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)

• 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

Download the PDF version: here