GROWTH MONITORING

What is Growing

Growth is the regular increase in size or weight of any living thing,

whether it is a plant, an animal or a human being. Regular and continuous
growth is the essence of health in early life of living objects. Optimal child
growth occurs only with adequate food, a caring, nurturing, social
environment and absence of illness, which provides full attention to the
growing baby.

What is Growth Monitoring

Growth monitoring consists of routine measurements to detect abnormal

growth, combined with some action when this is detected. Growth monitoring is
used to assess the growth rate of a child by periodic and frequent
anthropometric measurements in comparison to a standard.

Growth monitoring comprises:

1. measurement (the regular recording of a child's weight and sometimes their

height);

2. assessment (plotting weight against age or weight against height on a

growth chart;

3. analysis (interpreting the growth pattern of the child);

4. action related to the analysis (for example, counselling, providing

nutritional supplements or examining the child for disease)

Numerous countries still implement growth monitoring (GM) as their main community-based nutrition
activity. A health survey in 2003 showed that 154 countries worldwide used growth charts, with two-
thirds of the charts covering preschool-aged children. In the mid-1980s, several consultations
suggested that GM should be designed with additional promotional activities to become growth
monitoring and promotion (GMP.) GMP was envisioned as a cornerstone activity that would help
target at-risk children for secondary interventions, as a way of empowering caregivers and
households to take an active role in preventing malnutrition of their children, and as a way to
encourage the use of other services available through primary health clinics.

Differing opinions about the impact and outcomes of GM and GMP have led to different conclusions
from evaluations and assessments of community-based programmes including GM. This has led to
a relative lack of clarity and common ground in discussions about the value and place of GM and
GMP in addressing the problem of undernutrition in children.

*TYPES OF GROWTH MONITORING*

Growth monitoring is an important aspect of community health nursing as it helps to track the physical
and nutritional status of individuals, particularly children, and identify any potential health problems
early on. There are several types of growth monitoring that can be used, including:

Anthropometry: This type of growth monitoring involves measuring various body parts, such as height,
weight, and head circumference, to assess growth and development. This type of measurement
provides a quantitative assessment of an individual's growth and is useful for monitoring changes over
time.

They are noninvasive quantitative measurements of the body.

anthropometry provides a valuable assessment of nutritional status in children and

adults. Typically they are used in the pediatric population to evaluate the general
health status, nutritional adequacy, and the growth and developmental pattern of
the child. The core elements of anthropometry are

height, weight, head circumference, body mass index (BMI), body

circumferences to assess for adiposity (waist, hip, and limbs), and skinfold
thickness.
Body Mass Index (BMI): This is a measure of body fat based on height and weight. It is commonly used
to assess whether an individual is underweight, normal weight, overweight, or obese. This information is
important in determining the risk of health problems related to body weight, such as cardiovascular
disease, diabetes, and certain cancers.

Skinfold thickness measurements: This type of measurement involves using a caliper to measure the
thickness of a fold of skin at specific points on the body, such as the triceps or biceps. The thickness of
the skin fold is used to estimate body fat percentage, which can be used to assess the individual's
nutritional status.

Mid-upper arm circumference (MUAC): This measurement is used to assess the nutritional status of
individuals, particularly children. It involves measuring the circumference of the mid-upper arm and is a
quick and simple way to assess whether an individual is at risk of malnutrition.

Weight-for-age: This is a measure of growth that compares an individual's weight to the expected
weight for their age. It is commonly used to assess the growth of infants and young children and is a
good indicator of overall growth and development.

Height-for-age: This is a measure of growth that compares an individual's height to the expected height
for their age. It is used to assess whether an individual is growing at a normal rate and is a good
indicator of overall growth and development.

It's important to note that growth monitoring is not just limited to children, it can also be used to
monitor the growth and development of adults. For example, body composition analysis, such as dual-
energy x-ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA), can be used to assess body
fat percentage and muscle mass in adults.

Tools use in growth monitoring

1 . H e i g h t a n d W e i g h i n g scales: First and foremost, height and weight measurements are

the most commonly used tools for growth monitoring. A height board or a stadiometer is used to
measure the height of a child, while a scale is used to measure their weight. These two measurements
provide important information about the child’s overall growth and can be used to track changes over
time. They can also help determine if a child is underweight, overweight, or has a healthy weight for
their height.

2. Measuring tapes: A measuring tape is used to measure the circumference of a child’s head,
chest, and waist. These measurements provide insight into the child’s body shape and can help detect
any changes that may indicate an underlying health problem. For example, a sudden increase in the
circumference of a child’s head may indicate hydrocephalus, while an increase in the circumference of
their waist may indicate obesity.

3. Growth chart: A growth chart is a graphical representation of a child’s growth over time, based
on their height and weight measurements. It is used to track the child’s growth pattern and compare it
to the average growth pattern of other children their age. This can help identify any potential growth
problems early on and provide a basis for interventions if needed.

