Author: Gauri Kshirsagar

Growth charts are an important tool for monitoring the growth of children. Growth Monitoring is a screening tool to diagnose nutritional, chronic, systemic and endocrine disease at an early stage. Record of measurements is usually taken during your routine child visits to your pediatrician for vaccination or during sickness. Since the visit to your doctor may be sometimes hurried, it is better that you, yourself have a better understanding of the growth and development of your baby by plotting your own graphs.

Which growth charts are available in India?

While the health of children below five years is now closely monitored in the country at every clinic visit, it is also important to keep track of the growth of a child between the ages 5 and 18. Pediatricians rely on a growth chart to monitor the health of children.

There are 3 different types of charts available, separately for girls and boys, which you can download here:

1. Weight, Height and head circumference charts for 0-5 years of age:
   1. Boys: WHO Boys Height, Weight and Head charts 0-5 years
   2. Girls:WHO Girls Height, Weight and Head charts 0-5 years
2. Weight and Height for 5-18 years
   1. Boys: IAP boys Height and Weight Charts 5-18 years
   2. Girls: IAP Girls Height and Weight 5-18 years
3. Body Mass Index chart for 5-18 years
   1. Boys: IAP Boys Body Mass Index Charts 5-18 years
   2. Girls: IAP Girls Body Mass Index Charts 5 – 18 years

What are PERCENTILES on a growth chart and how do I compare them with my child’s?

Percentiles are measurements that show where a child is compared with others. On the growth charts, the percentiles are shown as lines drawn in curved patterns. As per the figure below, each normal measurement like weight, height and head circumference is given in a range of 97^th  percentile (Green line) and 3^rd percentile (Red line), with 50^th  percentile (Blue line) at the centre. Hence the measurements of you baby should be between this range on the graph. 

What does PERCENTILE reading mean on the graph?

It’s easier to explain this by an example. If your 12-month-old daughter is in the 40th percentile for height, that means 40 percent of 12-month-old girls weigh the same as or less than your baby, and 60 percent weigh more. The higher the percentile number, the bigger your baby is compared to other babies his same age. If your baby is in the 50th percentile for length, that means she falls right in the middle and is average length for baby girls his age.

Is it OK for my baby to have a less PERCENTILE reading?

Percentile ratings in a growth chart aren’t like grades in school. A lower percentile rating doesn’t mean there is anything wrong with your baby. Let’s say both parents are shorter than average, and their baby grows up to have the same stature. It would be perfectly normal for that child to consistently rank in the 10th percentile for height and weight as she grows up. If your baby is below the 50th percentile in weight, you may be tempted to try to feed her more. Don’t, even babies below the “normal” range will be fine as long as their growth remains steady. Babies tend to go through rapid growth spurts, during which they might put on a little extra weight or length.

When should I worry about the PERCENTILE readings?

It’s a concern if your baby’s percentile changes significantly. Any dramatic change (a drop from the 50th percentile to the fifth, for instance) is a red flag, and your doctor will want to keep closer tabs on your child. There could be a medical reason for the change that needs further evaluation.

Of course, a minor illness or a change in your baby’s eating patterns might result in a smaller drop, in which case the doctor may just follow your baby’s growth more closely for a while.

If your baby hasn’t been sick but his weight gain is slowing down while he’s still growing in length, your child’s doctor may suggest increasing the number of feedings. You may have to go in for more frequent visits to make sure that your baby starts gaining weight again.

How to plot a Growth Chart?

The most important chart is the WHO growth chart for the age 0-60 months i.e 0 to 5 years of age. Charts for boys and girls are different and hence choose accordingly. Pink chart is for baby girl and the blue chart is for baby boy. These charts are usually explained to the parents. Do keep it properly and take it at each doctor’s visit. The growth chart should be kept with the parents in a plastic sleeve.

