56cm 54 52 50 48 46 44 42 40 38 36 34 32 30 28 26 24 22cm 32cm 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16cm 2000g 1800 1600 1400

UK-WHO Chart 2009 DH Copyright 2009 Harlow Printing Limited Tel: 0191 455 4286 www.healthforallchildren.co.uk

GIRLS
24 25

24

28

29

30

31

32

33

34

35

36

37

38

39

40

41

Gestational age in weeks

23 to 42 weeks gestation
26
99.6th 98th

91st 75th

h t g len
d a e

42 54cm 52 50 48 46 44cm 38cm

72cm 70 68 66 64 62 60

GIRLS
3 4 5

8 2

10

11

12

13 3

14

15

16

17 4

18 )

19

20

21 5

22

23

24

25
99.6th
98th

26 6 70cm 68 66 64 62 60 58 56cm 46cm 45 44 43 42 41 40 39 38 37 36cm

Data Recording
Measurement 1
Recording Date Weight Head Circumference Length/Height Location Health worker name

2 weeks to 6 months
6

Corrected age post-term in weeks (calendar months

91st
75th

99.6th
98th
91st

37 36

50th
25th
9th 2nd
-3 SD

58 35 34 33 32 31cm 5.0kg 44 4.8 4.6 42cm 39cm 38 37 36 35 56 54 52 50 48 46

75th

0.4th

50th

-4 SD

25th
9th

6th 99. h t 98 t s 1 9 h t 5 7 h 50t h 25t

9th

h t g len

50th

25th
9th

2nd
0.4th
-3 SD

Measurement 2
Recording Date Weight Head Circumference Length/Height Location Health worker name

-4 SD

-5 SD

99.6th

Measurement 3
Recording Date Weight Head Circumference Length/Height Location Health worker name

2nd
th 0.4
-3 S D

98th

D -3 S

2nd h 0.4t

91st

75th

h
th .6 99

SD -4

D -4 S
D -5 S

h .6t 99

6th 99.

th 98

h 98t
st 91
th 75

d a he

50th

25th

Measurement 4
Recording Date Weight Head Circumference Length/Height Location Health worker name

9th
2nd

0.4th
-3 SD

4.4 4.2

-4 SD

th 98

st 91

th 50

Measurement 5
Recording Date Weight Head Circumference Length/Height Location Health worker name

st 91
th 75
th 50

4.0
th 75

th 25

-5 SD

3.8 34 3.6 33 32

9th
2nd

th 99.6

10.0kg 9.5

th 50

th 0.4
-3 S D

th 25
h 9t

3.4
th 25

98th

D -4 S

9.0
91st

Measurement 6
Recording Date Weight Head Circumference Length/Height Location Health worker name

3.2 3.0 2.8

31 30cm 8.0kg
75th
D -5 S

8.5 8.0 7.5

d 2n
h 4t 0.
S -3 D

9th

-4

SD

t h g i e w
TERM
For preterm infants, before starting plotting fill in the date boxes for speedy and accurate calculation of gestational and corrected age. Work backwards from EDD or forwards from DOB and gestation using calendar on flap.

d 2n

7.5 2.6 7.0 6.5 6.0 5.5 5.0 4.5 4.0 3.5 0.8 3.0 0.6 0.4 0.2 0.0kg 42 2.5 2.0 1.5kg 2 3 4
th .6 99

th 0.4
SD -3

2.4 2.2

S -4

2.0 1.8 1.6 1.4 1.2

th 98
st 91
th 75

e w

t h ig

50th

Measurement 7 7.0
Recording Date Weight Head Circumference Length/Height Location Health worker name

25th

6.5
9th
2nd

6.0 5.5

Measurement 8
Recording Date Weight Head Circumference Length/Height Location Health worker name

0.4th
-3 SD

5.0 4.5 4.0 3.5 3.0 2.5

-4 SD

1200 1000 800 600 400 200

-4 SD

h .6t 99 h t 98 st 91 h 75t h t 0 5 25th 9th

th 50
th 25

-5 SD

Measurement 9
Recording Date Weight Head Circumference Length/Height Location Health worker name

1.0

9th
d 2n
S -3

th 0.4
D

2nd
0.4th
-3 SD

-4 S

D
D

-5 S

Corrected age post-term in weeks (calendar months 1 5 6 7 8 2 9 10 11 12 3 13 4 14 15 16 17

Date boxes on this page are once per fortnight.

