Uses of Growth Chart

A growth chart (also called the "road-to-health" chart) was first designed by David Morley and later modified by the WHO. It is a visible display of a child's physical growth and development, designed primarily for the longitudinal follow-up of a child so that changes over time can be interpreted.

"The growth chart has been described as a passport to child health care... it is now a standard method of monitoring children's health and nutritional status."

Park's Textbook of Preventive and Social Medicine, p. 637-638

The 7 Uses of a Growth Chart

1. Growth Monitoring

The most fundamental use - it is of great value in child health care. By plotting serial weights against age, a health worker can track whether a child is following a normal trajectory or deviating from it over time. Weight is the most sensitive measure of growth; any deviation from normal can be detected easily by comparison with reference curves.

2. Diagnostic Tool

The growth chart helps identify "high-risk" children. Malnutrition (and other growth disorders) can be detected long before clinical signs and symptoms become apparent. This makes it a powerful early-warning instrument.

3. Planning and Policy Making

By grading malnutrition objectively, the chart provides an evidence base for planning and policy at both local and central levels of child health care. Programme planners can identify areas or populations with high burdens of undernutrition.

4. Educational Tool

Because of its visual character, the mother can be educated about the care of her own child and encouraged to participate more actively in growth monitoring. The chart makes trends immediately visible even to non-literate caregivers.

5. Tool for Action

It guides the health worker on the type of intervention that is needed. It helps make referrals easier - for example, a child falling below -2SD requires dietary counselling, while one below -3SD may need referral to a facility.

6. Evaluation

It provides a method to evaluate the effectiveness of corrective measures and the impact of health programmes or special interventions aimed at improving child growth and development.

7. Tool for Teaching

It can be used for teaching purposes - for example, demonstrating the importance of adequate feeding or showing the deleterious effects of diarrhoea on growth.

The Growth Chart as Used in India

India adopted the WHO Child Growth Standards 2006 in February 2009 for use within the National Rural Health Mission (NRHM) and ICDS. These standards are available for both boys and girls below 5 years of age and show:

Normal zone of weight for age
Undernutrition zone: below -2SD
Severely underweight zone: below -3SD

A joint "Mother and Child Protection Card" was developed, combining the growth chart with space for immunization records, breastfeeding data, developmental milestones, and birth records. It is kept by the mother and brought to the health centre at each visit.

WHO vs. NCHS Growth Standards

The chart below shows a comparison of WHO (2006) and NCHS weight-for-age Z-score curves for girls (birth to 60 months). The WHO standards, based on the Multicentre Growth Reference Study (MGRS) conducted in Brazil, Ghana, India, Norway, Oman, and the USA, better represent the growth of healthy, breastfed children from diverse ethnic backgrounds:

Fig. 6 - Comparison of WHO with NCHS weight-for-age Z-scores for girls (Park's Textbook of PSM)

Alternative Growth Monitoring Indicators

Growth charting (weight-for-age) is only one method. Other indicators include:

Height-for-age (detects stunting)
Weight-for-height (detects wasting)
Arm circumference (MUAC) - the last two are independent of age and are especially useful when the child's exact age is unknown

Source: Park's Textbook of Preventive and Social Medicine, pp. 636-638

Give me as points

Uses of Growth Chart

(Park's Textbook of Preventive and Social Medicine)

1. Growth Monitoring

Tracks the child's weight over time longitudinally
Detects deviations from the normal growth trajectory early
Weight is the most sensitive measure of growth

2. Diagnostic Tool

Identifies "high-risk" children
Detects malnutrition long before clinical signs and symptoms appear
Helps classify severity using Z-score zones (-2SD, -3SD)

3. Planning and Policy Making

Grades malnutrition objectively
Provides evidence base for planning at local and central levels
Helps allocate health and nutrition resources appropriately

4. Educational Tool

Visual nature makes it easy for mothers to understand
Educates mothers about their child's nutritional needs
Encourages active participation in growth monitoring visits

5. Tool for Action

Guides health workers on the type of intervention needed
Facilitates referrals - children below -2SD need counselling; below -3SD need facility referral
Prompts timely corrective action

6. Evaluation

Measures effectiveness of corrective measures
Assesses impact of nutrition programmes and special interventions
Provides objective evidence of improvement or deterioration

7. Tool for Teaching

Used to teach importance of adequate feeding
Demonstrates deleterious effects of diarrhoea on growth
Useful in training health workers and community volunteers

The growth chart has been described as a "passport to child health care" and is now a standard method of monitoring children's health and nutritional status.

This is a shared conversation. Sign in to Orris to start your own chat.