When you have completed this unit you should be able to: Measure the size of a child to assess growth. Know the value of growth monitoring. Use centile charts and growth curves. Understand different growth patterns. Identify obese children. Use the growth chart on the Road-to-Health Card. Assess neurodevelopment.
Growth is the increase in body size over a period of time. In order to assess growth, some measure of body size has to be accurately measured on two or more occasions. Growth is the increase of body size over a period of time. Growth is best assessed by determining the child’s: Size compared to [...]
Young children are weighed when lying on a scale. Wait until the child lies still before recording the weight to the nearest 10 g. Always weigh the child undressed or wearing only a vest. Always remove the nappy before weighing. Older children are weighed standing up. Record the weight to the nearest 100 g (0.1 [...]
The best method to assess growth is to measure the child’s size (e.g. weight) and then to repeat the measurements a few months later. The increase in size is due to growth. The greater the increase, the faster the child is growing. If there is no increase, the child is not growing. For this reason [...]
Weight should be measured and recorded every month for the first year of life, as young children grow fast. Children should be weighed every 6 months between 1 and 5 years. Height should be measured every year. Head circumference is not routinely measured unless there is a good reason. In addition, a child’s weight should [...]
It can be difficult to the measure head circumference accurately. Use a measuring tape and record to the nearest 1 mm. Measure the largest circumference of the head (occipito-frontal circumference) with the tape across the forehead and then around to the back of the head (occiput).
Height must be measured with the child standing barefoot. Keep both heels on the floor with the child’s back pressed against a wall. The child should stretch as tall as possible with the arms kept at the side while looking straight ahead. Move a square block of wood or a book down against the wall [...]
The following 3 measurements of body size are commonly used in children: Weight: This is the most commonly used measure of body size as it is easy and accurate to weigh a child. Height or length: This is a very useful measure of size, especially in older children. However, it is more difficult to measure [...]
These are also important measurements of growth. Height is the best method of measuring linear growth (stature) as height reflects growth over a longer period than does weight. Measuring height is therefore important in older children. Head circumference can be used to assess brain growth in children under 2 years. During this period brain growth [...]
Weight-for-age is usually used to monitor growth. It is particularly useful in small infants who normally gain weight fast. Normal weight gain suggests that the infant is healthy and growing normally. Failure to gain weight normally is often the earliest sign of illness or malnutrition (i.e. undernutrition). Therefore, a child’s weight should be measured at [...]
Growth monitoring is the regular measurement of a child’s size in order to document growth. The child’s size measurements must then be plotted on a growth chart. This is extremely important as it can detect early changes in a child’s growth. Both growing too slowly or too fast may indicate a nutritional or other health [...]
No, as the definition of growth is a change in body size over a period of time. Therefore, some other form of assessment of growth is needed when you cannot wait a few weeks or months to decide whether the child is growing normally or not. An assessment of growth can be made if the [...]
The size of most children (94%) falls between the 3rd and the 97th centiles. These children are regarded as having a normal (average or appropriate) size for their age and are growing well. Centile charts, therefore, indicate the range of normal growth. The range of size between the 97th and 3rd centiles is regarded as [...]
Make a mark along the bottom of the chart opposite the age of the child. Now draw an imaginary vertical line up from the mark. Similarly, make a mark opposite the child’s weight along the left or right hand side of the chart. Now draw an imaginary horizontal line from that mark. Make a dot [...]
When the infant’s size measurement falls below the 3rd centile. Children are underweight if their weight is below the 3rd centile. Similarly, children are shorter than normal if their height (length) falls below the 3rd centile. They have smaller heads than normal if their head circumference falls below the 3rd centile. 3% of normal children [...]
When the infant’s size measurement falls above the 97th centile. Children are heavier than normal if their weight is above the 97th centile. Similarly, they are taller (longer) than normal if their height (length) falls above the 97th centile. They have bigger heads than normal if their head circumference falls above the 97th centile.
Weight, height (or length), head circumference and weight-for-height can all be plotted on a centile chart. Weight is the measurement most commonly plotted on a centile chart. International centile charts are shown at the end of this unit.
