NAGPUR: While the health of children under five is now closely monitored in the country, it is also important to keep track of the growth of a child between the ages 5 and 18. Pediatricians rely on a tool called growth charts to monitor the health of children above five. The Indian Academy of Peadiatrics (IAP) has recently released an updated, Indianized version of growth charts. This update was long overdue since the last growth charts for Indian kids were designed 25 years ago.

Continuous monitoring of parameters like height and weight of children can help diagnose nutritional, chronic systemic and endocrine diseases at an early stage. IAP accepts the standard WHO 2006 growth chart for children under five. However, for older children factors like diet, environment and genetics play an important role that requires country-specific growth charts. Data were collected from 14 cities to help design the new version of the chart.

“Health parameters of children under five speak of the health of the nation and the monitoring of growth of kids in the age group 5-18 can help prepare the road map for the healthcare policies. This is why we also call them the ‘road to health’ charts,” said the convener of IAP Growth Chart Committee , Dr Vaman Khadilkar , who practises as a paediatric and adolescent endocrinologist in Mumbai and Pune.

“If we were to use the standard WHO or American charts, we would end up over diagnosing malnutrition and under diagnosing obesity . The chart we have designed is based on several studies and is representative of modern Indian children living a reasonably comfortable life,” he said. Khadilkar said that there was a drawback with this mode of data collection as most children in the study were enjoying optimal health and nutritional levels which could lead to skewed data. This problem was solved by removing unhealthy weight from the study population.

Another problem encountered while preparing the chart was the differences within the Indian population. “There is no uniformity within the country in different sets of population with regards to body type standards. The standard height among people from different states varies widely as do their diet and environment. We have people from Gujarat who are relatively shorter while those from Punjab are taller. Standard southern diet is high on rice and coconut oil while wheat is more popular in the north,” said city-based paediatrician Dr Vasant Khalatkar who is an executive member of central IAP. To resolve this, data were taken from children from a wide variety of backgrounds even within the same city.

These growth charts are available with all pediatricians.

HOW OFTEN TO MONITOR CHILDREN’S GROWTH

0-3 years:

What to monitor: Height, weight and head circumference. Penile length (PL) and testicular descent must be ascertained in newborns.

Before 6 months of age, height and weight must be measured for not more than once per fortnight

Thereafter, growth parameters must be noted every month

After 18 months, measurements can be made every six months.

4-8 years:

Height and weight to be measured every six months

Body mass index (BMI), penile length and sexual maturity rate (SMR) should be assessed yearly after the age of 6 years

9-18 years:

Height, weight, BMI and SMR to be assessed yearly

RED FLAGS

0-5 years:

Weight loss or lack of weight gain for a month in the first six months

Absence of weight gain for 2-3 months between 6-12 months

Being below third percentile on height-length or height-weight charts indicates malnourishment

5-18 years:

Rate of growth less than 5cm per year

Girls with underarm, pubic hair growth or breast budding before 8 years and boys with underarm, pubic hair, genital growth or testicular enlargement before 9 years

BMI being over 23 adult equivalent indicated being overweight and above 27 indicates obesity

