Weighing of the child at regular intervals, the plotting of that weight on a graph (called a growth chart) enabling one to see changes in weight, and giving advice to the mother based on this weight change is called ‘GROWTH MONITORING’

1. Growth Monitoring
DR. NOVMEET
RESIDENT, COMMUNITY MEDICINE
MMIMSR, MULLANA (AMBALA)

2. Growth and Development
 Growth refers to increase in the physical size of the body and
Development refers to increase in skills and functions.
 Both are considered together. because a child grows and
develops as a whole.
 Include not only physical aspect but also intellectual, emotional
and social aspects.
 Take place only in the presence of optimal nutrition, freedom
from recurrent infections, freedom from adverse genetic and
environmental influences.

3. What is Growth
 Growth is the regular increase in size or weight of
any living thing, whether it is a plant, an animal
or a human being. Regular and continuous growth
is the essence of health in early life of living
objects.
 Optimal child growth occurs only with adequate
food, a caring, nurturing, social environment and
absence of illness, which provides full attention to
the growing baby.

4. Determinants of Growth
 Some of the most important factors influencing the
growth and development are:-
• GENETIC INHERITANCE
• NUTRITION
• AGE
• SEX
• PHYSICAL SURROUNDINGS
• PSYCHOLOGICAL FACTORS
• INFECTIONS AND PARASITES
• ECONOMIC FACTORS
• OTHER FACTORS

5. HOW CHILDREN GROW
 In different parts of India, the average birth weight is between 2.7
and 2.9 kg.
 Most rapid at the younger age specially during the first year of
life.
 A baby should gain at least 500 gram weight per month in the first 3
months of life.
 On an average, a healthy baby doubles his birth weight by 5 months,
treble it by the end of 1st year and quadruple by the age of 2.

6. Cont.….
 When growth slows or stops, we say growth “falters”. This
is a sign that something is wrong with the child and must
be discovered at the earliest and set right.
 It can be said that “A GROWING CHILD IS A HEALTHY
CHILD”, and equally true that, “A CHILD WHO IS NOT
GROWING IS NOT HEALTHY”.
 THE MOST ACCURATE AND SENSITIVE MEASURE OF
GROWTH IS WEIGHT GAIN.

7. WHAT IS GROWTH MONITORING
 Monitoring means keeping a regular track of something, like every
week or every month
 Weighing of the child at regular intervals, the plotting of that
weight on a graph (called a growth chart) enabling one to see
changes in weight, and giving advice to the mother based on this
weight change is called ‘GROWTH MONITORING’
 It is the change in weight over a period of time which is most
important, rather than the weight itself.
 Should be done once every month, up to age of 3 years and at least
once in 3 months, thereafter.

8. Why Monitor Growth?
 Growth is the most sensitive indicator of child’s health
• normal growth only occurs if a child is healthy
 Growth assessment is an essential part of the examination
or investigation of any child.
 Allows objective detection of growth disorders at
population level at earliest opportunity
 It helps in early identification and treatment of the
growth disorder which improves outcome.
 It identifies under or over nutrition

9. Methods of Growth Monitoring
Weight for Age :
 Single best parameter for assessing physical growth.
 Careful repeated measurement at intervals, ideally from birth- 1 month
weekly, one month- 3 years every month and 3-5 years at every three months
is very important.
 Compare these measurements with reference standards of weight of children
of the same age.
 Best done on growth chart.

10. Cont.…
Height (Length) for age :
 Height should be taken in a standing position without footwear with the help
of height machine or measuring scale fixed to the wall.
 Suitable for children 2 years or above.
 The length of the baby at birth is about 50 cm. It increases by about 25 cm
during first year and by another 12 cm during the second year.
 Height is a stable measurement of growth as opposed to body weight.
Whereas weight reflects only the present health status of the child, height
indicates the events in the past also.
 Low height for age : also known as nutritional stunting or dwarfing. Reflects
past or chronic malnutrition.

11. Cont.….
Weight for Height:
 Weight and Height are interrelated.
 If there is low weight for height, it is called as nutritional wasting or
emaciation (acute malnutrition).
 A child less than 70 percent of the expected weight for height is classed as
severely wasted.

12. Cont.…
Head and Chest circumference :
 At birth head circumference is about 34 cm, about 2 cm more than the chest
circumference.
 By the age of 6 to 9 months, these two measurements become equal, after
which the chest circumference overtakes.
 This overtaking maybe delayed by 3 to 4 years in severely malnourished
children.
 According to an ICMR study conducted in 1984, the crossing over of chest and
head circumference did not take place until the age of two years and six
months in poor Indian children.

13. WHEN TO START GROWTH
MONITORING AND HOW OFTEN?
 Growth Monitoring must start at an early age in the child’s life, right from
birth
 The AWW should weigh all new borns and children from birth- 1 month
weekly, one month- 3 years every month and 3-5 years at every three
months.
 Children who are severely underweight, or who have not gained weight for 2
months, or who are “at risk” of under nutrition, should be weighed frequently
preferably every month.
 The golden principle of New WHO Growth Standards :- weighing and plotting
weight of children on the basis of completed weeks/months
 It is advisable to conduct four weighing sessions in a month at the AWC so
that all children are weighed every month.

