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Data Recording

Measurement 1
Recording Date GIRLS Please place sticker (if available) otherwise write in space provided.
Pubertal Assessment
The puberty phase may be ascertained through simple
questions about the appearance of secondary sexual
Growth patterns before and during puberty
Successive height measurements can show wide variation,
because it is difficult to measure height accurately. If there are
Weight
Length/Height UK Growth chart Name: ________________________________________

NHS / CHI No:


characteristics as well as by clinical examination.
By history from parents, carers or young person
concerns it is useful to measure on a few occasions over time.
Assessing growth during puberty is complex because the age

2-18 years
Location
when puberty starts varies.
Health worker name Pre-puberty In Puberty Completing Puberty
Hospital No: (Tanner stage 1) (Tanner stages 2-3) (Tanner stages 4-5)
Measurement 2 No signs of pubertal Any breast enlargement Started periods with signs What does a height in the shaded area below the 0.4th
Recording Date Date of Birth: development pubic or armpit hair of pubertal development centile mean?
Weight This chart provides some extra guidance about the lower limit
(0.4th centile) for height in girls 8-13 years. If a plot falls within
Length/Height When is further assessment required?
the shaded area on the height chart between 8 and 13 years,
Location Anyone who measures a child, plots or interprets charts If any of the following: pubertal assessment will be required and mid-parental centile
Health worker name should be suitably trained or supervised. For further Where weight or height or BMI is below the 0.4th Is the timing of puberty normal?
information and training materials see fact sheet and should be assessed.
centile, unless already fully investigated at an earlier
Measurement 3 The three vertical black lines (puberty lines) on the right hand If they are In puberty or Completing puberty, they are below
presentation on www.growthcharts.rcpch.ac.uk age.
Recording Date If the height centile is more than 3 centile spaces below page (8-18 years) of the chart indicate the normal age limits for the 0.4th centile and should be referred. In most instances a Pre-
Weight This chart is mainly intended to assess the growth of school the mid-parental centile. the phases of puberty described above. pubertal girl plotted in this area is growing normally, but
Length/Height age girls. It combines data from the UK 1990 growth A drop in height centile position of more than 2 centile comparison with the mid-parental centile and growth trajectory
Girls with measurements plotted on the left page will
Location
reference for children at birth and from 4 -18 years(1), with spaces, as long as measurement error has been will assist the assessment of whether further investigation is
the WHO growth standard for children aged 2 years to 4 excluded. usually be in the Pre-puberty phase. Puberty before 8
Health worker name needed.
years(2). The growth of children under 2 years of age should Smaller centile falls or discrepancies between childs years in girls is likely to be precocious and further months
Measurement 4 be plotted on the more detailed UK-WHO 0-4 years growth and mid-parental centile, if seen in combination, or if assessment is necessary. Centile terminology
charts. associated with possible underlying disease. Between 8-13 years most girls will be either Pre-
Recording Date If the point is within 1/4 of a space of
If there are any other concerns about the childs the line they are on the centile: e.g. 91st.
Weight puberty or In puberty. If there are no signs of puberty by
As well as simply using this chart for plotting growth data, it growth.
Length/Height also includes a number of new features which you may wish 13 years, then puberty is delayed and further assessment If not they should be described as
to use to help interpret the growth data. is indicated. being between the two centiles:
Location Adult Height Predictor e.g. 75th91st.
Health worker name birth centile plotting scale This allows you to predict the childs adult height based on From 13-16 years most girls will be either In puberty or
BMI look-up and plotting grid Completing puberty.
Measurement 5 their current height, but with a regression adjustment to A centile space is the distance between
scales to estimate adult height and mid-parental
allow for the tendency of very tall and short children to be After 16 years girls will usually be Completing puberty. two of the centile lines, or equivalent
Recording Date centile distance if midway between centiles.
less extreme in height as adults. Four girls out of five will If this is not the case, maturation is delayed and further
Weight guide to assessing puberty
have an adult height within 6 cm of the predicted adult assessment may be needed.
Length/Height
height.
Location
Measurement procedure
Accurate measurement is essential and shoes must be Instructions for use
Health worker name
removed for all measurements Plot the most recent height centile on the centile line on the Body Mass Index (BMI) centile look-up
Measurement 6 Height: Adult Height Predictor (on the flap to the right of the height
If weight is above the 75th centile or if 99.6
99.6
Recording Date Measure height recorded to the last centile chart) and read off the predicted adult height for this
Frankfurt weight and height centiles differ, the BMI
Weight Plane millimetre. A correctly installed centile. 9
98
8
centile should be calculated, as the BMI
Length/Height stadiometer or approved portable 91
91
Mid-Parental Centile centile is the best indicator of thinness and 99.6 )
ese
measuring device is the only
Location
equipment that can be reliably used fatness. The BMI look-up allows you to read b 7
75
5
The mid-parental centile is the average adult height centile
t (O

