Growth Patterns and Monitoring in Children

The  commonest  question  in  a  parents  mind  is –“Is my child growing well?”A growth  chartplotted at regular intervals is the simplest way to monitor the child’s growth i.e.for a parent to know whether their child is growing wellor there is some problem.

From  birth  to  3years  of  age,  the  baby’s  weight  ,  length  and  head  circumference  needs  to  be measured  and  entered  in  the  child’s  health  card    at  6weeks,  10  weeks,  14  weeks, 6months,  9months,  15  months,  18  months.  Thereafter  every  six  months,  between  the  age  of  3years  to  6years the weight and height should be measured every 6monthly. Beyond 6 years the BMI needs to be calculated every year.The calculation of BMI can be done by using the following formula:

BMI= Weight in kg/(Height in meters)²

Ideally  the  same  weight  and  height  scale  should  be used  for  these  measurements.  Head circumference should be measured by a trained health care worker.

These  measurements  are  to  be  plotted  on  a  growth  chart  to  observe  the  pattern  ofgrowth  and compare with the normal range of growth for same age and sex.These are also known as Road to Health charts.

Please  refer  to  the  icon  for  these  growth  charts.  There  are  a  number  of  curvy  lines  in  each  of these charts. These are reference lines for range of growth for children of our country. These are known as standard growth curves

The  area  between  the  lines -2  and  +2  (or  between  line  of  3  and  97  in  few  charts)  is  the  normal range for children in our country.If the child’s measurement falls in this area then the child is growing in the normal range for that age and sex, also known as the Road to Health. Any reading beyond the two lines is abnormal and needs to be discussed with the doctor.

The  curve  (i.e.  trend)  with  multiple  readings  gives  us  a  much  better  picture  about  the  child’s growth. Children who are growing normally follow a growth curve parallel to one of the standard growth  curves.  Weight  loss  or  failure to  gain weight can be identified by observing the child’s

growth curve over time. When weight “falters” or the growth curve “flattens” and is no longer parallel to the chart line this indicates the need for consulting a Pediatrician.

Refer and plot the child’s weight in the charts(annexed)and monitor your child’s growth.

Milestone Check Of Your Baby

Toy safety of your Baby

Guidelines of Toy safety

  • Give age appropriate toy to the child
  • Choose for your child toys which are well made
  • Avoid toys with sharp/cutting edges
  • Select toys which are washable and sturdy
  • Bring for your child bigger toys till the age of 3 years, so that all detachable parts of the toy are bigger than his mouth to prevent the possibility of choking if taken into mouth. Toy should be big but not heavy.
  • Don’t give balloons
  • Don’t give a toy with string or cord longer than 12 inches
  • Ensure that the colour used in the toys is non toxic
  • Avoid toys with small magnets 

Toys suiting different age Groups 

Newborn:

  • Hand held toys
  • Sensory toys
  • Activity center
  • Music player suitable for babaies
  • Wind Chimes
  • Light weight rattles 

3 to 6 months old:

  • Soft books with high contrast patterns
  • Soft stuffed animals
  • Activity bars
  • Unbreakable mirrors
  • Squeaky rubber toys
  • Board books
  • Coulorful teething rings 

6 to 9 months old:

  • Soft dolls or stuffed animals
  • Moving toys
  • Books
  • Busy Boards
  • Balls
  • Household items
  • Wood or soft blocks 

9 to 12 months old:

  • Shape sorter
  • Toy telephone
  • Push Toys
  • Balls
  • Books
  • Blocks 

12 to 18 months old:

  • Ride on vehicles
  • Large building blocks
  • Sorting and nesting toys
  • Push and pull toys
  • Climbing Gym
  • Balls
  • Picture books
  • Washable crayons and paper 

18 to 24 months old:

  • Puzzles
  • Large and small blocks
  • Toys to play house
  • Toy instruments
  • Train sets
  • Illustrated books and CDs
  • Balls
  • Child sized house hold equipments
  • Ride on toys
  • Washable crayons and paper
  • Art supplies
  • Construction toys 

30 to 36 months old:

  • Beginning board or memory games
  • Kid size dishes, pots and pans
  • Puzzles
  • Art supplies
  • Construction sets
  • Books
  • Outdoor equipments

Is This Normal or Abnormal?

Introduction

Parents probably receive a lot of advice and tips about taking care of your baby. The best person to ask is the pediatrician who shall give you appropriate advice. Avoid following advice given by non medical neighbors and relatives. Avoid self medication except giving paracetamol for fever.

A parent should always remember that each baby is unique and has its own pattern of growth and development, feeding habits and personality. Hence there is a range of normal growth and development. Parents should know about this range and monitor for the abnormal warning signs. As each baby is different, avoid comparing them with other’s children and getting upset when someone else does it. Whenever in doubt, consult a Pediatrician.

