Child Growth Monitoring/ Nutritional Status
Child Growth Monitoring/Nutritional Status
Source: de Onis et al. Worldwide practices in child growth monitoring. Journal of Pediatrics 2004;144:461-5.
Worldwide practices in child growth monitoring
Reference population
Reference
CountriesNumber %
NCHS/WHO 99 68Tanner 3 2Harvard 13 9Local 25 17Other 17 12Unknown 6 4
Comparison of existing growth charts
Data charact
Source
Study period
Population
Age-group
NCHS
Multiple different studies
1929-1975
US, white,bottle fed
Birth-20 yrs
CDC
Multiple different studies
1963-1994
US, mixed feeding, no racial/ethnic diff
Birth-20 yrs
WHO
Primary data
1997-2003
6 Countries pooled data. healthy children & practices, breastfed
Birth-5yrs
GROWTH CHARTS
Consist of a series of percentile curves that illustrate the distribution of selected
body measurements in the study population
Used to track the growth of children from infancy thru adolescence
Indicates the state of the child's health, nutrition and well being
Need for Growth Charts
Individual level
Community level
National level
Scientists
Monitoring & documenting growthComparison with references stdTo detect growth faltering
Monitoring health statusPerformance of programsComparison over time
Identification of problem areasNational/international comparisons
Research tool
Educate parents and allay their anxiety by showing normal growth in chart
Early identification of children’s growth failure for detection of malnutrition and taking appropriate interventions
Early identification-overweight/obesity
Community level
First 2 years
2 –10 years
>10 years
What needs to be monitored at community level
• Length/age• Weight/age• Weight /height or BMI• Head circumference/age
• Height/age• Weight/age• BMI/age
Above in relation to pubertal development
WHO Child Growth Standards 0-5 years
WHO Growth Reference StudyPrescriptive Approach
Optimal Nutrition• Breastfed infants• Appropriate complementary feeding
Optimal Environment• No microbiological contamination• No smoking
Optimal Health Care• Immunization• Pediatric routines
OptimalGrowth
WHO Child Growth Standards
Weight-for-age Length/height-for-age Weight-for-length/height Body mass index-for-age Mid-upper arm circumference-for-age Triceps skinfold-for-age Subscapular skinfold-for- age Head circumference-for-age
Attained growth
• Weight• Length/height• Head circumference• Arm circumference
Growth velocity
year 1 year 2 year 3
Longitudinal (0-24 months)
Cross-sectional (18-71 mo)
MGRS study design
Time schedule child anthropometry
Measurement Time frame Frequency No. of visits Birth Once 1 Weeks 2-8 Bi-weekly 4 3-12 months Monthly 10
Weight, length, head circumference
14-24 months Bi-monthly 6
3-12 months Monthly 10 Arm circumference Skinfold thicknesses 14-24 months Bi-monthly 6
WHO Multicentre Growth Reference Study
Mean length from birth to 24 months for the six MGRS sites
Age (days)
Mea
n of
Len
gth
(cm
)
0 200 400 600
5060
7080
BrazilGhanaIndiaNorwayOmanUSA
WHO Multicentre Growth Reference Study Group. Assessment of linear growth differences among populations in the WHO Multicentre Growth Reference Study. Acta Paediatr Suppl 2006;450:56-65.
Notes:1. A child in this range is very tall. Tanness is rarely a problem, unless it is so excessive that it may indicate endocrine such as a
growth-hormone-producing tumor. Refer a child in this range for assessment if you suspect an endocrine disorder (e.g. If perents of normal height have a child who is excessively tall fot his or her age)
2. A Child whose weight-for-age falls in this range may have a growth problem, but this is better assessed from weight-length/heoght or BMI-for Age.
3. A plotted point above 1 shows possible risk. A trent toward the 2 z-score line show definite risk4. It is possibke for a stunded or severely stunded child to become overweight
INTERPRETING GROWTH INDICATORS
Interpretation of different indicators
Indicator AcuteMalnutrition
ChronicMalnutrition
Wt-for-age
Ht-for-Age Normal
Wt-for-Ht Normal
Prevalence of stunting (below -2 SD length/height-for-age) by age based on the WHO standards and the NCHS
reference in Bangladesh
Source: de Onis M, Onyango AW, Borghi E, Garza C, Yang H, for the WHO Multicentre Growth Reference Study Group. Comparison of the WHO Child Growth Standards and the NCHS growth reference: implications for child health programs. Public Health Nutrition 2006;9:942-947.
0
10
20
30
40
50
60
70
80
0-5 6-11 12-23 24-35 36-47 48-60 0-60
Age (months)
%
NCHS WHO
Prevalence of underweight (below -2 SD weight-for-age) by age based on the WHO standards and the NCHS reference
in Bangladesh
Source: de Onis M, Onyango AW, Borghi E, Garza C, Yang H, for the WHO Multicentre Growth Reference Study Group. Comparison of the WHO Child Growth Standards and the NCHS growth reference: implications for child health programs. Public Health Nutrition 2006;9:942-947.
0
10
20
30
40
50
60
70
80
0-5 6-11 12-23 24-35 36-47 48-60 0-60
Age (months)
%
NCHS WHO
WHO Reference 5-19 years
National Center for Health Statistics (NCHS)