Growth monitoring

Introduction
• Growth monitoring and promotion (GMP) is an
operational strategy of regular and sequential
measurements for the assessment of growth and
development of the child in the community in
order to promote optimal health.

• The strategy recognizes growth to be the result of

overall health, nutrition, environment, social,
psychic and developmental factors rather than
sheer nutrition.
• It involves mothers and health workers in a
meaningful and reinforcing way, aiming at action
before overt malnutrition occurs.

• As far as possible, it should be a “mother-to-

mother” strategy facilitated and assisted by the
health workers.

• Growth monitoring is best initiated from birth

rather than when the child is already 2 to 3 years
old.
Types/ Methods of growth monitoring
1. Growth charts
2. Weight for age
3. Head circumference
4. Chest circumference
5. Subcutaneous fat/ mid upper arm circumference
(MUAC)
6. Bone age estimation
7. Tooth eruption
8. Body Mass Index (BMI)
9. Bangle test
Growth charts
 Introduction
• Growth charts are visible display of child’s
physical growth and development.

• It is also called “road to health chart”

• It is first designed by David Morley and was

later modified by WHO.
 Definition
• A growth chart is used by pediatricians and
other health care providers to follow a child's
growth over time.

• Growth charts consist of a series of percentile

curves that illustrate the distribution of selected
body measurements in children.
• Growth charts have been constructed by
observing the growth of large numbers of
normal children over time.

• The height, weight, and head

circumference of a child can be
compared to the expected parameters of
children of the same age and sex to
determine whether the child is growing
appropriately.
 Purpose
• growth chart is used to identify
children with growth failure
 Types of growth chart by CDC
1. Birth to 24 months: Boys Weight-for-length
percentiles and Head circumference-for-age
percentiles
2. Birth to 24 months: Boys Length-for-age
percentiles and Weight-for-age percentiles
3. Birth to 24 months: Girls Weight-for-length
percentiles and Head circumference-for-age
percentiles
4. Birth to 24 months: Girls Length-for-age
percentiles and Weight-for-age percentiles
 Use the workbook to complete the
following steps:
• a. Regular Weighing: In order to use the Road
to Health Chart for growth monitoring, we
must weigh and record the weight of a child
regularly (monthly, bi-monthly). Demonstrate
how to weigh a young child using a portable
scale that can be purchased or obtained
locally.
• b. Calculating Age: Weight is plotted together
with age on the Road to Health Chart. It is only
necessary to find out the child's age once, when
the chart and the calendar are first filled out. In
some areas, mothers do not know the ages or the
birth dates of their children. Where this is true, a
local-events calendar can be made relating events
that people are likely to remember (i.e., festivals,
holidays, political events, disasters, etc.) and
seasons (summer, winter, rainy, maize, harvest,
etc.) to specific months and years..
c. Recording Weight for Age on the Road to
Health Chart: Using the wall-sized chart,
demonstrate each step in completing a Road
to Health Chart for the first time and for
repeat weighings.
 Weight for Height

• It is calculated by dividing actual weight by

weight corresponding to the height and then
multiplying the quotient by 100.

• A value below 90.5% indicates malnutrition

and above 120% overweight/obesity.
 Head circumference
• Head circumference which represents growth of
the brain,
1. measures 34-35 cm at birth,
2. 41 cm at 3months,
3. 44 cm at 6 months,
4. 47 cm at one year,
5. 50 cm at 2 years,
6. 51 cm at 7 years and
7. 53 cm at 12 years.
• For measuring head size, place the tape over
the occiput at the back and just above the
supraorbital ridges in front (midforeahead)
and measure the point of highest
circumference
 Head/Chest Circumference Ratio

• At birth, head circumference is larger than chest

circumference by about 2.5 cm. By 6 to 12
months, both are equal.
• After first year, chest circumference tends to be
larger by 2.5 cm. By the age of 5 years, it is more
or less 5 cm greater in size than the head
circumference.
• For measuring chest circumference place the tape
at the level of the nipple in a plane at right angle
to the spine. Record the measurement in mid-
respiration
 Midarm Circumference

• Let the left arm hang naturally by the side of

body.
• Then place the tape firmly but without
compressing the tissues around the upper arm at
a point midway between tip of the acromian and
olecranon process
• In practice, the measurement of the upper arm
would correspond to the one recorded at the
midpoint. In preschool children, measurement <
12.5 cm means significant malnutrition.
 Bone age estimation
• Bone age means age as calculated from the
maturation and appearance of epiphyses.
• An average full-term newborn has the following 5
radiologically demonstrable ossification centres:
• Distal end of femur
• Proximal end of tibia
• Talus
• Calcaneus
• Cuboid
ERRUPTION OF TEETH
• The average age at which first tooth erupts is
6 to 7 months.
• The rest of the milk, deciduous or temporary
teeth appear at the rate of one tooth every
month.
• Thus, the number of teeth in an infant are:
age in months minus 6.
• By 2½ to 3 years the child has a full set of
temporary teeth numbering 20.
 ERUPTION OF PRIMARY TEETH (milk
teeth or deciduous teeth)
UPPER ARCH LOWER ARCH
CENTRAL 10 MONTHS 8 MONTHS
INCISORS
LATERAL INCISORS 11 MONTHS 13 MONTHS

CANINE 19 MONTHS 2O MONTHS

FIRST MOLAR 16YEARS 16 YEARS

SECOND MOLAR 29 YEARS 27 YEARS

 PERMANENT TEETH
6 to 7 years
Molar

Central and lateral incisors 6 to 8 years

Canines and premolars 9 to 12 years

Second molars 12 years

Third molars 18 years or later

 Body Mass Index (BMI)
• BMI correlates well with the subcutaneous fat
and the total body fat and, yet allows a variation
in the lean body mass. It is given by the following
formula:
• BMI = wt/ht in m2
• BMI remains constant (15 - 25 kg/met2) up to the
age of 5 years.
• A BMI > 25 kg/met2 points to overweight and >
30 kg/met2 establishes existence of obesity. A
BMI < 15 kg/met2 points to malnutrition
 Bangle test
• A quick nutritional survey can be done by
measuring the arm circumference, a bangle
which has an internal diameter of 4cms.

• If the bangle passes easily above the elbow

and to the child's upper arm, the child is in a
state of severe malnutrition.