Growth charts and their uses Flashcards
Why do we monitor growth?
- public health reasons
- clinical practice reasons
What are the public health reasons why we monitor growth?
- screen and survey population to see growth trends
e. g. recognise obesity and see what is being done
What are the clinical practice reasons of monitoring growth?
- assess health and nutrition of child
- diagnose disease
- monitor disease
When are babies weighed?
- birth
- first few weeks of life
- first year
- then no routine check unless they want to check at GP or A&E
Where are the weight measurements inputted?
- red book
- usually parents don’t fill this in after the 1st year
How do we monitor growth?
- weight
- height
- head circumference
How is weight measured?
- babies= no clothes of nappy
- older children= vest, pants, no shoes, no dolls/teddies in hands
- only class III clinical electronic scales in metric setting should be use
How is height measured in babies under 2?
- babies under 2= use proper equipment e.g. length board/mat bc accurate
- 2 measureres need to measure
- without nappy or footwear
How is height measured over the age of 2?
- use T piece or stadiometer
- ensure heels, bottom, back and head touching apparatus
- eyes and ears at 90 degrees
- no shoes
- measure on expiration
Why is it hard to measure the height of a baby until the age of 2?
- bc baby cant stant
- hard to keep baby still
- hard to stretch baby out
How do you measure head circumference?
- use narrow plastic of disposable paper tape
- measure where the head is widest (usually on forehead above ears)
Why is measuring the circumference of the head hard?!
- hard to measure
- depends on person measuring
- depend on where tape is placed on head
Why is measuring head circumference important?
- can indicate raised intracranial pressure
- indicate any head problems
What do you do once you have measured the height, weight and head circumference?
- plot on a graph
What is the purpose of growth chart?
- displays data and patterns
Why are there lines already on growth charts?
- they are data from cross sectional studies on children’s growth at all ages
- lines are based on SD from the mean
- each line represents 2 or 2 SDs
- lines evenly spread
What could have been a problem before with growth charts?
- could have been representative of certain ethnic group
(older charts represented a certain group of people) - now shows standard of how a child should grow
What does normal growth of a child depend on?
- ethnicity
- black babies = heavier, more muscle mass
- south Asian babies = smaller
- social class- nutrition
In the UK, what are the 2 charts used?
- 0-4 years use the UK-WHO chart
- 2-18 years chart used in school
How is the 0-4 years UK WHO chart made?
- made looking at baby growth patterns when BREAST FED MILK
- can measure occipital-frontal circumference in the first 2 years of life
Why are breastfed babies used as a variable?
- babies on breast milk grow optimally
What does the UK WHO graph miss out?
- chart shows no data for first 2 weeks of life
- bc baby loses weight
- lose all the excess blood, fluids etc in the first two weeks
- so weighing baby now is no indication of the weight in the future
What does the UK WHO have separate?
- pre-term section for babies who are born pre-term (below 37 weeks)
Explain the 2- 18 year old chart used in schools?
- used in schools
- take into account puberty
- section to measure parental height = to determine child height in future
How are growth charts plotted?
- single dot plotted
- look at age, weight, length, head circumference
- important to have frequent measurements to spot a pattern
How do you plot a preterm baby on a growth chart?
- babies born between 37 and 42 weeks plot at 0 on the main chart
- babies born before 37 weeks use preterm section, and then transfer over at corrected age.
For example if a baby is born at 34 weeks, how would you fill in a graph?
- 34 weeks= 6 weeks early
- plot on preterm chart until they are 8 weeks old (42 gestation weeks)
- transfer to main chart
- make dot at 8 weeks of life
- make arrow back to 2 weeks
(see pic on mohibs)
What factors are growth affected by?
- nutrition
- genetics
- hormones
- timing of puberty
- diseases
How does nutrition affect growth?
- main influence in womb
- birth weight in normal babies reflects mother’s placental function
- after birth nutrition important too
How do genetics affect growth?
- after 1st year, genetics get important
- tall parents have tall kids lol
Which hormones affect growth?
- GH
- Thyroid hormone
- Sex steroids
GH deficiency picked up from early school age
can give daily GH injections
How does puberty timing affect growth?
- sex steroids = active in puberty = play part in growth
Who enters puberty faster?
- girls
- so girls taller than boys at start of secondary school
- growth in girls ends soon after periods start at the end of puberty.
What is different about growth spurt in boys than in girls?
- growth spurt in boys comes later and lasts longer
- so get taller height in general
How can disease affect growth?
- intake (can’t feed)
- metabolism (increased energy requirements)
- output (absorption of nutrients)
What is showing in a growth velocity graph?
- rate of growth highest in first year of life
- lowest growth rate in primary school age
- growth rate rise at puberty
- growth rate falls again at puberty end
What are problems with growth?
- Faltering growth
- Short stature- not meeting height potential
- underweight- thin older children- BMI less than 2nd centile for age and gender
- overweight - child over 91st centile for age and gender= BUT COULD JUST BE TALL AND HEAVY WHICH MIGHT BE NORMAL NOT OVERWEIGHT
- obese - Child with BMI over 98th centile for age and gender
What could be the problem with underweight children?
- protection issue
- disease
- lacking nutrients
What is BMI?
- how much weight shoubd be for certain height
- NOT MEASURING adiposity (fat)
