Rates of growth: Rate of growth is highest in the first year of life and gradually reduces thereafter until child reaches puberty when there is another growth spurt that lasts 2-5 years.
Weight gain: Term neonate aged 0-2 months gains 30g per day; an infant aged 2-6 months gains 20g per day. A child doubles birth weight at 5-6 months and triples birth weight at 12 months.
Increase in height: Infants increases their height by about 25 cm in the first year and 10 cm in second year.
Head growth: head is measured by circumferences. At birth head circumference ranges between 33 cm and 37 cm.
Thereafter, it increases by 7.2 cm per month for the first 0-3 months; by 1 cm per month from 3-6 months of age; and lastly by 0.5cm per month from 6 to 12 months of age.These increments add to a total of 12 cm at the end of first year. Eighty percent of the brain growth occurs in the first two years of life.
Interpretation of changes in weight and height: Weight loss leads to wasting and is usually a sign of recent food shortage or illness. On the other hand, inadequate gain in height or length leads to stunting and is a sign of chronic lack of food or illness.
Body mass index (BMI)= weight in kg/(height in metres)^2. Children with BMI above the 85th percentile are overweight, while those above the 95th percentile are obese.
Head circumference below that expected for age is microcephaly and above expected is hydrocephaly or macrocephaly.
GROWTH MONITORING
Serial weight and height measurement and recording on the growth chart should be done as part of the Maternal and Child Health (MCH) programme. All children have their own individual growth curve, but if they deviate from the curve the reason should be investigated.
Growth monitoring after 9 months is generally inadequate as parents and health care providers tend to associate clinic attendance with immunization. So after the measles vaccine at 9 months few mothers see the need to come to the clinic unless the child is unwell. Also as the child grows bigger and maybe the mother has a new baby, the older child is no longer a priority. Growth. Growth monitoring at community level has been in existence for a long time in Kenya, but is probably not widespread.
It is necessary to make growth monitoring an important community activity. Growth monitoring is important throughout childhood to detect not only failure to grow well but also features of overnutrition like obesity, poor growth is detected by regular use of the growth chart. As soon as slowing growth is detected , action must be taken. The advice given to a mother depends on the age of the child. The advice must be practical and the mother must be able to do what she is told.
The community health workers can be trained and supported to do this. They together with the parents need to visualize the growth of children and seek help if the child is not growing appropriately. All children up to the age 5 years should be weighed regularly-preferably monthly weighing up to 5 years. To do this they need weighing scales and tools for length/height measurement. Currently, charts are readily available only for children up to 5 years.
When a Child Doesn’t Grow Well: Assess Nutritional Status
The following classifications are important for parents to know about their children to assist them to avoid malnutrition:
Classification Signs
Normal No low weight for age and no other signs of malnutrition
Very low weight Very low weight for age
Poor weight gain
Severe malnutrition Visible severe wasting, “baggy” signs
Oedema of both feet
When a child does not grow well:
Assess the child’s feeding.
Ask what the child is fed on.
Ask how many times the child is fed in a day.
Counsel the mother on feeding. Review the recommendations against th child’s growth chart, and discuss with the mother about any necessary changes.
Follow up programme for child
Review the progress of the child in 5 days.
Re-asses feeding.
Counsel mother about any new or continuing feeding problems.
If the child is very low weight for age, ask the mother to return 14 days after the initial visit to monitor the child’s weight.
Encourage the mother to continue the feeding programme until the child gains appropriate weight for age. If 14 days the child is no longer very low weight for age. And then advise her to maintain feeding the child an adequate nutritious, well balanced diet.
Refer all children for further evaluation if:
Weight has not increased in the last 2 months even though the mother/caregiver says they are following the advice on feeding practices.
Sick children are not gaining weight adequately. (Sick children may need to be referred immediately for other reasons).
Children continue to lose weight (consider TB, HIV infection among other problems).
Child’s weight is well below the bottom line on the chart.
Child has any sign of swelling of the feet and face (Kwashiorkor) or severe wasting (marasmus).
Advice to mothers should be:
Well babies less than 6 months old need no other milk milk or food apart from breastmilk.
Adding oil, margarine, or sugar, and milk, eggs, or mashed ground nuts makes uji and other foods energy rich and helps young children grow well.
Feed often-like 5 times a day: small children have small stomachs.
Feed older children at least 5 times a day.
Feed sick children at least one extra meal per day and continue for 1-2 weeks after they recover.
Continue to take interest in what the child feeds on even in the school years.
Mothers should know that the children are likely to have poor school performance if not fed well.
Avoid over feeding and limit non-nutritious snacks, especially if the child is overweight
Development
Besides nutrition, children need appropriate stimulation in order to reach their development potential. Both parents and health workers need to know the normal developmental milestones
Developmental milestones
Developmental; milestones Normal limits
Can lift head when prone 4 weeks
Social smile 4-6 weeks
Good head control 3-6 months
Turns to origin of the sound 2-3 months
Extends hand to grasp a toy 2-3 months
Sitting without support 5-9 months
Standing 7-13 months
Walking 12-18 months
Talking 9-24 months
Any child whose milestones are delayed needs careful assessment to identify the cause and offer appropriate therapy. If you cannot deal with the problem, refer.
Children need simple culturally appropriate toys to play with. Parents can be taught how to make simple toys with materials available in the home. Encourage parents to spend time with their young children. Encourage parents to talk to their children often, even the babies; they won’t understand the words, but they will learn about interaction