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Child growth charts e-learning tool Judith Myers and Kay Gibbons October 2011. Session outline. Re-cap child growth and growth charts New equipment guidelines Practice examples – WHO under 2; CDC over 2 Introduce e-learning tool . Child Growth = marker of health and development .

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Presentation Transcript
session outline
Session outline
  • Re-cap child growth and growth charts
  • New equipment guidelines
  • Practice examples – WHO under 2; CDC over 2
  • Introduce e-learning tool
child growth marker of health and development
Child Growth = marker of health and development
  • Quick, non-invasive techniques
  • Plotting serial measurements on charts
  • Abnormal growth can indicate underlying health or developmental problems
normal growth
‘Normal’ growth
  • Weight and length ‘tracking’ on centiles

Growth influenced by:

  • Genetics and epigenetics
  • Ethnicity
  • Birthweight
  • Nutrition
  • Environment
birth to 2 years
Birth to 2 years

Weight to nearest 10g

To nearest 0.1cm

purpose‘infantometer’ to nearest 0.1cm

2 3 years

Portable or fixed

‘for purpose’

To 100g / 0.1cm

2 & 3 ½ years
use of growth charts
Use of Growth charts
  • Individuals
    • Growth monitoring
    • Growth failure or excessive growth
    • Impact of illness and response to treatment
    • Screening
    • NHMRC, 2002, NHMRC 2003, Cochrane, (Panpanich) 1999, deOnis 2006 , WHO 1995. Garza 2006, NHMRC 2011
  • Population reporting
    • NHMRC, 2002
kas growth measures and charts
KAS Visits*

Birth – 2 years

Weight, length and head circumference

Plotting on WHO charts

2 – 5 years

Weight and stature at KAS visits

BMI when indicated

Plotting on CDC charts

* And whenever clinically indicated

KAS growth measuresand charts
birth to 2 years world health organisation who
Birth to 2 yearsWorld Health Organisation (WHO)

http://www.who.int/childgrowth/standards/en/

effect of ethnicity on infant growth

Brazil

Ghana

India

Norway

Oman

80

USA

70

Mean of Length (cm)

60

50

0

200

400

600

Age (days)

Effect of ethnicity on infant growth

Onis et al. WHO child growth standards. ActaPaed 2006

2 5 years cdc centre for disease control
2 – 5 years CDC (Centre for Disease Control)

http://www.cdc.gov/growthcharts/

differences plotting 0 2
Differences plotting 0 - 2
  • Head circumference matches closely at all key ages
  • Birth weight position is similar on CDC or WHO at all centiles
  • Length pattern matches closely, but by 2 years, WHO appear slightly ‘taller’ in the lower centile range
  • At 6 months, infants plotted on WHO appear ‘lighter’ when compared with CDC
  • At 2 years, children in lower centiles appear ‘heavier’ on WHO compared with CDC
summary of differences who compared to cdc charts
Summary of differences: WHO compared to CDC charts
  • More children 6 months - 2 years appear to grow slower
  • More children could be ‘overweight’
  • More children < 6 months ‘underweight’
  • More risk of ‘poor growth’ 2 – 4 months = breastfeeding
principles of child growth assessment
Principles of child growth assessment
  • Serial measurements of both weight and length / stature
  • Head circumference reflects early brain growth
  • Poor growth – decline in rate of weight gain first, followed by length/height gain
  • Appropriate growth when weight and length/height track along a curve – even it is ‘off’ chart
  • Correct for prematurity until 2 years
slide16

Further investigate

Unexplained weight loss

Weight not regained following acute illness

Weight or length stature ‘plateau’

Weight, length / stature or BMI increasing or decreasing centiles

  • ‘Flags’
    • Weight or length / stature < 5th centile
    • Weight or length /stature > 98th centile
    • BMI > 85th centile
measure and plotting
Measure and Plotting
  • 2 week check
    • Birth weight is plotted at age ‘0’ (37+ weeks)
    • If more than 10% below birth weight at 2 weeks need to assess
    • Weight change = current – birth (g)
    • % weight loss = weight loss ÷ birth weight x 100%
  • Pre-term
    • Pre-term charts used until expected birth date (Kitchen 1983)
    • ‘Correct’ until 2 years (KAS framework 2009)
measure and plotting 2 years
Measure and plotting 2 years
  • Weigh on either infant , platform scale or with parent/ carer
  • Measure height (stature) or recumbent length depending on child
  • Plot stature on CDC chart (length on WHO)
  • Plot on both if concerned
  • Child may appear ‘lighter’ transferring from WHO to CDC – this is normal
  • Child will appear ‘taller’ transferring from WHO to CDC – this is normal
summary of key points
Summary of key points

Chart changes don’t change individual child growth

Stick to one chart

Don’t rely on one measurement

Trend is more important than a single measurement

Need accurate measuring and plotting

Need calibrated, high quality equipment

Despite many parents’ perceptions the 50th percentile is not the goal for each child

key references
www.cdc.gov/growthcharts/

www.who.int/childgrowth/standards/en

http://consultations.nhmrc.gov.au/open_public_consultations/public-consultation-draf

Cole TJ. BMI cut-offs BMJ 2007

Garza C. New growth standards for the 21st century 2006

de Onis. Comparison of the WHO and CDC growth charts 2007

Key references