Paediatric Growth Charts: How Do We Use Them and Can We Use Them Better?

Abstract

Measurement of growth parameters is a key aspect of paediatric care.1 The admission of infants or children to a paediatric service provides an opportunity for the measurement of growth parameters. These measurements should then be reviewed and plotted correctly on standard growth charts,2 with intervention as indicated. We previously conducted a retrospective review of 103 consecutive admissions in our centre in November 2009 and elucidated the completeness of growth measurements and recordings in these children.3 Although almost all the children had measurement of their weight at admission, few had height and none had head circumference measured. In addition, growth charts were present and completed in a minority of the hospital records. Overall, this work demonstrated that opportunities were being missed to assess auxological parameters in children presenting to hospital acutely. Following the presentation of these outcomes to the department, new guidelines for the assessment of growth parameters at admission were instituted. These included a renewed emphasis on the importance of growth assessment, educational activities, reminders to measure and record growth and arrangements for a standardised location for the growth chart in paediatric medical notes. We have recently undertaken a further audit in November 2011. The notes of 100 consecutive admissions were reviewed, and the frequency of growth parameter documentation was assessed, following the previously described methodology.3 Weight was documented in 100% of the hospital notes of this group of children, whereas height was documented in 32%. Head circumference was documented in just 25% of the subset of children aged less than 2 years. Standard growth charts were present in the notes of 40% of children, and in 23% of cases the measured growth parameters were plotted on these charts, with no inappropriate plotting evident. Interestingly in 13% of cases either height, weight or both fell below the 3rd centile or above 97th centile for age. An appropriate management and follow-up plan was documented in the medical records of each of these children. These data demonstrate a moderate but encouraging improvement in the assessment and recording of growth in children presenting to this paediatric service. This change in practice was brought about by presentation of the issue to the department and highlighting the importance of growth assessment, prompting a change in guidelines for admitting doctors and nurses. Completion of an audit cycle along with ongoing educational activities will be important to further enhance the assessment of growth in children seen acutely in this centre. We remind practitioners of the importance of these core elements of paediatric practice.