Boys Growth Chart (0

July 2010 Code HP5141

Boys 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……………………………………………………………… When to measure

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

Plot measurements at the child’s actual age and then draw a line back the number of weeks the infant was preterm. Mark the spot with an arrow: this is the child’s Head circumference: use a narrow correction 2 4 6 gestationally 8 10 12 corrected 14 16 18 centile. 20 22 Gestational 24 26 28 30 32 34 plastic or paper tape to measure0 where should until4 one year born7 32 to 368 1 2 continue 3 5 for infants 6 the head circumference is greatest. weeks and two years for infants born before 32 weeks. 13 Any hat or bonnet should be removed. Be aware of cultural issues around touching heads.

When to weigh

12.5 12 11.5 11 10.5

Babies should be weighed in the first week as part of the assessment of feeding. Recovery of birthweight 10 usually occurs by 10 to 14 days, and indicates that feeding is 9.5 effective and that the child is well. Once feeding is 9 at the established, babies should usually be weighed 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 be 8routinely weighed more frequently than at each Well 7.5 Child/ Tamariki Ora check. 7

6.5 6 5.5

Centile terminology

Age in weeks/ months

If the point is closer than ¼ of a centile 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

Plotting for preterm infants (less than 37 weeks gestation): Draw a line back the number of weeks preterm and mark spot with arrow.

Interpreting the chart

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: 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 25 50 75 91 98 99.6

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 13.5 9

10

11

13 length and height accurately in Because it is difficult to measure pre-school children, successive measurements commonly show 12.5 99.6thare worries about growth, it is useful to wide variation. If there 12 measure on a few occasions over time; most healthy children will show a stable average position 11.5over time. Head circumference 98th centiles usually track within a range of one centile space. After 11 the first few weeks a drop or rise through two or more centile 10.51% of infants) and should be spaces is unusual (fewer than carefully assessed. 91st 10 9.5 75th Why do the length/height centiles change at 2 years?

The growth standards show length data up to 2 years of age, and 9 50th height from age 2 onwards. When a child is measured standing 8.5 up, the spine is squashed a little, so their height is slightly less 25th than their length; the centile lines shift down slightly at age 2 to 8 allow for this. It is important that this difference does not worry 7.5 9th parents; what matters is whether the child continues to follow the 7 same centile after the transition. 2nd 0.4th

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

40

Birth Head Circumference

36 h .6 t 99 th 98

91

st

40

25

75

91st

37

75th

36

50th

35

9t

th

38

34

9th

33

2n

25th

2nd

26

Gestation in weeks

32

2

34

36

38

4 1

12.5 12 11.5

42

2nd

Actual age

10.5

0.4th

9.5 9 8.5 8

5.5

34

Birth Weight

8

2

1.5

1.5

4

98th 91st 75th 50th 25th 9th 2nd 0.4th

d 2n h 4t 0.

Gestation in weeks 2 3

32

34

10 36

12

38

14

40

48

10

50

11

4

16

42

25th

45 44

0.4th

25th

91st

78

50th

25th

2nd

70 68

64 62

52 13.5

58cm

46

25 26 27 28 29

31 32 33 34 35 21/2

d h ea

44

9

98th

11.5 91st

75th

8.5

50th

8

25th

0.4th

.6t 99

9.5 9

7.5 7 6.5 6

98

th

10

8

2nd

6.5

10.5

8.5

9th

7

11

3.5

2.5

3

2

2.5

91

4

8

10

12

3

8

34

14

36

16

4

9

38

18

Age in weeks/ months 10 11

40

20

5

42

22

24

44

6

26

46

28

48

7

30

50

32

98th

25th 9th

●

2nd 0.4th

●

Measure length until age 2; measure height after age 2. A child’s height is usually slightly less than their length.

34

50th

84 80 76 72

112

h .6t 99 th 98 st 91 th 75 th 0 5 th 25 9th d 2n th 0.4

2 1.5 1 9

36

38

10

40

42

44

11

46

48

50

0.5kg 52

Recording Date ft/in

cm

6.5

195

6.4 6.2

25th

5.10 5.9

104

9th

100

0.4th

190 98th

91st

75th

180

50th

25th

5.6

9th

175

5.4 5.3

0.4th

th

.6

99

68

26 25

64cm th

98

23

Length/Height Location Health worker name

Measurement 2 Recording Date Weight Head Circumference Location Health worker name

