II. Precautions
- Defining whether a child's growth is normal is difficult due to conflicting guidelines and growth curves
- Diagnosis relies on accurately recorded weight and height on growth chart over time
III. Evaluation: Initial Criteria
- Expect False Positives with screening criteria as below
- Anthropometric Z Scores have replaced these criteria for diagnosis
-
Growth Faltering Screening relies on accurately recorded weight and height on growth chart over time
- Weight below 5th percentile for gender and Corrected age OR
- Weight for Length <5th percentile OR
- BMI for age <5th percentile OR
- Decreased Growth Velocity with Weight for Length falling by more than 2 major percentile lines
- Growth Faltering Diagnosis is based on anthropometric Z-Scores
- Z Scores are calculated from Weight for Length or BMI for age and range from -3 to +3
- Negative Z Scores represent lower than expected weight
- More negative values represent more severe Malnutrition (-1=mild, -2=moderate, -3=severe)
- Drop in Z-Score over time is also used to determine severity (drop of 1 = mild, drop of 2 = moderate, drop of 3 = severe)
- Resources
IV. Evaluation: Re-evaluate growth in relation to normal modifiers of growth pattern
- Growth may be adequate for genetic predisposition or Breast Feeding versus Bottle Feeding
- See Resources under Weight Measurement in Children (particular attention to WHO growth curves)
- Interpret trends (3rd percentile may be normal if always following 3rd percentile)
- Consider using modified growth charts
- Prematurity
- Ethnicity
- Down's Syndrome
- Turner's Syndrome
V. Evaluation: Further evaluate with most specific indicators of abnormal growth
- Anthropometric Z Scores (see above)
- Weight <75% of median Weight for Length
- Weight Velocity <5th percentile
VI. Resources
- CDC Growth Charts (includes WHO charts for under age 2 years)