Advice to Mother Based on Baby's Growth Chart (PSM)

Understanding the Zones on the Chart

In Maharashtra-type charts with Gomez grading, 4 grades of malnutrition are shown (Grade I to IV based on % of expected weight-for-age).

Key Principle: Direction of Growth is More Important Than Position

• Rising curve - weight gaining normally
• Flat curve - weight not increasing (growth faltering)
• Falling curve - weight loss - serious danger

Advice Based on Growth Chart Findings

1. Child in the Normal Zone (curve rising steadily)

• Reassure the mother - the child is growing well
• Continue exclusive breastfeeding for the first 6 months
• Introduce complementary/supplementary foods at 6 months
• Maintain immunization schedule
• Continue bringing the child for monthly weighing at the AWC
• Practice good hygiene to prevent diarrhoea and infections

2. Child in Normal Zone but Curve is Flat (no weight gain)

• Early warning - even though the child is still in normal zone, a flat curve means growth faltering
• Enquire about: recent illness (diarrhoea, fever), adequacy of feeding, food quality
• Counsel on adequate feeding - frequency, quantity, quality
• Emphasize the deleterious effects of diarrhoea on growth
• Advise ORS if diarrhoea occurs
• Follow up more closely at next visit

3. Child in Underweight Zone (below -2 SD) - Curve Rising

• Child has moderate malnutrition but is improving
• Provide supplementary nutrition through ICDS (take-home ration / hot cooked meals)
• Detailed dietary counselling - energy-dense foods, increased feeding frequency
• Check for and treat infections/worm infestations
• Ensure complete immunization
• Motivate mother for regular follow-up

4. Child in Underweight Zone - Curve Flat or Falling

• High-risk child - needs priority attention
• Refer to the AWW/ANM immediately (as shown on the chart: "Talk to the AWW/ANM immediately")
• Investigate for underlying illness (infections, TB, worm infestation)
• Provide supplementary feeding
• Counsel on correct feeding practices
• Refer to medical facility if needed

5. Child in Severely Underweight Zone (below -3 SD) - "Very Dangerous" Zone

• This is a medical emergency
• Refer immediately to AWW/ANM and then to hospital/nutrition rehabilitation centre
• Manage complications (hypoglycaemia, hypothermia, infections)
• Intensive nutrition rehabilitation
• Therapeutic feeding
• The chart itself says "Talk to the AWW/ANM immediately"

General Advice to Give to ALL Mothers at Every Visit

1. Bring the child every month for weighing at the Anganwadi Centre (AWC)
2. Breastfeed exclusively for 6 months; continue breastfeeding up to 2 years
3. Start complementary feeding at 6 months - mashed family foods, increasing consistency with age
4. Ensure all vaccines are given on schedule
5. Wash hands before feeding the child and after defecation - prevent diarrhoea
6. Give ORS during diarrhoea - do not stop feeding during illness
7. Bring the child to health centre during illness without delay
8. Vitamin A supplementation as per schedule
9. Deworm the child as recommended
10. Ensure the child sleeps under a mosquito net in malaria-endemic areas

Uses of Growth Chart (for awareness)

1. Tool for growth monitoring
2. Diagnostic tool - identifies high-risk children (malnutrition detected before symptoms appear)
3. Planning and policy tool - helps grade malnutrition for health planning
4. Educational tool - mother can be educated visually about her child's care
5. Tool for action - guides health worker on intervention needed
6. Teaching tool - demonstrates importance of adequate feeding and the harm of diarrhoea

The growth chart has been described as a "passport to child health care" - Park's Textbook of Preventive and Social Medicine, p. 637-638