Guidelines Dietary - Eat For Health

Appendix HAssessing growth and healthy weight in infants, childrenand adolescents, and healthy weight in adultsH1Assessing growth and healthy weight in infants, children and adolescentsMeasuring and recording the growth of infants and young children has been standard practice in Australia fordecades. Growth monitoring remains the best method of assessing nutritional status and overall health at thecommunity and primary care level.Measuring height and weight regularly is important. The most practical measures of growth status in childhoodare comparisons with standard growth charts that show the normal ranges of height for age, weight for age andBMI, by sex as well as length for age and head circumference for age for infants aged 0–2 years. As growth is adynamic process, several measurements are preferable when assessing infants and children. When only a singlemeasurement of weight and/or height is available, care is needed in interpretation.There are several widely accepted and practical tools available for assessment. The options are:• BMI using international reference standards (the International Obesity Task Force [IOTF] criteria) 122• 2000 US Centers for Disease Control and Prevention (CDC) BMI curves (also recommended by WHObefore 2006) 1074• WHO growth charts. 1075-1077The differences between these options have been reviewed. 1078Growth charts are not intended to be diagnostic but to contribute to the overall clinical impression of thechild being measured. Generally, irrespective of the reference or standard used, if a child is growing normally,growth approximately follows one of the lines on the chart. The growth trajectory may increase or decrease inadolescence dependent upon timing of the adolescent growth spurt.If the line of growth crosses a number of percentile lines or tends towards or crosses the 10 th or 90 th percentiles,the advice of health professionals should be sought. 351 In the first months of life it is normal for 5% of thepopulation to fall below the 5 th percentile, and this does not always indicate a problem. 351Care should always be taken when both measuring and plotting growth patterns to minimise error associatedwith poor measurement technique or error in plotting.It is important to note that the use of different methods of assessing overweight or obesity will give different results,so results cannot be directly compared. For that reason it is essential to state the criteria used when assessing theweight of an individual or population. This also applies for underweight, stunting or wasting level in a population.In Australia, the 2006 WHO BMI charts and the 2000 US CDC charts are commonly used.WHO growth chartsThe WHO has developed and uses growth reference charts for: 1041-1043• infants aged 0–2 years• children from birth to age 5 years• children from age 5–10 years• children and adolescents aged 5–19 years.For children younger than 5 years, tables and charts showing percentiles and Z-scores for BMI-for-age, weight-forage,weight-for-length and head circumference were published in 2006.Overweight is defined as two standard deviations above normal on the weight-for-height chart and underweight isdefined as weight-for-age two standard deviations below normal. 1076 For children and adolescents aged 5–19 years,tables and charts showing percentiles and Z-scores for BMI-for-age, height-for-age, and weight-for-age werepublished in 2007. The BMI Z-score-for-age chart defines overweight as greater than one standard deviationabove normal, obesity as greater than two standard deviations above normal, thinness as more than twostandard deviations below normal, and severe thinness as more than three standard deviations below normal. 1075AppendicesNational Health and Medical Research Council135