2. INTRODUCTION- Growth charts were popularised by David Morley.
Well baby clinics, PHC, and ICDS programmes utilizegrowth charts.
The wt.measurments of a child over a period of time areplotted on
the growth chart and any deviation from thenormal pattern can be
visualised and interpreted. An upward curve in the road to health
is ideal. A flat and downward curves are not desirable. WHO charts
blue for boys and pink for girls 3. AIMS AND RATIONALE Primarily to
identify children with growthdeviation and diseases and conditions
thatmanifest through abnormal growth. Secondarily to discuss health
promotion relatedto feeding, hygiene, immunisation and otheraspects
, education of parents to allay theiranxiety about their childs
growth also tosensitize health care workers to use growthcharts. 4.
USES OF GROWTH CHARTS- Diagnostic tool-To identify high risk
children. Planning and policy making Education tool for educating
mothers Tool for action helps in type of intervention thatis needed
Evaluation- of effectiveness of correctivemeasure and impact of a
programme of specialinterventions for improving Childs growth
anddevelopment Tool for teaching. 5. BACKGROUND The ICMR undertook
a nationwide cross sectionalstudy during 1956-1965 to establish
indian referancecharts. Irrelevant now as they were done on
lowersocio-economic class. The growth charts compiled by Agarwal et
al werebased on affluent urban children from all major zonesof
India measured 1989-1991.the data is now 20years old and irrelevant
now. In 2010-2011 Khadilkar et al have published thegrowth charts
on affluent children 5-18 years andhave also compared the growth of
2-5 years oldindian children with the new WHO growth charts. 6. WHO
GROWTH CHARTS MULTICENTRIC GROWTH REFERENCESTUDY(MGRS)-
Participating countries include Brazil, Ghana, India,Norway, Oman,
and USA. Data collected by trained staff using a commonprotocol
Sample selected from communities where there wereno environmental
constraints to growth. The new growth reference is based on
breastfeedingas the bilogical norm. Measurements include
weight/age, height/age, and 7. BASICS OF GROWTH CHARTS- Consists of
X axis which is usually in years or monthsand y axis that changes
according to the reference e.g.cm, inches, kg, kg/m2. the x axis is
usually devided into 12 equal parts(months) for each year. Standard
growth chart has 7percentile lines and include 3,10,25,50,75, and
97percentiles. The correlation between Z scores and percentiles
canbe confusing and in recent WHO MGRS study theseare tabulated
below for clarity. 8. Z score Exact percentile Rounded percentile0
50 50-115.9 15-22.33-30.111 84.1 852 97.7 973 99.9 99 9. Since
previous table is difficult to interpret it is further simplified
as follows:Z score Height for age Weight for ageBMI for age>3May
be abnormalMay be abnormal obese>2Normal Use BMI
Overweight>1Normal Use BMI Risk of overweight0 normal Use BMI
normal1989 values at allages. ALARMING RISE IN OBESITY- The
overallprevalence overweight and obesity was 18.2% byIOTF
classification and 23.9% by WHO standards. Prevalence of overweight
and obesity in boys>in girls Mean BMI values were significantly
>1989 data. This rising trend of BMI in this multicentric study
ringsalarm bells in terms of associated health 15. REFERENCES-
IAP-RECENT ADVANCES IN PEDIATRICS PARKS TEXTBOOK OF PSM NUTRITION
AND CHILD DEVELOPMENT - ELZABETH
