WHO GROWTH CHART & TRIVANDRUM

DEVELOPMENT SCALE

DR. KRISHNA.D.S

GROWTH CHART

Growth charts are visible display of child’s physical growth

and development. Also called as “road-to-health" chart.

It was first designed by David Morley for growth assessment

and was later modified by WHO

NEED FOR ASSESSMENT

Child growth is monitored to:

Assess adequacy of nutrition

Identify weight status and potential for obesity

Screen for disease related to abnormal growth

HOW GROWTH IS ASSESSED??

• The assessment of growth may be longitudinal or cross sectional.

• Longitudinal assessment of growth entails measuring the same child at

regular intervals.

• Cross sectional comparisons involve large number of children of same

age.

• Basic growth assessment involves measuring a child’s weight and

length or height

HISTORY

• In 1940, data developed by Meredith at Iowa, used for growth

assessment.

• In 1960 and 1970, two other data sets were used, Harvard growth

curves and Tanner growth curves.

• In 1956 and 1965 ICMR undertook a nationwide cross sectional study

and established Indian reference charts.

HISTORY

• In 1977, National Centre for Health and Statistics along with CDC

developed growth curves based on Fel’s longitudinal study from 1929

to 1975.

• In 2000, CDC developed a growth curve based on data from national

health surveys and birth certificates in the U.S

BACKGROUNDIn 1993 WHO undertook a comprehensive review of the uses and

interpretation of growth references

Did not adequately represent early childhood growth and that new

growth curves were necessary.

The World Health Assembly endorsed this recommendation in 1994.

In response WHO undertook the Multicentre Growth Reference Study

(MGRS) between 1997 and 2003 to generate new curves for assessing

the growth and development of children.

MGRS

• MGRS combined a longitudinal follow-up from birth to 24 months

and a cross-sectional survey of children aged 18 to 71 months.

• Data gathered from 8440 healthy breastfed infants and young children

from diverse ethnic backgrounds and cultural settings

• Aim- healthy children living under conditions that favour the

achievement of their full genetic growth potential

Criteria for Inclusion

• Access to health care and breastfeeding support

• Full term birth

• No smoking during pregnancy

• Exclusive or primarily breastfeeding > 4 months

• Began feeding solids by 6 months

• Continued breastfeeding > 12 months

The WHO charts support the theory that optimal nutrition +

optimal environment + optimal care = optimal growth

regardless of time, place or ethnicity.

Indicators• For the assessment WHO has provided charts for both boys and girls (age of

5yrs)

• Growth indicators are used to assess growth,length/height-for-age

weight-for-age

weight-for-length/height

BMI (body mass index)-for-age

WHO GROWTH CHART

x-axis:

• In WHO Growth chart, x-axes show age. Points plotted on vertical

lines corresponding to completed age (in months, or years)

y-axis:

• y-axes show length/height, weight, or BMI. Points plotted on or

between horizontal lines corresponding to length/height, weight or

BMI as precisely as possible

WHO GROWTH CHART

• Growth curves are constructed using Box Cox Power Exponential

Method (BCPE) along with curve smoothing by cubic splines.

Cut off values……• WHO growth standards are based on healthy children living in optimal

conditions so more extreme cutoffs are used to identify nutrition

risk.

• WHO charts use 2nd and 98th percentiles as the outermost percentile

cutoff values indicating abnormal growth.

• CDC use 5th and 95th percentile as cut off values.

Interpretation of growth curves

Suspect Risk,

• A child’s growth line crosses a z-score line.

• There is a sharp incline or decline in the child’s growth line.

• The child’s growth line remains flat (stagnant); i.e. there is no gain in

weight or length/height.

Normal growth curve runs parallel to the median curve.

In India….• India has adopted the new WHO Child Growth Standards (2006) in

February 2009

• These standards are available for both boys and girls below 5 years of

age.

• WHO growth chart has been incorporated with "Mother and Child

Protection Card"

Management

• Weight b/w curves 1 & 3-undernourished,require supplementary feeding at home

• Weight below curve 3 - consult the doctor and follow his advice.

• Weight below curve 4 - hospitalized for treatment

USES

• Growth monitoring

• Diagnostic tool

• Planning and policy making

• Educational tool

• Tool for action

• Evaluation

• Tool for teaching

TRIVANDRUM DEVELOPMENT SCALE• Screening tool to test the development delay in children under the age

of 2 yrs

• Developed by Child Development Centre, SAT, Trivandrum

• 17 test items, selected by trial and error from Bayley’s Scale of Infant

Development (Baroda norms).

• Helps to screen motor, mental, hearing and visual development.

How to use TDSC ??

• Left end of the horizontal line represents, the age at which 3% of

children passed the item and right end represents the age at which 97%

of the children passed that item.

• Vertical line is drawn from the chronological age

• Failure to achieve an item that falls short on the left hand side of

vertical line – developmental delay.

VALIDATION OF TDSC

• Done on the sample from coastal Neendakara Panchayath & Baby

Well clinic, SAT. (both in community and at hospital)

• Out of 1945 children screened 49 showed developmental delay.

• Denver Developmental Screening Test (DDST) was used as standard

for validation

TDSC has a sensitivity of 66.7% and specificity of 78.8%

Currently, used by Anganwadi workers in community field survey.

Can be interpreted by any person with minimal training.

Needs 5- 7 minutes

REFERENCES• WHO. WHO child growth standards. Geneva(Switzerland):

WHO;2007• World Health Organization. Training Course on Child Growth

Assessment. Geneva, WHO, 2008• Park K. Textbook of Preventive and Social Medicine. 23rd edition• AFMC Textbook of Public Health and Community Medicine – 1st

edition• Trivandrum Developmental Screening Chart MKC Nair, B George, E

Philip

THANK YOU