seminar

1. Growth charts
• The growth of the child is monitored by recording the
measurements of the child periodically & plotting against the
age, in a specially designed chart called Growth Chart
• These growth charts are primariy designed for longitudinal follow
up of a child(growth monitoring), to interpret the changes over
time
• It was first designed by David Morley for growth assessment.
• We use WHO and IAP charts for the interpretation

2. Growth
standards
• They represent norms of growth and
can be presented in tabular or
graphical manner
• In 1977, National Centre for Health
and Statistics along with CDC
developed growth curves based on
Fel’s longitudinal study from 1929 to
1975.
• In 2000, CDC developed a growth
curve based on data from national
health surveys and birth certificates
in the U.S

3. WHO growth chart
• In 1993 WHO undertook a comprehensive
review of the uses and interpretation of
growth references
• The need for internationally applicable growth
standards.
• 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.
• Participating countries include Brazil, Ghana, India,
Norway, Oman, and USA
• WHO charts –
blueforboysand pinkforgirls

5. Criteria for
the MGRS
Access to health care and breastfeeding support
Full term birth
No smoking during pregnancy
Exclusive or primarily breastfeeding > 4 months
Began feeding solids by 6 months
Continued breastfeeding > 12 months

6. Important points
• 2 types of growth chart available- percentile and standard deviation (z score)
• For the assessment WHO has provided charts for both boys and girls (age of 5yrs)
• Growth indicators are used to assess growth,
• height-for-age
• weight-for-age
• weight-for-length
• BMI (body mass index)-for-age
• Head circumfere for age
• Mid arm circumfere for age
• Skin fold thickness for age
• Major motor developmental milestones

9. Plotting of chart
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
plotted point– the point on a graph where a line extended from a measurement on
the x-axis (e.g. age) intersects with a line extended from a measurement on the y-
axis (e.g. weight)

10. Z – scores
• Normal distribution
• Z = (Observed value -
mean) / SD

11. To interpret the plotted graph
Measurements in the shaded boxes are in the normal range.

12. • Notes:
1. Achild in this range is very tall. Tallness is rarely a problem, unless it is so excessive that it may
indicate an endocrine disorder such as a growth-hormone-producing tumor. Refer a child in this
range for assessment if you suspect an endocrine disorder (e.g. if parents of normal height have a
child who is excessively tall for his or her age).
2. Achild whose weight-for-age falls in this range may have a growth problem, but this is better
assessed from weight-for-length/height or BMI-for-age.
3. Aplotted point above 1 shows possible risk.Atrend towards the 2 z-score line shows definite risk.
4. It is possible for a stunted or severely stunted child to become overweight.
5. This is referred to as very low weight in IMCI training modules. (Integrated Management of
Childhood Illness, In-service training. WHO, Geneva, 1997).

13. Velocity of growth
• Growth charts help to determine it
• One time measument cannot be relied upon
• When factors for growth retardation exist for long time the chart becomes abnormal.
• Plotting growth velocity is useful in early identification of factors affecting growth.
Growth monitoring
• IAP guidelines are-
• During infancy it is done via visit on vaccination later integrated with school heath
programs
• During adolescence sexual maturity rating staging should be monitored.

15. Advantages and Uses
• Truly global standard
• Seen as ‘gold standard’ of growth charts in terms of promoting good health outcomes, including across
cultures.
• Establishes breastfeeding as the biological norm.
• Have greater capacity to assist the early identification of epidemic of childhood obesity
• Diagnostic tool-To identify high risk children.
• Planning and policy making
• Education tool for educating mothers
• Tool for action helps in type of intervention that is needed
• Evaluation of effectiveness of corrective measure and impact of a programme of special
interventions for improving Childs growth and development
• Tool for teaching.

16. Growth chart used in India
• 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.
• A joint "Mother and Child Protection Card" has been developed which provides space for recording.
• family identification and registration
• Birth record
• Pregnancy record
• Institutional identification
• Care during pregnancy
• Preparation for delivery
• Registration under Janani Suraksha Yojana
• Details about immunization procedures
• Breast-feeding and introduction of supplementary food
• Milestones of the baby