Growth

 Background
 Indicators of Growth Problems

Background

Accurate and frequent assessment of growth is one of the most valuable tools in the care of preterm infants in the community. Inadequate growth indicates a need for further assessment and follow-up. Nevertheless, families report that health professionals do not always utilize growth assessment fully. Procedures for accurate measurement of height, weight, and head circumference have been established. If procedures are not carefully followed, the assessment will not be valid. Please see section on anthropometric measurements.

Growth is usually assessed by following the infant on a growth chart. Incremental growth velocity is also a useful tool, especially when assessment of growth is done very frequently and/or when the infant "falls off" standard growth charts.

Another potentially useful tool for infants with growth parameters that are below the growth charts is the calculation of z-scores. Sequential measurements and calculations of z-scores provide an indication of direction of growth parameters toward the norm as well as an indication of growth velocity. Free software for calculations of z-scores and other growth assessment parameters may be downloaded as part of the EpiInfo package from CDC and are often standard on EMR software.

Quick Check for the Health Professional

• Measure frequently and accurately
• Measure and assess weight, length, occipital frontal circumference (OFC, aka head circumference) for age, and weight for length
• Use special growth charts or use corrected age when using CDC Growth curves
• Assess growth rates
• Growth should follow appropriate curves for weight, length, OFC for age, and weight for length

Indicators of Growth Problems

Further nutrition assessment is warranted when:

• Weight for age, length for age, or weight for length at or below the 5^th percentile
• Weight gain is less than 20 g/d
• Weight for length is at or above the 90^th percentile
• Weight or length shifts down or up across growth channels

Criteria for referral for further evaluation (Adapted from Stice):

• Weight loss or no weight gain after discharge
• Weight or length falls below previous percentile ranks
• Not gaining at appropriate incremental rates
  
  

• Weight/length below the 5th percentile
• OFC not maintaining growth pattern approximate to weight and linear growth or incremental rates less than the following:
  
  

Nutrition Assessment: Growth Homepage
Gaining and Growing Homepage