APPENDICES
135Appendix H Assessing growth and healthy weight in infants, children
and adolescents, and healthy weight in adults
H1 Assessing growth and healthy weight in infants, children and adolescents
Measuring and recording the growth of infants and young children has been standard practice in Australia for
decades. Growth monitoring remains the best method of assessing nutritional status and overall health at the
community and primary care level.
Measuring height and weight regularly is important. The most practical measures of growth status in childhood
are comparisons with standard growth charts that show the normal ranges of height for age, weight for age and
BMI, by sex as well as length for age and head circumference for age for infants aged 0–2 years. As growth is a
dynamic process, several measurements are preferable when assessing infants and children. When only a single
measurement 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 WHO
before 2006)10 74
• WHO growth charts.1075-1077
The differences between these options have been reviewed.^1078
Growth charts are not intended to be diagnostic but to contribute to the overall clinical impression of the
child 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 in
adolescence 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 10th or 90th percentiles,
the advice of health professionals should be sought.^351 In the first months of life it is normal for 5% of the
population to fall below the 5th percentile, and this does not always indicate a problem.^351
Care should always be taken when both measuring and plotting growth patterns to minimise error associated
with 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 the
weight 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 charts
The 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-for-
age, 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 is
defined 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 were
published in 2007. The BMI Z-score-for-age chart defines overweight as greater than one standard deviation
above normal, obesity as greater than two standard deviations above normal, thinness as more than two
standard deviations below normal, and severe thinness as more than three standard deviations below normal.^1075