|
|
|
Indian Pediatr 2020;57: 997-998 |
 |
Pediatrician-Friendly IAP Growth Charts for
Children Aged 0-18 Years
|
|
Bakul Jayant Parekh 1*
and
Vaman Khadilkar2
1President, Indian Academy of Pediatrics 2020, and
2Convener, IAP Growth Chart Committee 2015.
Email: [email protected]
|
|
Growth is the fundamental physiologic process that characterizes
childhood. Secular trends in growth patterns are followed as
indicators of children’s health on a population level. Growth
can be worrisome along two variables: height (short stature) and
velocity (growth failure). Anthropometry is an invaluable tool
in the hands of a pediatrician to monitor growth. We must get
into the habit of regularly plotting these anthropometric data
on the appropriate growth chart until the age of 18 years, as
this will help in picking up the reason for failure to thrive
early and thereby help to reduce expensive investigations.
Growth charts are invaluable tools in the
assessment of childhood nutrition and growth. Indian Academy of
Pediatrics (IAP) produced and recommended IAP 2015 Growth charts
for monitoring Indian children between the ages of 5 and 18
years, and recommended simplified World Health Organization
(WHO) growth charts for monitoring of children under the age of
five years. A combined WHO-IAP height and weight chart allows us
to monitor growth from birth to 18 years on a single chart, and
the relation between the child’s height and the mid-parental
height (MPH) can be readily observed on the same chart even for
children younger than 5 years, which is not possible on the
split chart (separate charts for under-5 and older children).
IAP 2015 body mass index (BMI) charts were
designed to define overweight and obesity at 23 kg/m 2
and 27 kg/m2
adult-equivalent BMI cut-offs, and overweight and obese lines
were color coded as orange and red, respectively. However,
deriving BMI involves a calculation (weight in kg/height in
meters squared) which takes time and hence is often omitted by a
busy practitioner. Prevalence of overweight and obesity
increases in children as they get older, especially beyond the
age of 8 years. A quick BMI screening tool based on weight for
height that eliminates the need to calculate BMI will help to
rapidly decide if a child is overweight, obese, normal or
underweight. The tool has three lines which depict obese (OB),
overweight (OW) and underweight (UW), the overweight line is
orange and obese line is red (same color code as the IAP BMI
charts). Based on where the child’s weight lies on y axis for
the height on x axis, the child can be classified as having BMI
within the normal range (between UW and OW lines), overweight
(between OW and OB lines), obese (above the OB line) or
underweight (under the UW line).
MPH is necessary to understand a child’s
genetic potential so that the current height percentile can be
checked against MPH percentile. MPH is based on parents’
heights, but again involves a calculation and plotting at 18
years to know the mid parental percentile. MPH calculation is
gender-specific and the formula is father’s height+mother’s
height divided by 2, and then subtract 6.5 cm for a girl or add
6.5 cm for a boy. Pediatricians find this cumbersome and hence
MPH assessment often gets omitted. Here we present a MPH
percentile lookup tool which was designed in such a way that by
joining the father’s height on left to the mother’s height on
the right (both in cm) gives the MPH percentile (on the middle
line) for that specific gender e.g., joining mothers’
height of 150 cm to father’s height of 170 cm gives an
approximate value of 25 th
percentile of MPH on both scales. Using formula for a boy the
MPH is 166.5 cm and for a girl it is 154.5 cm. These correspond
to 25th percentile
of height both for boys and girls at 18 years, confirming the
accuracy of the lookup scale.
We present user-friendly growth charts for
everyday use by pediatricians (charts available at
https://iapindia.org/pdf/4422_Pediatrician-friendly-growth-charts-for-0-18-year-old-Indian-children-Dr-Bakul-Parekh-and-Dr-Vaman-khadilkar.pdf).
No calculations are involved while using these charts, neither
for BMI nor for MPH. In a busy clinic, lesser the calculations
the pediatrician performs, the better. Both these important
parameters can be read-off directly from the tools provided on
the chart.
An important reason for the popularity of
United Kingdom Royal College of Paediatrics and Child Health
(RCPCH) growth charts is that along with the standard percentile
lines, many tools such as the MPH percentile calculator, lower
percentile lines and BMI z score look up tool are provided,
which eliminate calculations. No such attempt has been made to
incorporate all these tools in the IAP growth charts so far;
although, it is the need of the hour. We believe that this need
will be fulfilled by these user-friendly charts.
The percentile curves for height and weight
in children below the age of 1 year are placed too close
together, making it cumbersome to plot and despite using
statistical smoothing, a small blip is evident at junction of 5
years (where WHO and IAP charts meet). We hope to improve these
shortcomings in future charts.
References
1. Khadilkar V, Yadav S, Agrawal KK, et al. Revised IAP growth charts for height, weight and
body mass index for 5-to 18-year-old Indian children. Indian
Pediatr. 2015;52: 47-55.
2. WHO Multicentre Growth Reference Study
Group, de Onis M. Enrolment and baseline characteristics in
the WHO Multicentre Growth Reference Study. Acta Paediatr.
2006;95:7-15.
3. Expert Panel on Integrated Guidelines
for Cardiovascular Health and Risk Reduction in Children and
Adolescents; National Heart, Lung, and Blood Institute.
Expert Panel on Integrated Guidelines for Cardiovascular
Health and Risk Reduction in Children and Adolescents:
Summary Report. Pediatrics. 2011;128:S213-56.
4. Khadilkar V, Lohiya N, Chiplonkar S,
Khadilkar A. Body mass index quick screening tool for IAP
2015 growth charts. Indian Pediatr. 2020;57:904-6.
5. Wright CM, Williams AF, Elliman D, et al.Using the
new UK-WHO growth charts. BMJ. 2010;340:c1140.
|
|
|
 |
|
