4. WHAT IS GROWTH
MONITORING?-a screening tool used to diagnose nutritional, chronic systemic and endocrine
disease at an early stage.
•Determine whether child’s growth is normal in comparison to standards given.
Aims of Growth Monitoring:
To identify children with under/over nutrition
To identify diseases and conditions that manifest through abnormal growth.
To discuss health promotion related to feeding, hygiene,immunization and other
aspects of the childs health and behavior.
Sensitive to use growth charts.
5. STEPS IN GROWTH
1.) Determining correct age of the child.
2.) Accurate weighing of the child.
3.) Plotting the weight accuracy on a growth chart of appropriate
4.) Interpreting the direction of the growth curve and recognizing if
the child is growing properly.
5.) Discussing the child’s growth and follow-up action needed with
6. HOW GROWTH IS ASSESSED
The assessment of growth may be by the following ways:
LONGITUDINAL: measuring an individual child at regular intervals.
CROSS-SECTIONAL: involve large no. of children at the same age.
BASIC: measurement of childs height, weight and length.
NUTRITIONAL: is a comprehensive evaluation carried out by a
registered dietician for defining nutritional status of a child. (direct,
7. NUTRITIONAL ASSESSMENT
IN 6 MAJOR WAYS:
1. Nursing history
2. Physical Examination
3. Calculating percentage of weight loss
4. Dietary history
5. Anthropometric measurements
- skin fold measurement
- mid-arm circuference (MAC)
- mid-arm muscle circumference (MAMC)
6. Lab data
-Albumin, prealbumin, 24hr urinary urea nitrogen, urinary creatinine, Hb level
% weight loss = usual weight – current weight
MAMC (cm) = MAC(cm) – 3.143 TSF (mm)
13. SCALES OF MEASUREMENTS
1. Z scores: deviation of the value of an individual from the median
value of reference population, divided by the standard deviation for the
*Fixed Z score interval fixed ht or wght difference for children of
14. 2. Percentile: rank position of an individual on given reference distribution,
stating what percentage of the group will the individual be equivalent to or
3. Percent of Median: ratio of a measured value in the individual. E.g. weight
to the median value of the reference data for the same age/ height =
expressed as a percentage
Comparison Between The Characteristics of the 3 Measures of ScalesCharacteristic Z score Percentile Percent of Median
Adherence to ref.
Yes Yes No
Yes No Yes
Yes Yes No
Useful for detecting
changes at extreme
Yes No Yes
- very low weight for height (below -
3z scores of the median WHO
-visible wasting & presence of
nutritional pitting edema
-failure to grow at full genetic
potential mentally & physically
16. Interpretation of different indicators
Indicator Acute Malnutrition Chronic Malnutrition
1.Waterlow’s Classification (protein-energy malnutritio
>m- 2 SD < m – 2 SD
> m – 2 SD Normal Wasted
< m – 2 SD Stunted Wasted &
Btw 90 & 110%
1st*, mild malnutrition Btw 75 & 89%
Btw 60 & 74%
17. 2. GOMEZ’S CLASSIFICATION
basis of weight retardation
”normal” ref. child is in the 50th
centile of Boston standards
Normal >95 >90
Mildly impaired 87.5 – 95 80-90
80- 87.5 70-80
18. 3.WELCOME TRUST
CLASSIFICATION-based on deficit in body weight for age & presence/absence of edema
*weight btw 60-80% of expected for age with edema = kwashiorkor
*weighing btw 60-80% of expected without edema = undernutrition
*without edema and weigh< 60% of expected weight for age= marasmus
Age Independent Anthropometric Indeces
Method Name of index Normal (severely
Dugdale’s index 0.88 – 0.97 (<0.79)
Rao’s index 0.15 – 0.16 (<0.14)
Kanawati 0.32-0.33 (≤0.25)
19. WHAT IS A GROWTH CHART
•Growth charts consist of a series of percentile curves that illustrate
the distribution of selected body measurements in children.
•The most powerful tool in growth assessment is the growth chart
used in combination with accurate measurements of height, weight,
head circumference, and calculation of the body mass index (BMI).
• Not intended to be used as a sole diagnostic instrument but
contribute to forming an overall clinical impression for the child being
CDC Growth Chart
WHO Growth Chart
20. STEPS IN PLOTTING
Step 1-Obtain Accurate Measurements.
Length- For children <2yrs the Frankfurt Plane is used. Older children
are measured by erect height.
For infant and toddlers head circumference should also be included.
21. STEPS IN PLOTTING
Step 2-Select the appropriate growth chart.
Based on the age and sex of the child being weighed and measured.
Birth up to 2 years of
2 to 19 years
WHO weight for age CDC Weight for age
WHO weight for length CDC Stature for age
WHO length for age CDC BMI for age
22. STEPS IN PLOTTING
Step 3- Record Data.
Includes Parents stature, Gestational age in weeks, Weight, length and
stature, Notable comments [Breastfeeding, non cooperative]
BMI for more than 2 years old.
23. WHO GROWTH CHART
X-axis: shows age. Points plotted on vertical lines corresponding to
completed age(in months or years)
Y-axis: show length/height, weight or BMI. Should be precise as
29. REMEDIAL ACTIONS CAN BE:
Counselling of the mother
Counselling of the mother aided by a growth chart
Treatment of concurrent disease such as diarrhea
Referral to a specialist for investigation and diagnosis
Professional health worker or social support
Notas del editor
Waterlow’s classification defines 2 groups of protein energy malnutrition:
With retarted growth whereby a drop in height/age ratio indicates a chronic condition
with a low weight for normal height; weight for height ratio indicates an acute cond. Of rapid weight loss/ wasting
Cut-off of 90% of reference is high and thus some normal children may be categorized as 1st degree malnourished
When measuring on weight for age, difficult to tell if low weight is due to sudden acute episode of malnutrition or chronic malnutrition