Nutrition Guideline
Healthy Infants and Young Children
Weight Velocity
For Professional Reference Only
Applicable to: Nurses, Physicians and Health Professionals
Recommendations
Weight velocity (weight change over a specific time period) is one component of childhood growth
monitoring.
Weight velocity should only be used when investigating growth concerns, should only be used in
conjunction with growth charts, and should be interpreted with caution.
Using weight velocity as a component of childhood growth monitoring is most relevant for children from
birth to 6 months of age when growth is most rapid.
Repeated or successive measures at or below the lower end of the approximate weekly weight gain
ranges provided in this guideline can signal a growth concern and will require further assessment.
For public health settings, there is currently not enough evidence to identify a specific upper weight
velocity threshold signaling excessive or rapid weight gain. However, if the child’s weight is also
inclining on the growth chart from the previously established growth pattern, further assessment may
be warranted.
Health Benefits
Serial growth measurements (e.g. weight, length and head circumference), and interpretation of these
measurements when plotted on an age and gender appropriate growth chart, help to assess a child’s
growth and development.1 When younger infants are seen within short time intervals, there may be limited
ability to detect growth changes on a growth chart.2 In such cases, weight velocity tables (weight change
over a specific time period) may help with earlier identification of growth problems,3 but should only be
considered in conjunction with other measures of growth (length and weight-for-length) and the child’s
placement on the growth chart in order to interpret growth rate.2
Key Questions
What is weight velocity?
Weight velocity refers to weight change over a specific time period.1 Compared to size-for-age measures
on growth charts, weight velocity reflects weight changes over shorter periods of time, such as one week.2
Therefore, weight velocity has potential for earlier identification of growth problems that may not be as
easily captured by a growth chart alone.1,3
How can weight velocity tables be used in growth assessment?
A child’s weight velocity can be influenced by a variety of factors and will fluctuate.2 For example, a low
weight velocity may be expected if a child was previously growing at a higher percentile and the rate of
weight gain is now slowing2 as the child is settling into their unique pattern of growth. A higher weight
velocity may reflect recovery after an illness.2 Since there are a number of reasons why a child’s weight
velocity may be increasing or slowing, it is imperative that weight velocity be interpreted in conjunction with
the child’s placement on the growth chart2 and in consideration of recent medical history.
April 2014
Page 10.1.1
Nutrition Guideline:
Healthy Infants and Young Children
Weight Velocity
For Professional Reference Only
Nutrition Guideline
Healthy Infants and Young Children
Weight Velocity
Applicable to: Nurses, Physicians and Health Professionals
Table 1 provides approximate weekly weight gain ranges for healthy infants. It was designed for use in
public health settings to provide guidance for health care providers when investigating potential growth
concerns. Health professional judgment is required along with this information to determine the best course
of action for an individual child.
Table 1. Approximate weekly weight gain for healthy term infants (Birth – 6 months)
The purpose of the values presented in this table is to provide a reference for typical growth of healthy
infants. This table is for health professional reference only and should not be distributed to clients.
Approximate Weekly Weight Gain (grams)* Points of emphasis:
Age in Months
Girls
Boys
Infants lose weight during the
first few days after birth.
Birth-1 mo
Infants usually return to their
birth weight by 2 weeks of
age.2,5
1-2 mo
130 – 360 g
165 – 420 g
2-4 mo
90 – 235 g
100 – 250 g
4-6 mo
50 – 170 g
50 – 180 g
If an infant has not returned to his or her birth
weight by 2 weeks of age, further assessment
should occur.
Weekly weight gain should be interpreted with
caution and should only be used in conjunction
with growth charts.2
o
In a given week, infants may gain above or
below the values provided and be
experiencing normal, healthy growth.
o
Repeated or successive measures at or
below the lower end of the ranges in this
table can signal a growth concern2,4 and will
require further assessment.
*Conversion – To convert grams to ounces divide by 28.
Adapted from: WHO Growth Velocity Standards6
Data for 1 to 2 months: 1-month weight increments (g) Girls and Boys Birth to 24 months (percentiles)
Data for 2 to 6 months: 2-month weight increments (g) Girls and Boys Birth to 24 months (percentiles)
Note: The lower and higher ends of the approximate weight gain ranges are based on growth at the 5th - 97th percentile for
weight velocity, respectively. These values have been chosen to represent a range for weight velocity unlikely to signal a growth
concern.
How do I interpret growth using the approximate weekly weight gain ranges in Table 1?
The purpose of the values presented in Table 1 is to provide a weight velocity reference for typical growth
of healthy infants. In a given time period, children may gain above or below the reference values provided
in Table 1 and still be experiencing normal healthy growth. For this reason, the reference values in Table 1
should be interpreted with caution and should only be used in conjunction with growth charts.2
April 2014
Page 10.1.2
Nutrition Guideline:
Healthy Infants and Young Children
Weight Velocity
Nutrition Guideline
Healthy Infants and Young Children
Weight Velocity
For Professional Reference Only
Applicable to: Nurses, Physicians and Health Professionals
Repeated or successive measures at or below the lower end of the ranges provided can signal a growth
concern2,4 and will require further assessment.
