Synopsis
Measure and plot paediatric growth accurately, select the correct UK chart and age correction, interpret centile trajectory and genetic potential, and recognise patterns that need nutritional, endocrine, neurological or safeguarding assessment.
- Use the current UK–WHO chart for sex and age: the detailed 0–4 years chart for most preschool children and the 2–18 years chart for school-age children and young people.
- For very preterm infants or significant early health problems, use the RCPCH neonatal and infant close monitoring chart and follow its gestational-correction instructions.
- Record the exact date, calculate exact age, mark the age on the horizontal axis and the measured value on the vertical axis, then place one precise point rather than a broad mark.
- Correct age for prematurity according to the chart: generally to 1 year after birth at 32–36 weeks and to 2 years after birth below 32 weeks.
- Measure supine length before age 2 years with an infantometer and standing height from age 2 with a calibrated stadiometer; the methods are not directly interchangeable.
- Plot weight, length or height and head circumference separately; from age 2 years calculate and plot BMI when weight or linear growth is concerning.
- A centile is a rank relative to the reference population, not a target and not the percentage of expected growth.
- Trajectory is more informative than one point: most healthy children track within a channel after early catch-up or catch-down growth.
- NICE thresholds for faltering weight depend on birth centile: crossing 1, 2 or 3 spaces is concerning from birth weights below the 9th, between the 9th–91st or above the 91st respectively.
- Current weight below the 2nd centile is a NICE threshold for concern whatever the birth weight; BMI below the 0.4th centile suggests probable undernutrition.
- Compare height with biological parental heights using the chart's mid-parental comparator; normal familial short stature should remain compatible with genetic potential and normal velocity.
- Always verify technique, equipment, transcription, chart, age and gestational correction before labelling a child with abnormal growth.
Key red flags
Weight loss outside the early neonatal period, or loss exceeding 10% of birth weight in the early days, requires clinical and feeding assessment rather than reassurance from a centile alone.
A head circumference below the 2nd centile, or movement across 2 or more centile lines, needs paediatric assessment in the context of development and neurological examination.
Height more than 2 centile spaces below the mid-parental centile can indicate undernutrition or a primary growth disorder.
Progressive downward crossing of weight followed by height, especially with diarrhoea, vomiting, systemic symptoms or food insecurity, requires cause-specific assessment.
Disproportion, dysmorphism, early hand preference, developmental regression, delayed puberty or abnormal neurological signs makes a normal-variant interpretation unsafe.
A biologically implausible jump in one measurement can be a plotting or measurement error, but must be repeated correctly rather than deleted or ignored.
Investigation priorities
Confirm that an apparent centile change is real before investigating disease.
Assess position, centile-space crossing and trajectory across all available reliable measurements.
Management branches
Growth is recorded at a scheduled review or clinical encounter.
- Select the correct RCPCH chart and determine exact and corrected age before measurement.
- Measure with calibrated equipment, plot a precise point and compare with every reliable previous value.
- Explain the pattern, record chart and technique, and define whether routine or earlier review is needed.