2.0kg

Measurement 10
Recording Date Weight Head Circumference Length/Height Location Health worker name

0g 23

Gestational age in weeks 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

5 18 19 20 21 22 23 24 25

40

41

6 26

D/M

D/M

D/M

D/M

D/M

D/M

D/M

D/M

D/M

D/M

D/M

D/M

D/M

D/M

D/M

D/M

D/M

EDD D/M

D/M D/M D/M D/M D/M D/M D/M D/M D/M D/M D/M D/M D/M

D/M

Instructions
Find the expected date of delivery (EDD) on the calendar and work upwards in the same column to find the weekly dates needed for the preterm date boxes until birth gestation is reached. For fortnightly dates on the 2 weeks to 6 months chart, work downwards in the same column from EDD (or DOB for term infants). If DOB or EDD is 31st December use 30th December; in a leap year use 28th February for 29th February. The date box date at 6 months may differ from the calendar months date by up to 2 days, if the error exceeds 2 days then the boxes are dated wrongly.

Neonatal and Infant Close Monitoring Growth Chart

GIRLS UKWHO
23 weeks gestation to 2 years corrected age

96cm
Please place sticker (if available) otherwise write in space provided.

94 92 90 88

GIRLS
6 months to 2 years
7 8 9

10

11

12

13

14

15

16

17

18

19

20

21

22
th 99.6
98th

23

24 94cm 92 90 88 86 84 82 80 78

Corrected age post-term in calendar months

Name: ____________________________________________ NHS / CHI No: Hospital No: Date of Birth: EDD: Gestation: __________weeks __________days
For preterm infants this chart is wholly gestationally corrected, using the date box method. Unlike the UK-WHO A4 chart the arrow drawn back method should not be used. New users need to be taught how to use this chart. A fact sheet and powerpoint can be downloaded free from www.growthcharts.rcpch.ac.uk

91st
75th
50th

86 84 82 80 78 76 74 72 70 68 66 64 62 60 58 56cm 46cm 45 44 43 42 41 40 39 38 37 36 35 34cm 13.0kg 12.5 12.0 11.5 11.0 10.5 10.0

When you get to the top of calendar (when working upwards from EDD) start again at the bottom in the same column. Week 1 8 15 22 29 5 12 19 26 5 12 19 26 2 9 16 23 30 7 14 21 28 4 11 18 25 2 9 16 23 30 6 13 20 27 3 10 17 24 1 8 15 22 29 5 12 19 26 3 10 17 24 2 9 16 23 30 6 13 20 27 6 13 20 27 3 10 17 24 1 8 15 22 29 5 12 19 26 3 10 17 24 31 7 14 21 28 4 11 18 25 2 9 16 23 30 6 13 20 27 4 11 18 25 3 10 17 24 31 7 14 21 28 7 14 21 28 4 11 18 25 2 9 16 23 30 6 13 20 27 4 11 18 25 1 8 15 22 29 5 12 19 26 3 10 17 24 31 7 14 21 28 5 12 19 26 Day 4 11 18 25 1 8 15 22 1 8 15 22 29 5 12 19 26 3 10 17 24 31 7 14 21 28 5 12 19 26 2 9 16 23 30 6 13 20 27 4 11 18 25 1 8 15 22 29 6 13 20 27 5 12 19 26 2 9 16 23 2 9 16 23 30 6 13 20 27 4 11 18 25 1 8 15 22 29 6 13 20 27 3 10 17 24 31 7 14 21 28 5 12 19 26 2 9 16 23 30 7 14 21 28 6 13 20 27 3 10 17 24 3 10 17 24 31 7 14 21 28 5 12 19 26 2 9 16 23 30 7 14 21 28 4 11 18 25 1 8 15 22 29 6 13 20 27 3 10 17 24 1 8 15 22 29 7 14 21 28 4 11 18 25 4 Month

