Understanding growth and puberty using the RCPCH UK 2-18 growth charts Why measure school aged children? Growth is best indicator of health Demonstration of normality of growth by age and stage of puberty Identify disorders of growth Assess obesity Key questions Is a child too short or tall for their age could there be a problem?
Has puberty started and is it progressing normally? Is growth normal for stage of puberty? Is this child overweight or obese? The new UK 2-18 charts will help you answer these questions Developed and published by RCPCH Based on updated UK 1990 growth references New design features: Puberty Phases BMI lookup and plotting grid Parental height comparator Adult height prediction
RCPCH UK 2-18 Growth chart Parent height comparator UK90 reference after age 4 WHO standards until age 4 Birth centiles Mid parental centile
scale Predicted adult height scale Using the Adult Height Predictor Use an X to mark the childs most recent height centile in the centre line Read off the childs estimated adult height from right scale 80% of children will be within
6 cm of this value Scale also shown in feet and inches on left x Using the Parent Height Comparator Mark mothers height on the left hand scale and fathers height on the right scale using arrows Draw a line between arrowheads and read off midparental centile where this crosses the central line
Regression adjustment means that children of very short or tall parents have mid parental centile nearer to average than expected Mid parental Centile = 75th Using the Parent Height Comparator Compare the mid-parental centile to the childs current
height centile (x) Nine out of ten childrens height centiles are within two centile spaces of the mid-parental centile Only 1 percent more than three centile spaces below Mid parental centile = 75th X within parental range X < 5% children < 1% children X
Interpretation of the mid-parental height centile (MPHC) Average centile for all children of these parents Compare to childs actual height centile Most children are within two centile spaces of the mid-parental centile Only 1 percent more than three centile spaces below Most have no treatable cause for their short stature, Investigate further if other concerns about the childs growth NB a child growing abnormally may still be within mid-parental height range
Body Mass Index (BMI) lookup Read weight and height centiles from the growth chart. Plot weight centile (left axis) against the height centile (bottom axis) Read off the corresponding BMI centile from the slanting lines Record centile on grid at top of chart Accurate to centile space
BMI = 91st centile BMI centile grid: plotting example >91st centile suggests overweight >98th centile is very overweight (clinically obese) BMI Interpretation A child whose weight is average for their height will have a BMI between the 25th and 75th centiles < 2nd centile may reflect undernutrition, but may simply reflect a small frame or low muscle mass
But BMI often varies from one measurement to the next due to measurement error Compare BMI to weight and height centiles using BMI plotting grid at top of chart Pre-puberty ONLY Puberty starting before 8 is precocious Growth during Puberty Plotting pubertal children on the UK 2-18 Growth charts
The 3 Phases of Puberty: from history Pre-puberty (Tanner stage 1) Girls In Puberty (Tanner stage 2-3) If all of the following: If any of the following: No signs of pubertal Any breast enlargement pubic or axillary hair development Boys If all of the following: If any of the following:
High voice and Slight deepening of the voice No signs of pubertal Early pubic or axillary hair development growth Enlargement of testes or penis Completing Puberty (Tanner stage 4-5) If all of the following Started periods with signs of pubertal development If any of the following:
Voice fully broken Facial hair Adult size of penis with pubic and axillary hair Puberty section of new 2-18 Chart Shaded zone marks area where 0.4th centile varies with phase of puberty Puberty Lines
Puberty Lines mark boundaries of normal pubertal development Most healthy children start puberty between these ages Most healthy children complete puberty between
these ages Shaded Puberty Zone Marks area where 0.4th centile varies with phase of puberty Heights in the shaded area below the 0.4th centile: Pre-puberty: if within 2 centiles of Mid-Parental Height = within the normal range In or Completing puberty = below normal range Summary: 2-18 charts will help you
assess The phases of puberty and how to use them to interpret growth charts Predict adult height and relate a childs height to the parents height Assess BMI without a calculator
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