Most centile charts have 7 centile lines on them, i.e. the 3rd, 10th, 25th, 50th, 75th, 90th and 97th centiles. Ninety seven percent of healthy children will fall below the 97th centile. Similarly 50% of healthy children will fall below the 50th centile and 3% below the 3rd centile. Therefore, each centile indicates what percentage [...]
A centile chart is a size for age chart that is used to decide whether the size of a child falls within the normal (average) range or whether the child is larger or smaller than normal. The size of a healthy child will increase normally with age. Without knowing a child’s age, one cannot decide [...]
Yes. As a child gets older height can be plotted on the chart used before to plot length. For practical purposes, the measurement of length is the same as height.
The weight-for-height gives an idea of how fat or thin a child is. Thin children have a low weight for their height while fat children have a high weight-for-height. Often the body mass index (weight in kg divided by height in metres) is used to determine fatness or thinness.
A growth curve (or growth line) illustrates the way a child is growing over a period of time. A growth curve can be determined when a child’s size measurements have been made on two or more visits and have been plotted as dots on a centile chart. If these dots are now joined together with [...]
A growth curve shows not only whether the child’s size is normal or not, but also whether the child is growing normally, faster or slower than expected. Therefore, a growth curve is a far better method of assessing growth than using size measurements taken on one occasion only as it reflects the child’s growth rate. [...]
If the child’s growth rate is normal, the growth curve will closely follow along (be parallel to) the centile lines and not cross more than one centile. A normal growth curve is plotted in Figure 3.2. A normal growth curve follows the centile lines. Special growth rate charts can be used to determine accurately whether [...]
Most children double their weight from birth to 6 months and treble (increase by three times) their birth weight by one year. The increase in weight and height is fastest in the first year of life and then slows down until puberty when growth is again fast for a short while. Growth in head size [...]
In younger children, weight is the most sensitive index of growth and poor weight gain is usually the first sign of malnutrition. In older children, height is the better index of growth. Height is the best index of growth in older children.
Some children who are heavier than normal are perfectly healthy. They are simply bigger for their age than most children. Other children are heavier than normal because they are obese (too fat).
This is a very important observation. Some children who weigh less than normal are healthy and simply smaller for their age than most children. However, in a poor community, most children who weigh less than normal are malnourished (undernourished) or have an illness.
Determine the child’s growth pattern.
Large-for-age Overweight-for-age Wasted Growth faltering Stunted These growth patterns indicate that the child may have a medical, nutritional or social problem. It is, therefore, very important that all children who do not have a normal growth pattern are identified as soon as possible in order that they can be carefully examined. Some of these children [...]
These children appear healthy but are symmetrically large. Their weight, height and head circumference are all equally above the 97th centile. Their growth curves run parallel above the 97th centile. Most of these children have tall parents and are genetically large. Some may have been large at birth with a high birth weight. They are [...]
These children can often be recognised by simple inspection. Their weight falls above the 97th centile (overweight-for-age) while their height and head circumference usually fall in the normal range. Their growth curve for weight often shows a weight gain faster than normal. They are too fat. A weight above the 97th centile with a height [...]
Wasting is a danger sign and suggests malnutrition or illness. These children usually look very thin and have a weight that falls below the 3rd centile while their height and head circumference often fall within the normal range. These children also have a body mass index below the 3rd centile, i.e. they are underweight for [...]
Infants with growth faltering (failure to thrive or slow growth) have not been gaining weight normally. Their weight may be static (remaining the same) or may even be dropping. Their height and head circumference may also not be increasing normally. This is a very important growth pattern to recognise as most of these children have [...]
Stunted children are shorter than normal for their age. As they are often symmetrically small and do not look thin, their stunting is often missed. Usually their growth curves have followed the centiles although their weight, height and head circumference all fall below the 3rd centile. Stunting usually occurs before 3 years of life. It [...]
Short children usually become short adults as catch-up growth is difficult to achieve. Severe stunting due to malnutrition before 2 years of age is associated with schooling difficulties later.
A very common pattern of growth in poor communities throughout the world is normal weight gain for the first 6 months while the infant is being breastfed. Then, between 6 months and a year, there is faltering of both weight and length as the child receives inadequate food. By a year the child is stunted, [...]
Puberty is a time of rapid growth. It occurs earlier in girls than in boys. Puberty also occurs earlier in well-nourished children than in malnourished (undernourished) children. The puberty growth spurt usually lasts 2 years, starting at about 11 years in girls and 13 years in boys.