Plotting instructions
From birth until 2 weeks after the expected date of delivery (EDD) plot measurements on the 23-42 weeks gestation chart. From EDD plus 2 weeks (42 weeks gestation) plot measurements on the 2 weeks to 6 months chart. Gestational correction is always required when plotting babies born preterm (before 37 completed weeks of gestation). Do not apply any gestational correction for term babies (37-42 completed weeks of gestation). If desired the chart may also be used to look up relative size for gestation but always plot birth data for babies born between 37-42 completed weeks at 40 weeks.
9

Which children is this chart suitable for?

This chart has been designed for plotting growth measurements of preterm infants from birth to the age of 2 years post-menstrual age. The chart is also suitable for term neonates or young infants requiring close monitoring. After this the UK-WHO 0-4 years charts can be used. For healthy preterm babies born at or after 32 weeks gestation the UK-WHO 0-4 years charts can be used from birth, unless there is a need for detailed growth assessment.

6th 99. h t 98 t s 91 h t 5 7 h 50t h t 5 2

9th 2nd
D -3 S
D -4 S

h t g n le

25th
9th

2nd
0.4th
-3 SD

76 74

January February March April May June July August September October November December

-4 SD

72 70cm 53cm 52

-5 SD

99.6th
98th

51 50 49 48 47 46 45 44 43 42

h 0.4t

11 18 25 1 8 15 22 29 6 13 20 27 3 10 17 24 1 8 15 22 29 5 12 19 26 2 9 16 23 30 7 14 21 28 4 11 18 25 2 9 16 23 30

91st

-5 SD

th 99.6

Calculating gestational, post-menstrual and corrected age from dates is difficult and mistakes are common. Although the chart can be plotted in the conventional way, this chart provides date boxes which will allow you to move directly from dates to gestational age and reduce the risk of error. To do this effectively, when first used the chart needs to be prepared as below. Before starting plotting use the calendar to fill in date boxes. Then use the date boxes for speedy and accurate calculation of age. For preterm infants 1. If expected date of delivery (EDD) is not known, plot birthweight at the exact gestational age and then calculate the date of the next completed week (e.g. for date of birth (DOB) 24/2/09 at 27 weeks +3 days gestation, date at 28 weeks gestation will be 28/2/09). Then write in the date (day and month only) at each completed week of gestation, using the calendar (left) as a guide, until EDD is reached.
27

A specialist growth chart for low birthweight

The special features of this chart include: A date box system to assist accurate calculation of gestational age Large scale for detailed monitoring Low reading (SD) lines to allow assessment of very small infants The three charts display data from two sources: 1. 23-42 weeks gestation. This chart is based on reanalysed UK1990 data and illustrates the size at birth of UK infants born at 23-42 weeks gestation around 1990 1. The 23-42 weeks gestation chart does not describe how preterm infants grow after birth because it shows only birth measurements of infants born at different gestational ages. The weight of many babies born before 32 weeks, particularly the sickest and most immature, may fall by more than two centile spaces in the early days. 2. 2 weeks to 6 months corrected age and 6 months to 2 years corrected age charts. These charts are derived from the UK-WHO 0-4 years growth charts and use World Health Organization (WHO) data on healthy, non-deprived breastfed children of mothers who did not smoke 2. These charts do not reflect the usual growth of the preterm infant population. However individual infants who have remained well should follow the trajectory indicated by the centile lines at their corrected age.

