Increasing weight

  • Phoebe was born at term weighing 3.4 kg and measuring 49.5 cm.  She is now 2 ½ years old and has been attending your clinic regularly for monitoring of her health and development.  She has reached all developmental milestones as expected.  Her weight and length measurements are shown in the table below. What concerns might you have regarding Phoebe's growth?


    Weight (kg)







    1 month




    3 months




    5.5 months




    9 months




    12 months




    18 months




    24 months






    Height/Stature (cm)

    BMI (kg/m2)

    2 ½ years





    Case study questions and activities

    1. Plot Phoebe's growth.  What growth charts do you use to plot Phoebe's weight and length measurements on?

    The WHO weight-for-age and length-for-age charts are used from birth to 2 years of age.  After 2 years of age the CDC charts can be used.  At this age height rather than length should be measured.  CDC BMI charts can also be used from 2 years of age.case3_c_weight_girls.gif









  • 2. How would you describe Phoebe’s growth pattern?

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    From birth to age 6 months Phoebe’s weight tracked around the 50th percentile on the WHO growth chart.  After 6 months weight percentiles began to increase. Between 18 months and 2 years the increase became more rapid with weight nearing the 97th percentile.   At 2 ½ years of age her weight when plotted on the CDC growth charts is between the 90th and 97th percentiles. 

    From birth to age 12 months her length tracked around the 50th percentile.   After this time it steadily increased towards the 85th percentile on the WHO charts.  At 2 ½ years height rather than length was measured and when plotted on the CDC charts was just over the 75th percentile.  Phoebe’s BMI is 17.9 kg/m2 and on the CDC BMI chart is just below the 90th percentile.

    3. How do you interpret Phoebe’s growth?

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    At age 2 ½ years BMI is between the 85th and 95th percentile.  Phoebe is therefore defined as being ‘overweight’.  

    4. What concerns do you have for Phoebe’s future growth and development?

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    Overweight children are at risk of low self-esteem, negative self-image and social isolation and arrange of serious medical conditions. They also have a greater risk of becoming overweight as an adult.  

    5. What recommendations might you give Phoebe’s parents? 

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    Recommendations / actions may include but are not limited to:
    • Discuss Phoebe’s growth with her parents in context with her overall health and development using sensitivity and a partnership approach.  A family approach to healthy lifestyle habits is recommended. These strategies promote health and wellbeing for the child and family. 
    • Review both child feeding practices and family eating habits.  For example encourage healthy family eating patterns including: enjoying fruit and vegetables, breads and cereals, meat / chicken and dairy products. Limit sugary and high fat foods. Offer water as drink of choice and limit sugar-sweetened drinks.
    • Review lifestyle and activity levels. For example limit TV viewing and encourage active outdoor play.
    • Refer to a GP or paediatrician
    • Refer to a dietitian

    6. Could action have been taken earlier?

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    Discussions about child growth can take place whenever growth is measured. Between the age of 1 and 2 years Phoebe’s weight increased more quickly than expected for her age and her length. Healthy lifestyle discussions can also take place at any time.

    Key Learnings from this case study

    1. From the age of 2 years CDC growth charts can be used rather than WHO growth standards. 
    2. After 2 years of age according to chart requirements Height/Stature rather than length should be measured.
    3. BMI can be calculated and plotted on CDC BMI- for -age chart.  BMI is a standard tool for measuring overweight and obesity in children over 2 years of age.  BMI =    Weight (kg) / Height (m2)
    4. Serial measurements are required for making a growth assessment.