Enjoy your baby’s development with calmness and patience. It is seen that calm parents have a calm and happy baby while anxious parents have fussy babies.

Common issues during first few months of life

  1. A Crying Baby- Most parents get very perturbed whenever the baby starts crying and try to relate the crying to a medical condition. Crying is the baby’s way of talking and communicating in the first six months of his/her life. Crying is not always a sign of hunger. Parents need to calmly try to understand this crying language and decipher the baby’s needs.

    When does a baby normally cry?
    -  When the baby is hungry
    -  When the baby is wet due to urine or stool
    -  When the body temperature of the baby is hot or cold (too much or less clothing)
    -  When the baby wants company or change of environment (cuddle the baby and take it to another room)
    -  When the baby is sleepy (sing to the baby)
    -  When the baby has colic (burping after feeds and positioning baby on its stomach with head to the side)

    Abnormal crying is seen when
    -  baby is sick ie baby not sucking well/inconsolable/ repeatedly vomiting/ has fast breathing/ fever ≥ 38°C/ earache/has not passed urine for 8 hrs/ has loose motions with blood. These are called danger signs and parents should seek immediately medical help.
  2. Breast engorgement in baby- do not squeeze it. It will subside after a few days. It happens due to maternal hormones present in breast milk.
  3. Bleeding per vagina in a baby girl- Again due to maternal hormones in breast milk , usually subsides in 4 days. If it continues seek medical help.
  4. Vomiting- All babies normally bring out a small amount of curd like liquid after feeds. This reduces if baby is burped properly after feeds for at least 10 minutes. If baby keeps bringing out milk as it is, it is vomiting and parents need to seek medical help especially if baby is not gaining weight. Avoid overfeeding / feeding when baby is not hungry.
  5. Baby Feeding Adequately or not- If baby is passing urine 6-8 times a day, gaining weight and sleeping well then baby is getting adequate milk. Most babies sleep through the day and keep awake through the night. They follow a routine of feeding, passing urine and sleeping. It’s by three months that baby remains awake for sometime during the day and starts sleeping for longer durations at night.
  6. Constipation- baby can pass stools once in 3-4 days. Consult Pediatrician if baby passes hard stools or baby has blood in stools or regularly passes stools once in 5days or more.
  7. Infant Colic- This usually starts to occur after two months of age, usually in the evenings between 6pm -11pm.

    Preventive measures
    a) Proper attachment of baby to the breast so that milk and not air is sucked by baby. Please refer to Breast feeding Guide for more details.
    b) Burping after feeds for 10min. Place the baby on its stomach with head turned to the side. This should be done after one hour of feeding to avoid baby throwing up milk. Gas production in baby is not due to mother eating heavy/ oily food items. It is due to improper breast feeding, excessive crying in baby or improper positioning of bottle wherein baby takes in a lot of air.
    Repeated episodes of colic with change in stool consistency/ vomiting / abdominal distention/ not gaining weight are danger signs. Immediately show the baby to pediatrician.
  8. Fever- Parents should always use a thermometer to measure temperature and fever. Keep the thermometer in the armpit for 3-5 minutes, never put it in the mouth. Fever is body temperature ≥ 100°F. Too many warm clothes can also raise the body temperature. Immunization does cause fever for 48 hrs but any fever beyond 48 hrs is abnormal.
    Fever is usually due to infection and parents must consult a pediatrician immediately. Do not insist on getting medication on phone without doctor having seen the baby except for dose of paracetamol and ORS.
  9. Diarrhoa- This is passing loose watery stools frequently or change in frequency and/or consistency of stools.
    Normally a newborn baby passes blackish green stools for first few days of life. Thereafter the babies pass golden yellow colored sticky stools about 6-8 times a day. Diarrhoea in a baby less than four months is usually a sign of sepsis (severe infection) and baby has one or more danger signs along with diarrhea. Danger signs such as poor sucking / lethargy in baby/ thirsty baby /sunken eyes / blood in stools/ repeatedly vomiting/ not passed urine for 8hrs/ abdominal distension, indicate baby needs immediate hospitalization.
    At 3-4 months the baby’s stool frequency settles to about 2-3 times a day. Hence beyond 3 months of age, diarrhoea is loose stools with a frequency more than 4 times a day. Oral rehydration solution and Zinc is the treatment. Consult your doctor for dosing.

    Preventive measures for Diarrhoea
    -  Should wash hands before feeding or touching the baby.
    -  immunization with Rota virus vaccine
    -  Exclusive breast feeding. Avoid bottle feeding. Prefer feeding by katori. Bottle feeding requires intensive sterilization measures.
  10. Jaundice- jaundice is common in the newborn. It usually starts on 3rd day and subsides by 7-10 days. Jaundice can be prolonged in sick babies, premature and small babies.

