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50cm 49 48 47 46 45
GIRLS
0 1 year
14
3
16
18
4
20
22
5
24
26
6
28
30
7
32
34
8
36
38
9
40
42
44
10
46
48
11
50 52 50cm
19 20 21 22 23 11/2
99.6th
98th 91st
25 26 27 28 29 21/2
31 32 33 34 35 3
37 38 39 40
GIRLS
1 4 years
th 99.6
Data Recording
Birth Measurement
Recording Date Weight Head Circumference
ft/in
49 48 47 46 45 44 43 42 41 40cm
98th
5.11 5.10
180
39 38 37 36
91st
75th
44 43
99 .6 th
42 41 40 39 38
99.6th 98th 91st
37 36 35 34 33 32 31cm 66cm 64 62 60 58
th .6 99 th 98 t s 91 h t 75 h t 50 h t 25
d a e h
head
75th 50th
25th
9th
2nd
G
50th
25th
Measure length until age 2; measure height after age 2. A childs height is usually slightly less than their length.
5.9 5.8
99.6th
175
98th
91st
75th
98th
5.7
91st
170
Measurement 2
Recording Date Weight Head Circumference Length/Height
0.4th
5.6
75th
9th
2nd
0.4th
82cm
th 99.6
98th
50 th
i e h
len
t h g
5.5
50th
165
50th
25th
5.4
25th
98 th
5.3
9th
160
9th
2nd
0.4th
5.2
2nd
91 st
5.1
0.4th
75 th
155
Measurement 3
Recording Date Weight Head Circumference Length/Height Location Health worker name
5.0
80 78 76 74 72 70 68 66 64 62 60 58cm
h 9t d 2n th 4 0.
9th
91st
75th
2n d
h t g
88
4.11
150
25 th
Gestation in weeks
0.4th
32
34
36
38
40
42
Plotting preterm infants Use the low birthweight chart for infants less than 32 weeks gestation and any other infants requiring detailed assessment. Use this section for infants of less than 37 weeks gestation. As with term infants there may be some weight loss in the early days. From 42 weeks, plot on the 01 year chart with gestational correction.
Gestational age (7 weeks preterm) Actual age
th .6 99 h t 98 st 91 th 5 7 th 0 5 th 25
h 9t d 2n h 4t . 0
h t g n le
50th
25th
9th
2nd
0.4th
84cm Plot childs height centile on the pink lines 30kg above; the black numbers show average female 29 adult height for this centile; 28 80% of children will be within 6 cm of this 27 value. 26 25 24
h .6t 99
Measurement 4
Recording Date Weight Head Circumference Length/Height Location Health worker name
0.4 th
Measurement 5
Recording Date Weight Head Circumference Length/Height Location Health worker name
14kg 13.5 13
th 99.6
23 22 21 20 19 18
h 75t
23 22
th 98
Measurement 6
Recording Date Weight Head Circumference Length/Height Location
www.healthforallchildren.co.uk
12.5 12
21 20
Gestational correction Plot actual age then draw a line back the number of weeks the infant was preterm and mark the spot with an arrow; this is the gestationally corrected centile.
98th
11.5 11
t 91s
19 18 17
Measurement 7
Recording Date Weight Head Circumference Length/Height Location Health worker name
Birth Weight
Some degree of weight loss is common after birth. Calculating the percentage weight loss is a useful way to identify babies who need assessment.
91st
10.5 10
75th
9.5 9 8.5
17 16 15 14 13 12 11 10 9 8 7 6
1
25th
7
99 .6t h
6.5 6 5.5 5
9t 25 50 75 91 98t 99. h 6th th th th st h
99.6th 98th 91st 75th 50th 25th 9th 2nd 0.4th
9th
2nd
0.4th
h .6t 99
h 98t
DH Copyright 2009
3 2.5 2 1.5 1
th 75 h t 50 h t 25
h 9t d n 2 h 4t . 0
t 91s
h 75t
e w
t h ig
t h g i e
50th
50th
16 15
Measurement 8
Recording Date Weight Head Circumference Length/Height Location Health worker name
25th
14
9th
13
2nd
91 9 st 8th
12 11
0.4th
Measurement 9
Recording Date Weight Head Circumference Length/Height Location Health worker name
h 50t
25th
9th
2nd
h 0.4t
UK - WHO Chart 2009
Measurement 10
Recording Date Weight Head Circumference Length/Height Location Health worker name
d 2n h 4t . 0
Gestation in weeks
1
42
32
34
36
38
40
0.5kg 0
10
12
14
16
18
20
22
24
26
28
30
32
GIRLS UKWHO
Growth Chart 0 4 years
Who should use this chart?
