Poor growth

  • What is poor growth?

    The best indicator of poor growth in children is weight and /or length tracking downwards on percentiles on the weight and / or length for age growth charts.

    Other popular, but less reliable definitions in the past included:
    'weight dropping percentile lines on weight for age growth chart'
    'weight and length are more than 2 percentile lines apart on the weight and length for age growth charts'
    'weight or length for age below the 3rd percentile'

    What are the consequences of poor growth?

    Poor growth in early childhood can have short and long-term consequences on children's health and development. Poor growth may alter body composition, growth potential, learning and development.

    Why does poor growth occur?

    Poor growth occurs when the energy (food) needs of the child are more than the amount the child consumes. There are a number of causes of poor growth including:
    • Endocrine or genetic disorders
    • Acute illness
    • Chronic illness
    • Physical or developmental concerns
    • Nutritional factors
    • Birth complications
    • Chromosomal abnormality

    Who to refer to?

    Refer to GP or Paediatrician for assessment of poor growth 

    Assessment and monitoring of a child with poor weight gain requires:

    • sensitivity and a partnership approach
    • assessment and regular review by a doctor
    • more frequent weighing and measuring as advised by a doctor and / or dietitian
    • follow-up assessment for illness or chronic disease
    • accurate assessment of feeding and intake
    • nutritional intervention for 'catch up' growth and ongoing monitoring by a doctor and / or dietitian 

    Key message:
    Infant feeding and growth can be highly emotive aspects of parenting. Child health practitioners should avoid generating unnecessary anxiety and guilt about infant weight gain. A partnership approach is recommended.

    How is growth assessed in populations?

    • For growth assessment of groups of children, and for research purposes, the number of   children above or below a given reference point is used to identify population prevalence data of growth.
    • Z-scores are useful for these purposes.
    • Z-scores describe the distance from the median in terms of standard deviations and are comparable between different age groups and allow comparison across children at different growth lines. 
    • The 'normal' population range is from -2 to +2 standard deviation z-scores with the median z-score being zero.
    • For example, cut-points can be defined to classify population prevalence of malnutrition, stunting, wasting and overweight; usually below -2 and above +2 z-scores respectively. 
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