Birth Weight

BirthHead Circumference

124cm

120

116

112

108

104

100

96

92

88

84cm

96cm

92

88

84

80

76

72

68

64

60cm

66cm

64

62

60

58

56

54

52

50

48

46

44cm

50cm

49

48

47

46

45

44

43

42

41

40

39

38

37

36

35

34

33

32

31cm3432 36 38 40 42

82cm

80

78

76

74

72

70

68

66

64

62

60

58cm

50cm

49

48

47

46

45

44

43

42

41

40cm

14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50

39

38

37

36

35

34

33

32

31

30

29

28

27

26

Hea

d Ci

rcum

fere

nce

(cm

)W

eigh

t (kg

)

Gestation in weeks

Age in weeks/ months

Age in weeks/ months

5.5

5

4.5

4

3.5

3

2.5

2

1.5

1

3432 36 38 40 42

Gestation in weeks1 2 3

3

4

4

5

5

6

6

7

7

8

8

9

9

10

10

11

11

Actual age

Gestational age(7 weeks preterm)

2 4 6 8 10 12 14 16 18 20 24 26 28 30 32 34 36 38 40 42 44 46 48 5022

99.6th

98th

91st

75th

50th

25th

9th

2nd

0.4th

99.6th

98th

91st

75th

50th

25th

9th

2nd

0.4th

99.6th

98th

91st

75th

50th

25th

9th

2nd

0.4th

99.6th

98th

91st

75th

50th

25th

9th

2nd

0.4th

99.6th

98th

91st

75th

50th

25th

9th

2nd

0.4th

99.6th

98th

91st

75th

50th

25th

9th

2nd

0.4th

99.6th

98th

91st

75th

50th

25th

9th

2nd

0.4th

99.6th

98th

91st

75th

50th

25th

9th

2nd

0.4th

99.6th

98th

91st

75th

50th

25th

9th

2nd

0.4th

2nd

9th

25th

50th

75th

91st

98th

99.6th

0.4th

2nd

9th

0.4th

25th

50th

75th

91st

98th

99.6th

552cm

50

48

46

44

42

40cm

30kg

29

28

27

26

25

24

23

22

21

20

19

18

17

16

15

14

13

12

11

10

9

8

7

6

5kg11/2

11/2

2 21/2

21/2

3

3

31/2

99.6th

98th

91st

75th

50th

25th

9th

2nd

0.4th

13 14 15 16 17

13 14 15 16 17

19 20 21 22 23

19 20 21 22 23

25 26 27 28 29

25 26 27 28 29

31 32 33 34 35

31 32 33 34 35

37 38 39 40

37 38 39 40 41 43 44 45 46 47

99.6th

98th

91st

75th

50th

25th

9th

2nd

0.4th

2

99.6th

98th

91st

75th

50th

25th

9th

2nd

0.4th

99.6th

98th

91st

75th

50th

25th

9th

2nd

0.4th

99.6th

98th

91st

75th

50th

25th

9th

2nd

0.4th

ft/in

5.11

5.10

5.9

5.8

5.7

5.6

5.5

5.4

5.3

5.2

5.1

5.0

4.11

180

175

170

165

160

155

150

99.6th

98th

91st

75th

50th

25th

9th

2nd

0.4th

cm

Adult HeightPrediction

Age in months/ years

Age in months/ years

� Measure length until age 2; measureheight after age 2.

� A child’s height is usually slightly lessthan their length.

Preterm GIRLS0–1 year

GIRLS1–4 years

Some degree of weightloss is common after birth.Calculating the percentageweight loss is a useful wayto identify babies whoneed assessment.

Plot child’sheight centile onthe pink linesabove; the blacknumbers showaverage femaleadult height forthis centile;80% of childrenwill be within±6 cm of thisvalue.Plotting preterm infants

Use the low birthweightchart for infants less than 32weeks gestation and anyother infants requiringdetailed assessment.Use this section for infantsof less than 37 weeksgestation. As with terminfants there may be someweight loss in the early days.From 42 weeks, plot on the0–1 year chart withgestational correction.

Gestational correctionPlot actual age then draw aline back the number ofweeks the infant was pretermand mark the spot with anarrow; this is the gestationallycorrected centile.

UK - W

HO Chart 2009 © DH Copyright 2009 Harlow Printing Limited Tel: 0191 455 4286 www.healthforallchildren.co.uk

24kg

23

22

21

20

19

18

17

16

15

14

13

12

11

10

9

8

7

6

5kg

Data Recording

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Birth Measurement

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Measurement 2

Measurement 4

Measurement 6

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Measurement 8

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Measurement 10

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Measurement 3

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Measurement 5

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Measurement 7

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Measurement 9

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

52

52

14kg

13.5

13

12.5

12

11.5

11

10.5

10

9.5

9

8.5

8

7.5

7

6.5

6

5.5

5

4.5

4

3.5

3

2.5

2

1.5

1

0.5kg0

11kg

10.5

10

9.5

9

8.5

8

7.5

7

6.5

6

5.5

5

4.5

4

3.5

3

2.5

2

1.5

1

0.5kg12 48

12

head

length

weight

head

weight

height

length

When to measure length or heightLength or height should be measured whenever there areany worries about a child’s weight gain, growth or generalhealth.

