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1. The Growth Chart
Dr.AnubrataKarmakar
Department of Community Medicine
Medical College Kolkata

2. Growth Chart
Growth charts are visible display of child’s physical growth &
development. Also called as “road-to-health” chart.
It was first designed by David Morley for growth assessment & later
modified by WHO.
Growth chart is designed for: longitudinal follow up (growth
monitoring) of a child.
Growth chart is plotted between: weight for age & weight for
length/height.

3. Need for assessment
Child growth is monitored to:
Assess adequacy of nutrition.
Identify weight status & potential foe obesity.
Screen for disease related to abnormal growth.

4. How growth is assessed?
•The assessment of the growth may be longitudinalor cross sectional.
•Longitudinal assessment of growth chart entails measuring the same
child regular interval.
•Cross sectional comparisons involve large number of children of same
age.
•Basic growth assessment involve measuring a child’s weight & length
or height.

5. Indicators
•For the assessment WHO has provided charts both boys & girls( age
of 5 years)
•Growth indicators are used to assess growth,
Length/height-for-age.
Weight-for-age.
Weight-for-length/height.
BMI (body mass index)-for-age.

6. WHO HOME BASED GROWTH CHART
•WHO growth chart has 2 reference curves:
-Upper Reference Curve(URC): 50
th
percentile for boys
-Low Reference Curve(LRC): 3
rd
percentile for girls.
•Road to Health: Is the space b/w two growth curves(weight channel).It
includes zone of normally for most population, i.e. 95% of healthy normal
children used as a reference fall in this area.
•ICDS GROWTH CHART: has 3 reference curve
Reference standard.
2SD below the reference standard.
3SD below the reference standard.

7. In India…………….
•India has adopted the new WHO Child Growth Standards(2006) in
February 2009.
•These standards are available for the both boys & girls below 5 years
of age.
•WHO growth chart has been incorporated with “Mother & Child
Protection Card”.

8. Key facts about growth chart
•Direction of growth in a growth chart is more important the position
of dots.
-Periodic weight record is more useful than a single weight plot.

9. Use
•Growth monitoring tool
•Diagnostic tool for identifying high risk children
•Planning & policy making.
•Educational tool
•Tool for action.
•Evaluation of corrective measures & impact of aprogramme.
•Tool for teaching.

10. -Low weight for height: is known as ‘Nutritional Wasting’ or
‘Emaciation’ ( Acute Malnutrition)
-Low height for age: is known as ‘Nutrition stunting or drawfting’
(chronic malnutrition)
•Age-independent parameters for growth assessment:
-Weight for height
-Mid upper arm circumference
-Thickness of subcutaneous fat
-MAC : Head circumference

11. .•Gomez Classification of malnutrition: Is based on ‘weight for age’
Weight for age Gradeof malnutrition
> 90% Grade 0 (normal)
75-89% Grade I (Mild PEM)
60-74% Grade II (ModeratePEM)
< 60% Grade III (Severe PEM)
Wasting (Weightfor Height) Stunting(height for age ) Grade of malnutrition
>90 % > 95 % Grade 0 (normal)
80-90 % 87.5 -95% Grade I (Mild PEM)
70-80 % 80 -87.5 % Grade II (ModeratePEM)
< 70 % < 80 % Grade III (Severe PEM)
Waterlowclassification of malnutrition : is based on Wasting & Stunting

12. •Welcome Trust Classification:
Weight for age With edema Without edema
60-80% Kwashiorkor Under nutrition
< 60% Marasmic-Kwashiorkor Marasmus

15. WHO Growth Chart
•Normal –Greenzone (upper line is the median)
•Moderately underweight –Yellow zone (-2 SD to -3 SD)
•Severely underweight –Red zone (below -3 SD)
Growth Curve

16. W/H charts for boy and girl: NEW Section
•AWW records weight and height of children
•Monitors growth, detects early growth faltering and counsels parents for preventing malnutrition
•AWW identifies and counsels parents of children with wasting
•ANM examines children with severe wasting and refer the ones with complications to health
facility
p. 32-35
Wasting in among U-5 children is high at 21%
1
1
Source: NFHS-4

17. How to take weight?

26. Thank you