GROWTH PARAMETRES AND THEIR ASSESSMENTbyDr. Azher ShahAssociate Professor Department of PaediatricsAzra Naheed Medical College, LAHORE

GoalsGrowth?

Development?

Methods for Nutritional Assessment?

Growth Parametres?

How to utilize growth charts?

Growth & Development

Growth

• Quantitative increase in size of body and can be measured in terms of HEIGHT and WEIGHT

Development

• Qualitative functional maturation assessed in terms of acquisition of skills and ability to cope with the situation

Growth & Development (Cont…)

Growth and development are so closely related that they are usually assessed simultaneously

Growth Assessment

Goals of Growth Assessment

• To determine if there are growth abnormalities that point to the presence of an underlying disease

• To prevent nutritional disorders and the increased morbidity and mortality that accompany them

Growth Assessment (Cont…)

Nutritional Assessment

• It is quantitative evaluation of nutritional status

Four components

• Dietary, medical, and medication history• Physical examination• Anthropometric and body composition measurements• Laboratory tests

Anthropometry

Height

Weight

Body Mass Index

Head Circumference

Growth Charts

Growth measurements should be plotted on growth charts

Growth is most rapid in healthy children during early infancy and adolescence

Serial measurements must be obtained

Children whose length, height, or weight measurements fall below the 5th percentile, above the 95th percentile, or cross two major centile curves are at nutritional risk

WHO Child Growth StandardsWHO growth charts describe normal child growth from birth to 5 years under optimal environmental conditions

These standards can be applied to all children everywhere

The reference lines on the WHO growth charts are either percentile lines or z-scores

The WHO standards define a population that is somewhat longer and leaner than the CDC references; this discrepancy is most dramatic during mid and late infancy

The WHO standards are less likely to categorize a child as undernourished, and more likely to categorize a child as overweight

Length or HeightLength is measured in children younger than 2 years who are measured in the recumbent position

Height or stature is measured in children older than 2 years who are measured while standing

Measurement should be performed three times to improve accuracy, and the mean should be plotted on a standardized growth chart

For a given individual, measured length is typically greater than standing height

Length or Height (Cont…)

Average length at birth is 50 cm

Increases 25 cm in first year of life

At 3 years 90 cm

At 4 years 100 cm

Then height increases by 5 cm / year until puberty when growth spurt of 9-10 cm / year for 2-3 years

Age Length or Height in Centimeter

At Birth 50

At 1 year 75

2-12 years [Age(years)x6]+77

WeightWeight measurements should be obtained on a scale that has been calibrated properly

Infant should be weighed without diapers and to the nearest 0.01 kg

Older child should be measured without shoes, in little or no outer clothing, and to the nearest 0.1 kg

Measurement should be plotted on a standardized growth chart

Weight (Cont…)Average weight at birth is 3.2 kg (7 lbs)

Birth weight is doubled at 5-6 months of age

Tripled at one year

4 times at 2 years of age

Annual increase is about 2 Kg / year till puberty

Age Weight (kg)

At Birth 2.50-3.25

3-12 monthsAge (months) + 9

2

1-6 years [Age(years)x2]+8

7-12 years[Age(years)x7]-5

2

Body Mass Index (BMI)BMI characterizes the relative proportion between the child's weight and height

BMI is calculated from the weight and square of the height as BMI = body weight (kg) ÷ height (meters) squared

BMI a valid predictor of adiposity, and is therefore the best clinical standard for defining obesity in children and adults

BMI greater than the 85th percentile is overweight and greater than the 95th percentile is obese

BMI less than the 5th percentile is underweight

Weight for HeightLike BMI, the ratio of weight to height can be used to predict adiposity

For children aged 0 to 2 years, the ratio of weight to length is generally used instead of BMI

For children aged 3 to 5 years, BMI for age and weight-for-height measures predict adiposity equally well

A child's weight-for-height can be compared to normal standards using a chart

Head CircumferenceHead circumference is measured at the maximum diameter through the glabella and occiput to the nearest 0.01 cm

Recorded value should be the mean of three measurements

It is measured in children from birth to 3 years of age because this is the period of rapid brain growth

It should be measured in older children with abnormal growth because it may be helpful in determining the etiology

Measurement should be plotted on a standardized growth chart

Head CircumferenceAbnormal head growth is defined as a head circumference (also called fronto-occipital circumference) greater than two standard deviations above or below the mean for a given age, gender, and gestation

Microcephaly is a head circumference greater than two standard deviations below the mean

Macrocephaly is a head circumference greater than two standard deviations above the mean

Growth Velocity (for Height)

Height velocity measurements are the most sensitive in detecting growth abnormalities early in the course of all types of chronic illness

Any child older than 2 years whose height velocity is less than 4 cm/year should be monitored carefully for progressive nutritional deficits

During puberty, peak height velocity is 5 to 11 cm/year in boys, and 6 to 10 cm/year in girls; the age of peak height velocity varies substantially

Growth Velocity (for Weight)

Any prepubertal child whose weight velocity is less than 1 kg per year should be monitored carefully for progressive nutritional deficits

During puberty, weight gain is more rapid; peak weight velocity is generally between 1 and 4 kg per six months in a healthy population

Malnutrition

The degree of acute and chronic malnutrition can be assessed clinically using various anthropometric measurements

During periods of nutritional deprivation, weight deficits occur initially, followed by length or height deficits and finally by head circumference deficits

Obesity

The clinical evaluation of a child with obesity includes assessment of the BMI or weight-to-height ratio

Precise measurement of the body fat content is not generally necessary or helpful for clinical decision-making

Short or Tall Stature

Radiographic studies of bone age can help to clarify the presence of abnormal growth patterns

Summary

Growth and Development

Growth parameters

Use standardized growth charts

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