Discussions with parents

    • Discussions with parents about child feeding and growth always requires a sensitive approach
    • Sensitivity is important no matter which growth chart is used and where on the chart the child is growing
    • Overall, most children do grow well. Discussion about child growth should occur at most child health visits
    • Always reinforce the positive things about the child's growth and development
    • The following approach may be helpful:
      1. Show the parent /carer the child's length / height on the length /height for age growth chart
      2. Show where the child's weight is on the weight for age growth chart
      3. Explain the centile lines on the chart; e.g. 3% of all children grow below the bottom, 3% of all children grow above the top, half of all children grow above the 50th and half of all children grow below the 50th. Despite the wide variation these are all normal
      4. Discuss the trend in child's weight and length / height compared with previous measurements
      5. Discuss similarities or differences in weight and length / height centiles, especially for children under 2 years of age where BMI is not applicable
      6. If there is a change in the trend of child's growth, ask the parent / carer can they think of anything which may have contributed to the change. Try to use open-ended questions to prompt discussion

     

  • The following video is an example of discussion about child growth by a GP with the parent of a young child

  • Click here to download a transcript of the video


    Summary of all key messages:

    • Growth assessment is quick and easy. It provides valuable information about the general health and wellbeing of the child
    • Use an age-appropriate, gender-specific growth chart and ensure a broad working understanding of the background to the chart
    • Use calibrated, age-appropriate equipment and best practice measurement technique
    • Accurately transfer the measurements onto the growth chart or the electronic plotting tool
    • Consider the trend of growth over time. E.g. serial measurements rather than single measures and weight in relation to length / height
    • Many healthy children grow on centile lines at the top or bottom of the growth chart
    • Many healthy children have small 'dips' above or below a particular centile line or growth curve anywhere on the growth chart
    • Growth rates that continue to increase or decrease over time are not normal and do need further investigation
    • Growth charts are not a sole diagnostic tool but rather contribute to forming an overall clinical impression of the child
    • Consider the overall assessment of child - are they otherwise happy, healthy and meeting developmental milestones
    • Time, expertise and resources are needed to explain measurements and plotting on the child's growth chart to parents
    • Always ensure sensitivity and a partnership approach
    • If there are concerns about the child's growth refer for further investigation

     

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