GROWTH_CHARTS in community medicine_19_2_14.ppt

Normal growth and development of child take place only if there is optimal nutrition, freedom from recurrent episodes of infections, and adverse genetic and environmental influences.
Growth : Increase in the physical size of the body.
Development is increase in skills and functions.

1. Growth charts charts
Presenter: Dr Madhusudan M

Growth Charts
1
Dr. Madhusudan

2. Plan of presentation
Introduction
Growth monitoring
Growth charts-history and types
Dr. David Cornelius Morley
Uses of growth charts
References
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3. IntroductionIntroduction
Normal growth and development of child
take place only if there is optimal
nutrition, freedom from recurrent episodes
of infections, and adverse genetic and
environmental influences.
Growth : Increase in the physical size of
the body.
Development is increase in skills and
functions.

4. Introduction
Growth : Increase in the physical size of the body.
Development is increase in skills and functions.
Normal child is one whose characteristics fall within the range of
measurements accepted as normal for majority of children in the
same age group.
Normal growth and development take place only if there is optimal
nutrition, freedom from recurrent episodes of infections, and adverse
genetic and environmental influences.
It is the nature of this process which is crucial for health, ill health, life or
death.
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5. Growth monitoring
Growth monitoring is the process of maintaining regular
observation of a child’s growth.
It starts with measurements of weight daily, weekly, monthly,
bimonthly etc.
The successive weights are plotted on the growth chart of the child
health card.
A curve deviating downwards indicates a situation that the child is
losing weight.
The child needs extra care immediately
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6. Growth monitoring
Growth Monitoring was popularized by David Morley in 1960s’and
70s’ .
This strategy proved that growth monitoring could improve nutritional
status.
His “road to health” chart was a tool which possessed a number of
precise functions-
(a)Provide a health record of the child which included weight & also
relevant information on immunization, disease episodes, family
planning, etc.
(b) Provide a support for the less qualified rural health worker.
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7. Growth monitoring
In 1982, growth monitoring i.e. the regular weighing of children and charting
their weight on a chart was taken up by UNICEF as part of the GOBI
program.
One of the basic activities of under 5 clinics.
Anganwadis under ICDS is also based on growth monitoring and
supplementary feeding for children <6yrs
Importance
Helps in early detection of abnormal growth and development.
Facilitates the early treatment or correction of any conditions that may be
causing abnormal growth and development.
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8. Growth charts- history
 Haiti, mid 60’s- Beghin with Fougère and King designed a growth chart based on
Gomez classification, to select children for referral to nutritional rehabilitation centers.
 Colombia- Rueda Williamson adapted a chart developed earlier by Tony, which
combined weight and height.
Also promoted his “auxogramme” which, was also used for counselling the child’s
mother.
Dr David Morley introduced the concept of growth monitoring and developed the
earliest growth charts. (‘Road to Health’ charts).
The growth chart shows progressive changes in the height and weight of a child in a
graphic form.
They depict average and permissible range of variation for the particular age and
attribute.
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9. Growth charts- history
The Indian Council for Medical Research (ICMR) undertook a
nationwide cross sectional study during 1956 and 1965 to
establish Indian reference charts.
The measurements were made on children of the lower socio-
economic class and hence cannot be used as a reference standard.
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10. Dr. David Cornelius Morley
Born in Northampton, England.
Graduated from St. Thomas hospital, London.
He devised Road to Health chart- trained the local women to use it.
He tried a new vaccine of Measles, between 1962-1965 and made Imesi-Ile
the first community in the world to record the elimination of Measles.
He initiated to set up 2 charities- Teaching Aids at low Cost (TALC) and The
Child to Child Trust.
He devised a 2 ended spoon to prepare the correct rehydration solution.
He encouraged John Zeal to create Thermo Spot.
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11. Growth charts
The Growth or “Road to health” chart is a visible display of a
Child’s physical growth and development.
It is designed primarily for the longitudinal follow up of a child.
Growth chart offers a simple and inexpensive way of monitoring
weight gain.
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12. WHO prototype growth chart
(home based)
This has only 2 reference curves.
The upper curve represents the 50
th
percentile for boys.
The lower curve represents 3
rd
percentile for girls.
If the child is growing normally, its growth line will be above the 3rd percentile
and will run parallel to the "road-to-health curves.
Direction of growth is more important than the position of dots on the line.
Flattening or falling of the child's weight curve signals growth failure, earliest
sign of PEM
. The objective in child care is to keep the child above the 3rd percentile.
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14. NCHS Growth charts
NCHS (National Center for Health Statistics) developed the growth
charts in 1977 and were adopted by the WHO as a clinical tool to
monitor growth of children.
 CDC (Center for Disease Control) in 2000 brought out growth
charts and they represent the revised and improved version of
NCHS charts.
The CDC introduced two BMI charts besides 16 (8 for boys and 8
for girls) charts.
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15. WHO Child growth standards 2006