Plotting measurementsFor babies born at term (37 weeks or later), plot eachmeasurement on the relevant chart by drawing a small dotwhere a vertical line through the child’s age crosses ahorizontal line through the measured value. The lettering onthe charts (‘weight’, ‘length’ etc.) sits on the 50th centile,providing orientation for ease of plotting.

Plot birth weight (and, if measured, length and headcircumference) at age 0 on the 0–1 year chart. The colouredarrows at age 0 represent UK birth weight data and showthe child’s birth centile.

Weight gain in the early days varies a lot from baby to baby,so there are no lines on the chart between 0 and 2 weeks.However, by 2 weeks of age most babies will be on a centileclose to their birth centile.

For preterm infants a separate low birth weight chart isavailable for infants of less than 32 weeks gestation and anyother infant requiring detailed assessment. For healthyinfants born from 32 weeks and before 37 weeks, plot allmeasurements in the preterm section (to the left of the main0–1 year chart) until 42 weeks gestation, then plot on the0–1 year chart using gestational correction, as shown below.

The preterm section can also be used to assess the relativesize of infants at the margin of ‘term’ (e.g. 37 weeksgestation), but these measurements should also be plottedat age 0 on the 0–1 year chart.

Gestational correctionPlot measurements at the child’s actual age and then draw aline back the number of weeks the infant was preterm. Markthe spot with an arrow (see diagram): this is the child’sgestationally corrected centile. Gestational correction shouldcontinue until at least 1 year of age.

Predicting adult heightParents like to know how tall their child will be as an adult. Thechild’s most recent height centile (aged 2–4 years) gives a goodidea of this for healthy children. Plot this centile on the adultheight predictor to the right of the height chart to find theaverage adult height for children on this centile. Four out of fivechildren will have adult heights that are within 6cm above orbelow this value.

Weight–height to BMI conversion chartBMI indicates how heavy a child is relative to his or her heightand is the simplest measure of thinness and fatness from the ageof 2, when height can be measured fairly accurately. This chart4

provides an approximate BMI centile, accurate to a quarter of acentile space. For greater accuracy, calculate BMI and plotdirectly on a BMI centile chart.

BMI =weight in kg

BMI = (height in m)2

Interpreting the chartAssessing weight loss after birthMost babies lose some weight after birth but 80% will haveregained this by 2 weeks of age. Fewer than 5% of babies losemore than 10% of their weight at any stage; only 1 in 50 are10% or more lighter than birth weight at 2 weeks.

Percentage weight loss can be calculated as follows:

Weight loss = current weight–birth weight Percentage weight loss = Weight loss

� 100%Birth weight

For example, a child born at 3.500kg who drops to 3.150kg at5 days has lost 350g or 10%; in a baby born at 3.000kg, a300g loss is 10%.

Careful clinical assessment and evaluation of feeding techniqueis indicated when weight loss exceeds 10% or recovery of birthweight is slow.

What do the centiles mean?These charts indicate a child’s size compared with children of thesame age and maturity who have shown optimum growth. Thechart also shows how quickly a child is growing. The centile lineson the chart show the expected range of weights and heights (orlengths); each describes the number of children expected to bebelow that line (e.g. 50% below 50th, 91% below the 91st).Children come in all shapes and sizes, but 99 out of 100 childrenwho are growing optimally will be between the two outer lines(0.4th and 99.6th centiles); half will lie between the 25th and75th centile lines.

Being very small or very big can sometimes be associated withunderlying illness. There is no single threshold below which achild’s weight or height is definitely abnormal, but only 4 per1000 children who are growing optimally are below the 0.4thcentile, so these children should be assessed at some point toexclude any problems. Those above the 99.6th centile forheight are almost always healthy. Also calculate BMI if weightand height centiles appear very different.

What is a normal rate of weight gain and growth?Babies do not all grow at the same rate, so a baby’s weight oftendoes not follow a particular centile line, especially in the firstyear. Weight is most likely to track within one centile space (thegap between two centile lines, see diagram). In infancy, acuteillness can lead to sudden weight loss and a weight centile fallbut on recovery the child’s weight usually returns to its normalcentile within 2–3 weeks. However, a sustained drop throughtwo or more weight centile spaces is unusual (fewer than 2% ofinfants) and should be carefully assessed by the primary careteam, including measuring length/height.

Because it is difficult to measure length and height accurately inpre-school children, successive measurements commonly showwide variation. If there are worries about growth, it is useful tomeasure on a few occasions over time; most healthy children willshow a stable average position over time.

