Information 1–3

  • Undertaken to monitor a child’s growth and act early on identified risks associated with growth and development or chronic conditions
  • The World Health Organisation (WHO) standard growth charts are used from birth to 5 years. The Centre for Disease Control (CDC) Standard Child Growth charts can be used from 2 years of age. See Resource 1.

Health check recommendations

  • All newborns at first 1–6 weeks postnatal visit
  • Weight and length/height at each child health check to 5 years then:
    • opportunistically until 15 years
    • annually until 15 years for Aboriginal and Torres Strait Islander and rural and remote children
  • Include a 9 month health check for Aboriginal and Torres Strait Islander and rural and remote children
  • Head circumference at each child health check until 2 years
  • Fontanelles palpated at 6, 12 and 18 months of age
  • All children have body mass index (BMI) calculated once between 2½–3½ and 4–5 years, then opportunistically until 15 years of age

1. Procedure 1

  • Perform the measurements as per Table 1.
  • Plot the measurements on the appropriate chart e.g. length/height for age, weight for height or BMI for age. See Resource 1. and 2.
  • Children born prematurely have their measurements plotted on a Fenton growth chart (Resource 3.) or according to their corrected age on a standard chart

Determining corrected age

Corrected age = baby’s age in weeks since birth minus the number of weeks premature (40 minus infants gestational age in weeks).Example:

A 16 week old infant born at 32 weeks

= 16 - (40 - 32)

= 16 - 8

= 8 weeks of age (corrected)

  • < 37 weeks gestation have their age corrected for 1 year
  • < 32 weeks gestation have their age corrected for 2 years
  • Refer child to an appropriate clinician if anomalies are identified
  • Provide brief intervention
  • If a child requires follow-up assessment place on a recall register

Record all information in the child’s Personal Health Record booklet

Table 1. Body measurements for children

Measurement

Procedure

Weight

Weigh using baby scales or stand-on scales

Length or height

Measure length with a measuring board or height with a stadiometer

Head circumference

Measure using non-stretchable (paper) tape measure < 2 years

Fontanelle

Palpate anterior and posterior fontanelles

BMI

See 1.7 Calculating BMI

  1. Weighing children < 2 years of age 1
    • Ensure the baby scales are accurate and regularly calibrated
    • Bare weigh all babies to 2 years of age
    • Zero the scales if required
    • Record the weight to the nearest gram (g)
  2. Weighing children > 2 years of age 1
    • Ensure the stand-on or chair scales are accurate and regularly calibrated
    • Ensure the child removes all heavy clothing, shoes, jumpers etc.
    • Zero scales if required
    • Position the child on the centre of the scales so body weight is distributed evenly
    • Record the weight to the nearest gram (g)
  3. Measuring length < 2 years of age 1
    • For accuracy, this measurement requires 2 people; clinician and parent
    • Flexible plastic measuring boards are less accurate, but good for home visiting
    • Remove shoes and any excessive clothing
    • Lay baby on their back (supine) on the measuring board
    • Ask parent to hold the top of the baby’s head (crown) against the headboard by placing their hands either side of the baby’s head
    • Inform parent that you will extend the baby’s legs while they ensure the crown stays against the headboard
    • Ensure the shoulders and buttocks are flat against the measuring board
    • Extend both the baby’s legs at the hips, keeping the back of the knees flat against the board by adding a slight amount of traction (pull)
    • Slide the foot plate level with the base of both the baby’s feet
    • The length is recorded to the nearest millimetre (mm)
  4. Measuring height > 2 years of age 1
    • Ensure the stadiometer is accurate
    • Remove child’s shoes
    • Position the child with their head, back, buttocks and heels against the wall
    • Ask them to stand straight with weight distributed evenly, heels together, looking forward and arms hanging by their sides
    • Pull the measuring plate down to the top of their scalp
    • Record the measurement to the nearest millimetre (mm)
  5. Measuring head circumference < 2 years of age 1
    • Use a non-stretchable (paper) tape measure
    • Position the child laying down, sitting up or in the parent’s arms
    • Remove any objects from the child’s hair
    • Identify the broadest section of the child’s skull
    • Place the measuring tape slightly above the eyebrows and pinna of the ears and around the occipital prominence at the back of the skull
    • Measure to nearest millimetre (mm)
    • Repeat measurement
    • If the two measurements differ by more than 3 mm take a third measurement
    • Record the average of the 2 largest measurements
  6. Palpating fontanelles < 18 months of age 1
    • Sit or lay the child on examination table or have the parent hold them in their arms
    • Gently palpate the anterior (front) and posterior (rear) fontanelles for openness, size, or whether bulging or depressed
  7. Calculating BMI 1–3
    • Calculate BMI using the below calculation OR plot weight-to-height on an age appropriate BMI chart OR use an online calculator. See Resource 2.

