PLOTTING, TRENDS, INTERPRETATION OF
NEW WHO CHILD GROWTH STANDARDS
Dr. Naveeda Khatoon
NIPCCD, Bangalore
AKNOWLEDGEMENT
The present slides have been prepared
by the WHO team and Global Trainers
The five steps of Growth Monitoring are:Step I:
Determining correct age of the child.
Step II:
Accurate weighing of the child.
Step III:
Plotting the weight accurately on a growth chart.
Step IV:
Interpreting the direction of the growth curve.
Step V: Discussing the child’s growth with the mother for
follow- up.
Where to put the date of Birth?
4
t
h
CLINICAL ASSESSMENT
Bitot
spot
Oedema
of Feet
Oedema feet
Kwashiorkor
Marasmus
Protein Energy Malnutrition
Sever Wasting
Keratomalacia
BITOT’S SOPTS
BITOT’S SOPTS
Koilonychias
Koilonychias
Goiter
Iodine Deficiency
Disorders
Angular Stomatitis
Cretinism
Rickets
INTERPRETING TRENDS FROM THE GROWTH CHART
Identifying Growth Problems
 If your child’s weight falls in the yellow zone on the growth card, she/he is
moderately underweight.
 If your child’s weight falls in the orange zone on the growth card, she/he is
severely underweight.
Trends indicative of growth problems are:
 A child’s growth line crosses a different colour zone.
 There is a sharp incline or decline in the child’s growth line even within
the same colour zone.
 The child’s growth line remains flat (stagnant); i.e. there is no gain in
weight over three consecutive months
GROWTH CURVE CROSSING A COLOUR ZONE
Growth lines that cross different colour zones shown on the growth
chart indicate a change in growth trend
If your child’s growth line crosses a coloured zone (either from above or below),
there has been a significant change in the her/his growth. For example from
green to yellow colour.
If the shift is toward the green zone, this is a good change indicating that your
child is growing well.
If your child’s line stays close to the green zone, occasionally crossing above
and below it, there is no cause for worry as it indicates that the child’s growth is
within the normal range.
But, if the shift is away from the green zone towards yellow or orange zone,
this indicates an increased risk of malnutrition.
If your child’s growth line is declining so that it may cross a colour zone soon,
the change may be problematic.
FLAT GROWTH LINE (STAGNATION)
A flat growth line, also called stagnation, usually indicates a problem.
If your child’s weight stays the same over time as height or age
increases, the child most likely has a problem.
For children in age groups where the growth rate is fast, as shown by
steep growth curves (e.g. during the first 6 months of life), even one
month’s stagnation in growth represents a possible problem.
SHARP DECLINE OR INCLINE IN THE GROWTH LINE
A sharp decline in the growth line of a normal or undernourished child
indicates a growth problem.
This means she/he is losing too much weight rapidly.
If your child has been ill or severely undernourished, a sharp incline is
expected during the re-feeding period as the child experiences “catch-up”
growth.
Such “catch up” growth may also be seen in babies who are born low birth
weight i.e. below 2.5 kg.
COUNSELLING THE MOTHER/CAREGIVER
 Weigh the child and plot her/his weight on the growth chart in the
mother’s presence. It is very important to communicate what you have
found with her, so the first step is to inform her in a clear and sensitive
way.
 With the help of the growth chart, explain that you are trying to see if
the child is growing as expected, or if there is any growth problem.
Explain the points and trends on the chart to her clearly and simply.
 If a child is growing well, be sure to say so to the mother and
compliment her.
 If there is a problem, explain the nature of the problem to the mother
and discuss what she can do to overcome it.
How to Proceed Now
 Use separate charts for girls and separate
for boys
 Plot all newborns in New register.
 Plot all children born in last six months in
new register transferring all data from old
register.
How to Proceed Now
 Plot all children’s data of last three visits
excluding the present visit in new register.
 Transfer all data of children who are now plotted
as
- Moderately underweight (yellow Track)
- Severely underweight (Orange Track)
- Stagnating or showing downward trend in
green track
How to Proceed Now
 Transfer all data of Child
 Identify the following children for special care:
- showing any Clinical sign of Micronutrient
deficiency
- Any sibling death due to malnutrition
- Mother/father HIV positive
- Father/Mother TB +
- All LBW, babies
- Preterm
- Twins
- Suffered from Measles, Diarrhoea,
Pneumonia, Not immunized so far
 The trend of present track warrants using
previous data.
AN URGENT NEED IS A MANUAL FOR ALL THE
TEACHING INSTITUTES
NIPCCD IS IN THE PROCESS OF
PREPARING THE TRAINING MANUAL ON
ADOPTION OF NEW WHO GROWTH
STANDARDS IN INDIA
Thanks
for patient hearing