UK children have relatively large heads compared to the WHOstandard, particularly after the age of 6 months. After the age of6 weeks a head circumference below the 2nd centile will be seenin only 1 in 250 children. A head circumference above the99.6th centile, or crossing upwards through 2 centile spaces,should only cause concern if there is a continued rise after 6months, or other signs or symptoms.

Why do the length/height centiles change at 2 years?The growth standards show length data up to 2 years of age,and height from age 2 onwards. When a child is measuredstanding up, the spine is squashed a little, so their height isslightly less than their length; the centile lines shift down slightlyat age 2 to allow for this. It is important that this difference doesnot worry parents; what matters is whether the child continuesto follow the same centile after the transition.

Please place sticker (if available) otherwise write in space provided.

Name: ________________________________________

NHS/CHI No:

Hospital No:

Date of Birth:

Very Overweight (Obese)

Overweight

months

months

Wei

gh

t C

enti

le

99.6

98

91

75

50

25

9

2

0.4

BM

I Cen

tile

99.69891755025920.4

Height Centile0.4 2 9 25 50 75 91 98 99.6

Date:

Age:

BMI Centile:

Actual age

Gestational age(7 weeks preterm)

GIRLS UK–WHOGrowth Chart 0–4 years

Who should use this chart?Anyone who measures a child, plots or interprets chartsshould be suitably trained, or be supervised by someonequalified to do so. For further information and trainingmaterials see www.growthcharts.rcpch.ac.uk

A growth chart for all childrenThe UK–WHO growth chart combines World HealthOrganization (WHO) standards with UK preterm and birthdata. The chart from 2 weeks to 4 years of age is based onthe WHO growth standard, derived from measurements ofhealthy, non-deprived, breastfed children of mothers who didnot smoke.1 The chart for birth measurements (32 –42 weeksgestation) is based on British children measured around1990.2 The charts depict a healthy pattern of growth that isdesirable for all children, whether breast fed or formula fed,and of whatever ethnic origin.3

When to weighBabies should be weighed in the first week as part of theassessment of feeding and thereafter as needed. Recovery ofbirthweight indicates that feeding is effective and that thechild is well. Once feeding is established, babies shouldusually be weighed at around 8, 12 and 16 weeks and 1 yearat the time of routine immunisations. If there is concern,weigh more often; however, weights measured too closetogether are often misleading, so babies should be weighedno more than once a month up to 6 months of age, onceevery 2 months from 6 to 12 months of age, and once every3 months over the age of 1 year. However, most children donot need to be weighed this often.

Instructions for use1. Read off the weight and height centiles from the growth

chart.

2. Plot the weight centile (left axis) against the height centile(bottom axis) on the chart above.

3. If between centiles, read across in this position.

4. Read off the corresponding BMI centile from the slantinglines.

5. Record the centile with the date and child’s age in the databox.

InterpretationIn a child over 2 years of age, the BMI centile is a better indicatorof overweight or underweight than the weight centile; a childwhose weight is average for their height will have a BMIbetween the 25th and 75th centiles, whatever their heightcentile. BMI above the 91st centile suggests that the child isoverweight; a child above the 98th centile is very overweight(clinically obese). BMI below the 2nd centile is unusual and mayreflect undernutrition.

References1. www.who.int/childgrowth/en2. Cole TJ, Freeman JV, Preece MA. British 1990 growth reference centiles for

weight, height, body mass index and head circumference fitted by maximumpenalized likelihood. Stat Med 1998;17:407-29.

3. www.sacn.gov.uk/reports_position_statements/index.html4. Cole TJ. A chart to link child centiles of body mass index, weight and height.

Eur J Clin Nutr 2002;56:1194-9.

Centile terminology

© DH Copyright 2009

Data Recording (continued)

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Measurement 11

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Measurement 12

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Measurement 14

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Measurement 16

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Measurement 18

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Measurement 20

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Measurement 13

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Measurement 15

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Measurement 17

Recording Date

Weight

Head Circumference

Length/Height

Location

Health worker name

Measurement 19

Manufacture 13 Nov. 12 UK-W

HOA4G

Issue 2

If the point is within 1/4 of a space ofthe line they are on the centile: e.g. 91st.

If not they should be described asbeing between the two centiles:e.g. 75th–91st.

A centile space is the distance betweentwo of the centile lines, or equivalentdistance if midway between centiles.

Plotting for preterm infants(less than 37 weeks gestation):Draw a line back the number ofweeks preterm and mark spot witharrow.

Weighing and measuring

When measuring children up to 2 years, remove allclothes and nappy; children older than 2 years shouldwear minimal clothing only. Always remove shoes.

Weight: use only class III clinical electronic scales inmetric setting.

Length: (before 2 yearsof age): properequipment is essential(length board or mat).Measurers should be trained.

Height: (from 2 years): use a rigidrule with T piece, or stadiometer.Position head and feet as illustratedwith child standing as straight aspossible.

Head circumference: use anarrow plastic or paper tape tomeasure where the headcircumference is greatest.

FrankfurtPlane