98th

91st
75th

head

75th
50th

25th

9th
2nd
0.4th
-3 SD

50th
25th
9th

-4 SD

2nd
0.4th
-3 SD
-5 SD

41 40cm 16.0kg 15.5 15.0

98th

th 99.6

-4 SD
-5 SD

14.5 14.0

91st

13.5 13.0 12.5

birth

Gestational age in weeks 29 30 31 32 33 34 35 36 37 38 39

<

28

40

TER

DOB and gestation using calendar on flap.

41

D/M

EDD 28 8/3 4 D/M D/M D/M D/M D/M D/M D/M D/M D/M D/M D/M D/M /4 11 /4 18 /4 25 /4 2 /5 9 /5 16 /2 7 /5 23 /3 14 /3 21 /3 2 /5 D/M

75th

12.0 11.5

2. If EDD is known, write into the date box marked EDD then work backwards on the 23-42 weeks chart, writing in the date (day and month only) using the calendar (left) as a guide, for each completed week of gestation until birth gestation is reached. The date boxes are weekly on page 1 (23-42 weeks) Fortnightly on page 2 (2 weeks to 6 months) Per Calendar month on page 3 (6-24 months) For all infants After 42 weeks post-menstrual age use the 2 weeks to 6 months chart. Mark the expected date of each completed fortnight after EDD (or DOB for term infants) in the boxes at the bottom of the chart, using the calendar (left) as a guide, and use these to identify the gestationally corrected age. On the 6 months to 2 years chart the date boxes are per calendar month (4.33 weeks). These dates can be calculated using the date in the EDD box. If a childs EDD was 23/1/10 then mark 23/7/10 in the 6 month box, 23/8 in the 7 month box, 23/9 in the 8 month box, etc. By age 6 months the data box date may be up to 2 days different from the calendar months date. This is not a problem, but the calendar month date should be used from 6 months. If day error is >2 days then a mistake has been made in dating the boxes.

h .6t 99

h 98t
t 91s

Measuring
Remove all clothing, including caps or bonnets, footwear and nappy. Weight: Use class III electronic scales. Length: Use length board or mat. Do not use measuring tape. Head circumference: Use non-stretchable tape. Anyone who takes measurements should be suitably trained or supervised by someone competent. For further information and training materials see www.growthcharts.rcpch.ac.uk This is a new chart which is still being evaluated and any feedback will be appreciated, via the feedback form on www.growthcharts.rcpch.ac.uk
References 1. Cole TJ, Freeman JV, Preece MA. British 1990 growth reference centiles for weight, height, body mass index and head circumference fitted by maximum penalized likelihood. Stat.Med. 1998;17:407-29. 2. WHO Child Growth Standards www.who.int/childgrowth/en 3. Engle WA; American Academy Of Pediatrics. Age Terminology During The Perinatal Period: Policy Statement Pediatrics 2004 114:1362-4. DH Copyright 2009

9.5 9.0 8.5 8.0 7.5 7.0 6.5 6.0 5.5 5.0 4.5 4.0kg 6 7

h 75t
50th

t h g i e w

50th

11.0 10.5 10.0

25th

9th

9.5 9.0 8.5

2nd

0.4th
-3 SD

8.0
UK-WHO NICMA4G Manufacture 4 Sept. 12

25th
9th
2nd
-3 SD

7.5
-4 SD

7.0 6.5 6.0

-5 SD

0.4th

-4 SD

Date boxes on this page are per calendar month. To complete, use the EDD day. e.g. If EDD = 23/1/10, enter 23/7/10 at 6m, 23/8 at 7m, 23/9 at 8m, etc.

5.5 5.0 4.5 4.0kg

-5 SD

Corrected age post-term in calendar months 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

24

Once you reach the end of the year start again at the top, in the same column.

D/M/Y D/M/Y D/M/Y D/M/Y D/M/Y D/M/Y D/M/Y D/M/Y D/M/Y D/M/Y D/M/Y D/M/Y D/M/Y D/M/Y D/M/Y D/M/Y D/M/Y D/M/Y D/M/Y