4. Nutrition assessment tool: This tool is used to assess a child’s dietary intake and determine if they
are getting the right nutrients to support their growth and development. For example, a food diary or a
24-hour recall can be used to determine if a child is consuming enough calcium, iron, and other essential
nutrients.
Determinants/Factors that measure Growth monitoring
Some of the most important factors influencing the growth and development are:

1. Genetic inheritance - especially height, weight, mental, social development

and personality.

2. Nutrition before and after birth - Retardation in an infant indicates

malnutrition.
3. Age - Growth rate is maximum during fetal life, first two years of life and
during puberty.

4. Sex - Men usually are larger in size than women. During puberty girls
grow fast and earlier than boys, but boys grow more.

5. Infections and infestations - Infection with TORCH during intrauterine life

retards growth of fetus. Recurrent infections like diarrhea and measles
especially in a malnourished child will adversely affect the growth.

6. Physical surroundings - Sun shine, good housing, lighting ventilation

have their effect on growth and development.

7. Psychological factors - Love, tender care and proper child parent

relationship are all found to influence growth in a child.

8. Economic factors - Higher the family income better is the nutritional status
of an infant.

9. Other factors - Birth order, Birth spacing, Education of parents (higher the
educational level better the growth).

Importances of Growth monitoring as an essential part of primary health care

● Provide an opportunity to prevent undernutrition before it occurs. GM helps

community
workers identify infants and children who have growth faltering (or are at risk
for faltering) and promotes timely actions to improve the situation within a
short time frame

● Assist in focusing attention and resources on children at risk.

● Motivate families and caregivers to change and improve practices.

● Help target and tailor counselling messages.

● Produce ancillary benefits. GM sessions provide opportunities for

immunisation, screening and treatment for diarrhoea, malaria, and
pneumonia, counselling on various health and

nutrition topics and the provision of other community-level health or

preventive services as needed.

● It aims to improve the nutritional status of children, and ultimately to

reduce mortality and morbidity in children under five years.

Community-based monitoring (CBM) is a process of gathering, analyzing and using

health information by community members to make informed decisions about their own
health and well-being. CBM plays a crucial role in community health nursing as it helps
identify health problems and needs in a community, monitor the implementation of
health interventions, and evaluate the impact of health programs.

In CBM, community members are trained to collect and analyze data on the health
status and needs of their community. The information gathered can include disease
outbreaks, mortality rates, and access to healthcare services. The data collected is then
used to develop and implement effective health interventions tailored to the specific
needs of the community.

One of the key advantages of CBM is that it empowers communities to take control of
their own health and well-being. CBM encourages community members to actively
participate in the health decision-making process, which leads to more effective and
sustainable health interventions. CBM also provides a more accurate and up-to-date
picture of the health situation in a community, compared to traditional health surveys
that rely on data collected by external sources.

Another benefit of CBM is that it helps identify health disparities and inequities within a
community. By collecting and analyzing data on the health status of different sub-groups
within a community, CBM can help identify and address health disparities that may not
be apparent through traditional health assessments.

In order for CBM to be effective, it is important to ensure the involvement and

participation of all members of a community, including women, children, and
marginalized groups. This requires the development of community-led monitoring
systems that are accessible, inclusive, and culturally sensitive.

In conclusion, community-based monitoring plays a crucial role in community health

nursing by empowering communities to take control of their own health, identifying
health disparities and needs, and ensuring the effective implementation and evaluation
of health interventions.q

Home-based growth monitoring :

To enable parents to measure their children’s height and monitor children’s physical growth at home, 3
pilot versions of a growth chart were locally developed and tested. All 3 poster prototypes showed the
height distribution for the WHO reference population. Specifically, for each age, the poster showed
whether the child was in the green [height-for-age z score (HAZ) > −1], yellow (−2 < HAZ < −1), or red
(HAZ < −2) zone. This color coding was adapted from midupper arm circumference (MUAC)
measurement tapes most parents reported to be familiar with in focus groups.

The first prototype illustrated growth trajectories through the use of a baobab tree; the second poster
illustrated growth through the use of maize stalks

Use of Technology in Growth Monitoring

Advances in knowledge and technology have created opportunities to help

monitor child growth.With the progress of information technology and the
prevalence of smartphones, an opportunity to improve the children health
services has been arisen.Smartphones have overcome the portability constraint of
personal computer systems and provided access to health information in
anywhere and at any time. Therefore, nowadays they have become a popular and
powerful platform for developing mobile health. Mobile health (m-health)
services lead to the early prediction and management of every abnormality or
disorder. In addition, using pervasive computing in healthcare systems reduces
costs and improves services for patients. Besides, doctors and nurses become
enabled to monitor and take care of patients in anywhere and at any time.