    Danger signs for jaundice which require urgent attention are
    -  Early jaundice within 24 hrs of birth
    -  Hand and feet also stained yellow
    -  Baby passing white stools
    -  Yellow eyes beyond 3weeks of age 

FAQs asked during first two years of a baby’s life

  1. Which is the ideal sleeping position for the baby, on their back or on their tummy?
    Research shows that the back sleep position is the safest for babies. The back sleep position carries the lowest risk of SIDS. Babies who sleep on their backs are less likely to get fevers, stuffy noses, and ear infections. The back sleep position makes it easier for babies to look around the room and to move their arms and legs.
    The baby can be also put on their stomach when he / she is awake and when someone is watching over. This should be done at least an hour after feeding to avoid vomiting. Supervised Tummy Time helps strengthen your baby's neck and shoulder muscles, develop motor skills, prevent flat spots on the back of the head and reduce colic and gassiness. Pressure on the same part of the baby's head can cause flat spots. Such flat spots are usually not dangerous and typically go away on their own once the baby starts sitting up. The flat spots also are not linked to long-term problems with head shape. Making sure your baby gets enough Tummy Time is one way to help prevent these flat spots.
  2. Why do babies wake so often at night?
    Newborns wake up approximately every 2 hours around the clock, whether they are fed by breast or bottle. Their tummies are tiny. Hence babies must feed frequently, even at night, to get enough calories to sustain their rapid growth rate. As they grow, babies can drink more at one time and sleep better.
    Young babies wake easily because they dream a lot. Dreaming is a part of normal brain development. Babies may spend up to 30 minutes dreaming before they fall into deep sleep. By the time the baby is 3–4 months old, it will spend less time dreaming, and more time in deep sleep. Young babies wake frequently to stay safe and comfortable. Most babies will sleep through the night by 6–9 months of age.
    Baby’s frequent waking through the night can be very challenging for parents. Parents should be prepared for this sleep deprivation and take good care of their diet, rest and ask baby’s grandparents for help.
  3. Is my baby growing well?
    Baby loses weight in the first few days of life and usually reaches its birth weight by 10th -14th day. Thereafter it should gain about 20- 30grams a day. Baby should double its birth weight by 4 months and should be at least three times its birth weight by one year of age. During the second year of life the child usually gains about 2-3 kgs. Ask your doctor to plot the height and weight of the baby on the Road to health charts usually present in the immunization cards. This chart will tell you about your baby’s growth.
  4. Eruption of Milk Teeth-
    Milk Teeth usually erupt between 6months to ten months. Teething requires no medication. Baby gets relief by massage of gums with coconut oil. Encourage the baby to chew on long fingers of cucumber/carrot/toast/roti. Clean teeth with a soft muslin cloth. Avoid giving milk/ bottle feeding while sleeping as it leads to unhealthy eruption and caries. Start using a soft baby toothbrush without paste by ten months of age. Teach baby to brush his/her teeth twice a day, before sleeping and in the morning. Teeth if not erupted beyond 10 months, please consult a pediatrician.
  5. Potty training and Diapers-
    Preferably avoid diapers. Use cotton nappies. Take baby to toilet to pass urine as soon as baby wakes up. Once baby is able to sit without support baby’s potty training can start. The baby can be made to sit on a plastic infant potty in presence of a parent. Ensure that baby sits on potty daily for about 15min after having its first feed. Gradually the baby will learn to go to the potty for both urine and stool. Few parents continue to regularly use diapers for their convenience. A baby will not get toilet trained if diapers are used regularly.
  6. Is my child developing normally?
    There is a range of age at which babies attain each mile stone. Also premature babies may achieve milestones as per their maturity than as per age in months. Discuss this with your doctor if your baby is premature.
    Red Flag Signs denoting delay are as follows
    At 6weeks - no eye contact, no smile,
    At 4months - no head control
    At 6 months - Does not reach out for objects, Floppy baby, no response to sound, Poor social response to people
    At 9 months - Unable to sit without support, fisting persists.
    At 12months - Unable to stand with support
    At 18months – Unable to speak single word with meaning
    At 2years - unable to walk without support
    If any of these red flag signs are present, your baby needs urgent Pediatric consultation.
  7. Is Immunization essential for my baby?
    Baby is susceptible to infections as the body defense mechanism is still building up. Immunization during the first few years of life is essential to protect baby from life-threatening infections. No vaccine provides 100% protection, though most of the vaccines do give high degree of protection. Vaccines significantly decrease chance of disease and even partial protection is useful to prevent complications.