(new)
In 1993, WHO reviewed NCHS growth references and concluded that
they did not adequately represent early childhood growth.
A Multicentric Growth Reference Study was undertaken b/w 1997-2003
in Brazil, Ghana, India, Norway, Oman and USA & primary growth data
was collected from 9440 healthy breastfed infants and young children (0-
60 mths) from widely diverse ethnic background and cultural settings.
The new WHO standards can be used to assess children everywhere,
regardless of ethnicity, socio economic status and type of feeding.
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22. WHO growth reference for school-aged
children and adolescents
Data from the 1977 National Center for Health Statistics (NCHS)/WHO
growth reference (1–24 years) were merged with data from the under-
fives growth standards’ cross-sectional sample (18–71 months) to smooth
the transition between the two samples.
The merged data sets resulted in a smooth transition at 5 years for height-
for-age, weight-for-age and BMI-for-age.
 The new curves are closely aligned with the WHO Child Growth
Standards at 5 years, and the recommended adult cut-offs for overweight
and obesity at 19 years.
They fill the gap in growth curves and provide an appropriate reference
for the 5 to 19 years age group.
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29. Growth charts used in India
India has adopted the new WHO growth standards in Feb 2009 for
monitoring the young child growth and development within the NRHM
and ICDS.
These standards are available for both boys and girls below 5 years of
age.
The chart is easily understood by the health worker as well as the
mother.
The growth chart shows normal zone of weight for age, under nutrition (
below -2SD ) and severely under nutrition zone ( below-3SD ).
It is the direction of the curve that is more important than the position of
dots on the line.
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30. Interpretation of growth chart
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31. Old growth chart used in Anganwadi
This growth chart has 4 reference curve.
The topmost curve corresponds to 80% of the median (50
th
percentile)of the WHO
reference standard- approximately 2SD below the median.
The lower lines represent 70%, 60% and 50% of median.
Purpose of these lines is to indicate the degree of malnutrition as recommended by IAP.
If the child growth curve is between 80% and 70% lines. It is considered satisfactory.
 If the growth curve is between 70% and 60% lines: Grade I malnutrition
 If the growth curve is between 60% and 50% lines: Grade II
 If the growth curve is below 50% line: Grade III
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32. Old growth chart used in Anganwadi
The growth charts used in ICDS in India contain 4 reference lines,
representing 80 per cent, 70 per cent, 60 per cent and 50 per cent of
the 50
th
percentile of Harvard standard.
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34. Implications of adopting new WHO Child
Growth Standards in ICDS
 Detection in more number of severely underweight children.
The Anganwadi Worker with the help of New Growth Chart would
be able to assess correctly severely underweight children and
number of such children would increase in each Anganwadi
Centres. The number of normal children would also increase in all
the Anganwadi Centres.
The new charts would now help us in comparing growth of our
children within projects, districts, states & also other countries.
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35. Uses of Growth Chart
Growth monitoring
Diagnostic tool
Planning and policy making
Educational tool
Tool for action
Tool for evaluation
Tool of teaching
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36. References References
Park K. Textbook of Preventive and Social medicine.22
nd
edition. Jabalpur:
Banarsidas bhanot; 2013.
Park K. Textbook of Preventive and Social medicine.20
th
edition. Jabalpur:
Banarsidas bhanot; 2009.
Balwar Rajvir.Textbook of Public health and community medicine. Pune:
Department of Community Medicine, AFMC; 2009.
http://www.talcuk.org/about/professor-davidmorley.htm. online accessed on
13/8/2013., 6 pm.
http://www.who.int/en/ online accessed on 13/8/2013.,6 pm.
http://wcd.nic.in/icds.htm. online accessed on 19/8/2013.,9 pm.
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