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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

Countries
Number %

NCHS/WHO 99 68
Tanner 3 2
Harvard 13 9
Local 25 17
Other 17 12
Unknown 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 growth
Comparison with references std
To detect growth faltering
Monitoring health status
Performance of programs
Comparison over time
Identification of problem areas
National/international comparisons
Research tool
Educate parents and allay their anxiety
by showing normal growth in chart
Early identification of childrens 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
Child Growth
Standards 0-5 years
WHO Growth Reference Study
Prescriptive Approach
Optimal Nutrition
Breastfed infants
Appropriate complementary feeding
Optimal Environment
No microbiological contamination
No smoking
Optimal Health Care
Immunization
Pediatric routines
Optimal
Growth
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)
M
e
a
n

o
f

L
e
n
g
t
h

(
c
m
)

0 200 400 600
5
0

6
0

7
0

8
0

Brazil
Ghana
India
Norway
Oman
USA
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 risk
4. It is possibke for a stunded or severely stunded child to become overweight
INTERPRETING GROWTH INDICATORS
Interpretation of different indicators



Indicator Acute
Malnutrition
Chronic
Malnutrition
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
Reference
5-19 years
National Center for Health
Statistics (NCHS)