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Infants and toddlers
Plotting and Assessing Infants and Toddlers up to age of 4
Presentation 5
Adapted from training materials of the Royal College of Paediatrics and Child Health [RCPCH]
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Infants and toddlers
When to weigh?
• After the first week and once feeding is established babies usually need to be weighed only when seen for routine health checks, unless there is a concern:– birth, 6-8 weeks, and school entry (including
measuring BMI).– opportunistic times include: immunisations
and surveillance checks
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Infants and toddlers
What is a normal rate of weight gain?
• Weight usually tracks within one centile
• Acute illness weight loss and weight centile fall– A child’s weight usually returns to its normal centile within 2 to 3 weeks.
• Less than 2% of infants will show a sustained drop through two or more weight centile spaces on the new WHO charts– These children should be assessed by the primary care team, including
measuring length/height
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Infants and toddlers
Length measurements commonly show wide variation
Measured length will vary
in same child depending on mood of child
and style of measurer
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Infants and toddlers
Length & Height Changes at 2 years
When a child is measured standing up, the spine is squashed a little so the child may appear shorter.
The UK/WHO charts shift down slightly to account for this when measuring height standing for the first time
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Infants and toddlers
What is a normal rate of growth?
• Measure length or height whenever concerned about weight gain or growth
• Measurements commonly show wide variation– If worried measure on a few occasions
– Healthy children usually show a stable general pattern over time
• What is a normal rate of head growth?– Head circumference usually tracks within one centile space
– Fewer than 1% of infants drop or rise through >2 centile spaces after the first few weeks
Should be carefully expressed
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Infants and toddlers
Adult height prediction
• Plot the most recent height• Find the corresponding centile
on the adult scale
• Four out of he five children will
be within 6cm of this value
when an adult
For example, if a child is on the 75th centile for height, the Adult Height Predictor suggests they may reach an Adult Height of 181cm +/- 6cm
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Infants and toddlers
When should a single measurement trigger assessment?
• There is no single threshold below or above which a child’s weight or height is defiantly abnormal
• Further assess…– All children with measurements below 0.4th centile
– Child with height above 99.6th centile plus other concerns
• If weight is above 99.6th centile after age 2, lookup BMI centile
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Infants and toddlers
Body Mass Index (BMI) lookup
• Read off the weight and
height centiles from the
growth chart.
• Plot the weight centile
(left axis) against the height centile (bottom axis)
• Read off the
corresponding BMI centile
from the slanting lines
• Record centile with date
in the data box
• Accurate to ¼ centile space
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Infants and toddlers
Interpreting Body Mass Index (BMI)
• 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
• BMI above the 98th centile is very overweight (clinically obese)
• BMI below the 2nd centile is unusual and may reflect under-nutrition
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Infants and toddlers
Body Mass Index (BMI)
• BMI indicates how heavy a child is relative to their height
• BMI = weight (kg) ÷ height (m)2
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Infants and toddlers
Summary
• After first 2 weeks, if well, weights required only at time of routine reviews
• Measure length or height and head whenever concerned about weight gain, growth or development
• Any child with measurement consistently <0.4th centile should be assessed in more detail
• Adult height can be predicted from age two using recent height centile using height predictor
• If weight is above 99.6th centile, BMI should be calculated using BMI lookup from 2 years
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Infants and toddlers
© 2010 Royal College of Paediatrics and Child Health www.growthcharts.rcpch.ac.uk
Measuring and plotting: Activity 3 Answers
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Infants and toddlers
© 2010 Royal College of Paediatrics and Child Health www.growthcharts.rcpch.ac.uk
Measuring and plotting: Activity 3 Answers
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Infants and toddlers
© 2010 Royal College of Paediatrics and Child Health www.growthcharts.rcpch.ac.uk
Measuring and plotting: Activity 3 Answers