charts: Cut offs and their
interpretation

33. 33
Percentile z score

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35. 35
However, growth patterns differ amongst different
populations, especially in children above the age of 5
years, as nutritional, environmental and genetic
factors, and timing of puberty seem to play a major
role not only in the attainment of final height but also
in the characteristics of the growth curve.
Hence, it is necessary to have country-specific growth
charts to monitor growth of children between 5-18
years.

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39. Most children tend to track along a percentile, referred to as
“following the curve.” A normal exception commonly occurs
between 6 and 18 mo of life.
Between 6 and 18 mo of age, infants may shift percentiles
upward or downward toward their genetic potential.
39

40. For full-term infants, size at birth reflects the influence
of the uterine environment; however, size at 2 yr
correlates with mean parental height, reflecting the
influence of genes.
This tracking often represents the mid-parental height
and a corresponding weight, where mid-parental
height is calculated in cm as follows:
• Boys: [(maternal height + 13) + paternal height]/2
• Girls: [maternal height + (paternal height − 13)]/2
40

41. It is important to correct for various factors in plotting and
interpreting growth charts.
For premature infants, over diagnosis of growth failure can
be avoided by using growth charts developed specifically for
this population.
A cruder method, subtracting the weeks of prematurity from
the postnatal age when plotting growth parameters.
41

42. While VLBW infants may continue to show catch-up
growth through early school age, most achieve weight
catch-up during the 2nd yr and height catch-up by 2.5 yr.
For children with particularly tall or short parents, there
is a risk of over diagnosing growth disorders if parental
height is not taken into account.
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44. 44
Growth monitoring is one of the basic activities of the
under 5 clinics where the child is weighed periodically at
(ideally)
monthly intervals during the 1st year,
every 2 months during the 2nd year and
every 3 months thereafter up to the age of 5 to 6 years.
There are no national policies for growth monitoring
beyond the age of 6 years.
SCHEDULE: Park

45. 45
The AWW should weigh all
• new borns and children from birth- 1 month weekly,
• one month- 3 years every month and
• 3-5 years at every three months.
• However, children who are severely underweight, or who have
not gained weight for 2 months, or who are “at risk” of under
nutrition, should be weighed frequently preferably every month.
AWW were advised to conduct four weighing sessions in a month
at the AWC so that all children are weighed every month.
SCHEDULE: National Institute of Public
Cooperation and Child Development

46. Recommended intervals and
Parameters for Growth Monitoring by
IAP
Birth to 3 years:
Immunization contacts at birth, 6, 10 and 14
weeks, 6, 9, 12 months, 15 and 18 months may be
conveniently used for growth monitoring. An
opportunistic monitoring at other contacts (illness) is
recommended.
46

47. Normally growing babies should not be weighed more
than once per fortnight under 6 months and no more
than monthly thereafter, as this increases anxiety. After
18 months measurements are to be taken every 6
monthly.
It is recommended that the height, weight and head
circumference be measured up to 3 years of age. Penile
length (PL) and testicular descent should be
ascertained in the newborn period.
47

48. 4 to 8 years:
It is recommended that height and weight be
measured 6 monthly during this period and BMI, PL
and SMR should be assessed yearly from 6 years of
age.
9-18 years:
It is recommended that height, weight, BMI
and SMR be assessed yearly during this period.
48

49. 49
First five years
If the Weight for height is below -3 SD (red line on
Weight for height/ length growth charts) immediate
referral is needed.
Children below 3rd percentile for height/length and/or
weight need careful follow up for the growth trajectory.
Crossing of two major percentile lines i.e, going from
above 75th percentile to below 50th percentile on
height or weight chart.
When to refer

50. 50
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.
Head circumference below 3rd percentile or
above 97th percentile on growth chart.

51. 51
Five to eighteen years
Height below 3rd percentile or above 97th percentile on 5-
18 year IAP charts.
Crossing of two major percentile lines (upward or
downward)
A child below or above mid parental range for height
Rate of growth less than 5 cm/year.
When to refer

52. 52
Watch growth trend carefully when the BMI is over
the 23 adult equivalent cut off line (yellow line on
BMI chart for 5-18 year). Refer when it crosses or is
above 27th adult equivalent line (red line on BMI
charts for 5-18 year).
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.

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• GOBIFFF: Growth Monitoring, Oral Rehydration, Breast
Feeding, Immunisation, Female Eduction, Family
Spacing, Food Supplements
• Udisha
• School health programme
• ICDS
• RMNCH+A
• The National Rural Health Mission
• Integrated programme for Street Children
• Creche Scheme for the children of working mothers
• Immunisation programme
• Mother and Child Tracking System
• RBSK
NATIONAL PROGRAMMES

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