11/13/24, 7\:33 PM Guide | Paediatric growth chart interpretation

Paediatric growth chart interpretation

Table of contents

Introduction

Growth charts are an important tool used to compare the growth of an individual to the growth of a normal population (the
reference population). Thus, they may be used to de
The current UK-WHO growth charts combine World Health Organisation standards with UK preterm and birth data to depict a
healthy pattern of growth that is desirable for all children, whether breastfed or formula-fed and of whatever ethnic origin.
The growth chart used to plot the measurements of weight, height/length and head circumference should correspond to the
child’s sex and age. See the paediatric growth assessment guide for instructions on taking these measurements.

RCPCH Growth Charts

Copies of the NHS and RCPCH approved growth charts are available online\:

0-4 years

Girls
Boys

2-18 years

Girls
Boys

Neonatal and infant close monitoring (NICM)

Girls
Boys

Plotting

0-4 years

For babies born at term (>/= 37 weeks), plot each measurement on the relevant chart by drawing a small dot where a vertical
line through the child’s age crosses a horizontal line through the measured value - height/length, weight or head
circumference (see Fig. 1 below).
Plot birth weight/length/head circumference at age 0.

For pre-term infants

If \<32 weeks gestation – the NICM chart should be used.
If >32 weeks and before 37 weeks, plot all measurements in the preterm section until 42 weeks gestation. Then plot on the 0-
1-year chart using gestational correction as shown in Fig. 2 (below).
Gestational correction\: plot measurements at the child’s actual age, then draw a line back the number of weeks the infant was
preterm. Mark the spot with an arrow\: this is child’s gestationally corrected centile. This should continue until at least 1 year of
age.
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2-18 years

Plot each measurement on the relevant chart by drawing a small dot where a vertical line through the child’s age crosses a
horizontal line through the measured value - height or weight (see Fig. 1 below).
Figure 1. Plotting example

Centile terminology

Below is a summary of some of the key points you should understand when it comes to centiles, with an included chart that
illustrates each of the points\:
1. If the point is within 1/4 of a space of the line, they are on the centile (i.e. 91st).
2. If not, they should be described as being between the two centiles (i.e. 75th-91st).
3. A centile space may be considered the equivalent distance if midway between centiles.
4. A centile space may also be considered the distance between two of the centile lines.
5. Plotting for PRE-TERM INFANTS\: Draw a line back the number of weeks preterm and mark with an arrow (Dot = actual age /
Arrow = gestational age).
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Figure 2. Centile terminology (the key is above)

Percentiles

Growth charts indicate\:
A child’s size compared with children of the same age and maturity who have shown optimal growth.
How quickly a child is growing.
Centile lines show the expected range of weights and heights (or lengths). They describe the number of children expected to
be BELOW that line (i.e. 50% below the 50 th st
, 91% below the 91 )\:
99 out of 100 children who are growing optimally will be between the two outer lines (0.4 th th
– 99.6 Half will lie between the 25 th th
and 75 centile lines.
centiles).
Babies do not all grow at the same rate – so a baby’s weight often does not follow a particular centile line. Most likely, the
weight will track within one centile space (Fig. 1). Acute illness can lead to sudden weight loss and a weight centile fall, but
children generally recover to their normal centile within 2-3 weeks.
A sustained drop through two or more weight centiles is unusual and should be investigated.
Healthy children generally show a stable average height/length position over time.
After 6 weeks of age, a head circumference below the 2 nd
centile will be seen in only 1 in 250 children and should be
investigated. Furthermore, a head circumference above the 99.6 th
centile, or crossing upwards through 2 centile spaces
should only be cause for concern if there is continued rise after 6 months, or other signs and symptoms (i.e. irritability, vomiting,
full or bulging fontanelle, persistent downwards gaze).
Between 2-18 years - Further assessment is required with any of the following\:
Weight or height or BMI is below the 0.4 th
centile (unless already fully investigated at an earlier age).
The height centile is more than 3 centile spaces below the mid-parental centile (see below).
A drop in the height centile position of more than 2 centile spaces.
Any other concerns about the child’s growth.

