growth assessment and charts

Question 1

growth assessment

Answer 1

to assess growth, need to compare their height against a comparative/reference population
percentile position correlates to a Z score and vice versa (1Z score=0.67- between 1 percentile)

Question 2

growth data- reference vs standard

Answer 2

growth standard explains what optimal would be
to create a standard you would create a sample of optimal people eg for a weight standard you would pick the healthiest peoplee

Question 3

reference characteristics

Answer 3

cross sectional data
distance
more variation
limited inclusion criteria
UK 1990 reference

Question 4

standard

Answer 4

longitudinal data
distance and velocity
less variation
strict inclusion criteria
prescriptive growth as it ought to be
WHO 2006 standard

Question 5

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UK90 references

Answer 5

combined data on 37,000 individuals from 17 distinct cross sectional surverys representative of england, scotland and wales
not a fair comparison as it is a historic sample that may not have been optimal at the time

Question 6

WHO charts

Answer 6

decided they needed new growth charts
differences in weight gain seen between breast fed and formula fed infants
healthy breast-fed infants show similar growth patterns around world
decided to produce charts that set breast feeding as norm for infant feeding
breast fed= lower risk of obesity

Question 7

who charts developed

Answer 7

15 year programme of planning, data collection and analysis
new study of growth of breast fed infants of non smoking, non deprived mothers from birth to 5 years
very similar growth patterns in all 6 centres
charts are a description of optimal rather than average growth
suitable for children worldwide as all growth should be same across the world if there are no constraints on growth

Question 8

UK- who charts

Answer 8

SACN recommended- adoption of WHO charts in UK from 2 weeks - 4 years - continue to use UK birth and pre term data as no who preterm data
WHO sample didnt include preterm babies as they are not optimal so cant use who charts from birth
design and new instructions developed by expert group and tested in focus groups of staff and parents

Question 9

calulating % weight loss

Answer 9

weight change = current weight - birth weight

% weight loss= (weight loss/birth weight) x100

is normal to lose weight after birth- 80% will have regained this by 2 weeks of age, fewer than 5% of babies will lose more than 10%
a baby 10% or more below birth BW at 2 weeks will need assessment

Question 10

normal weight gain

Answer 10

weight usually tracks with one centile
actute illness- weight loss and weight centile fail
less than 2% of children will show a sustained drop through 2 or more weight centile spaces on the new WHO charts- failure to thrive (need assessment)
going down is more concerning than going up in centiles

no single threshold below or above a child’s weight/height that is definitely abnormal

Question 11

BMI

Answer 11

not used before 2 years of age- not entirely accurate for ant age as does not consider fat mass and body composition
children are not considered obese but overweight/ very overweight

Question 12

pre term infants

Answer 12

looking at percentile of infants who were born pre term uses a gestational correction in order to allow for pre term birth

Question 13

length and height

Answer 13

when a child is measured standing up, the spine is squashed so the child may appear shorter
therefore height tends to be lower than length