This section looks at feasible ways to timely detect and refer children with malnutrition from primary health care units and communities.
Growth Monitoring Chart
- Plotting the Weight on the Growth Monitoring Chart
- Interpretation of good or bad Growth
- Challenges with the Growth Monitoring Chart
Detection and Referral of Children with Acute Malnutrition
- Screening for Acute Malnutrition
- Interpretation of Mid-Upper Arm Circumference (MUAC) indicators
- Setting up a referral system for Acute Malnutrition (community and facility level)
- MUAC Resources
Detection and Referral of Micronutrient Deficiencies
- Clinical Signs of Iron Deficiency Anaemia, Vitamin A Deficiency and Iodine Deficiency Disorders
- Detection and Referral of Severe Anaemia
Growth Monitoring Chart
Plotting the weight on the Growth Monitoring Chart
 | Growth Monitoring Chart Click for larger images: Small | Medium | Large Download  pdf to view/print |
Three steps for appropriate plotting include:
- Find the child's age on the chart
- The first box called "Born" on the horizontal axis should be filled with the name of the month the child was born (i.e. March). All the other boxes should be filled with the subsequent months (i.e. April, May, June, etc). Based on the month, mark a straight dotted line up the middle of the column.
- Find the child's weight on the chart.
- The vertical axis of the growth chart indicates the weight of the child in kilos. Based on the child weight, follow the horizontal faint line across corresponding to the child weight (to the nearest 100g) across the card until it crosses the right month column. Put a dot in the middle of the column representing the month of weighing.
- Draw the Growth Curve.
- Draw a line from the previous dot, if any, to the new one to make the child's growth curve.
Interpreting Good or Bad Growth
Good Growth
- The child has gained enough weight if the curve is going up and the slope is parallel to one of the reference curves.
- Even if the child is small, the growth curve should still go up and should be parallel to one of the reference curves to show the child is growing well.
- If the child has missed one growth monitoring session, the "At 60 days" column of the Table of Minimum Expected Weight Gain should be used to calculate the child's expected weight, based upon his/her weight of two months before. The child's growth will be classified as adequate or inadequate.
- If the child has missed two or more growth monitoring sessions, the child's weight should be plot on the growth card but it can not be joint with the previous dot. The "Adequate growth" can be assessed only in the next month.
Bad Growth
- The child growth is static if the curve is flat. This is a dangerous sign that need to be further investigated.
- The child has lost weight if the child's growth curve shows a downward direction.
- The child's growth is slowing and the weight gain is less than expected if the curve is less steep than the reference curve.
Using the Table of Minimum Expected Weight Gain
- Every child, whether big or small, should gain a known amount of weight each month if she/he is growing well.
- The table of expected minimum weight gain gives the expected weights after one month and after two months. It is useful to check on a child's growth to determine whether a child has gained an adequate amount of weight or not.
- Children should be referred for suspected acute malnutrition in the following cases:
- They do not gain weight for more than two months.
- They are losing weight.
- They are falling below the bottom line:
Challenges with the Growth Monitoring Chart
- The birth weight is recorded for delivery at health facilities but seldom for home delivery.
- The date of the weighing and the weight of child are not always recorded.
- The weight is not always plotted in the chart.
- Special events witch may affect children growth are not recorded.
- After the immunization cycle is completed, children are not taken anymore on a monthly / two monthly bases making it difficult to plot their growth.
- Very often nutrition counselling and health education is not given along the weighing session due to lack of time and personnel.
- Even if the weight-below-the-curve indicates suspicion of acute malnutrition, it is not a diagnostic feature.
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