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GROWTH PARAMETRES AND THEIR ASSESSMENTbyDr. Azher ShahAssociate Professor Department of PaediatricsAzra Naheed Medical College, LAHORE
GoalsGrowth?
Development?
Methods for Nutritional Assessment?
Growth Parametres?
How to utilize growth charts?
Growth & Development
Growth
• Quantitative increase in size of body and can be measured in terms of HEIGHT and WEIGHT
Development
• Qualitative functional maturation assessed in terms of acquisition of skills and ability to cope with the situation
Growth & Development (Cont…)
Growth and development are so closely related that they are usually assessed simultaneously
Growth Assessment
Goals of Growth Assessment
• To determine if there are growth abnormalities that point to the presence of an underlying disease
• To prevent nutritional disorders and the increased morbidity and mortality that accompany them
Growth Assessment (Cont…)
Nutritional Assessment
• It is quantitative evaluation of nutritional status
Four components
• Dietary, medical, and medication history• Physical examination• Anthropometric and body composition measurements• Laboratory tests
Anthropometry
Height
Weight
Body Mass Index
Head Circumference
Growth Charts
Growth measurements should be plotted on growth charts
Growth is most rapid in healthy children during early infancy and adolescence
Serial measurements must be obtained
Children whose length, height, or weight measurements fall below the 5th percentile, above the 95th percentile, or cross two major centile curves are at nutritional risk
WHO Child Growth StandardsWHO growth charts describe normal child growth from birth to 5 years under optimal environmental conditions
These standards can be applied to all children everywhere
The reference lines on the WHO growth charts are either percentile lines or z-scores
The WHO standards define a population that is somewhat longer and leaner than the CDC references; this discrepancy is most dramatic during mid and late infancy
The WHO standards are less likely to categorize a child as undernourished, and more likely to categorize a child as overweight
Length or HeightLength is measured in children younger than 2 years who are measured in the recumbent position
Height or stature is measured in children older than 2 years who are measured while standing
Measurement should be performed three times to improve accuracy, and the mean should be plotted on a standardized growth chart
For a given individual, measured length is typically greater than standing height
Length or Height (Cont…)
Average length at birth is 50 cm
Increases 25 cm in first year of life
At 3 years 90 cm
At 4 years 100 cm
Then height increases by 5 cm / year until puberty when growth spurt of 9-10 cm / year for 2-3 years
Age Length or Height in Centimeter
At Birth 50
At 1 year 75
2-12 years [Age(years)x6]+77
WeightWeight measurements should be obtained on a scale that has been calibrated properly
Infant should be weighed without diapers and to the nearest 0.01 kg
Older child should be measured without shoes, in little or no outer clothing, and to the nearest 0.1 kg
Measurement should be plotted on a standardized growth chart
Weight (Cont…)Average weight at birth is 3.2 kg (7 lbs)
Birth weight is doubled at 5-6 months of age
Tripled at one year
4 times at 2 years of age
Annual increase is about 2 Kg / year till puberty
Age Weight (kg)
At Birth 2.50-3.25
3-12 monthsAge (months) + 9
2
1-6 years [Age(years)x2]+8
7-12 years[Age(years)x7]-5
2
Body Mass Index (BMI)BMI characterizes the relative proportion between the child's weight and height
BMI is calculated from the weight and square of the height as BMI = body weight (kg) ÷ height (meters) squared
BMI a valid predictor of adiposity, and is therefore the best clinical standard for defining obesity in children and adults
BMI greater than the 85th percentile is overweight and greater than the 95th percentile is obese
BMI less than the 5th percentile is underweight
Weight for HeightLike BMI, the ratio of weight to height can be used to predict adiposity
For children aged 0 to 2 years, the ratio of weight to length is generally used instead of BMI
For children aged 3 to 5 years, BMI for age and weight-for-height measures predict adiposity equally well
A child's weight-for-height can be compared to normal standards using a chart
Head CircumferenceHead circumference is measured at the maximum diameter through the glabella and occiput to the nearest 0.01 cm
Recorded value should be the mean of three measurements
It is measured in children from birth to 3 years of age because this is the period of rapid brain growth
It should be measured in older children with abnormal growth because it may be helpful in determining the etiology
Measurement should be plotted on a standardized growth chart
Head CircumferenceAbnormal head growth is defined as a head circumference (also called fronto-occipital circumference) greater than two standard deviations above or below the mean for a given age, gender, and gestation
Microcephaly is a head circumference greater than two standard deviations below the mean
Macrocephaly is a head circumference greater than two standard deviations above the mean
Growth Velocity (for Height)
Height velocity measurements are the most sensitive in detecting growth abnormalities early in the course of all types of chronic illness
Any child older than 2 years whose height velocity is less than 4 cm/year should be monitored carefully for progressive nutritional deficits
During puberty, peak height velocity is 5 to 11 cm/year in boys, and 6 to 10 cm/year in girls; the age of peak height velocity varies substantially
Growth Velocity (for Weight)
Any prepubertal child whose weight velocity is less than 1 kg per year should be monitored carefully for progressive nutritional deficits
During puberty, weight gain is more rapid; peak weight velocity is generally between 1 and 4 kg per six months in a healthy population
Malnutrition
The degree of acute and chronic malnutrition can be assessed clinically using various anthropometric measurements
During periods of nutritional deprivation, weight deficits occur initially, followed by length or height deficits and finally by head circumference deficits
Obesity
The clinical evaluation of a child with obesity includes assessment of the BMI or weight-to-height ratio
Precise measurement of the body fat content is not generally necessary or helpful for clinical decision-making
Short or Tall Stature
Radiographic studies of bone age can help to clarify the presence of abnormal growth patterns
Summary
Growth and Development
Growth parameters
Use standardized growth charts
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