Who growth chart

brief presentation on WHO Growth Chart

1. WHO GROWTH CHART & TRIVANDRUM DEVELOPMENT SCALE DR. KRISHNA.D.S

2. 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

3. NEED FOR ASSESSMENT Child growth is monitored to: Assess adequacy of nutrition Identify weight status and potential for obesity Screen for disease related to abnormal growth

4. HOW GROWTH IS ASSESSED?? The assessment of growth may be longitudinal or cross sectional . Longitudinal assessment of growth entails measuring the same child at regular intervals. Cross sectional comparisons involve large number of children of same age. Basic growth assessment involves measuring a child’s weight and length or height

5. HISTORY In 1940, data developed by Meredith at Iowa, used for growth assessment. In 1960 and 1970, two other data sets were used, Harvard growth curves and Tanner growth curves. In 1956 and 1965 ICMR undertook a nationwide cross sectional study and established Indian reference charts.

6. HISTORY 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

7. BACKGROUND In 1993 WHO undertook a comprehensive review of the uses and interpretation of growth references Did not adequately represent early childhood growth and that new growth curves were necessary. The World Health Assembly endorsed this recommendation in 1994 . 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.

8. MGRS MGRS combined a longitudinal follow-up from birth to 24 months and a cross-sectional survey of children aged 18 to 71 months . D ata gathered from 8440 healthy breastfed infants and young children from diverse ethnic backgrounds and cultural settings Aim- healthy children living under conditions that favour the achievement of their full genetic growth potential

9. Criteria for Inclusion 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

10. The WHO charts support the theory that optimal nutrition + optimal environment + optimal care = optimal growth regardless of time, place or ethnicity.

11. Indicators For the assessment WHO has provided charts for both boys and girls (age of 5yrs) Growth indicators are used to assess growth, length/height-for-age weight-for-age weight-for-length/height BMI (body mass index)-for-age

12. 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

13. WHO GROWTH CHART Growth curves are constructed using Box Cox Power Exponential Method (BCPE) along with curve smoothing by cubic splines.

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

15. Interpretation of growth curves Suspect Risk, A child’s growth line crosses a z-score line. 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.

16. 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. WHO growth chart has been incorporated with " Mother and Child Protection Card "

17. 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

18. USES Growth monitoring Diagnostic tool Planning and policy making Educational tool Tool for action Evaluation Tool for teaching

19. TRIVANDRUM DEVELOPMENT SCALE Screening tool to test the development delay in children under the age of 2 yrs Developed by Child Development Centre, SAT, Trivandrum 17 test items , selected by trial and error from Bayley’s Scale of Infant Development (Baroda norms). Helps to screen motor, mental, hearing and visual development.

20. How to use TDSC ?? Left end of the horizontal line represents, the age at which 3% of children passed the item and right end represents the age at which 97% of the children passed that item. Vertical line is drawn from the chronological age Failure to achieve an item that falls short on the left hand side of vertical line – developmental delay.

21. VALIDATION OF TDSC Done on the sample from coastal Neendakara Panchayath & Baby Well clinic, SAT. (both in community and at hospital) Out of 1945 children screened 49 showed developmental delay. Denver Developmental Screening Test (DDST) was used as standard for validation

22. TDSC has a sensitivity of 66.7% and specificity of 78.8% Currently, used by Anganwadi workers in community field survey. Can be interpreted by any person with minimal training. Needs 5- 7 minutes

23. REFERENCES WHO . WHO child growth standards. Geneva(Switzerland): WHO;2007 World Health Organization. Training Course on Child Growth Assessment. Geneva, WHO, 2008 Park K. Textbook of Preventive and Social Medicine. 23 rd edition AFMC Textbook of Public Health and Community Medicine – 1 st edition Trivandrum Developmental Screening Chart MKC Nair, B George, E Philip

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