DEVELOPMENT AND GROWTH CHART MONITORING.pptx

new born growth chart

1. GROWTH AND DEVELOPMENT SCREENING M.Sudha College of N ursing, SRIPMS

2. Introduction Growth: Increase in the physical size of the body as whole or any of its parts associated with increase in cell number and cell size. Growth Chart: The growth of the child is monitored by recording the weight of the child periodically & plotting against the age, in a specially designed chart called Growth Chart.

3. GROWTH CHART Growth charts are visible display of child’s physical growth and development . Also called as “road-to-health" chart. It was first designed by David Morley for growth assessment and was later modified by WHO

4. Why to monitor growth? Child growth is monitored to: Assess the adequacy of nutrition Identify weight status and potential for obesity Screen for disease related to abnormal growth

5. HOW GROWTH IS ASSESSED ?? Basic growth assessment involves measuring a child’s weight and length or height

6. About the chart…. Well baby clinics, PHC, and ICDS programmes utilize growth charts. The wt. measurements of a child over a period of time are plotted on the growth chart and any deviation from the normal pattern can be visualised and interpreted. An upward curve in the road to health is ideal. A flat and downward curves are not desirable. WHO charts – blue for boys and pink for girls

7. Growth chart for boys

8. Growth chart for girls

9. WHO GROWTH CHART MULTICENTRIC GROWTH REFERENCE STUDY(MGRS ) Participating countries include Brazil, Ghana, India, Norway , Oman , and USA. Data collected by trained staff using a common protocol Measurements included weight/age, height/age, and weight/height . Data on BMI was generated for children under 5 for the 1st time.

10. WHO GROWTH CHART X-axis : In WHO Growth chart, x-axes show age. Points plotted on vertical lines corresponding to completed age (in months, or years) Y -axis : y-axes show length/height, weight, or BMI. Points plotted on or between horizontal lines corresponding to length/height, weight or BMI as precisely as possible

11. Cut off values…… WHO growth standards are based on healthy children living in optimal conditions so more extreme cut offs are used to identify nutrition risk . WHO charts use 2nd and 98th percentiles as the outermost percentile cut off values indicating abnormal growth. CDC use 5th and 95th percentile as cut off values.

12. Interpretation of growth curves Suspect Risk, 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. Normal growth curve runs parallel to the median curve.

13. Management Weight b/w curves 1 & 3 -undernourished, require supplementary feeding at home Weight below curve 3 - consult the doctor and follow his advice. Weight below curve 4 - hospitalized for treatment

14. USES OF GROWTH CHART Growth Monitoring. Diagnostic tool-To identify high risk children. Planning and policy making. Education tool for educating mothers. Tool for action- Helps in the type of intervention that is needed. Evaluation tool- Effectiveness of corrective measure and impact of a programme of special interventions for improving Childs growth and development Tool for teaching.

15. Development It is the process of functional and physiological maturation of the individual. It is a progressive increase in skill and capacity to function. It includes psychological, emotional and social changes.

16. Developmental Screening It is the practice of systematically looking for and monitoring signs that a young child may be delayed in one or more areas of development. Screening is defined as a brief, formal, standardized evaluation that aids in the early identification of patients at risk for a developmental and/or behavioral disorder

17. Approaches to Screening The three approaches to screening include Informal, Routine and focussed developmental screening Informal screening is based on observing the child during a routine pediatric check up and asking parents about their concerns about child's development.

18. Routine formal screening involves systematic developmental screening of all children with the help of standardized screening instruments. Focussed screening involves developmental screening of the following groups of children: (a) Children whose parents express developmental concerns or in whom teachers and physicians suspect problems. (b) Newborns with conditions that have known to have high risk for developmental - mental delay

19. Developmental Screening Tools There are a variety of screening tests to choose from, many of which are completed by parents and require only a short period of time to administer and score. These questionnaire screening forms are convenient, as there are no directly administered test items and scoring requires minimal training.

20. Screening tools The Parents’ Evaluation of Developmental Status The Ages and Stages Questionnaire (ASQ) Modified Checklist for Autism in Toddlers (M-CHAT) Denver Development Screening Test (DDST). The DP II (Developmental Profile) Vineland Social Maturity Scale (VSMS)

21. Screening tool used in India The Baroda Development Screening Test for Infants The Developmental Assessment Tool for Anganwadis (DATA) Trivandrum Developmental Screening Chart (TDSC) The Disability Screening Schedule (DSS) The Early Language Milestone Scale (ELM scale)

22. Denver Development Screening Test (DDST). The DDST is used to screen children from two weeks through 6 years of age in four developmental domains; gross motor, fine motor adaptive, personal social and language skills. The test consists of 5 items but only those items are administered which are appropriate to the child's age.

23. Each item is scored pass or fail. A delay score is given to an item which is failed by the child that is passed by more than 90% of children in the normative age group. Scores are interpreted as "abnormal", "questionable", or "normal” in each sector. The main usefulness of the test is that it is easy to administer and score and does not require extensive training or experience in testing.

24. The DDST is most useful in identifying children with moderate to severe motor or cognitive deficit. However its usefulness is limited in detecting more subtle delays Concerns about the inadequate psycho- metric properties of the DDST prompted a major revision of the test and led to the development of Denver II.

25. The major differences between the DDST and Denver II are an increase in the language items, inclusion of articulation items, a new age scale, a new category of identifying milder delays, and a behaviour rating scale. However, this test too has been criticized for its limited specificity and has not been extensively used in the Indian setting.