Some of these technologies include:

Mobile app for monitoring undernutrition in child

Mobile app for monitoring obesity in child

the “Vaccine Reminder” and “Child Vaccination Schedule” apps help parents to
schedule the vaccination program.Furthermore, there are other applications,
among which “Baby Development-Growth Log” is mainly intended to draw
growth charts. The “Child Growth Tracker” application is one of the top rated
Google Play apps for monitoring child growth. The app records the criteria for
height, weight, head circumference, and then shows the child’s growth status
from birth to age 20. The interesting point about this app is that the growth
charts change according to different geographical areas. For each geographical
location, it provides a graph related to that region. The “WHO growth standards”
app is provided to review children’s growth criteria based on WHO growth
standards. In this application, parents enter age, arm circumference, weight,
height, and head circumference; then, the child's growth status is shown.

ROLES OF SOME HEALTH CARE PROVIDERS IN GROWTH MONITORING.

Growth monitoring is a critical component of preventive care for children, and several healthcare
providers play important roles in ensuring that children receive regular assessments of their physical
growth and development. Some of the key roles that healthcare providers play in growth monitoring
include:

Pediatricians: Pediatricians are primary care physicians who specialize in the care of children. They are
responsible for conducting regular check-ups and monitoring a child's growth, including weight, height,
and head circumference measurements. They also provide guidance on nutrition and physical activity to
help children reach their full growth potential.

Family Physicians: Family Physicians are general practitioners who provide comprehensive care for
patients of all ages. They also play an important role in growth monitoring by performing regular check-
ups, measuring a child's height and weight, and assessing overall development.

Nurses: Nurses are an essential component of the healthcare team, and they play a vital role in growth
monitoring by taking accurate measurements of a child's height, weight, and head circumference. They
also assist with monitoring a child's overall health and providing educational resources to families.

Dietitians: Dietitians are experts in the field of nutrition and can play a crucial role in growth monitoring
by providing guidance on proper nutrition to support healthy growth and development. They may also
provide recommendations for supplements or special diets, if necessary.

Physical Therapists: Physical therapists can also play a role in growth monitoring by assessing a child's
motor development and making recommendations for physical activity to promote healthy growth and
development.

Overall, growth monitoring is a collaborative effort that requires the involvement of multiple healthcare
providers. By working together, healthcare providers can ensure that children receive the care they
need to reach their full potential.
Challenges and limitations associated with growth monitoring

1. lack of understanding on the part of health workers about the role of growth
monitoring;

many existing training methods only look at teaching the skills of growth
chart completion or checking it for errors;

2. lack of involvement of mothers in monitoring the growth and development of

their children;

3. lack of commitment of senior health personnel to the monitoring of

children's growth and development;

4. lack of planning and facilities when children with growth faltering are
detected
5. Inaccurate Measurements
6 . Limited Resources

7. Lack of Awareness

8. Cultural and Social Barriers

9. The birth weight is recorded for delivery at health facilities but seldom for home
delivery.

10. Special events witch may affect children growth are not recorded.

11. After the immunization cycle is completed, children are not taken anymore on a
monthly / two monthly bases making it difficult to plot their growth.

12. Very often nutrition counselling and health education is not given along the
weighing session due to lack of time and personnel.
Strategies for Improving Growth Monitoring

1. Education and Awareness Programs

2. Integration of Growth Monitoring into Community Health Programs

3. Partnership with Local Health Centers

4. Use of more technology

*CONCLUSION*

In conclusion, growth monitoring is a crucial aspect of community health nursing that plays a significant
role in the assessment and promotion of child growth and development. It involves the measurement
and tracking of various physical and physiological parameters that reflect the growth and development
of children. The importance of growth monitoring stems from its ability to detect early signs of
malnutrition, health problems and developmental delays, thereby enabling prompt intervention and
improvement in child health outcomes.

Healthcare providers play a critical role in growth monitoring as they collect and interpret data and
provide advice to families and communities on how to optimize child growth and development. There
are various types of growth monitoring programs, including home-based and community-based
monitoring, and different tools and assessment techniques are used, including anthropometric
measurements and growth charts. The use of technology in growth monitoring has the potential to
improve the accuracy and efficiency of data collection and interpretation.

However, growth monitoring also has its limitations and challenges, including the need for trained
personnel, cost, and the need to continuously update growth charts to reflect changing population
demographics. Despite these challenges, growth monitoring remains an essential aspect of primary
health care and holds promise for improving child health outcomes.

In the future, growth monitoring programs will continue to evolve and improve, leveraging technology
and innovative strategies to overcome the challenges and limitations. The ultimate goal of growth
monitoring remains to provide children with the best possible health outcomes and ensure their full
potential for growth and development. As such, growth monitoring will continue to be an essential part
of community health nursing and a key area of focus for healthcare providers.