Growth monitoring: Uncovering important insights into children’s health

Regular measurements of weight and height as part of growth monitoring play an important role in child health surveillance, helping to detect potential health and nutrition problems in infants and children while providing assurance of healthy development.1–3

What is the right method of measuring weight and length/height?

Measurements should be taken carefully as errors can arise due to incorrect calibration, careless reading technique, or diurnal variation of height.1,4,5 The following is a quick guide to proper measurement techniques:


When and how often should growth be assessed?

Although one-time measurements reflect a child’s size and may be used to screen for risk of malnutrition, they do not provide adequate information on a child’s growth rate.2 Serial measurements of weight and height/length should be recorded in accordance with a growth chart (eg World Health Organization [WHO] Child Growth Standards or a country-specific chart) to characterize a child’s growth pattern.2 It is generally recommended that weight should be measured at birth, in the first week, at 8, 12, and 16 weeks, 1 year, and then again between 2 and 2.5 years of age. The length/height of a child may be assessed when there are concerns about his or her growth; it should also be measured when the child is between 2 and 2.5 years old.7–9

What is considered appropriate growth for children?

For most children growing normally, their length/height or weight will consistently track a percentile curve or be parallel to the same percentile curves on the growth chart.1,2 To determine whether a child is thriving appropriately according to his or her genetic potential, the mid-parental height calculation adjusted for gender can be used.10

What could signify concern for a child’s development?

The WHO has developed a set of broad cut-off indicators to screen and classify the growth status of children (Table 1). A growth pattern that demonstrates a sharp incline or decline, or a growth line that stays flat may be indicative of a problem or risk.2,11 The interpretation of growth charts should always be used in combination with an overall clinical assessment of the child.11


What are the indications for using oral nutritional supplementation?

A balanced and varied diet is crucial in supporting healthy development and growth of children.11,13 According to the American Academy of Pediatrics, oral nutritional supplementation may be beneficial in children with growth faltering, extremely selective diets, poor appetite, chronic diseases, or developmental disabilities.14

1. Infant & Toddler Forum. Growth and its measurement: Toddler Factsheet 3.1. Trowbridge; 2014.
2. Canadian Paediatric Society. Paediatr Child Health 2010;15:84–98.
3. Michaelsen KF. World Rev Nutr Diet 2015;113:1–5.
4. Hall DM. Arch Dis Child 2000;82:10–5.
5. Voss LD & Bailey BJ. Arch Dis Child 1997;77:319–22.
6. Puntis JWL. World Rev Nutr Diet 2015;113:6–13.
7. National Institute for Health and Clinical Excellence. Public Health Guidance 11 Maternal and Child Nutrition. London; 2008.
8. Department of Health. Healthy Child Programme: Pregnancy and the first five years of life. London: Department of Health; 2010.
9. Hall D, Elliman D eds. Health for all Children. 4th ed. Oxford: Oxford University Press; 2003.
10. Marchand V et al. Paediatr Child Health 2012;17:447–54.
11. Birth to School Entry Reference Group. Guidelines for growth monitoring: Growth faltering. In: Community Health - Policies Procedures and Guidelines (Manual). Perth: Government of Western Australia, Department of Health; 2014:1–14.
12. Canadian Task Force on Preventive Health Care. CMAJ 2015;187:411–21.
13. Shields B et al. BMJ 2012;345:e5931.
14. American Academy of Pediatrics Committee on Nutrition. Pediatric Nutrition. 7th ed. (Kleinman RE, Greer FR, eds.). Elk Grove Village, IL: American Academy of Pediatrics; 2013.
15. Miceli Sopo S et al. Int Arch Allergy Immunol 2014;164:40–45.
16. Shergill-Bonner R. J Fam Health Care 2010;20:206–209.
17. Vandenplas Y et al. Nutrition 2013;29:184–194.

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