CHART 1 : Weight, Height and Head Circumference chart for 0-5 years of age

1. At the first visit the child’s name, date of birth and other details should be entered on the growth chart. 
2. There are different charts for boys and girls
3. There are three sections on the growth chart, which I will discuss one by one:
   1. Weight
   2. Head circumference
   3. Height/length

WEIGHT

When you visit the doctor, the weight of the baby is usually measured by a pediatric scale or an hanging scale. Another method by which you can use to measure your baby’s weight is to use a simple bathroom digital scale.To figure out your baby’s weight using a bathroom scale, first weigh yourself and jot down your weight. Then, climb onto the scale while holding your baby. Subtract your weight from this second number to get your baby’s weight.

HEIGHT/LENGTH

Your baby’s length can be measured in a variety of ways. The simplest way to this at home is to use a simple tape measure. To do this, you will first lay your baby on her back. Position her head against a wall or other flat surface. Then, you will need to hold your baby’s knees together and press on them gently so her legs stick straight out. You can then use the tape measure to calculate the distance from the wall down to the baby’s heels. This is often easiest to do when one person holds the baby and another holds the tape measure. Use inches or centimeters, whichever you prefer, to record your baby’s length.

HEAD CIRCUMFERENCE

Measuring your baby’s head can be somewhat tricky. The best method is to use a fabric measuring tape. Place this measuring tape around the largest part of your baby’s head. This should be just above the eyebrows and ears, and will go around the entire head. This measurement is known as the occipital-frontal circumference, or OFC, and is generally taken in centimeters. This is to measure till the age of 5 years

CHART 2: Weight and Height chart for 4-18 years

1. At the first visit the child’s name, date of birth and other details should be entered on the growth chart.
2. There are three sections on the growth chart, which I will discuss one by one:
   1. Weight
   2. Height

WEIGHT

A simple bathroom scale is sufficient to measure weight

HEIGHT

For Growth Chart 5-18 years: Most commonly used but a crude method to assess the genetic potential of height is to calculate the mid-parental height (Target height). The mid parental height is a child’s expected adult height based on the heights of the parents. It is calculated by the formula:

1. Boy’s height in cms = (Father’s height + Mother’s height) / 2 + 6.5 cms
2. Girl’s height in cms = (Father’s height + Mother’s height) / 2 – 6.5 cms
3. Calculate the child’s target height and plot it at 18 years and mark it with an arrow on the growth chart.

CHART 3: Body Mass Index

It is calculated as: Body Mass Index: BMI = weight/height²

BMI, or body mass index, is a calculation that uses height and weight to estimate how much body fat a person has. Childhood obesity is on the rise and in response many doctors  are adding BMI to the routine  health screening.

When are parameters are to be plotted on the graph?

1. Birth to 3 years:
   1. During Immunization visits at birth, 6, 10 and 14 weeks, 9 months, 15-18 months may be conveniently used for growth monitoring.
   2. An additional monitoring visit at 6 months with opportunistic monitoring at other contacts (illness) is recommended.
   3. Normally growing babies should not be weighed more than once per fortnight under 6 months and no more than monthly thereafter, as this increases anxiety.
   4. After 18 months measurements are to be taken every 6 monthly.
   5. It is recommended that the height, weight and head circumference be measured upto 3 years of age.
2. 4 to 8 years: It is recommended that height and weight be measured 6 monthly during this period and BMI should be assessed yearly from 6 years of age.
3. 9- 18 years: It is recommended that height, weight, and BMI be assessed yearly during this period.

Here are some tips to help kids maintain a healthy weight:

• Encourage kids to be active every day. Experts recommend that kids get 60 minutes or more of physical activity daily.
• Offer fruits and vegetables at meals and snacks and encourage your child to eat five or more servings a day.
• Serve appropriate portion sizes.
• Limit sugar-sweetened beverages and offer low-fat milk or waterinstead.
• Limit screen time (time spent watching TV, playing video games, using a smartphone, computer, or other device) to less than 2 hours a day.
• Set a good example by eating healthy, being physically active, and limiting the time you spend in front of a screen

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