Growth GridsAugust 2013

3 Growth Grid Categories Infants and children < 24 months of

age Children 24 months and older Pregnant women

Which grids do we show? Infants and children < 24 months of

age› Length-for-age› Weight-for –length

Children 24 months and older› Height-for-age› BMI-for-age

Growth Grids Cheat Sheet Tells you which growth grids to show

depending on the age of the client. The grids that you should not show are in

grey font. Tells you the cut-offs for short stature,

underweight and overweight.

Test Your Knowledge Which Growth Grids Do We Show for

Each Client?

How To Explain a Growth Grid for a Premie

What grids s› Wei› Len

How to Explain a Growth Grid for an Overweight Child

Birth to 23 Months› 2.3rd percentile weight-for-length

2 – 5 Years› 5th percentile BMI-for-age› No changes

Other Sample Growth Grids How to explain Is their growth normal or not? Do any of the measurements seem

incorrect? Do they need to be referred to the RD?

Short Stature Birth to 23 Months

› 2.3rd percentile length-for-age

2 – 5 Years› 5th percentile Height-for-age› No changes

At Risk of Short Stature Birth to 23 Months

› > 2.3rd percentile and 5th percentile length-for-age

2 – 5 Years› > 5th percentile and 10th percentile

Height-for-age› No changes

High Weight-for-Length Birth to 23 Months

› 97.7th percentile weight-for-length

Overweight 2 – 5 Years

› 85th percentile and < 95th percentile BMI-for-age

› Same definition as the current risk ‘At Risk of Becoming Overweight’

Obese 2 – 5 Years

› 95th percentile BMI-for-age› Same definition as the current risk

“Overweight”

Thyroid Disorders Hyperthyroidism Hypothyroidism

Additional medical conditions include, but not limited to the following Congenital Hypothyroidism

› Infants born with an under active thyroid Congenital Hyperthyroidism

› Excessive thyroid hormone at birth Postpartum Thyroiditis

Inborn Errors of Metabolism More specifically defines ‘inborn errors

of metabolism’ Expanded the list of examples

Explaining Growth Grids What is important to include when

explaining growth grids? What do you think the caregiver needs

to know?

Pick a partner!

Practice Explaining Grids Take turns Determine what the risks, are based on

the grids. How would you explain the risks without using the risk name.

Explain the grids What did your partner say that you

think worked well? What do you think should have been

said, avoided or explained differently?

What does following a curve mean?

Explaining Grids How did you or your partner explain

the girds? What did you think worked well?

Beginning the Grid Explanation

Have you ever seen a/this grid before? Opens up the conversation about

behavior change/the situation

BMI Calculation used to compare a child’s

weight, height and age. Used to determine if they are gaining

to fast or too slow. Used to determine how they are

growing/developing

Weight-for-LengthBMI-for-Age

Can show if child is getting enough to eat or not. › May be getting too many snacks, getting

too many calories. › May not be getting enough to eat

Explaining Risks Overweight (weight/length) – gaining

weight faster than what is recommended/expected

Overweight (BMI/age) – gaining weight faster than compared to other children their same age

Short Stature – dropped %tile – not growing as fast as they were

General – Recommended weight is expected between these lines, your child falls _____. What are your thoughts about it?

Example of What to SaySingle point: length/ht-for-age

This is your child’s growth chart. Have you ever seen one before?

P: This one shows how tall <child’s name> is compared to other <boys> his same age.

C: He is close to the <90th percentile>. This means that if we had 100 <boys> his same age and lined them up from the shortest to the tallest, he would be taller than about <90> and shorter than <10>.

E: We like to see children above the 10th percentile so we don’t have any concerns about his growth right now. How do you feel about that? (What are your thoughts?) We will be following his growth over the next few years to make sure he continues to grow well. (Save education for later)

Example of What to SayBMI-for-age < 5th %ile

P: This chart shows how heavy your child is compared to other <boys> his same age.

C: He is <below the 5th percentile>. This means that if we had 100 <boys> his same age and lined them up from the heaviest to the thinnest, he would be smaller/thinner/lighter than most of them.

E: It looks like his growth has been falling off over the last 6 months and he is not gaining weight. How do you feel about that? (What are your thoughts?) (Save education for later)

Example of What to SayWeight-for-length 95th %ile

P: This chart shows how heavy or thin your child is compared to other <boys> his same height.

C: He is at the <95th percentile>. This means that if we had 100 <boys> his same height and lined them up from the thinnest to the heaviest, he would be heavier than most of them.

E: This means that he is gaining weight more quickly then expected. How do you feel about that? (What are your thoughts?) (Save education for later)

Explaining Grids - Repeat With your partner

› Try one of the examples discussed to explain the growth grids

› Switch and let your partner explain the grids

How did that feel? What did you try?