July 2010 Code HP5140
Girls New Zealand – World Health
Organization Growth Chart 0–5 Years
Measurement 11
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 12
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 14
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 15
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 16
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 17
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 18
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Anyone who measures a child, and/or plots or interprets
charts, should be suitably trained or be supervised by
someone qualified to do so. For further information
and training materials see www.moh.govt.nz/wellchild
and www.growthcharts.rcpch.ac.uk
A growth chart for all children
This chart, which is suitable for use with New Zealand
children up to age 5 years, combines World Health
Organization (WHO) standards with United Kingdom
preterm and birth data. The chart from 2 weeks to 5
years of age is based on the WHO growth standard,
derived from measurements of healthy, non-deprived,
breastfed children of mothers who did not smoke.1 The
chart for birth measurements (32–42 weeks gestation)
is based on British children measured around 1990.2
The charts depict a healthy pattern of growth that is
desirable for all children, whether breastfed or formula
fed, and of whatever ethnic origin.
Weighing and measuring
Weight: use only clinical electronic scales in metric
setting. For children up to 2 years, remove all clothes
and nappy; children older than 2 years should wear
minimal clothing only. Always remove shoes.
Length: (before 2 years of age): proper
equipment is essential (length board
or mat). Measurers should be trained.
The child’s shoes and nappy should
be removed.
Height: (from 2 years):
use a rigid rule with T piece,
or stadiometer; the child’s shoes
should be removed.
Name……………………………………………………………………………
NHI No…………………………………………………………………………
Date of birth………………………………………………………………
11
When to weigh
Babies should be weighed in the first week as10.5
part of the
assessment of feeding. Recovery of birthweight
10 usually
occurs by 10 to 14 days, and indicates that feeding is
effective and that the child is well. Once 9.5
feeding is
established, babies should usually be weighed
9 at the
time of routine checks. If there is concern, weigh more
8.5
often; however, weights measured too close together
are often misleading, so babies should not be8routinely
weighed more frequently than at each Well Child/
7.5
Tamariki Ora check.
Length or height should be measured at each Well Child/
Tamariki Ora check or whenever there are any worries
about a child’s weight gain, growth or general health.
Head circumference should be measured to age 1.
Plotting measurements
For babies born at term (37 weeks or later), plot each
measurement on the relevant chart by drawing a small
dot where a vertical line through the child’s age crosses
a horizontal line through the measured value. The
lettering on the charts (‘weight’, ‘length’ etc.) sits on the
50th centile, providing orientation for ease of plotting.
Plot birth weight (and, if measured, length and head
circumference) at age 0 on the 0–1 year chart. The
coloured arrows at age 0 represent UK birth weight
data and show the child’s birth centile.
Weight gain in the early days varies a lot from baby to
baby, so there are no lines on the chart between 0 and 2
weeks. However, by 2 weeks of age most babies will be
on a centile close to their birth centile.
For preterm infants, use a separate low-birthweight
chart for infants of less than 32 weeks gestation and any
other infant requiring detailed assessment. For healthy
infants born from 32 weeks and before 37 weeks, plot
all measurements in the preterm section (to the left of
the main 0–1 year chart) until 42 weeks gestation, then
plot on the 0–1 year chart using gestational correction,
as shown below.
The preterm section can also be used to assess the
relative size of infants at the margin of ‘term’ (eg, 37
weeks gestation), but these measurements should also
be plotted at age 0 on the 0–1 year chart.
Gestational correction
7
6.5
6
5.5
space from a centile line they are
described as being on that centile.
If not they should be described as
being between the two centiles:
e.g, 75th–91st.
A centile space is the distance between
two of the centile lines, or equivalent
distance if midway between centiles.
Gestational age
(7 weeks preterm)
Actual age
Assessing weight loss after birth
Most babies lose some weight after birth, but 80% will have
regained this by 2 weeks of age. Careful clinical assessment
and evaluation of feeding technique is indicated when weight
loss exceeds 10% or recovery of birth weight is slow.
Percentage weight loss can be calculated as follows:
When to measure
Plot measurements at the child’s actual age and then
draw a line back the number of weeks the infant was
Head circumference: use a narrow
preterm. Mark the spot with an arrow: this is the child’s
plastic or paper tape to measure0 where
2 4 6 gestationally
8 10 12 corrected
14 16 18 centile.