www.healthforallchildren.co.uk
Health worker name off the BMI centile, accurate to a quarter of a 98 5
50
0
(see illustration). If a child cannot to be expected for all children of these parents. It
ig h t
Measurement 7 stand, measure lying down, using incorporates a regression adjustment to allow for the centile space. There is a BMI centile grid at
91 erwe eigh 2
25
5

Weight Centile
an approved length measuring tendency of very tall and short parents to have children with the top of the growth chart where the v w
y O Over 9
Recording Date
device and plot as for height. less extreme heights. Comparing this to the childs current centiles for children with high or low values 75 er
V tile 2
Weight
Position head height centile can help assess whether the childs growth is can be plotted.
e n
Ic
Length/Height
and feet as proceeding as expected. The larger the discrepancy between 50 0.4
0.4
BM

Harlow Printing Limited Tel: 0191 455 4286


Location illustrated with the two, the more likely it is that the child has some sort of Instructions for use
Health worker name child standing as growth disorder. Most childrens height centiles (nine out of 25
1. Note the weight and height centiles from
straight as ten) are within two centile spaces of the mid-parental
Measurement 8 the growth chart.
possible. centile, and only 1 percent will be more than three centile 9
Recording Date spaces below. 2. Plot the weight centile against the height
centile on the the BMI look-up. 2
Weight Weight: Instructions for use
Length/Height Remove heavy clothing and shoes and 3. If between centiles, read across in this
The Mid-parental Centile Comparator is on the flap to the 0.4 months
Location weigh using class III clinical electronic position.
right of the height centile chart. If possible measure both
scales in metric setting. 4. Read off the corresponding BMI centile
Health worker name parents heights, or else use reported heights. Plot their
from the pink slanting lines.
heights on the Mothers and Fathers height scales. Join the
Measurement 9 5. Plot the centile in the BMI grid at the top
Plotting two points with a line between them. The mid-parental
0.4 2 9 25 50 75 91 98 99.6

Issue 2
Recording Date Plot each measurement by placing a small dot where a of the growth chart at the appropriate
centile is where this line crosses the centile line in the middle.
Weight vertical line through the childs age crosses a horizontal line Compare the mid-parental centile to the childs current age. Height Centile
Length/Height through the measured value. height centile, plotted on the adult height predictor centile What does a high or low BMI mean?

UK2-18A4G
Location The lettering on the charts (weight, length etc.) sits on the scale. A BMI above the 91st centile suggests overweight. A child above the 98th centile is very overweight (clinically obese). BMI below the
Health worker name 50th centile to provide orientation. 2nd centile is unusual and may reflect undernutrition, but may simply reflect a small build.
Mid-parental target height
Measurement 10 Birth centile plotting scale

Jan. 13
This can be obtained by plotting the mid-parental centile on
Recording Date The chart starts at age 2 years, but there is a plotting scale on the main chart at age 18 and reading off the corresponding References
Weight the left of the chart where for term infants, birth weight (and
height. Four girls out of five will have an adult height within 1. Freeman JV, Cole TJ, Chinn S, Jones PRM, White EM, Preece MA. Cross sectional stature and weight reference curves for the UK, 1990. Arch Dis Child 1995; 73:17-24.
if measured, length) can be plotted to allow comparison of

