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Nutrition and Food Services Department
Child growth charts e-learning tool
Judith Myers and Kay Gibbons
October 2011
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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
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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
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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
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Nutrition and Food Services Department
Birth to 2 years
To nearest 0.1cm
Weight to nearest 10g
purpose‘infantometer’ to nearest 0.1cm
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Nutrition and Food Services Department
2 & 3 ½ years
Portable or fixed
‘for purpose’To 100g /
0.1cm
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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
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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
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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)
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Nutrition and Food Services Department
Birth to 2 yearsWorld Health Organisation (WHO)
http://www.who.int/childgrowth/standards/en/
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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
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Nutrition and Food Services Department
2 – 5 years CDC (Centre for Disease Control)
http://www.cdc.gov/growthcharts/
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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
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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
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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
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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
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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)
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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
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Nutrition and Food Services Department
How do key KAS growth points compare?
Question
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Nutrition and Food Services Department
Comparison 1: Boy weight for age
CDC (left) and WHO (right) at 4 months
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Nutrition and Food Services Department
Comparison 1: Boy weight for age
CDC (left) and WHO (right) at 4 months
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Nutrition and Food Services Department
Comparison 2: Boys weight for age: CDC (left) and WHO (right) at 2 years
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Nutrition and Food Services Department
Comparison 2: Boys weight for age: CDC (left) and WHO (right) at 2 years
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Nutrition and Food Services Department
Comparison 2: Boys weight for age: WHO (left) and CDC (right) at 2 years
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Nutrition and Food Services Department
Comparison 3: Boys length for age at 2 – WHO (left) and CDC (right)
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Nutrition and Food Services Department
Does changing to WHO make any difference to children’s growth assessment?
Question
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Nutrition and Food Services Department
Comparison 4: ?underweight or normalWHO (left) and CDC (right)
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Nutrition and Food Services Department
Comparison 4: ?underweight or normalWHO (left) and CDC (right)
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Nutrition and Food Services Department
Comparison 5: underweight or normal?
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Nutrition and Food Services Department
Comparison 5: underweight or normal?
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Nutrition and Food Services Department
Comparison 6: normal or overweight?
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Nutrition and Food Services Department
Comparison 6: normal or overweight?
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Nutrition and Food Services Department
Comparison 6: normal or overweight?
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Nutrition and Food Services Department
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Nutrition and Food Services Department
18.4 kg/m2>85th centile = ‘overweight’
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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
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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