20 22 Gestational
24 26 28 30
32 34
correction
the head circumference is greatest.
should
until4 one year
born7 32 to 368
1
2 continue
3
5 for infants
6
Any hat or bonnet
weeks and two years for infants born before 32 weeks.
13
should be removed.
Age in weeks/ months
12.5
Be aware of cultural
Centile terminology
issues around
12
If the point is closer than ¼ of a centile
touching heads.
11.5
Interpreting the chart
Plotting for preterm infants
(less than 37 weeks gestation):
Draw a line back the number of
weeks preterm and mark spot
with arrow.
Weight loss = current weight – birth weight
Percentage weight loss = Weight loss x 100%
Birth weight
For example, a child born at 3.500kg who drops to 3.150kg at 5 days
has lost 350g or 10%; in a baby born at 3.000kg, a 300g loss is 10%.
What do the centiles mean?
A single point on these charts indicates a child’s size compared
with children of the same age and maturity who have shown
optimum growth. When there is more than one point, the
chart shows how quickly a child is growing. The centile lines
on the chart show the expected range of weights and heights
(or lengths); each describes the number of children expected
to be below that line (eg, 50% below 50th, 91% below the
91st). Children come in all shapes and sizes, but 99 out of 100
children who are growing optimally will be between the two
outer lines (0.4th and 99.6th centiles); half will lie between the
25th and 75th centile lines.
Being very small or very big can sometimes be associated with
underlying illness. There is no single threshold below which a
child’s weight or height is definitely abnormal, but only 4 per
1000 children who are growing optimally are below the 0.4th
centile, so these children should be assessed at some point to
exclude any problems. Those above the 99.6th centile for height
are almost always healthy. Also calculate BMI for children over
2 if weight and height centiles appear very different (more than
two centile lines different).
Predicting adult height
(Note that this is in the Health Professionals’ Notes, but not the
Well Child/Tamariki Ora Healthbook.)
Parents like to know how tall their child will be as an
adult. The child’s most recent height centile (aged 2–5
years) gives a good idea of this for healthy children.
Plot this centile on the adult height predictor to the
right of the height chart to find the average adult height
for children on this centile. Four out of five children will
have adult heights that are within 6cm above or below
this value.
Weight–height to BMI conversion chart
BMI indicates how heavy a child is relative to his or her
height and is the simplest measure of underweight
or overweight from the age of 2, when height can be
measured fairly accurately. This chart3 provides an
approximate BMI centile, accurate to a quarter of a
centile space.
weight in kg
BMI =
BMI = (height in m)2
99.6
e)
bes
98
t (O
igh ht
we
ver erweig
O
y
Ov
Ver
91
75
50
99.6
98
91
75
50
25
9
2
0.4
BMI Centile
Measurement 13
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Who should use this chart?
Weight(kg)
Data Recording (continued)
This information is based on original materials developed by
and copyright © 2009 Royal College of Paediatrics and Child
Health, United Kingdom. It was adapted by the New Zealand
Ministry of Health in July 2010.
Please place sticker if available, otherwise write in space provided.
Weight Centile
Health Professionals’ Notes
25
9
2
0.4
0.4 2 9 255075919899.6
Height Centile
What is a normal rate of weight gain and growth?
Babies do not all grow at the same rate, so a baby’s weight often
does not follow a particular centile line, especially in the first year.
Weight is most likely to track within one centile space (the gap
between two centile lines, see diagram). In infancy, acute illness
can lead to sudden weight loss and a weight centile fall, but on
recovery the child’s weight usually returns to its normal centile
within 2–3 weeks. However, a sustained drop through two or more
weight centile spaces is unusual (fewer than 2 % of infants) and
should be carefully assessed by the primary care team, including
36 measuring
38 40 42 length/height.
44 46 48 50 52
9
10
11
13.5
Because it is difficult to measure
13 length and height accurately
in pre-school children, successive measurements commonly
12.5 are worries about growth, it
show wide variation. If there
99.6th
is useful to measure on a 12
few occasions over time; most
healthy children will show a stable average position over time.
11.5
Head circumference centiles usually track within a range of
98th
one centile space. After the11first few weeks, a drop or rise
through two or more centile spaces is unusual (fewer than
10.5
1 % of infants) and should
be carefully assessed.
91st
10
Why do the length/height
centiles
change at 2 years?