The position of the child’s weight, height, head circumference on the centile lines, and the growth curves for all these measurements, determines the child’s growth pattern. Therefore, more than one measurement of size (e.g. weight and height) is needed to establish the growth pattern. Most normal healthy children have a weight, height and head circumference [...]
Love and emotional security are needed for normal growth. Stressed and emotionally deprived children grow slower that normal and may become stunted. Growth hormone is not secreted normally in emotionally deprived children. This has been well-documented in some children in orphanages.
This is very difficult and often not successful. Management consists of a low-calorie diet, increased exercise and family therapy. The whole family needs to be educated about healthy eating and lifestyle behaviour. The goal is to lose weight and then maintain a normal weight. A motivated child and parents are essential if the management is [...]
There is still no internationally accepted method of defining obesity in childhood. However, the clinical diagnosis can usually be made on simple inspection of the child as these children appear very fat. A body mass index for age above the 97th centile is regarded as obesity in older children and adolescents. The diagnosis of obesity [...]
Children are usually considered overweight if their body mass index is between the 85th and 97th centile. These children also look fat. A child is not considered overweight if the weight for age is above the 97th centile but the body mass index is normal. These children are simply big for their age. The definition [...]
It is better not to use weight alone to decide whether a child is overweight as some children are heavy because they are simply big while others are heavy because they are fat. Usually the body mass index for age (i.e. weight in kg/height in m2) is used to decide whether a child is overweight [...]
The patient-held Road-to-Health Card is the child’s formal medical record. It gives the child’s medical history, immunisation record, developmental milestones and growth record. Growth is plotted on a weight-for-age chart (growth chart) which is part of the Road-to-Health Card. A blank Road-to-Health Card growth chart is given at the end of this unit. The Road-to-Health [...]
It is important that the Road-to-Health Card be presented by the mother every time the child attends a clinic or hospital or visits a private doctor. Each child must be weighed at every visit and the weight must be plotted accurately on the card. The pattern of weight gain must always be examined and the [...]
The weight-for-age chart is an essential part of the Road-to-Health Card. The area between the 3rd and 97th centiles is shaded in. It is important that the infant’s weight remains within this shaded area and increases parallel to the centiles. If the infant’s weight keeps within this normal weight-for-age range, it is following the ‘road [...]
If failure to gain weight adequately does not respond to management at a primary care clinic, the child must be referred for further assessment and management. This is particularly important in children with a weight that falls or crosses centiles. Usually these children are referred to a special nutritional clinic where the following steps should [...]
Once the child’s growth has been assessed, advice and counseling should be given to the mother to promote normal growth and nutrition. It is of little value to assess growth without taking active steps to promote good growth.
Neurodevelopmental milestones are largely predictable as children get older although there is a range between different normal children. Delayed milestones are warning signs that neurodevelopment may be abnormal. Children with delayed milestones should be referred for formal neurodevelopmental assessment. The following milestones should be achieved: Smile at mother: 8 weeks Good head control: 6 months [...]
Neurodevelopment is the progressive, orderly change of behaviour and activities which are seen as a children becomes older. Their physical ability and understanding of the world around them increases and matures with age. A healthy neurological system and a safe, stimulating environment is needed for normal neurodevelopment, as is normal hearing and vision.
Developmental milestones are used to monitor neurodevelopment in childhood. These are easily observable developmental achievements such as smiling, sitting and walking. Milestones are assessed by both history and examination. The neurodevelopmental monitoring of milestones must be part of the routine growth and developmental screening of all children. Milestones are used to assess neurodevelopment in childhood. [...]
These can be formally graded into 5 stages (from pre-puberty to full sexual development). Genital development (appearance of penis, testes and scrotum) and pubic hair are scored in boys while breast development and pubic hair are scored in girls. Menstruation in girls starts towards the end of puberty when the growth spurt is almost complete. [...]
Puberty is the time when the physical signs of sexual maturity (secondary sexual characteristics) appear due to the secretion of sex hormones in older children. Puberty is earlier in girls (8 to 13 years) than boys (10 to 15 years). The timing of puberty has become progressively earlier over the past 100 years. A marked [...]
