Measurement 11
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Please place sticker if available, otherwise write in space provided.
Name …………………………………………………………………………
NHI No ………………………………………………………………………
Date of birth ……………………………………………………………
When to measure
Length or height should be measured at each Well Child/
Tamariki Ora check or whenever there are any worries
about a child’s weight gain, growth or general health.
Head circumference should be measured to age 1.
Plotting measurements
For babies born at term (37 weeks or later), plot each
measurement on the relevant chart by drawing a small
dot where a vertical line through the child’s age crosses
a horizontal line through the measured value. The
lettering on the charts (‘weight’, ‘length’ etc.) sits on the
50th centile, providing orientation for ease of plotting.
Plot birth weight (and, if measured, length and head
circumference) at age 0 on the 0–1 year chart. The
coloured arrows at age 0 represent UK birth weight data
and show the child’s birth centile.
Weight gain in the early days varies a lot from baby to
baby, so there are no lines on the chart between 0 and 2
weeks. However, by 2 weeks of age most babies will be
on a centile close to their birth centile.
For preterm infants, use a separate low-birthweight
chart for infants of less than 32 weeks gestation and any
other infant requiring detailed assessment. For healthy
infants born from 32 weeks and before 37 weeks, plot
all measurements in the preterm section (to the left of
the main 0–1 year chart) until 42 weeks gestation, then
plot on the 0–1 year chart using gestational correction,
as shown below.
The preterm section can also be used to assess the
relative size of infants at the margin of ‘term’ (eg, 37
weeks gestation), but these measurements should also
be plotted at age 0 on the 0–1 year chart.
Gestational correction
Plot measurements at the child’s actual age and then
draw a line back the number of weeks the infant was
preterm. Mark the spot with an arrow: this is the child’s
gestationally corrected centile. Gestational correction
should continue until one year for infants born 32 to 36
weeks and two years for infants born before 32 weeks.
Centile terminology
Interpreting the chart
Assessing weight loss after birth
Most babies lose some weight after birth, but 80% will have
regained this by 2 weeks of age. Careful clinical assessment
and evaluation of feeding technique is indicated when weight
loss exceeds 10% or recovery of birth weight is slow.
Percentage weight loss can be calculated as follows:
Weight loss = current weight – birth weight
Percentage weight loss = Weight loss
x 100%
Birth weight
For example, a child born at 3.500kg who drops to 3.150kg at 5 days
has lost 350g or 10%; in a baby born at 3.000kg, a 300g loss is 10%.
What do the centiles mean?
A single point on these charts indicates a child’s size compared
with children of the same age and maturity who have shown
optimum growth. When there is more than one point, the
chart shows how quickly a child is growing. The centile lines
on the chart show the expected range of weights and heights
(or lengths); each describes the number of children expected
to be below that line (eg, 50% below 50th, 91% below the
91st). Children come in all shapes and sizes, but 99 out of 100
children who are growing optimally will be between the two
outer lines (0.4th and 99.6th centiles); half will lie between the
25th and 75th centile lines.
Being very small or very big can sometimes be associated with
underlying illness. There is no single threshold below which
a child’s weight or height is definitely abnormal, but only 4
per 1000 children who are growing optimally are below the
0.4th centile, so these children should be assessed at some
point to exclude any problems. Those above the 99.6th centile
for height are almost always healthy. Also calculate BMI
for children over 2 if weight and height centiles appear very
different (more than two centile lines different).
What is a normal rate of weight gain and growth?
Babies do not all grow at the same rate, so a baby’s weight often
does not follow a particular centile line, especially in the first year.
Weight is most likely to track within one centile space (the gap
between two centile lines, see diagram). In infancy, acute illness
can lead to sudden weight loss and a weight centile fall but on
recovery the child’s weight usually returns to its normal centile
within 2–3 weeks. However, a sustained drop through two or more
weight centile spaces is unusual (fewer than 2% of infants) and
should be carefully assessed by the primary care team, including
measuring length/height.
Because it is difficult to measure length and height accurately in
pre-school children, successive measurements commonly show
wide variation. If there are worries about growth, it is useful to
measure on a few occasions over time; most healthy children will
show a stable average position over time. Head circumference
centiles usually track within a range of one centile space. After
the first few weeks a drop or rise through two or more centile
spaces is unusual (fewer than 1% of infants) and should be
carefully assessed.
Why do the length/height centiles change at 2 years?
The growth standards show length data up to 2 years of age, and
height from age 2 onwards. When a child is measured standing
up, the spine is squashed a little, so their height is slightly less
than their length; the centile lines shift down slightly at age 2 to
allow for this. It is important that this difference does not worry
parents; what matters is whether the child continues to follow the
same centile after the transition.
Health Professionals’ Notes
Boys New Zealand – World Health
Organization Growth Chart 0–5 Years
Predicting adult height
(Note that this is in the Health Professionals’ Notes, but not the
Well Child/Tamariki Ora Healthbook.)
Parents like to know how tall their child will be as an
adult. The child’s most recent height centile (aged 2–5
years) gives a good idea of this for healthy children.