9.5
75th
The growth standards show length data up to 2 years of age, and
9
height from age 2 onwards. When
a child is measured standing
50th
up, the spine is squashed
a little,
8.5 so their height is slightly less
than their length; the centile lines shift down slightly at age 2 to
25th
8
allow for this. It is important that
this difference does not worry
parents; what matters
7.5 the child continues to follow the
9this whether
same centile after the transition.
2nd
0.4th
7
6.5
6
5.5
Date
Age
BMI Centile
Instructions for use
1. Read off the weight and height centiles from the growth chart.
2. Plot the weight centile (left axis) against the height centile
(bottom axis) on the chart above.
3. If between centiles, read across in this position.
4. Read off the corresponding BMI centile from the slanting lines.
5. Record the centile with the date and child’s age in the data box.
Interpretation
In a child over 2 years of age, the BMI centile is a better
indicator of overweight or underweight than the weight
centile; a child whose weight is average for their height
will have a BMI between the 25th and 75th centiles,
whatever their height centile. BMI above the 91st
centile suggests that the child is overweight; a child
above the 98th centile is very overweight (clinically
obese). BMI below the 2nd centile is unusual and may
reflect undernutrition.
References
1.www.who.int/childgrowth/en
2. Cole TJ, Freeman JV, Preece MA. 1998. British 1990 growth reference centiles for weight, height, body mass index and head circumference fitted by maximum penalized likelihood. Stat Med;17:407–29.
3. Cole TJ. 2002. A chart to link child centiles of body mass index, weight and height. Eur J Clin Nutr;56:1194–9.
Preterm
50cm
49
39
Birth
Head Circumference
h
41
99
th
.6
42
st
91
th
50
99.6th
25
th
98th
9th
91st
75th
2n
d
50th
25th
9th
34
36
38
0.4th
40
4
1
12.5
12
11.5
42
Gestational age
(7 weeks preterm)
9th
2nd
Actual age
10.5
0.4th
Gestational correction
Plot actual age then draw a
line back the number of
weeks the infant was preterm
and mark the spot with an
arrow; this is the gestationally
corrected centile.
10
9.5
9
8.5
8
5.5
34
Birth Weight
34
36
38
8
40
42
9
44
46
48
10
50
11
48
99.6th
46
44cm
50th
25th
9th
2nd
25
1.5
1.5
9t
2
d
2n
h
4t
0.
1
1
50th
4
6
32
8
34
10
36
12
38
14
40
4
16
42
w
h
.6t
99
98
78
76
74
25th
72
9th
70
2nd
68
52
13.5
2
24
1
12.5
12
13.5
13
th
99.6
4
6
28
8
2
7
30
10
32
12
3
8
34
14
36
16
4
9
38
91st
18
40
20
5
75th
50th
25th
5.5
42
24
44
6
26
46
28
48
7
30
50
32
25 26 27 28 29
31 32 33 34 35
21/2
head
46
43 44 45 46 47
31/2
●
Measure length until age 2; measure
height after age 2.
A child’s height is usually slightly less
than their length.
he
100cm
96
92
124
116
t
112
h
t
h
ig
9
8
9th
7.5
2nd
7
0.4th
6.5
5.5
4
4.5
3.5
4
3
3.5
2.5
3
2
2.5
1
84
80
76
72
68
10
40
42
44
11
46
48
50
108
25th
5.8
104
9th
100
0.4th
96
99.6th
91st
5.5
170
Location
Health worker name
5.2
4.11
Weight
Length/Height
160
2nd
92
Measurement 2
Head Circumference
25th
5.1
Health worker name
Recording Date
165
50th
5.3
Length/Height
Location
98th
5.6
5.0
Recording Date
Weight
9th
2nd
Birth Measurement
Head Circumference
175
5.4
th
.6
99
th
98
t
s
91
th
75
th
50
th
25
9th
th
g
n
le
h
.6t
99
d
2n
th
0.4
155
0.4th
Measurement 3
Recording Date
Weight
150
88cm Plot child’s
height centile on
the pink lines
30kg above; the black
numbers show
average female
29
adult height for
this centile;
28
80% of children
will be within
±6 cm of this
27
value.