Manufacture 4
Length/Height 7 cm of this target height. However the predicted adult 2. www.who.int/childgrowth/en
the birth centile with later growth. For further relevant references see fact sheet downloadable from www.growthcharts.RCPCH.ac.uk
Location height (above) is usually closer than mid-parental target Copyright RCPCH 2012
Health worker name height to the childs final height.
99.6th 99.6th 99.6th 99.6th
Very Overweight (obese) Very Overweight (obese) Parent Height Comparator
98th 98th 98th 98th
91st Overweight 91st 91st Overweight 91st Mothers
height
75th 75th 75th 75th
ft/in cm Fathers
50th BMI CENTILE FROM LOOKUP OVERLEAF 50th 50th BMI CENTILE FROM LOOKUP OVERLEAF 50th
61
height
185
25th 25th 25th 25th cm ft/in
200 67
9th 9th 9th 9th
6 Mid-parental
2nd 2nd 2nd 2nd centile 66
0.4th 0.4th 0.4th 0.4th
511 180 91st
145cm 145cm 185cm 185cm 195 65"
31/2 4 41/2 5 51/2 6 61/2 7 71/2 8 10 11 12 13 14 15 16 17 18

GIRLS
510

GIRLS 180 99.6th 180 59 175 190


64

63"
140 2-8 years 99
.6t
h 140 8-18 years 98th 62"
58
175 175 75th
21/2 3 9
170 185 61"
91st 57

Puberty starting before 8 years is precocious

Puberty is delayed if no signs are present by 13 years

Puberty completing after 16 years is delayed


th
98
135 135 170 170 6
56
75th

t
st 180 511

h
91 165

g
165 165 55

i
50th 50th 510

e
130 130
54

h
th 175 59
75
160 25th 160
53 160
58
125 th 125 9th
50 155 155 52 170 57
25th
Transit point 2nd 51 155 56

t
from UK-WHO th
25 150 150
to UK90 data. 165 55
120 120 0.4th 5

h
h
.6t
99 54
9th 145 145 411 150

g th 160

i
98 53
9th
410
115 d 115
140 140

e
2n st 52
91 145
49 155 51

h th th
0.4 135 75 135cm
110 110 Fathers height: ____________
th
50
130 95kg Mothers height: ___________
th
25 Mid-parental Centile
105 105cm Plot the the Mothers and
125 4th
90
9th ty 0. Fathers heights on their
uber 99.6th
Pre-p respective scales and join the
120 d 85 two points with a line. The
2n
100 th mid-parental centile is where
.6 50kg
99 this line crosses the centile line
th
0.4 in the middle.
th 115 80
98 Compare the mid-parental
98th
Birth For all Children centile to the childs current
95 st 45
91 plotted in this height centile, plotted on the
centiles 110cm 75 adult height predictor centile
th
shaded area see
75 h instructions. scale.
Length .6t Nine out of ten childrens
99
th 70kg 91st 70
90 50 height centiles are within
40 two centile spaces of the
th mid-parental centile.
25
65 65
5566 h 75th Adult Height Predictor
99.6th 9t
h 98t
85 35 ft/in cm
98th
5544 60 60 59

Puberty starting before 8 years is precocious

Puberty is delayed if no signs are present by 13 years

Puberty completing after 16 years is delayed


2n
d 99.6th 175

t
91st

h
5522 50th
t

ig
75th
4t
h 91s 58 98th
50th 0. 55 55
5500 80 30
25th

9th
2nd
4488
4466
75th
50
99
.6
th

we 25th

50
57

56
91st 170

t
9th 75th

h
0.4th
75cm 50th 25

g
444cm
4cm 55 165

i
45 2nd 45 50th

e
25th

w
th 54
98 0.4th 25th
9th 40 40
20kg 20 53 160
2nd
th 9th
Weight 99.6 st
0.4th 91 52
98th
35 35
5 2nd
15 91st 15 h 51 155
99.6th 75t
98th 4.5 75th 30 30 0.4th
50th 50
91st
4 50th
25th
75th
9th
3.5 25 25th 25 411 150
50th 10 2nd 10
0.4th
25th 9th
3 Predicted Adult Height
9th 2nd Plot the most recent height
20 0.4th
20
2nd 2.5 centile on the relevant centile
0.4th 5 Age in years 5 Age in years line and
2kg Read off the predicted adult
1 1 1 1 1 1
15 15 height for this centile.
2 2 /2 3 3 /2 4 4 /2 5 5 /2 6 6 /2 7 7 /2 8 8 9 10 11 12 13 14 15 16 17 18
Four out of five children will
be within 6 cm of this value.
0kg 0kg 10kg 10kg