Growth Monitoring

DR. NOVMEET RESIDENT, COMMUNITY MEDICINE

MMIMSR, MULLANA (AMBALA)

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.

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.

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

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.

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.

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.

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

Methods of Growth MonitoringWeight 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.

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.

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.

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.

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.

STEPS IN GROWTH MONITORINGFive steps :-o Step 1: Determining correct age of the childo Step 2: Accurate weighing of the childo Step 3: Plotting the weight accurately on a growth chart of

appropriate gendero Step 4: Interpreting the direction of the growthcurve

and recognising if the child is growing properlyo Step 5: Discussing the child’s growth and follow-up action

needed with the mother

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.

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.

WEIGHING OF INFANTS AND CHILDREN The two types of scales are being used

in ICDS for weighing children1. The ‘bar scale’ and 2. The ‘salter or dial type scale’

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 Scale1. With only 500 gm markings between kilograms2. With 100 gm as well as 500 gm markings between

kilograms

Now-a-days only 100 gm type scale is used

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 Kilogram2. With 50 grams divisions per Kilogram

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

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

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.

Cont... OTHER GROWTH CHARTS1. 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

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.

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

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’

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

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

Interpreting growth curve The nutritional status of the child is assessed as per the

plotted weight-for-age, as given in the box below.

USES OF THE GROWTH CHART1. For growth monitoring which is of great value in child

health care2. 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 needed6. Evaluation: of the effectiveness of corrective measures

and the impact of the programme or of special intervention

7. Tool for teaching

THANK YOU