Other charts

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Mid-parental centile

The mid-parental centile is the average adult height centile to be expected for all children of these particular parents.
The scale is located on the right-hand side of the chart (Fig. 3).
Calculating the mid-parental centile
If possible, measure both the parent’s heights. If not available, use reported heights.
Mark their heights on the relevant Mother and Father scales.
Join the two points with a line between them. The mid parental centile is where this line crosses the centile line in the
middle.
Interpreting the mid-parental centile
Compare the mid-parental centile to the child’s current height centile (this may help assess whether the child’s growth is
proceeding as expected).
If a large discrepancy exists between the mid-parental centile to the child’s current height centile, the more likely it is that the
child has some sort of growth disorder.
9 out of 10 children’s height centiles are within +/- 2 centile spaces of the mid-parental centile.
Figure 3. Mid-parental centile chart example

Adult height predictor chart

The adult height predictor chart (Fig. 4) allows for a prediction of the child’s adult height based on their current height
(adjusted to allow for very tall and short children to be less extreme as adults).
Predicting a child's adult height
Plot the most recent height centile on the centre line and read o
80% of children will be within +/- 6cm of this value as adults.
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Figure 4. Adult height predictor chart example

Pubertal assessment

The 2-18 years growth chart contains puberty lines from age 8 to 18 years old for girls and 9 to 18 years old for boys.
These lines indicate the normal age limits for the phases of puberty.

Girls

Pre-puberty
T a n n e r s t a g e 1
No signs of pubertal
development.
In puberty
T a n n e r s t a g e 2 & 3
Any breast enlargement, pubic or armpit
hair.
Completing puberty
T a n n e r s t a g e 4 & 5
Started periods with signs of pubertal
development.
Interpretation
Puberty before 8 years old in girls is likely to be precocious and further investigation is necessary.
If a patient is between 8-13 years old and is plotting within the shaded area of the chart for their height centile, pubertal
assessment is required, and mid-parental centile should be assessed.
If they are "In puberty
" or "Completing puberty
"
– they are BELOW the 0.4 th
centile and should be referred for further
investigation.
If "Pre-pubertal"
, they are generally growing normally but should be compared to their mid-parental centile.
If there are no signs of puberty by 13 years of age, then puberty is delayed and further assessment is indicated.
If the patient is older than 16 years old and not in the "completing puberty stage"
, maturation is delayed, and further
investigation is required.

Boys

Pre-puberty
T a n n e r s t a g e 1
In puberty
T a n n e r s t a g e 2 & 3
Completing puberty
T a n n e r s t a g e 4 & 5
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If both of the following\:
High voice
No signs of pubertal
development
If any of the following\:
Slight deepening of the voice
Early pubic or armpit hair
growth
Enlargement of testes or penis
If any of the following\:
Voice fully broken
Moustache and early facial hair growth
Adult size of penis with pubic and axillary
hair
Interpretation
Puberty before the age of 9 years in boys is likely to be precocious and further investigation is necessary.
If a patient is between 9-14 years old and is plotting within the shaded area of the chart for their height centile, pubertal
assessment is required and mid-parental centile should be assessed.
If they are "In puberty
" or "Completing puberty
"
– they are BELOW the 0.4 th
centile and should be referred for further
investigation.
If "Pre-pubertal"
, they should be referred for further investigation and compared to their mid-parental centile. After
investigation, these children are often found to be growing normally.
If there are no signs of puberty by 14 years of age, then puberty is delayed and further assessment is indicated.
If the patient is older than 17 years old and not in the "completing puberty stage"
, maturation is delayed, and further
investigation is required.

BMI Centiles

The growth charts also provide an opportunity to calculate the child’s BMI from the age of 2.
Both 0-4 years (boys & girls) and 2-18 years (boys & girls) charts provide a simple graph to convert the child’s weight centile
and height centile to their BMI centile.
Interpretation
A child whose weight is average for their height will have a BMI between the 25 th th
and 75 centile.
centiles, whatever their height
A BMI above the 91 st
centile suggests the child is overweight.
A BMI above the 98 th
centile is very overweight (clinically obese).
A BMI below the 2 nd
centile is unusual and may re
may simply re

Down syndrome

The Down Syndrome Medical Interest Group (DSMIG) and RCPCH have developed cross-sectional growth charts for boys and
girls with Down syndrome for use from term to 18 years old.
Reasons for using these charts include\:
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