Quality standard

Quality statement 1: Measurement of growth

Quality statement 1: Measurement of growth

Quality statement

Babies and preschool children have their measurements plotted on a growth chart if there are concerns about faltering growth.

Rationale

It is important that all babies and preschool children have their measurements plotted on a growth chart. If concerns are raised about the growth of a baby or preschool child, regular measurement and plotting of their weight and length or height on the UK–WHO growth chart in their personal child health record ('red book'), or electronic equivalent, can confirm whether their growth is faltering. Early identification of faltering growth in a baby or preschool child enables a management plan to be developed promptly to improve their growth.

Quality measures

Structure

a) Evidence of local arrangements to ensure that primary and community healthcare professionals are trained to weigh and to measure the length or height of babies and preschool children and plot this information on the UK–WHO growth chart.

Data source: Local data collection, for example training records.

b) Evidence of local arrangements to ensure that calibrated equipment is available for primary and community healthcare professionals to weigh babies and preschool children.

Data source: Local data collection, for example equipment servicing records.

c) Evidence of local arrangements and protocols to ensure that babies and preschool children are weighed and measured at each of the mandated health visiting team contacts.

Data source: Local data collection, for example from service specifications or local protocols.

Process

a) Proportion of babies and preschool children whose weight and height or length measurements are plotted on the UK–WHO growth chart during each of the mandated health visiting team contacts if there are concerns about faltering growth.

Numerator – the number in the denominator whose weight and height or length measurements are plotted on the UK–WHO growth chart at every mandated health visiting contact.

Denominator – the number of babies and preschool children in whom there are concerns about faltering growth.

Data source: Local data collection, for example local audit of patient records.

b) Proportion of babies and preschool children whose weight and height or length measurements are plotted on the UK–WHO growth chart at appropriate intervals if there are concerns about faltering growth.

Numerator – the number in the denominator whose weight and height or length measurements are plotted on the UK–WHO growth chart at appropriate intervals.

Denominator – the number of babies and preschool children in whom there are concerns about faltering growth.

Data source: Local data collection, for example local audit of patient records.

What the quality statement means for different audiences

Service providers (such as community maternity services, GP practices and health visiting services) ensure that calibrated equipment is available for all babies and preschool children to be weighed, and that staff are trained to weigh and measure them. They ensure that processes are in place for babies and preschool children to be weighed and measured at appropriate intervals if there are concerns about faltering growth. Services ensure that community and primary healthcare professionals are trained to plot the measurements on the UK–WHO growth chart and to recognise faltering growth in babies and preschool children.

Healthcare professionals (such as health visitors, community midwives, GPs and practice nurses) weigh and measure babies and preschool children and plot this information on the UK–WHO growth chart. If parents or carers raise concerns about faltering growth, or healthcare professionals have concerns about this, they weigh and measure babies and preschool children at appropriate intervals.

Commissioners (such as clinical commissioning groups and local authorities) ensure that they commission services in which babies and preschool children are weighed and measured, and these measurements are plotted on the UK–WHO growth chart if there are concerns about faltering growth.

Babies and preschool children whose growth raises concerns are weighed and measured regularly by a midwife, health visitor, GP or practice nurse. Their measurements are recorded on their growth chart. If the measurements show that the baby or preschool child is not growing as expected (faltering growth), steps can be taken to help improve their growth.

Definitions of terms used in this quality statement

Measurements

The measurements taken are the weight and the length (under 2 years of age) or height (2 years or older) of babies and preschool children. [Adapted from NICE's guideline on faltering growth: recognition and management of faltering growth in children, recommendation 1.2.2 and terms used in this guideline]

Concerns about faltering growth

This can include healthcare professionals being concerned about a baby or preschool child's growth, for example if they, or the parents or carers, think the baby or preschool child appears to be:

  • not feeding or eating

  • not growing as expected

  • thin or unwell.

Healthcare professionals may also have concerns about faltering growth in babies and preschool children if:

  • they lose more than 10% of their birthweight in the early days of life

  • they do not return to their birthweight by 3 weeks of age

  • there is a fall across 1 or more weight centile spaces, if birthweight was below the 9th centile

  • there is a fall across 2 or more weight centile spaces, if birthweight was between the 9th and 91st centiles

  • there is a fall across 3 or more weight centile spaces, if birthweight was above the 91st centile

  • the current weight is below the 2nd centile for age, whatever the birthweight.

[NICE's guideline on faltering growth: recognition and management of faltering growth in children, recommendations 1.1.5 and 1.2.1 and expert opinion]

Appropriate intervals

If there are concerns about faltering growth, weight is measured at appropriate intervals taking account of factors such as age and the level of concern, but usually no more often than:

  • daily up to 1 month old

  • weekly between 1 and 6 months old

  • fortnightly between 6 and 12 months old

  • monthly from 1 year old.

If there are concerns about faltering growth, length or height is monitored no more than once every 3 months. [Adapted from NICE's guideline on faltering growth: recognition and management of faltering growth in children, recommendations 1.1.5, 1.2.27 and 1.2.30]