26
25
th
98
23
Head Circumference
Location
Health worker name
Measurement 4
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 5
Recording Date
Weight
Head Circumference
24
Length/Height
23
Health worker name
Location
Measurement 6
st
22
91
22
Recording Date
21
Head Circumference
Weight
21
Length/Height
h
75t
h
50t
t
h
ig
17
16
15
14
h
13
t
9.6
9
8th
12
9
11
91
10
20
we
st
18
17
25th
9th
16
15
14
2nd
6
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 8
Recording Date
Weight
Head Circumference
Length/Height
12
Health worker name
Location
Measurement 9
11
Recording Date
10
Head Circumference
Length/Height
9
h
25t
8
9th
2nd
1.5
Recording Date
13
0.4th
h
8
Measurement 7
Weight
th
75
50t
9
Location
Health worker name
19
18
2
0.5kg
52
5.9
75th
50th
64cm
7
1
9
38
180
Data Recording
Length/Height
88
19
9.5
5.11
5.7
75t
cm
5.10
120
91s
Adult Height
Prediction
ft/in
98th
●
42
40cm
128cm
th
25th
0.4th
1– 5 years
99.6
75th
50th
9th
GIRLS
10.5
6
36
49
4
Age in months/ years
2nd
44
37 38 39 40 41
3
98th
91st
48
11
5
34
50
20
4.5
0.5
8
52
2
99.6th
11.5
8.5
6
22
12.5
10
6.5
Age in weeks/ months
10
11
19 20 21 22 23
11/2
12
98th
7
0.4th
12 13 14 15 16 17
552cm
24kg
14kg
5
6
26
66
58cm
1.5
15
80
60
t
h
g
ei
2nd
2
0
41
62
7.5
2.5
18 0.5kg
20 22
0.4th
64
8
h
9t
d
2n h
4t
0.
3
42
0.4th
8.5
25th
1.5 in weeks/ months
Age
Gestation
in weeks
2
3
1
2
4
44
2nd
9
th
75
th
50
th
25
3.5
45
43
50th
9.5
9th
5
46
40cm
10
75th
Some degree of weight
loss is common after birth.
Calculating the percentage
weight loss is a useful way
to identify babies who
need assessment.
5.5
47
9th
10.5
91st
75th
25th
11
st
0.4th
91st
50th
11.5
98th
4.5
75th
48
13
0.
6
98th
50cm
49
h
t
g
len
31cm
6.5
99.6th
50 52
75th
th
2
2.5
48
11
d
2n
h
4t
0.
7
9
5
7 9 9
th 0th 5th 1st 8th 9.6th
2.5
3
46
98th
8
h
Weight (kg)
3.5
3
44
10
91st
8.5
3.5
4
42
h
32
9
4
4.5
40
9
th
33
9.5
4.5
5
38
99.6
7.5
5.5
36
9t
91
UK-WHO chart 2010 based on DH copyright 2009 reproduced with permission
35
10
6
0.5
0
36
10.5
5
6.5
34
8
11kg
7.5
7
37
66cm
25th
11
32
7
82cm
Plotting preterm infants
64
Use the low birthweight
chart for infants less than 32
62
weeks gestation and any
th
.6
60
other infants requiring
99
h
6detailed
8 assessment.
10 12 14 16 18 20 22 24 26
28 30 32
8t
9
58
Use this
st
2 section for
3 infants 4
5
7
916
of less than 37 weeks
th
56
75
gestation. As with term 99.6th
th
months
50
infants there may be some 98th Age
54 in weeks/
th
weight loss in the early days. 91st
25
From 42 weeks, plot on the 75th
h
52
9t
0–1 year chart with
d
2n
50th
gestational correction.
h
50
4t
13
Weight (kg)
2nd
Gestation in weeks
32
2
99
th
98
st
91
th
75
th
50
th
25
38
26
0
h
th
75
27
30
d
a
e
h
t
.6
39
th
28
28
6
91st
40
0.4
29
26
98th
43
98
t
Head Circumference (cm)
30
24
99.6th
44
36
32
22
5
Age in weeks/ months
45
33
20
0 –1 year
46
35
18
4
47
37
31
16
3
48
38
34
14
GIRLS
7
0.4th
Age in months/ years
6
5kg
5kg
2
3
4
11/2
21/2
31/2
41/2
12 13 14 15 16 17 19 20 21 22 23 25 26 27 28 29 31 32 33 34 35 37 38 39 40 41 43 44 45 46 47 49 50 51 52 53 55 56 57 58 59 60
Location
Health worker name
Measurement 10
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name