Anyone who measures a child, plots or interprets charts should be suitably trained, or be supervised by someone qualified to do so. For further information and training materials see www.growthcharts.rcpch.ac.uk
Name: ________________________________________ NHS / CHI No: Hospital No: Date of Birth: When to measure length or height Length or height should be measured whenever there are any worries about a childs weight gain, growth or general health. Plotting measurements For babies born at term (37 weeks or later), plot each measurement on the relevant chart by drawing a small dot where a vertical line through the childs age crosses a horizontal line through the measured value. The lettering on the charts (weight, length etc.) sits on the 50th centile, providing orientation for ease of plotting. Plot birth weight (and, if measured, length and head circumference) at age 0 on the 01 year chart. The coloured arrows at age 0 represent UK birth weight data and show the childs birth centile. Weight gain in the early days varies a lot from baby to baby, so there are no lines on the chart between 0 and 2 weeks. However, by 2 weeks of age most babies will be on a centile close to their birth centile. For preterm infants a separate low birth weight chart is available for infants of less than 32 weeks gestation and any other infant requiring detailed assessment. For healthy infants born from 32 weeks and before 37 weeks, plot all measurements in the preterm section (to the left of the main 0 1 year chart) until 42 weeks gestation, then plot on the 0 1 year chart using gestational correction, as shown below. The preterm section can also be used to assess the relative size of infants at the margin of term (e.g. 37 weeks gestation), but these measurements should also be plotted at age 0 on the 0 1 year chart. Gestational correction Plot measurements at the childs actual age and then draw a line back the number of weeks the infant was preterm. Mark the spot with an arrow (see diagram): this is the childs gestationally corrected centile. Gestational correction should continue until at least 1 year of age. months Centile terminology
If the point is within 1/4 of a space of the line they are on the centile: e.g. 91st. If not they should be described as being between the two centiles: e.g. 75th91st. A centile space is the distance between two of the centile lines, or equivalent distance if midway between centiles.
Measurement 12
Recording Date Weight Head Circumference Length/Height Location Health worker name
Predicting adult height Parents like to know how tall their child will be as an adult. The childs most recent height centile (aged 2 4 years) gives a good idea of this for healthy children. Plot this centile on the adult height predictor to the right of the height chart to find the average adult height for children on this centile. Four out of five children will have adult heights that are within 6cm above or below this value.
Measurement 13
Recording Date Weight Head Circumference Length/Height Location Health worker name
BMI Centile
99.6 98
Measurement 14
Recording Date Weight Head Circumference Length/Height Location Health worker name
Weight Centile
91 75 50 25 9 2 0.4
Measurement 15
Recording Date Weight Head Circumference Length/Height Location Health worker name
0.4
25
50
75
91
98 99.6
Measurement 16
Recording Date Weight Head Circumference Length/Height Location Health worker name
Measurement 17
Recording Date Weight Head Circumference Length/Height Location Health worker name
Frankfurt Plane
Instructions for use 1. Read off the weight and height centiles from the growth chart. 2. Plot the weight centile (left axis) against the height centile (bottom axis) on the chart above. 3. If between centiles, read across in this position. 4. Read off the corresponding BMI centile from the slanting lines. 5. Record the centile with the date and childs age in the data box. Interpretation In a child over 2 years of age, the BMI centile is a better indicator of overweight or underweight than the weight centile; a child whose weight is average for their height will have a BMI between the 25th and 75th centiles, whatever their height centile. BMI above the 91st centile suggests that the child is overweight; a child above the 98th centile is very overweight (clinically obese). BMI below the 2nd centile is unusual and may reflect undernutrition.
References 1. www.who.int/childgrowth/en 2. Cole TJ, Freeman JV, Preece MA. British 1990 growth reference centiles for weight, height, body mass index and head circumference fitted by maximum penalized likelihood. Stat Med 1998;17:407-29. 3. www.sacn.gov.uk/reports_position_statements/index.html 4. Cole TJ. A chart to link child centiles of body mass index, weight and height. Eur J Clin Nutr 2002;56:1194-9.
DH Copyright 2009
Measurement 18
Recording Date Weight Head Circumference Length/Height Location Health worker name
Head circumference: use a narrow plastic or paper tape to measure where the head circumference is greatest.
Measurement 19
Recording Date Weight Head Circumference Length/Height Location Health worker name
Recording Date Weight Head Circumference Length/Height Location Health worker name
Actual age
Manufacture 13
Plotting for preterm infants (less than 37 weeks gestation): Draw a line back the number of weeks preterm and mark spot with arrow.
Nov. 12
Measurement 20
When to weigh Babies should be weighed in the first week as part of the assessment of feeding and thereafter as needed. Recovery of birthweight indicates that feeding is effective and that the child is well. Once feeding is established, babies should usually be weighed at around 8, 12 and 16 weeks and 1 year at the time of routine immunisations. If there is concern, weigh more often; however, weights measured too close together are often misleading, so babies should be weighed no more than once a month up to 6 months of age, once every 2 months from 6 to 12 months of age, and once every 3 months over the age of 1 year. However, most children do not need to be weighed this often.
UK-WHOA4G
Issue 2