165

Measurement 3 Recording Date

160

Plot child’s height centile on 88cm the blue lines above; the black 30kg numbers show average male adult height for 29 this centile; 80% of children will be within 28 ±6 cm of this value. 27

h gt n le

Weight Head Circumference

Length/Height 170

2nd

5.5

96

185

5.8 5.7

2nd

99.6th

6.0 5.11

108

Data Recording Birth Measurement

6.3

92

88

Adult Height Prediction

6.1

75th

t h g hei

120 116

t

91s

92

Weight Head Circumference Length/Height 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

Recording Date

21

Head Circumference

91

Weight Length/Height

20

h

75t

19

17 16 15 14

w

th

.6

99

13

th

98

12 11 10

20

t h eig

18 17

25th

16 9th

15

2nd

14

0.4th

st

91

8

Weight Head Circumference Length/Height Location Health worker name

Measurement 8 Recording Date Weight Head Circumference Length/Height

12

Health worker name

Location

11

Recording Date

10

Head Circumference

Weight

h 50t 25t

Length/Height

9

9th

2nd

8

0.4th

7

7

6

12 13 14 15 16 17

Recording Date

Measurement 9

th

75

5kg

Measurement 7

13

h

9

Location Health worker name

19 50th

18

5.5

1 0.5 8 52

124

12

3

32

1– 5 years

th

96

21

3.5

7

128cm

99.6

100cm

12.5

4.5

30

BOYS

75th 50th

40cm

22

4

2

49 4

Age in months/ years

42

13

5

28

43 44 45 46 47 31/2

13.5 9.6th

6

6

37 38 39 40 41 3

98th 91st

50 48

2

99.6th

24kg 14kg

5.5

6

19 20 21 22 23 11/2

60

4.5

26

12 13 14 15 16 17 552cm

66

5

1

4

74 72

1.5

2

76

9th 0.4th

7.5

2

24

82 80

75th

t h g i e w 50th

2.5

15

42

98th

9.5

75

3

43

41

10

th 25 h 9t d 2n h 4t 0.

4

0

46

2nd

10.5

0.4th

3.5

18 0.5kg 20 22

47

11

2nd

4.5

48

75th

12

9th

5

49

50th

9th

9

1.5 in weeks/ months Age

8

46

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

6

9

44

91st

6

1

2

42

98th

6.5

52 50cm

99.6th

11.5

7

99.6th

50

12.5

8

1

1

40

99.6th

h

2

2.5

48 11

st

2.5

3

46

th

3.5

3

44 10

th

Weight (kg)

4

42

13

8.5

3.5

4.5

38

46

9

4

5

36

48

9.5

9t 25 50 75 91 98 99. th th th st th h 6th

UK-WHO chart 2010 based on DH copyright 2009 reproduced with permission

31cm

10

4.5

5.5

40 9

h t g n le

7.5

6

0.5 0

h 9t d 2n h 4t 0.

32

10.5

5

6.5

38

9

11kg

7.5 7

36

8

84cm

44cm

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

34

9.6th

66cm

9th

Gestational age (7 weeks preterm)

11

32

7

40cm

Plotting preterm infants 64 Use the low birthweight chart for infants less than 32 62 th weeks gestation and any .6 99 60 other infants requiring h 8t 6detailed 8 assessment. 10 12 14 16 18 20 22 24 926 28 30 32 st 58 91 Use this 2 section for 3 infants 499.6th 5 6th 7 75 of less than 37 weeks 98th 56 th gestation. As with term 50 th months infants there may be some 91st Age 5 54 in weeks/ 2 weight loss in the early days. 75th h 9t From 42 weeks, plot on the 52 d 2n 0–1 year chart with 50th th .4 gestational correction. 0 50 25th

13

Weight (kg)

0.4th

40

30

50

0

39

98th

h

50 th

th

99.6th

d

27

th .6 99 th 98 st 91 th 75 th 50 th 25

41

th

28

28

6

d a e h

42

0.4

Head Circumference (cm)

29

26

91st

43

30

24

98th

44

31

22 5

Age in weeks/ months

45

32

20

0 –1 year

46

37

33

18 4

47

38

34

16

3

48

39

35

14

BOYS

6

Age in months/ years 11/2

21/2

2 19 20 21 22 23

25 26 27 28 29

31/2

3 31 32 33 34 35

37 38 39 40 41

41/2

4 43 44 45 46 47

49 50 51 52 53

5kg 55 56 57 58 59 60

Location Health worker name

Measurement 10 Recording Date Weight Head Circumference Length/Height Location Health worker name