Monitoring of growth of a child ..


Growth denotes increase in physical size of the body whereas development mean improvement in function and skills of an individual. The factors affecting growth and development are genetic inheritance, nutrition, age , sex, infections or other ill health, environment, psychological factors, economical and others. Here I draw attention on growth monitoring. Growth monitoring is concept of measuring of growth parameters regularly in order to maintain average growth of the child which will help his or her good physical health and development.

We identified 4 phases in monitoring growth of a child

1 Fetal  2 Infantile 3 childhood  4 Pubertal

1 Fetal

Fetal growth monitoring done while the child is growing in the mothers uterus. We monitor mothers weight , sympisio fundal height and USS parameters.

2-3 Infantile and child hood phase

Weight , length, OFC, mid arm circumference

Growth monitoring is done regularly from birth of a child and use weight , length or height , OFC.


Weight is measured in kilograms.  Zero error to be adjusted  and   minimal cloths without shoes  and usually record in  morning with basal conditions.

A baby should gain at least 500g per month in the first three months of life. On an average, a baby weighs double the birth weight by five months, trebles its birth weight by one year and quadruples its birth weight by two years.

Weight is measured monthly up to 6/12  , 2 monthly up to 1 year and 3 monthly after one year up to 5 years.


Length/ height  is measured in centimeters. once in 3/12 using the infantometer in infants and after 1 year height is measured by the stadio meter. Height of an individual is influenced by genetic as well as environmental factors.

  • At birth about 50 cm
  • Infancy 23-28 cm /year
  • by 1 year 75 cm— Child hood velocity 5- 6.5 cm / year
  • 4 years 100cm
  • Puberty 8.3cm/year for girls and 9.5cm /year for boys




Occippito Frontal circumference

OFC  is measured in centimeter. Head size relates to the size of the brain which increases rapidly during infancy. Head circumference is recorded by passing the tape around the head over the supraorbital ridges of frontal bone in front and the most protruding point of occiput on the back of the head.

It is measured once in every 3 months. At birth 33cm-35cm, first 3/12 increase by 6cm(2cm/month),second 3/12 by 3cm(1cm/12),1 year 12 cm from bith

More frequent measuring is required if any abnormality is detected at birth or at any point where the abnormal recordings are shown.

Mid arm circumference

MAC or calf circumference indicate status of muscle development. Well-nourished children have a nearly constant arm circumference (about 16 cm) between 1 and 5 years. Undernourished children have a thinner upper arm and a smaller AC. Poor musculature and wasting are cardinal features of PEM in early childhood.

It is also measured in centimeter. Usually left arm is measured. The circumference is measured on the left upper arm half way between the end of the shoulder (acromion and the tip of the elbow (olecranon). To locate this point, the arm is flexed at a right angle. Then the arm is allowed to hang freely and a tape-measure put firmly round it.

Subcutaneous Fat

Subcutaneous fat constitutes bodies main energy reserves. Standard skin fold caliper are used and the skin fold measured consist of double layer of skin and sub cutaneous fat.

In young children, the triceps skin-fold is used. The site is exactly at the mid upper arm as determined by the method used for mid arm circumference.

Child health development record

CHDR is used to record growth values regular intervals and it is recommended for all children and are maintained at least up to five years. It is a visible display of the child’s physical growth and development and it is useful for longitudinal follow-up of a child. There are separate charts for boys and girls.

CHDR will show graphical recording of child’s weight, height and OFC .Recording should be done correctly according to age and sex as 2 different records are available for male and female children.

As it is a graphical record it is easy to identify if any deviation from the base line even to the parents.  This will help to assess child growth pattern and relevant interventions can be done as required. However it is important to customize the situation according to the sir Lankan standards.

As mentioned earlier Child’s development also should be assessed periodically to identify developmental abnormalities early and to provide appropriate  management and it is also should be a part of the process of growth monitoring.

Gross and fine motor development, social behavior, hearing, vision, and language development should be assessed and documented in CHDR.


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