Infants and toddlers 1 Plotting and Assessing Infants and Toddlers up to age of 4 Presentation 5 Adapted from training materials of the Royal College of

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Infants and toddlers

Plotting and Assessing Infants and Toddlers up to age of 4

Presentation 5

Adapted from training materials of the Royal College of Paediatrics and Child Health [RCPCH]

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When to weigh?

• After the first week and once feeding is established babies usually need to be weighed only when seen for routine health checks, unless there is a concern:– birth, 6-8 weeks, and school entry (including

measuring BMI).– opportunistic times include: immunisations

and surveillance checks

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What is a normal rate of weight gain?

• Weight usually tracks within one centile

• Acute illness weight loss and weight centile fall– A child’s weight usually returns to its normal centile within 2 to 3 weeks.

• Less than 2% of infants will show a sustained drop through two or more weight centile spaces on the new WHO charts– These children should be assessed by the primary care team, including

measuring length/height

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Length measurements commonly show wide variation

Measured length will vary

in same child depending on mood of child

and style of measurer

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Length & Height Changes at 2 years

When a child is measured standing up, the spine is squashed a little so the child may appear shorter.

The UK/WHO charts shift down slightly to account for this when measuring height standing for the first time

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What is a normal rate of growth?

• Measure length or height whenever concerned about weight gain or growth

• Measurements commonly show wide variation– If worried measure on a few occasions

– Healthy children usually show a stable general pattern over time

• What is a normal rate of head growth?– Head circumference usually tracks within one centile space

– Fewer than 1% of infants drop or rise through >2 centile spaces after the first few weeks

Should be carefully expressed

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Adult height prediction

• Plot the most recent height• Find the corresponding centile

on the adult scale

• Four out of he five children will

be within 6cm of this value

when an adult

For example, if a child is on the 75th centile for height, the Adult Height Predictor suggests they may reach an Adult Height of 181cm +/- 6cm

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When should a single measurement trigger assessment?

• There is no single threshold below or above which a child’s weight or height is defiantly abnormal

• Further assess…– All children with measurements below 0.4th centile

– Child with height above 99.6th centile plus other concerns

• If weight is above 99.6th centile after age 2, lookup BMI centile

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Body Mass Index (BMI) lookup

• Read off the weight and

height centiles from the

growth chart.

• Plot the weight centile

(left axis) against the height centile (bottom axis)

• Read off the

corresponding BMI centile

from the slanting lines

• Record centile with date

in the data box

• Accurate to ¼ centile space

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Interpreting Body Mass Index (BMI)

• A child whose weight is average for their height will have a BMI between the 25th and 75th centiles– Whatever their height centile

• BMI above the 91st centile suggests that the child is overweight

• BMI above the 98th centile is very overweight (clinically obese)

• BMI below the 2nd centile is unusual and may reflect under-nutrition

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Body Mass Index (BMI)

• BMI indicates how heavy a child is relative to their height

• BMI = weight (kg) ÷ height (m)2

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Summary

• After first 2 weeks, if well, weights required only at time of routine reviews

• Measure length or height and head whenever concerned about weight gain, growth or development

• Any child with measurement consistently <0.4th centile should be assessed in more detail

• Adult height can be predicted from age two using recent height centile using height predictor

• If weight is above 99.6th centile, BMI should be calculated using BMI lookup from 2 years

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© 2010 Royal College of Paediatrics and Child Health www.growthcharts.rcpch.ac.uk

Measuring and plotting: Activity 3 Answers

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Documents

Infants and toddlers 1 Plotting and Assessing Infants and Toddlers up to age of 4 Presentation 5 Adapted from training materials of the Royal College of