PLOTTING, TRENDS, INTERPRETATION OF NEW WHO CHILD GROWTH STANDARDS

1. PLOTTING, TRENDS, INTERPRETATION OF NEW WHO CHILD GROWTH STANDARDS Dr. Naveeda Khatoon NIPCCD, Bangalore

2. The present slides have been prepared by the WHO team and Global Trainers AKNOWLEDGEMENT

3. The five steps of Growth Monitoring are:- Step I: Determining correct age of the child. Step II: Accurate weighing of the child. Step III: Plotting the weight accurately on a growth chart. Step IV: Interpreting the direction of the growth curve. Step V: Discussing the child’s growth with the mother for follow- up.

6. Where to put the date of Birth?

8. 4th

14. CLINICAL ASSESSMENT

15. Bitot spot Oedema of Feet

16. Oedema feet

17. Kwashiorkor

18. Marasmus

19. Protein Energy Malnutrition

20. Sever Wasting

21. Keratomalacia BITOT’S SOPTS

22. BITOT’S SOPTS

23. Koilonychias

24. Koilonychias

25. Goiter

26. Iodine Deficiency Disorders

27. Angular Stomatitis

28. Cretinism

29. Rickets

30. INTERPRETING TRENDS FROM THE GROWTH CHART Identifying Growth Problems • If your child’s weight falls in the yellow zone on the growth card, she/he is moderately underweight. • If your child’s weight falls in the orange zone on the growth card, she/he is severely underweight. Trends indicative of growth problems are: • A child’s growth line crosses a different colour zone. • There is a sharp incline or decline in the child’s growth line even within the same colour zone. • The child’s growth line remains flat (stagnant); i.e. there is no gain in weight over three consecutive months

32. GROWTH CURVE CROSSING A COLOUR ZONE • Growth lines that cross different colour zones shown on the growth chart indicate a change in growth trend • If your child’s growth line crosses a coloured zone (either from above or below), there has been a significant change in the her/his growth. For example from green to yellow colour. • If the shift is toward the green zone, this is a good change indicating that your child is growing well. • If your child’s line stays close to the green zone, occasionally crossing above and below it, there is no cause for worry as it indicates that the child’s growth is within the normal range. • But, if the shift is away from the green zone towards yellow or orange zone, this indicates an increased risk of malnutrition. • If your child’s growth line is declining so that it may cross a colour zone soon, the change may be problematic.

35. FLAT GROWTH LINE (STAGNATION) • A flat growth line, also called stagnation, usually indicates a problem. • If your child’s weight stays the same over time as height or age increases, the child most likely has a problem. • For children in age groups where the growth rate is fast, as shown by steep growth curves (e.g. during the first 6 months of life), even one month’s stagnation in growth represents a possible problem.

36. SHARP DECLINE OR INCLINE IN THE GROWTH LINE • A sharp decline in the growth line of a normal or undernourished child indicates a growth problem. • This means she/he is losing too much weight rapidly. • If your child has been ill or severely undernourished, a sharp incline is expected during the re-feeding period as the child experiences “catch-up” growth. • Such “catch up” growth may also be seen in babies who are born low birth weight i.e. below 2.5 kg.

38. COUNSELLING THE MOTHER/CAREGIVER • Weigh the child and plot her/his weight on the growth chart in the mother’s presence. It is very important to communicate what you have found with her, so the first step is to inform her in a clear and sensitive way. • With the help of the growth chart, explain that you are trying to see if the child is growing as expected, or if there is any growth problem. Explain the points and trends on the chart to her clearly and simply. • If a child is growing well, be sure to say so to the mother and compliment her. • If there is a problem, explain the nature of the problem to the mother and discuss what she can do to overcome it.

39. How to Proceed Now • Use separate charts for girls and separate for boys • Plot all newborns in New register. • Plot all children born in last six months in new register transferring all data from old register.

40. How to Proceed Now • Plot all children’s data of last three visits excluding the present visit in new register. • Transfer all data of children who are now plotted as - Moderately underweight (yellow Track) - Severely underweight (Orange Track) - Stagnating or showing downward trend in green track

41. How to Proceed Now • Transfer all data of Child • Identify the following children for special care: - showing any Clinical sign of Micronutrient deficiency - Any sibling death due to malnutrition - Mother/father HIV positive - Father/Mother TB + - All LBW, babies - Preterm - Twins - Suffered from Measles, Diarrhoea, Pneumonia, Not immunized so far • The trend of present track warrants using previous data.

42. AN URGENT NEED IS A MANUAL FOR ALL THE TEACHING INSTITUTES NIPCCD IS IN THE PROCESS OF PREPARING THE TRAINING MANUAL ON ADOPTION OF NEW WHO GROWTH STANDARDS IN INDIA

43. Thanksfor patient hearing