Plotting Child Growth

  • Dr Jill Sewell, Paediatrician and Deputy Director Community Child Health, Royal Children’s Hospital outlines some of the common issues associated with growth assessment in children.

  • Click here to download a transcript of the video

    Plotting pre-term infants

    • Infants born before 37 completed weeks gestation are considered preterm
    • The growth of significantly premature infants should be regularly monitored by a paediatrician and plotted on an appropriate preterm chart
    • Once the infant reaches their expected birth date, growth is plotted on the WHO 0 - 2 year old growth charts
    • All lengths and weights for premature infants are plotted as 'corrected' age taking into account the number of weeks a baby was born early
    Corrected age = Actual age - number of weeks premature
    • For all infants born at 37 or more weeks, birthweight is plotted at age '0', and then growth is plotted at actual age on the WHO 0 - 2 year old growth chart
    • It is recommended to correct age for prematurity for children born before 37 weeks until the age of 2 years
    Key points about birthweight and early weight gain in infants:
    • 80% of infants lose some weight after birth
    • Percentage birthweight rather than actual weight lost is more useful
    • If the infant is still more than 10% below birth weight at 2 weeks, the infant needs assessment for feeding problems or unrecognised illness
    • The growth of significantly premature infants should be regularly monitored by a paediatrician and plotted on a preterm chart
    • Correct for prematurity until 2 years
    • Plot child growth as 'corrected' age until 2 years

    Plotting infants and toddlers

    For healthy infants, weight, length and head circumference are measured according to child health monitoring schedule recommendations in each state and territory, and routinely as a standard part of any health consultation 

    • Plot the child's weight and length / height on the relevant chart (or electronically) and compare to the previous measures
    • Use dots to plot but don't join the dots into a line
    • Age errors are the most common plotting mistakes
    • Weight gain and growth usually 'track' along or near a centile line 
    • After acute illness, and for children with medical conditions, more frequent growth monitoring may be needed. e.g. weigh infants up to 6 months of age up to once a month, once every 2 months  (infants between 6 and 12 months of age) and once per 3 months (from 1 year of age)
    • After an acute illness weight should usually return to the 'normal' centile within 2 - 3 weeks 
    • Length measurements can show wide variation due to variation in the method used (length, or height / stature) and the cooperation levels of the toddler.
    • When a child is measured standing up, the spine is compressed a little, so the child may appear 'shorter' compared to recumbent length measure. Practitioners should always note whether length or height has been measured particularly in children around 2 years of age. 

    Key messages: 

    Accuracy in plotting requires:

    • Date of recorded measurements
    • Use dots to plot - don't join the dots into a line
    • Age errors are the most common plotting mistakes
    • Small changes in centile measures may occur at 'crossover' of charts. For example from the 0 - 2 year old charts to the 2 - 18 year old charts or from length to height charts.  
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