Plot this centile on the adult height predictor to the
right of the height chart to find the average adult height
for children on this centile. Four out of five children will
have adult heights that are within 6cm above or below
this value.
Weight–height to BMI conversion chart
BMI indicates how heavy a child is relative to his or her
height and is the simplest measure of underweight
or overweight from the age of 2, when height can be
measured fairly accurately. This chart
3
provides an
approximate BMI centile, accurate to a quarter of a
centile space.
Date
Age
BMI Centile
Instructions for use
1. Read off the weight and height centiles from the growth chart.
2. Plot the weight centile (left axis) against the height centile
(bottom axis) on the chart above.
3. If between centiles, read across in this position.
4. Read off the corresponding BMI centile from the slanting lines.
5. Record the centile with the date and child’s age in the data box.
Interpretation
In a child over 2 years of age, the BMI centile is a better
indicator of overweight or underweight than the weight
centile; a child whose weight is average for their height
will have a BMI between the 25th and 75th centiles,
whatever their height centile. BMI above the 91st
centile suggests that the child is overweight; a child
above the 98th centile is very overweight (clinically
obese). BMI below the 2nd centile is unusual and may
reflect undernutrition.
References
1. www.who.int/childgrowth/en
2. Cole TJ, Freeman JV, Preece MA. 1998. British 1990 growth reference
centiles for weight, height, body mass index and head circumference
fitted by maximum penalized likelihood. Stat Med;17:407–29.
3. Cole TJ. 2002. A chart to link child centiles of body mass index, weight
and height. Eur J Clin Nutr;56:1194–9.
This information is based on original materials developed by
and copyright © 2009 Royal College of Paediatrics and Child
Health, United Kingdom. It was adapted by the New Zealand
Ministry of Health in July 2010.
Who should use this chart?
Anyone who measures a child, and/or plots or interprets
charts, should be suitably trained or be supervised by
someone qualified to do so. For further information
and training materials see www.moh.govt.nz/wellchild
and www.growthcharts.rcpch.ac.uk
A growth chart for all children
This chart, which is suitable for use with New Zealand
children up to age 5 years, combines World Health
Organization (WHO) standards with United Kingdom
preterm and birth data. The chart from 2 weeks to 5
years of age is based on the WHO growth standard,
derived from measurements of healthy, non-deprived,
breastfed children of mothers who did not smoke.
1
The
chart for birth measurements (32–42 weeks gestation)
is based on British children measured around 1990.
2
The charts depict a healthy pattern of growth that is
desirable for all children, whether breastfed or formula
fed, and of whatever ethnic origin.
Weighing and measuring
Weight: use only clinical electronic scales in metric
setting. For children up to 2 years, remove all clothes
and nappy; children older than 2 years should wear
minimal clothing only. Always remove shoes.
Length: (before 2 years of age): proper equipment is
essential (length board or mat). Measurers should be
trained. The child’s shoes and nappy
should be removed.
Height: (from 2 years):
use a rigid rule with T
piece, or stadiometer;
the child’s shoes
should be removed.
Head circumference: use a narrow
plastic or paper tape to measure where
the head circumference is greatest.
Any hat or bonnet
should be removed.
Be aware of cultural
issues around
touching heads.
When to weigh
Babies should be weighed in the first week as part of the
assessment of feeding. Recovery of birthweight usually
occurs by 10 to 14 days, and indicates that feeding is
effective and that the child is well. Once feeding is
established, babies should usually be weighed at the
time of routine checks. If there is concern, weigh more
often; however, weights measured too close together
are often misleading, so babies should not be routinely
weighed more frequently than at each Well Child/
Tamariki Ora check.
Data Recording (continued)
Measurement 12
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 13
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 14
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 15
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 16
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 17
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 18
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
2 4 6 8 10 12 14 16 18 20 24 26 28 30 32 34 36 38 40 42 44 46 48 50
16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50
99.6th
98th
91st
75th
50th
25th
9th
2nd
0.4th
Weight (kg)
1 2 3 4 5 6 7 8 9 10 11
Age in weeks/ months
Age in weeks/ months
22
2 4 6 8 10 12 14
3 4 5 6 7 8 9 10 11
52
52
13.5
13
12.5
12
11.5
11
10.5
10
9.5
9
8.5
8
7.5
7
6.5
6
5.5
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
0
13
12.5
12
11.5
11
10.5
10
9.5
9
8.5
8
7.5
7
6.5
6
5.5
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
1 2
Actual age
Gestational age
(7 weeks preterm)
If the point is closer than ¼ of a centile
space from a centile line they are
described as being on that centile.
If not they should be described as
being between the two centiles:
e.g, 75th
–
91st.
A centile space is the distance between
two of the centile lines, or equivalent
distance if midway between centiles.
Plotting for preterm infants
(less than 37 weeks gestation):
Draw a line back the number of
weeks preterm and mark spot
with arrow.
BMI =
weight in kg
BMI = (height in m)
2
Weight Centile
99.6
98
91
75
50
25
9
2
0.4
BMI Centile
99.6
98
91
75
50
25
9
2
0.4
Height Centile
0.4 2 9 25 50 75 91 98 99.6
Very Overweight (Obese)
Overweight
July 2010 Code HP5141
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