Rapid postnatal weight gain has been linked to long-term effects, such as increased risk for hypertension,
cardiovascular disease, type 2 diabetes, osteoporosis and obesity, particularly for preterm and/or low birth
weight infants experiencing catch-up growth.7,8,9 However, there is not enough evidence to determine a
specific weight velocity threshold for “rapid” growth or to suggest that repeated or successive measures at
or above the upper end of the ranges selected for Table 1 signal a growth concern. In these situations, if
the child’s weight is also inclining on the growth chart from the previously established growth pattern,
further assessment may be warranted. Future research is needed to determine what patterns of successive
measurements, over what velocity thresholds, and over which time intervals have the best diagnostic and
prognostic validity for specific diseases.2
When further assessment is indicated, it is important to consider the many factors that could be affecting
growth. These factors may include the child’s overall health, presence or recent history of acute or chronic
illness, nutrition (e.g. breast or formula feeding, formula preparation), feeding relationship, stress or change
in child’s life, family growth patterns, availability/access to healthy foods, physical activity and sleep.
A referral to a physician should be considered to look into any biological causes such as digestive issues,
endocrine disorders, allergies, infections or diseases. A referral to a dietitian for individual consultation may
also be beneficial.
When is weekly weight gain less relevant?
Weekly weight gain becomes less relevant as a growth monitoring tool after 6 months of age when a child’s
growth typically slows. At this time, the lower end of the approximate weekly weight gain ranges may be too
low to be a sensitive indicator for potential growth concerns. Longer time intervals may be necessary to
identify changes in growth patterns after 6 months of age; therefore growth charts are the preferred tool.
What data was used to develop the approximate weekly weight gain ranges in Table 1?
The ranges provided in Table 1 were calculated from the World Health Organization’s child growth velocity
standards.6 The lower and higher ends of the approximate weight gain ranges are based on growth at the
5th - 97th percentile for weight velocity, respectively. These values have been chosen to represent a range
for weight velocity unlikely to signal a growth concern.
It should be noted that a child’s percentile for weight velocity is not necessarily the same as their percentile
on the growth charts. For example, if a child is growing at the 5 th percentile for weight velocity, it does not
mean that they are growing along the 5th percentile on the growth chart. This is because growth charts
represent attained weight and weight velocity represents the rate of weight gain.
April 2014
Page 10.1.3
Nutrition Guideline:
Healthy Infants and Young Children
Weight Velocity
Nutrition Guideline
Healthy Infants and Young Children
Weight Velocity
For Professional Reference Only
Applicable to: Nurses, Physicians and Health Professionals
Are there any handouts on healthy growth for infants and young children that I can use with my
clients?
For nutrition resources visit Nutrition Education Materials at
http://www.albertahealthservices.ca/nutrition/Page11115.aspx and click on Child/Adolescents.
For more information related to healthy infants and children see Healthy Parents Healthy Children.
References
Dietitians of Canada, Canadian Paediatric Society, the College of Family Physicians of Canada, Community Health
Nurses of Canada. Promoting optimal monitoring of child growth in Canada: using the new WHO growth charts
[collaborative statement on the Internet]. 2010 [cited 2013 Aug 23]. Available from: http://www.cps.ca/tools/growthcharts-statement-FULL.pdf.
1
WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Growth velocity based on weight,
length and head circumference: Methods and development [document on the Internet]. 2009 [cited 2011 Sept 29];
Geneva: World Health Organization. Available from:
http://www.who.int/childgrowth/standards/velocity/technical_report/en/index.html.
2
Danner E, Joeckel R, Michalak S, Phillips S, Goday PS. Weight velocity in infants and children. Nutr Clin Pract.
2009;24:76-9.
3
4
Roche AF, Sun SS. Human growth: assessment and interpretation. Cambridge: Cambridge University Press; 2003.
5
Riordan L. Breastfeeding and Human Lactation, 3rd ed. Sudbury, Mass: Jones and Bartlett Publishers; 2010.
World Health Organization. Child growth standards: Weight velocity [data tables on the Internet]. 2011 [cited 2011
Aug 16]. Available from: http://www.who.int/childgrowth/standards/w_velocity/en/index.html.
6
Barker DJP, Eriksson JG, Forsen T, Osmond C. Fetal origins of adult disease: strength of effects and biological
basis. Int J Epidemiol. 2002;31:1235-9.
7
Singhal A, Cole TJ, Fewtrell M, Deanfield J, Lucas A. Is slower early growth beneficial for long-term cardiovascular
health? Circulation 2004;109:1108-13.
8
ESPGHAN Committee on Nutrition: Aggett PJ, Agostoni C, Axelsson I, De Curtis M, Goulet O, Hernell O et al.
Feeding preterm infants after hospital discharge: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr
Gastroenterol Nutr. 2006 May;42(5):596-603.
9
April 2014
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Nutrition Guideline:
Healthy Infants and Young Children
Weight Velocity