Growth monitoring consists of routine measurements to detect abnormal growth, combined with some action when this is detected. As primary care workers worldwide invest time in this activity, we sought evidence of its benefits and harms. The review objectives are to evaluate the effects of routine growth monitoring on: 1. The child, in relation to preventing death, illness or malnutrition; and referrals for medical care, medical specialist assessment or professional social support follow-up. 2. The mother, in relation to nutritional knowledge, anxiety or reassurance about the child's health, and satisfaction with services.
Growth is the increase in body size over a period of time. In order to assess growth, some measure of body size has to be accurately measured on two or more occasions.
Growth is best assessed by determining the child’s:
Body size compared to that of other children of the same age
Growth curve
Growth pattern
The following 5 measurements of body size are commonly used in children:
Weight: This is the most commonly used measure of body size as it is easy and accurate to weigh a child.
Height or length: This is a very useful measure of body size, especially in older children. However, it is more difficult than weight to measure accurately. Height is measured with the child standing. In infants the measurement is taken lying down and is then called length. A child’s length and height are the same.
Weight-for-height or weight-for-length: No need for the child’s age in young children.
Head circumference: This is a useful measure of boy size but must be measured correctly.
Mid-upper arm circumference (MUAC): This is a quick and simple method that can be used in the home or clinic. However it is more useful as a screen for malnutrition than as a measure of growth.
Young children are weighed when lying on a scale. Wait until the child lies still before recording the weight to the nearest 10 g. Always weigh the child undressed or wearing only a vest. It is best to remove the nappy before weighing. Always remove a wet nappy.
Older children are weighed standing up. Record the weight to the nearest 100 g (0.1 kg). Remove all the child’s clothes, except the underpants, before weighing.
Before weighing a child, always check that the scale reads zero. Scales should be calibrated weekly.
Height must be measured with the child standing barefoot. Keep both heels on the floor with the child’s back pressed against a wall. The child should stretch as tall as possible with the arms kept at the side while looking straight ahead. Ideally, a special measuring device should be used, with a fixed tape or ruler on the wall and a sliding head board. Otherwise move a square block of wood or a book down against the wall until it touches the top of the child’s head. Then measure the distance from the floor to the block of wood, to the nearest 1 mm, to get the correct height.
Under 2 years: It is difficult to measure an infant’s standing height. Therefore, the lying length is often measured. If possible, a measuring board should be used. The infant is laid down on their back with legs fully extended. One person holds the infant’s head against the top board while another person gently stretches the infant’s legs, keeping the knees flat and pressing the heels of the infant’s feet against the bottom board. Measuring the distance, to the nearest 1 mm, between the boards gives the length of the infant. It is inaccurate to simply measure length with a tape measure.
Growth monitoring is the regular measurement of a child’s size (weight, height or length and head circumference) in order to document growth. The child’s size measurements must then be plotted on a growth chart. This is extremely important as it can detect early changes in a child’s growth. Both growing too slowly or too fast may indicate a nutritional or other health problem. Therefore, growth monitoring is an essential part of primary health care in children. Measuring a child’s size is of very little value unless it is used for growth monitoring.
Weight-for-age is usually used to monitor growth. It is particularly useful in small infants who normally gain weight fast. Normal weight gain suggests that the infant is healthy and growing normally. Failure to gain weight normally or losing weight is often the earliest sign of illness or malnutrition. Therefore, a child’s weight should be measured at a clinic visit in order to monitor growth.
These are also important measurements of growth. Height or length is the best method of measuring linear growth (stature) as it reflects growth over a longer period than does weight. Measuring height is therefore particularly important in older children.
Head circumference can be used to assess brain growth in children under 36 months of age. During this period brain growth is fast and, therefore, head circumference increases rapidly. A small head (microcephaly) suggests a small brain, while a large head suggests hydrocephaly. Head circumference is less accurate in assessing brain growth over 36 months as there is little increase in head circumference in older children.
Therefore, measuring head circumference is most useful in young children, and height in older children.
If a child’s weight gain is normal, the height and head circumference is usually also normal. However, it is particularly important to measure height and head circumference in children who are not gaining weight normally.
