Children & Growth Charts

Growth charts and assessment for chiropractors caring for kidsChiropractors caring for children should keep their own records of infant and childrens’ growth charts. This includes transcribing any past history of records and continuing your own measurements in the clinic at discrete intervals. Growth and Assessment is an important unit taught in Kiro Kids chiropractic paediatric courses and this is a brief summary of growth charts and the information contained within them.

Growth refers to an increase in size. This is easy to gauge by measuring your baby’s length, weight and head circumference.

You may not even need to use a growth chart – as your baby grows, you may notice him outgrowing his clothes, bassinet or baby bath, or other items that seemed enormous when he was just a newborn.

Growth charts (percentile charts)

Percentile charts are based on measurements of babies and children from a certain population (for example, all the Australian babies in a certain year). The Victorian government percentile charts have been updated recently using data drawn from between 1963 and 1994. These charts, along with many other percentile charts used in Australia, are based on United States surveys.

As normal variations in height and weight are considerable, the percentile charts are drawn to allow for the variations. If you look at percentile charts you’ll see that the lines represent the 5th, 10th, 25th, 75th, 90th and 97th percentiles for weight, height and head circumference.

Length is measured when the baby is lying down. Height is only measured for children over two years of age when the child is standing. Most babies’ weight and length fall somewhere between the 5th and 97th percentile, although there are exceptions.

Understanding the charts

If a baby is on the 5th percentile for height and weight, it means that 95% of babies are taller and heavier than she is. A baby on the 90th percentile for height and weight is taller and heavier than 90% of other babies. In both examples, the baby is within the normal range, even if these are at different ends of the percentile range. Head circumference can also be charted on the percentile chart. A baby’s head grows rapidly in the first year, making it easy to check that it’s growing at the right rate.

The general guidelines that are usually given for growth are:

  • a baby loses 5-10% of birth weight in the first week and regains this by 2-3 weeks
  • birth weight is doubled by 4-6 months and tripled by 12 months
  • birth length increases 1.5 times in 12 months
  • birth head circumference increases by about 7.6 cm in 12 months.

The following example explains how you should read a percentile chart:

  • 3% of children will be below the 3rd percentile and 3% of children will be above the 97th percentile
  • 15% of children will be below the 15th percentile and 15% of children will be above the 85th percentile
  • 50% of children will be below the 50th percentile and 50% of children will be above the 50th percentile

The 50th percentile is not a pass, it means that 50% of the normal population is below this line and 50% is above it.

If a baby’s height or weight is ‘off the chart’ (above the 97th percentile or below the 3rd), there is a higher chance of something being wrong and it is wise to investigate this further. In many cases though, all is well. Three in every 100 normal babies will weigh less than the 3rd percentile, often because both parents are small.

The varied conditions and reasons that height, weight and head circumference may alter from the percentile lines they have been following uniformly are many and varied. The implications can be dire if ignored and and chiropractors caring for children should have an implicit understanding of the charts and the information they convey.

One of the Kiro Kids seminars included within NIP Academy Platinum membership is titled Neurological Examination of the Child and includes a section on growth and assessment. It is a section of an entire weekend seminar devoted to clinical safety and prudency in providing chiropractic care for children and imperative for infant care and beyond.

 

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