Child growth charts e-learning tool Judith Myers and Kay Gibbons October 2011

Nutrition and Food Services Department

Child growth charts e-learning tool

Judith Myers and Kay Gibbons

October 2011

Nutrition and Food Services Department

Session outline

n Re-cap child growth and growth charts n New equipment guidelinesn Practice examples – WHO under 2; CDC over 2n Introduce e-learning tool

Nutrition and Food Services Department

Child Growth = marker of health and development

n Quick, non-invasive techniquesn Plotting serial measurements on charts n Abnormal growth can indicate underlying health

or developmental problems

Nutrition and Food Services Department

‘Normal’ growth

n Weight and length ‘tracking’ on centiles

Growth influenced by:n Genetics and epigenetics n Ethnicityn Birthweightn Nutritionn Environment

Nutrition and Food Services Department

Birth to 2 years

To nearest 0.1cm

Weight to nearest 10g

purpose‘infantometer’ to nearest 0.1cm

Nutrition and Food Services Department

2 & 3 ½ years

Portable or fixed

‘for purpose’To 100g /

0.1cm

Nutrition and Food Services Department Use of Growth charts

• Individuals• Growth monitoring• Growth failure or excessive growth• Impact of illness and response to treatment• Screening • NHMRC, 2002, NHMRC 2003, Cochrane, (Panpanich) 1999, deOnis 2006 , WHO

1995. Garza 2006, NHMRC 2011

• Population reporting• NHMRC, 2002

Nutrition and Food Services Department KAS growth measuresand charts

n KAS Visits*n Birth – 2 years

Weight, length and head circumference Plotting on WHO charts

n 2 – 5 years Weight and stature at KAS visits BMI when indicated Plotting on CDC charts

* And whenever clinically indicated

Nutrition and Food Services Department

Charts in the Victorian ‘My health and development’ record

Girls Boys Centiles

0 – 24 months WHO Head circWeight for ageLength for age

Head circ.Weight for ageLength for age

5th – 98th

2 – 18 years CDC Weight for ageHeight (stature) for ageBMI for age

Weight for ageHeight (stature) for ageBMI for age

5th – 98th

5th – 98th (includes 85th and 95th centiles)

Nutrition and Food Services Department

Birth to 2 yearsWorld Health Organisation (WHO)

http://www.who.int/childgrowth/standards/en/

Nutrition and Food Services Department

Effect of ethnicity on infant growth

Age (days)

Mea

n of

Le

ng

th (

cm)

0 200 400 600

5060

7080

BrazilGhanaIndiaNorwayOmanUSA

Onis et al. WHO child growth standards. ActaPaed 2006

Nutrition and Food Services Department

2 – 5 years CDC (Centre for Disease Control)

http://www.cdc.gov/growthcharts/

Nutrition and Food Services Department Differences plotting 0 - 2

n Head circumference matches closely at all key agesn Birth weight position is similar on CDC or WHO at all

centilesn Length pattern matches closely, but by 2 years,

WHO appear slightly ‘taller’ in the lower centile range

n At 6 months, infants plotted on WHO appear ‘lighter’ when compared with CDC

n At 2 years, children in lower centiles appear ‘heavier’ on WHO compared with CDC

Nutrition and Food Services Department Summary of differences: WHO compared to CDC charts

n More children 6 months - 2 years appear to grow slower

n More children could be ‘overweight’ n More children < 6 months ‘underweight’n More risk of ‘poor growth’ 2 – 4 months =

breastfeeding

Nutrition and Food Services Department

Principles of child growth assessment

n Serial measurements of both weight and length / stature n Head circumference reflects early brain growthn Poor growth – decline in rate of weight gain first, followed

by length/height gainn Appropriate growth when weight and length/height track

along a curve – even it is ‘off’ chartn Correct for prematurity until 2 years

Nutrition and Food Services Department

n ‘Flags’ Weight or length / stature

< 5th centile Weight or length /stature

> 98th centile BMI > 85th centile

n Further investigate Unexplained weight loss Weight not regained

following acute illness Weight or length stature

‘plateau’ Weight, length / stature

or BMI increasing or decreasing centiles

Nutrition and Food Services Department Measure and Plottingn 2 week check

Birth weight is plotted at age ‘0’ (37+ weeks) If more than 10% below birth weight at 2 weeks need to assess Weight change = current – birth (g) % weight loss = weight loss ÷ birth weight x 100%

n Pre-term Pre-term charts used until expected birth date

(Kitchen 1983)

‘Correct’ until 2 years (KAS framework 2009)

Nutrition and Food Services Department

Measure and plotting 2 years Weigh on either infant , platform scale or with parent/ carer Measure height (stature) or recumbent length depending on child Plot stature on CDC chart (length on WHO) Plot on both if concerned

Child may appear ‘lighter’ transferring from WHO to CDC – this is normal

Child will appear ‘taller’ transferring from WHO to CDC – this is normal

Nutrition and Food Services Department

How do key KAS growth points compare?

Question

Nutrition and Food Services Department

Comparison 1: Boy weight for age

CDC (left) and WHO (right) at 4 months

Nutrition and Food Services Department

Comparison 1: Boy weight for age

CDC (left) and WHO (right) at 4 months

Nutrition and Food Services Department

Comparison 2: Boys weight for age: CDC (left) and WHO (right) at 2 years

Nutrition and Food Services Department

Comparison 2: Boys weight for age: CDC (left) and WHO (right) at 2 years

Nutrition and Food Services Department

Comparison 2: Boys weight for age: WHO (left) and CDC (right) at 2 years

Nutrition and Food Services Department

Comparison 3: Boys length for age at 2 – WHO (left) and CDC (right)

Nutrition and Food Services Department

Does changing to WHO make any difference to children’s growth assessment?

Question

Nutrition and Food Services Department

Comparison 4: ?underweight or normalWHO (left) and CDC (right)

Nutrition and Food Services Department

Comparison 4: ?underweight or normalWHO (left) and CDC (right)

Nutrition and Food Services Department

Comparison 5: underweight or normal?

Nutrition and Food Services Department

Comparison 5: underweight or normal?

Nutrition and Food Services Department

Comparison 6: normal or overweight?

Nutrition and Food Services Department

Comparison 6: normal or overweight?

Nutrition and Food Services Department

Comparison 6: normal or overweight?

Nutrition and Food Services Department

Nutrition and Food Services Department

18.4 kg/m2>85th centile = ‘overweight’

Nutrition and Food Services Department Summary of key points

n Chart changes don’t change individual child growth

n Stick to one chartn Don’t rely on one measurementn Trend is more important than a single

measurementn Need accurate measuring and plottingn Need calibrated, high quality equipmentn Despite many parents’ perceptions the 50th

percentile is not the goal for each child

Nutrition and Food Services Department Key references

n www.cdc.gov/growthcharts/n www.who.int/childgrowth/standards/enn http://consultations.nhmrc.gov.au/open_public_cons

ultations/public-consultation-drafn Cole TJ. BMI cut-offs BMJ 2007n Garza C. New growth standards for the 21st century

2006n de Onis. Comparison of the WHO and CDC growth

charts 2007