BMI = weight in kilograms (kgs) ÷ height in metres squared (m2

  • Calculating BMI in children > 10 years is important to identify risk of chronic conditions early

2. Results

  1. Interpretation 1
    • View the current plotted result in relation to past plotted results
    • For clearer interpretation plotted points should be joined to form a continuous line and note:
      • how the line tracks and moves in relation to the surrounding centile lines
      • multiple plotted points over a short time will produce a jagged line
      • few plotted points over a longer time produces long smoother lines
    • A healthy child’s measurement should generally, over time, follow a consistent curve in relation to surrounding centile lines
  2. Weight gain for children to 12 months 1,2
    • A general guide for weight gain variation is:
      • an initial weight loss (up to 10% of the birth weight) after birth
      • weight gains by 4–6 days of age
      • return to birth weight by 2 weeks of age
      • gains of 150–200 g/week up to 3 months
      • from 3 months of age children should consistently gain weight over time, tracking along their centile line
  3. Head circumference and length 1
    • Head circumference should consistently increase over time, tracking along their centile line
  4. Children’s fontanelles 1
    • For infants < 6 months of age, the anterior fontanelle diameter generally does not exceed 4–5 cm, should feel soft and slightly depressed with some pulsation
    • In a markedly depressed fontanelle the cranial bones around the edge of the fontanelle can be easily palpated and visualised. This indicates dehydration
    • A bulging fontanelle feels tense with marked pulsations, and may indicate an episode of prolonged crying or increased intracranial pressure from infection
    • The fontanelles should get progressively smaller beyond 6 months of age
    • The anterior fontanelle closes by 18 months of age and posterior by 2 months
  5. BMI for children 1–3
    • BMI categories for children are:
      • < 5th centile–underweight
      • 25th to < 84th centile–healthy weight
      • 85th to < 94th centile–overweight
      • > 95th centile–obese
    • A child > 10 years of age with a BMI > 85th centile risks developing chronic conditions.See Special considerations (child)

Figure 1. Growth chart interpretation

Normal ideal

  • Measurements tracking generally consistently with centile over time
  • Measurements that fluctuate toward and then away from, or over a centile is expected
  • Measurements rarely track exactly along or parallel to a centile

Body measurements normal

Abnormal

  • Measurements track upwards across 2 centile lines
  • This child is at risk of developing Overweight and obesity (child) and associated chronic conditions

Possible causes

  • Diet high in saturated fats and sugars
  • Formula fed
  • Socioeconomic disadvantaged or living in rural and remote locations
  • Adverse childhood experiences e.g. disability, bullying, violence, abuse
  • Increased sedentary behaviour and reduced physical activity
  • Poor sleep

Body measurements abnormal

Abnormal

  • Measurements track downwards across 2 centile lines
  • This child is at risk of Poor growth (child)

Possible causes

  • Low weight, preterm, defects or disability at birth
  • Ineffective feeding e.g. breast, formula, feeding aversion
  • Aboriginal and Torres Strait Islander children or socioeconomic disadvantaged
  • Dysfunctional family home e.g. DV
  • Postnatal depression, anxiety or attachment issues

3. Brief intervention 1–3

  • Reassure parents that a child tracking along a centile is normal, even if the centile is low (i.e. 3rd %ile)
  • Provide Diet and nutrition and Physical activity and sleep related Resources 4. to parents of children with low or high weight or BMI measurements
  • Children > 10 years of age with a BMI > 85th centile will require frequent pathology investigations. See Special considerations (child). Discuss the association of an elevated BMI with:
    • adult obesity
    • type 2 diabetes
    • hypertension
    • stroke
    • heart disease
    • depression

4. Referral

  • For a bulging or depressed fontanelle refer to the Primary Clinical Care Manual
  • Refer to a MO/NP, child health nurse or dietitian for further investigations if the child’s:
    • measurements indicate rapid growth or decline
    • different body measurements vary by 2 or more centiles when compared with one another e.g. weight on the 10th centile and length on the 75th centile
    • if a child’s fontanelles are too wide, close early or remain open longer than expected for age
  • If child’s weight measurements have crossed 2 centiles in an upward trajectory or is > 97th centile manage as per Overweight and obesity (child)
  • If child’s weight measurements have crossed 2 centiles in a downward trajectory manage as per Poor growth (child)
  • If a child > 10 years has a BMI > 85th centile manage as per Special considerations (child)

5. Follow-up

  • Place the child on a recall register to monitor growth if required
  • Ensure all referrals are actioned
  • Provide the parent with details for the next scheduled follow-up appointment

6. References

7. Resources

  1. The WHO Child Growth Standards charts and the CDC standard growth charts
  2. Online Healthy weight calculator for children and teenagers
  3. Fenton Preterm Growth Charts
  4. Child weight management resources for health professionals

Last updated: September 2024

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