Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Growth data indicating acute danger
A growth-chart abnormality is rarely an emergency alone, but rapid weight loss, severe dehydration or a rapidly changing head circumference with neurological signs may reflect acute illness.
Action: Assess ABCDE and hydration immediately when weight loss accompanies lethargy, poor intake, reduced urine, shock or suspected neglect. For vomiting, altered consciousness, seizures, a tense fontanelle or rapidly increasing head circumference, obtain urgent paediatric and neurological assessment rather than arranging routine remeasurement. Confirm an unexpected value promptly with correct technique, but do not let measurement uncertainty delay treatment of an unwell child.
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.
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.
Investigation priorities
01
First-line: repeat anthropometry with calibrated equipmentFirst stepFirst line
Confirm that an apparent centile change is real before investigating disease.
02
First-line: serial UK–WHO chart reviewFirst line
Assess position, centile-space crossing and trajectory across all available reliable measurements.
Management branches
Routine plottingMeasure, plot and verify
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.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.