Growth charts

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 – blue for boys and pink for girls

4. Criteria for the MGRS

5. 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

6. Plotting of chart

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

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

9. Notes: A child 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). A child 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. A plotted point above 1 shows possible risk. A trend towards the 2 z-score line shows definite risk. It is possible for a stunted or severely stunted child to become overweight. This is referred to as very low weight in IMCI training modules. (Integrated Management of Childhood Illness, In-service training. WHO, Geneva, 1997).

10. 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.

11. 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.

12. 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