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Assess
the child’s growth
Complete
a growth chart accurately plotting height,
weight and head circumference on the CDC Growth
charts of the United States.
Plotting
growth measurements:
Assessing
growth is a part of each pediatric encounter
because this is a sensitive measure of overall
health of the child. There are growth curves
available for different age groups (0-36 months,
2-20 years).
Infants
should be weighed naked or in a diaper only.
If the weight is too high/low recheck the weight
and accuracy of the scale. Fluctuations in
weight influence management of children, especially
those who are hospitalized.
Most
children younger than 2 years cannot/ will
not stand by themselves so their length is
measured instead of their height. There are
measuring devices to assist with accurate assessment.
If there is any concern about growth, measure
the length at least twice.
The
tape should encircle the most prominent portions
of the head. For increased accuracy, measure
three times. It is easy to make small changes
in the measurements accidentally. Do not start
your examination by obtaining this measurements
b/c the infant may start crying!
BMI
should be calculated in all children and
followed in addition to height and weight.
To calculate BMI:
-
Wt
(kg)/ stature (cm) / stature (cm) x
10,000
-
Or
Wt (lb) / stature (in) / stature (in)
x 703
Special
situations
Premature
infants: the growth of premature infants
is typically “corrected” for their
premature birth. Although special growth charts
are available, many pediatricians plot the
current weight at the “chronological” age
and then subtract the months/weeks of prematurity
(e.g. if the child was born at 30 weeks they
subtract 10 weeks) and plot the growth parameters
at the “corrected” age. Plotting
the corrected age usually continues until age
2 years.
Other populations:
there are special growth
charts available to
plot the growth for
children with Down
syndrome, Turner syndrome
and achondroplasia
Assess
the child’s development
Use a comment developmental screening instrument such as the Denver
II or Ages and Stages questionnaire. You should practice doing
this during your pediatrics/family medicine clerkships
Tips
for doing a developmental assessment:
-
Ask
open-ended questions about each area of development
outlined on the Denver II
-
Know
1-2 items in each category that you can ask
initially, and then follow up any concerns
(yours or the parents) by asking more specific
questions from the Denver or other screening
tool.
-
You
will get information about the child’s
development by history and your own personal
observation
-
Be
alert to the possibility of a problem when
the head circumference is at one extreme or
the other
-
Sequential
measurements of growth are sensitive measures
of overall health.
-
Alteration
in the rate of growth “crossing percentiles” should
alert you to possible underlying problems.
-
Typical
weight gain: 20-30 grams/day in the newborn
period
Typical height velocity:
-
In
children 5 years –puberty, normal
growth velocity is = 5 cm; < 5 cm/year
should be investigated; <4 cm is pathologic
-
-
Growth
hormone deficiency (high weight to height
ratio)
-
Chronic
disease (e.g. inflammatory bowel disease…low
weight to height ratio)
-
Constitutional
growth delay (normal weight to height ratio)
Developmental
delays identified on tools used in clinician’s
office are “red flags” and warrant
further, more formal investigation.
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