Child Growth Monitoring/Nutritional Status

Source: de Onis et al. Worldwide practices in child growth monitoring. Journal of Pediatrics 2004;144:461-5.

Worldwide practices in child growth monitoring

Reference population

Reference

CountriesNumber %

NCHS/WHO 99 68Tanner 3 2Harvard 13 9Local 25 17Other 17 12Unknown 6 4

Comparison of existing growth charts

Data charact

Source

Study period

Population

Age-group

NCHS

Multiple different studies

1929-1975

US, white,bottle fed

Birth-20 yrs

CDC

Multiple different studies

1963-1994

US, mixed feeding, no racial/ethnic diff

Birth-20 yrs

WHO

Primary data

1997-2003

6 Countries pooled data. healthy children & practices, breastfed

Birth-5yrs

GROWTH CHARTS

Consist of a series of percentile curves that illustrate the distribution of selected

body measurements in the study population

Used to track the growth of children from infancy thru adolescence

Indicates the state of the child's health, nutrition and well being

Need for Growth Charts

Individual level

Community level

National level

Scientists

Monitoring & documenting growthComparison with references stdTo detect growth faltering

Monitoring health statusPerformance of programsComparison over time

Identification of problem areasNational/international comparisons

Research tool

Educate parents and allay their anxiety by showing normal growth in chart

Early identification of children’s growth failure for detection of malnutrition and taking appropriate interventions

Early identification-overweight/obesity

Community level

First 2 years

2 –10 years

>10 years

What needs to be monitored at community level

• Length/age• Weight/age• Weight /height or BMI• Head circumference/age

• Height/age• Weight/age• BMI/age

Above in relation to pubertal development

WHO Child Growth Standards 0-5 years

WHO Growth Reference StudyPrescriptive Approach

Optimal Nutrition• Breastfed infants• Appropriate complementary feeding

Optimal Environment• No microbiological contamination• No smoking

Optimal Health Care• Immunization• Pediatric routines

OptimalGrowth

WHO Child Growth Standards

Weight-for-age Length/height-for-age Weight-for-length/height Body mass index-for-age Mid-upper arm circumference-for-age Triceps skinfold-for-age Subscapular skinfold-for- age Head circumference-for-age

Attained growth

• Weight• Length/height• Head circumference• Arm circumference

Growth velocity

year 1 year 2 year 3

Longitudinal (0-24 months)

Cross-sectional (18-71 mo)

MGRS study design

Time schedule child anthropometry

Measurement Time frame Frequency No. of visits Birth Once 1 Weeks 2-8 Bi-weekly 4 3-12 months Monthly 10

Weight, length, head circumference

14-24 months Bi-monthly 6

3-12 months Monthly 10 Arm circumference Skinfold thicknesses 14-24 months Bi-monthly 6

WHO Multicentre Growth Reference Study

Mean length from birth to 24 months for the six MGRS sites

Age (days)

Mea

n of

Len

gth

(cm

)

0 200 400 600

5060

7080

BrazilGhanaIndiaNorwayOmanUSA

WHO Multicentre Growth Reference Study Group. Assessment of linear growth differences among populations in the WHO Multicentre Growth Reference Study. Acta Paediatr Suppl 2006;450:56-65.

Notes:1. A child in this range is very tall. Tanness is rarely a problem, unless it is so excessive that it may indicate endocrine such as a

growth-hormone-producing tumor. Refer a child in this range for assessment if you suspect an endocrine disorder (e.g. If perents of normal height have a child who is excessively tall fot his or her age)

2. A Child whose weight-for-age falls in this range may have a growth problem, but this is better assessed from weight-length/heoght or BMI-for Age.

3. A plotted point above 1 shows possible risk. A trent toward the 2 z-score line show definite risk4. It is possibke for a stunded or severely stunded child to become overweight

INTERPRETING GROWTH INDICATORS

Interpretation of different indicators

Indicator AcuteMalnutrition

ChronicMalnutrition

Wt-for-age

Ht-for-Age Normal

Wt-for-Ht Normal

Prevalence of stunting (below -2 SD length/height-for-age) by age based on the WHO standards and the NCHS

reference in Bangladesh

Source: de Onis M, Onyango AW, Borghi E, Garza C, Yang H, for the WHO Multicentre Growth Reference Study Group. Comparison of the WHO Child Growth Standards and the NCHS growth reference: implications for child health programs. Public Health Nutrition 2006;9:942-947.

0

10

20

30

40

50

60

70

80

0-5 6-11 12-23 24-35 36-47 48-60 0-60

Age (months)

%

NCHS WHO

Prevalence of underweight (below -2 SD weight-for-age) by age based on the WHO standards and the NCHS reference

in Bangladesh

Source: de Onis M, Onyango AW, Borghi E, Garza C, Yang H, for the WHO Multicentre Growth Reference Study Group. Comparison of the WHO Child Growth Standards and the NCHS growth reference: implications for child health programs. Public Health Nutrition 2006;9:942-947.

0

10

20

30

40

50

60

70

80

0-5 6-11 12-23 24-35 36-47 48-60 0-60

Age (months)

%

NCHS WHO

WHO Reference 5-19 years

National Center for Health Statistics (NCHS)