Growth Chart Approach

  • WIPE, blah blah
  • Mention you should take Hx and perform PE
  • Mention taking vital signs
  • Ask the child to remove their shoes and empty their pockets, if infants remove all clothes

 

  • Head circumference:
    • From the occipital protuberance to the area most prominent above the eyebrows
    • Measure it 3 times and take the average
  • Height and weight
    • Infant:
      • Length:
        • Lay the infant down on infantometer
        • Head facing upwards, knees completely extended, feet 90° angle
        • Head + feet -> touch the ends of the board
      • Weight: put the baby on the baby scale
    • Child:
      • Height: (if < 2 yrs -> measure the length)
        • Stand upright facing forward
        • Head, shoulder blades, buttocks, heels -> should touch the back side of the stadiometer
      • Weight: zero the scale before the child stands on it

 

  • Calculate BMI = Wt (kg) \ Ht² (m²)
Classification BMI (> 2yrs) Percentiles (< 2yrs)
Underweight < 18 < 5th
Normal 18 – 25 5th – 85th
Overweight 25 – 30 85th – 95th
Obese > 30 > 95th

 

  • What is failure to thrive?
    • Wight falls or remains below the 3rd percentile for age and sex
    • Weight falling and crossing over 2 or more percentiles
    • Weight < 80% of the median weight for height
  • What causes failure to thrive?
    • Organic:
      • Inadequate intake -> cleft lip\palate, neuromuscular, cerebral palsy, GERD
      • Malabsorption -> celiac, CF
      • Impaired metabolism -> chromosomal, enzymatic
      • Increased requirements -> heart failure, chronic lung ds, chronic infections
    • Non-organic: (>80%)
      • Abuse \ negligent
      • Poverty
      • Poor infant bonding
      • Improper formula preparation, breast-feeding technique
  • If the child’s growth is normal, what will you do?
    • Reassure parents + advise them the F\U after 6 months – 1 year

 

growth

 


Download the PDF version: here

 

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