14. STEPS IN GROWTH MONITORING
 Five steps :-
o Step 1: Determining correct age of the child
o Step 2: Accurate weighing of the child
o Step 3: Plotting the weight accurately on a growth chart of
appropriate gender
o Step 4: Interpreting the direction of the growth curve and
recognising if the child is growing properly
o Step 5: Discussing the child’s growth and follow-up action needed
with the mother

15. DETERMINING CORRECT AGE OF THE CHILD
 In the Integrated Child Development Scheme (ICDS)
programme, growth monitoring is done by weight for age
method comparing the weight of the child with his age.
 If the child’s age is not known correctly, it is not possible to
assess the growth of the child and have an accurate growth
chart.
 An under or over estimate of even two or three months
could result in the child being considered either healthy or
undernourished than what he actually is.
 The AWW should be aware of all the births taking place in
her area.

16. CONTD…
 If there are no records of births in a given area,
AWWs can assess the age of a child:
 With the help of Mother and Child Protection Card (MCPC)
 With the help of birth certificate
 From the mother, if she remembers the exact date of
birth
 Using a local events calendar.

17. WEIGHING OF INFANTS AND CHILDREN
 The two types of scales are being used in ICDS
for weighing children
1. The ‘bar scale’ and
2. The ‘salter or dial type scale’

18. SALTER WEIGHING SCALE
 Reliable, light and portable
 Can weigh children weighing up to 25 kg
 Round in shape, with the needle in the centre
 Weights are marked in kilograms around the dial
 Two types of Salter Scale
1. With only 500 gm markings between kilograms
2. With 100 gm as well as 500 gm markings between
kilograms
 Now-a-days only 100 gm type scale is used

20. BAR WEIGHING SCALE
 Light metal scale
 It is reliable, sensitive and portable and can
weigh children up to 20 kilograms
 Two types :-
1. With 100 grams divisions per Kilogram
2. With 50 grams divisions per Kilogram

22. GROWTH CHARTS
 Important tools in the assessment of growth and nutritional
status for clinical as well as epidemiological use.
 Consist of a series of percentile curves that illustrate the
distribution of selected body measurements in the study
population
 Indicates the state of the child's health, nutrition and well
being

23. NEED FOR GROWTH CHARTS AT
COMMUNITY LEVEL
 For early identification of children’s growth failure for detection of
malnutrition and taking appropriate interventions
 For early identification of overweight/obesity in the children
 To sensitize health workers
 To educate parents and allay their anxiety by showing normal
growth in chart

24. Earlier charts:
 Many countries do not have their national growth
charts.
 For such countries and for international
comparisons, the WHO adopted growth charts
which had been constructed by the National
Centre for Health Statistics (NCHS) of the United
States of America in 1978, known as NCHS/WHO
growth charts.
 But this chart was not representing the growth of
the children very faithfully.

25. Cont...
 OTHER GROWTH CHARTS
1. The NCHS 1977 Growth Curves. based on
growth of American children developed in 1977.
Adopted by WHO for international use
2. The CDC 2000 Charts. A revised version of
earlier NCHS chart: Revision of previous existing
14 charts with introduction of 2 new BMI charts
3. Euro-Growth 2000 Charts

26. NEW WHO GROWTH STANDARDS
 The new WHO child growth standards represent a shift from
describing how children grow to prescribing how they should grow.
 Earlier, In ICDS, growth monitoring of children (weight-for-age) was
done using IAP Classification by modifying Harvard Standards.
 India adopted the new WHO Child Growth Standards (2006) in
February 2009, for monitoring the young child growth and
development within the National Rural Health Mission and the
ICDS.

27. NEW ICDS GROWTH CHARTS
 Also known as “Road to Health” Charts.
 Is a part of the Mother & Child Protection
(MCP) Card
 Contains weight-for-age growth charts based on
New WHO Child Growth Standards

28. Cont.…
 Separate growth charts for girls and boys
 The first half of the register has growth charts
for girls with ‘pink border’ and the second half
is for boys with the ‘blue border’

31. GROWTH CURVE
 Formed by joining the plotted points on a growth chart
 Direction of the growth curve indicates whether the child
is growing or not
 Helps in determining the growth pattern of a child.
 It is very important to consider the child’s whole situation
while assessing the growth pattern

32. DIRECTION OF CHILD’S GROWTH CURVE
 The growth curve of a normally growing child usually follows a track that is roughly
parallel to the 1ST or 2nd printed curve lines.
 The direction of the growth curve of the child can be upward, flat or downward

34. Interpreting growth curve
 The nutritional status of the child is assessed as per the plotted
weight-for-age, as given in the box below.

35. USES OF THE GROWTH CHART
1. For growth monitoring which is of great value in child
health care
2. Diagnostic tool: for identifying “high risk” children.
3. Planning and policy making: by grading malnutrition, it
provides an objective basis for planning and policy
making in relation to child health care.
4. Educational tool: for mothers.
5. Tool for action : helps health worker on the type of
intervention needed
6. Evaluation: of the effectiveness of corrective measures
and the impact of the programme or of special
intervention
7. Tool for teaching

36. THANK YOU