Growth Charts Flashcards
How should Babies be weighed?
- without any clothes or nappy
- children older than two can be weighed in vest and pants but no shoes, footwear and dolls or teddies
- only class III clinical electronic scales in metric setting should be used
How to measure head circumference?
- should be measured using a narrow plastic or disposable paper tape
- measurement should be taken where the head circumference is widest
How to measure length
- measure length before the age of 2 if concenrent
- measure without nappy or footwear
How to measure height?
- measured from two years of age using a rigid rule with T piece
- ensure heels, bottom. bacl and head are touching the apparatus with eyes and ears at 90o
How to plot the growth chart?
- record measurement and date in ink, plot in pencil
- use dot
- age errors are commonest source of plotting mistakes, use a calender or date wheel to calculate age
- age in weeks for first 6-12 months
- clendar months thereafter
- count forward from the date of birth to current moth using date of birth
What do the centiles show?
- optimum range of weights and heights
- describes the percentage expected to be below that line
- 50% below 50th
- 91% below the 91st
- 1 in 250 below 0.4th
- half of all children should be between 25th-75th centile
Centile terminology
- if the [pint is exactly on the centile line or within 1/4 of a space of the centile line, the child is described as being on that centile e.g. 91st centile
- if not they should be described as being between centile x and Y e.g. between the 75th -91st centile
Plotting in the first two weeks
- birth weight centiles still based on UK 1990 data
- WHO charts start from 2 weeks
- no centile lines between birth (0weeks) and 2 weeks
- allows for weight loss and regain before 2 weeks
What is a term infant described as in weeks? and where is it plotted in the graph?
- 37 weeks or more at age 0 weeks
Calculating percentage weight loss
Weight change
= currrent weight - birth weight
percentage weight loss
= weight loss / birth weight x100%
Assessing neonatal weight loss
- most babies lose some weight after birth
- 80% will have regained this by 2 weeks of age
- fewer than 5% of babies lose more than 10%
- only 1 in 50 are 10% lighter at 2 weeks
- a baby 10% or more below birth weight at or before 2 weeks needs careful assessment for:
- feeding problems
- unrecognised illness
Plotting on the pre-term section
- for infants born 32-36 weeks gestation
- up till EDD (term) plus 2 weeks
- for infants <32 weeks or any nenonate needing close monitoring use new low birth weight chart
- after EDD plus two weeks move over to 0-1 chart with gestational correction
What is gestational correction
- adjust the plot of a measurement to account for number of weeks a baby was born early
- number of weeks early = 40 weeks minus gestational afe
- should not be used for term infants 37 weeks
- should be continued for 2 years
- 1 year for infants born 32-36 weeks
Plotting with gestational correction
- plot emasurement at actual afe
- draw a line back the number of weeks the baby was early and mark this with an arrow
Causes of a heavy child
- over feeding
- diabetic mother
- endocrine
Causes of falling weight
- neglect
- under-feeding
- chromosomal abnormality
Causing of a falling height
- severe malnutrition, constiutional delay, familial
How to calculate mean parental height
-Boys and girls
Boys
- plot father height directly onto growth chart
- plot mothers height directly onto growth chart +12.5 cm
- calculate the mid parental height
Girls
- plot mother height onto growth chart
- plot fathers height subtractng the correction factor of 12.5cm
- calculate the mid parental height
target range = mid-parental height +8.5cm
Causes of short stature
- below the 2nd centile
- normal - genetic short stature, constitutional delay in growth or adolsecence
- intrauterine growth retardation
- dysmorphic syndromes
- skeletal dysplasia e.g. achondroplasia
- chronic systemic diseases
Growth failure
failure to maintina an appropriate heigh velocity for age and maturity, in the absence of other clinical features growth failure indicates frowth hormone deficiency
Sexual Preococity
Early sexual development irresepctive of cause: precocious puberty is true puberty beginning <8 years in girls and <9 years in boys
early or advanced puberty is true puberty beginning aged 8-10 in girls and 9-11 in boys
delayed puberty
Standard definiting is B1 >13 in girls and G1 >14 years in boys
