🍽️nutrition assessment review
3.3 Growth Charts and Reference Standards
3 min read•Last Updated on July 30, 2024
Growth charts are essential tools for tracking children's physical development. They allow healthcare professionals to compare a child's growth to reference populations, helping identify potential issues early on. These charts provide valuable insights into growth patterns and velocities.
Different types of growth charts exist, including international standards like WHO charts and national standards like CDC charts. These charts typically include percentiles for weight, length/height, and BMI, allowing for comprehensive assessment of a child's growth over time.
Growth charts for child assessment
Purpose and importance
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- Track and monitor physical growth and development of children over time
- Allow comparison of an individual child's growth to a reference population
- Identify potential growth problems early (undernutrition, overnutrition, growth disorders)
- Early detection allows for timely intervention and management
- Essential for assessing growth velocity and patterns by regularly plotting weight, length/height, and head circumference
- Educate and reassure parents about their child's growth and development
- Set realistic expectations
- Valuable tools for healthcare professionals to make informed decisions
- Further assessment, referrals, or interventions based on growth patterns
Types of growth charts
International and national standards
- World Health Organization (WHO) growth charts
- International standard for children from birth to 5 years
- Based on data from healthy, breastfed children from diverse ethnic backgrounds
- Centers for Disease Control and Prevention (CDC) growth charts
- Commonly used in the United States for children and adolescents aged 2 to 20 years
- Based on a representative sample of U.S. children, including both breastfed and formula-fed infants
- Specialized growth charts for specific populations
- Preterm infants (Fenton growth charts)
- Children with Down syndrome, Turner syndrome, or other genetic conditions that affect growth
Chart components and age-specific parameters
- Growth charts divided into percentiles
- Indicate the percentage of children in the reference population below a particular measurement at a given age
- 50th percentile represents the median value
- Infants (birth to 2 years) charts include:
- Weight-for-age
- Length-for-age
- Weight-for-length
- Head circumference-for-age
- Children and adolescents (2-20 years) charts include:
- Weight-for-age
- Stature-for-age
- BMI-for-age
Interpreting growth data
Plotting measurements and creating growth curves
- Obtain accurate measurements using standardized techniques and equipment
- Weight, length/height, and head circumference
- Measure at regular intervals, typically at well-child visits
- Plot weight on the vertical axis, age on the horizontal axis
- Similarly plot length/height and head circumference
- Calculate BMI using weight and height measurements
- Plot BMI on BMI-for-age charts
- Connect plotted points to create a growth curve
- Compare to the percentile lines on the chart
- A child's growth curve should generally follow a consistent percentile line over time
Factors influencing growth patterns
- Consider birthweight, parental height, and pubertal stage when interpreting growth charts
- Genetic potential and environmental factors can influence individual growth patterns
- Crossing of percentile lines may indicate accelerated (upward) or decelerated (downward) growth
- Consistent deviation from a child's established growth pattern warrants further investigation
Individual growth vs reference standards
Comparing individual growth to reference population
- Growth percentile indicates relative position compared to the reference population
- Example: A child at the 75th percentile for weight is heavier than 75% of children of the same age and sex in the reference population
- Growth patterns consistently tracking along a percentile line are generally considered normal
- Even if not at the 50th percentile
- Take into account familial and ethnic variations in growth patterns
Identifying potential growth concerns
- Significant deviation from reference standards may indicate growth issues
- Crossing two or more major percentile lines (90th to 50th)
- Growth faltering or acceleration, warranting further evaluation
- Stagnation of weight gain or slowing of linear growth velocity
- Particularly in infants and young children
- May indicate undernutrition or an underlying health problem
- Rapid weight gain, especially when crossing percentile lines upward
- Sign of overnutrition or an endocrine disorder
- Obesity defined as BMI ≥95th percentile for age and sex
- Discrepancies between weight and length/height percentiles
- Weight at 90th percentile, length at 10th percentile
- Suggests growth disproportion (stunting, wasting)
- Requires further assessment
- Microcephaly (head circumference <3rd percentile) or macrocephaly (head circumference >97th percentile)
- May indicate underlying neurological or developmental issues
- Should be evaluated by a healthcare professional