1 / 37

Child growth charts e-learning tool Judith Myers and Kay Gibbons October 2011

Child growth charts e-learning tool Judith Myers and Kay Gibbons October 2011. Session outline. Re-cap child growth and growth charts New equipment guidelines Practice examples – WHO under 2; CDC over 2 Introduce e-learning tool . Child Growth = marker of health and development .

mahola
Download Presentation

Child growth charts e-learning tool Judith Myers and Kay Gibbons October 2011

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Child growth charts e-learning toolJudith Myers and Kay GibbonsOctober 2011

  2. Session outline • Re-cap child growth and growth charts • New equipment guidelines • Practice examples – WHO under 2; CDC over 2 • Introduce e-learning tool

  3. Child Growth = marker of health and development • Quick, non-invasive techniques • Plotting serial measurements on charts • Abnormal growth can indicate underlying health or developmental problems

  4. ‘Normal’ growth • Weight and length ‘tracking’ on centiles Growth influenced by: • Genetics and epigenetics • Ethnicity • Birthweight • Nutrition • Environment

  5. Birth to 2 years Weight to nearest 10g To nearest 0.1cm purpose‘infantometer’ to nearest 0.1cm

  6. Portable or fixed ‘for purpose’ To 100g / 0.1cm 2 & 3 ½ years

  7. 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

  8. KAS Visits* Birth – 2 years Weight, length and head circumference Plotting on WHO charts 2 – 5 years Weight and stature at KAS visits BMI when indicated Plotting on CDC charts * And whenever clinically indicated KAS growth measuresand charts

  9. Charts in the Victorian ‘My health and development’ record

  10. Birth to 2 yearsWorld Health Organisation (WHO) http://www.who.int/childgrowth/standards/en/

  11. Brazil Ghana India Norway Oman 80 USA 70 Mean of Length (cm) 60 50 0 200 400 600 Age (days) Effect of ethnicity on infant growth Onis et al. WHO child growth standards. ActaPaed 2006

  12. 2 – 5 years CDC (Centre for Disease Control) http://www.cdc.gov/growthcharts/

  13. Differences plotting 0 - 2 • Head circumference matches closely at all key ages • Birth weight position is similar on CDC or WHO at all centiles • Length pattern matches closely, but by 2 years, WHO appear slightly ‘taller’ in the lower centile range • At 6 months, infants plotted on WHO appear ‘lighter’ when compared with CDC • At 2 years, children in lower centiles appear ‘heavier’ on WHO compared with CDC

  14. Summary of differences: WHO compared to CDC charts • More children 6 months - 2 years appear to grow slower • More children could be ‘overweight’ • More children < 6 months ‘underweight’ • More risk of ‘poor growth’ 2 – 4 months = breastfeeding

  15. Principles of child growth assessment • Serial measurements of both weight and length / stature • Head circumference reflects early brain growth • Poor growth – decline in rate of weight gain first, followed by length/height gain • Appropriate growth when weight and length/height track along a curve – even it is ‘off’ chart • Correct for prematurity until 2 years

  16. 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 • ‘Flags’ • Weight or length / stature < 5th centile • Weight or length /stature > 98th centile • BMI > 85th centile

  17. Measure and Plotting • 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% • Pre-term • Pre-term charts used until expected birth date (Kitchen 1983) • ‘Correct’ until 2 years (KAS framework 2009)

  18. 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

  19. How do key KAS growth points compare? Question

  20. Comparison 1: Boy weight for age CDC (left) and WHO (right) at 4 months

  21. Comparison 1: Boy weight for age CDC (left) and WHO (right) at 4 months

  22. Comparison 2: Boys weight for age: CDC (left) and WHO (right) at 2 years

  23. Comparison 2: Boys weight for age: CDC (left) and WHO (right) at 2 years

  24. Comparison 2: Boys weight for age: WHO (left) and CDC (right) at 2 years

  25. Comparison 3: Boys length for age at 2 – WHO (left) and CDC (right)

  26. Does changing to WHO make any difference to children’s growth assessment? Question

  27. Comparison 4: ?underweight or normalWHO (left) and CDC (right)

  28. Comparison 4: ?underweight or normalWHO (left) and CDC (right)

  29. Comparison 5: underweight or normal?

  30. Comparison 5: underweight or normal?

  31. Comparison 6: normal or overweight?

  32. Comparison 6: normal or overweight?

  33. Comparison 6: normal or overweight?

  34. 18.4 kg/m2>85th centile = ‘overweight’

  35. Summary of key points Chart changes don’t change individual child growth Stick to one chart Don’t rely on one measurement Trend is more important than a single measurement Need accurate measuring and plotting Need calibrated, high quality equipment Despite many parents’ perceptions the 50th percentile is not the goal for each child

  36. www.cdc.gov/growthcharts/ www.who.int/childgrowth/standards/en http://consultations.nhmrc.gov.au/open_public_consultations/public-consultation-draf Cole TJ. BMI cut-offs BMJ 2007 Garza C. New growth standards for the 21st century 2006 de Onis. Comparison of the WHO and CDC growth charts 2007 Key references

More Related