 Hello everyone, so this is the last session on growth charts, okay, one of my favorite session after cross graded old and 45 points of counseling and what I am going to discuss today is basically WHO growth chart, both percentile and Z score, okay. So I am going to take you into the basics of growth chart, what are these growth charts, how do they come up, you know, and if it is when they have been in use. So all that I am going to discuss, we have created really good tutorials on WHO growth chart, percentile growth chart, we are also working on Z score, but you know, we would put it up as soon as it gets ready, okay. But let us start with, you know, WHO growth chart, it will be my session and then after that we will also kind of put up our tutorials that we have created for wait for age and length for age. But I want you to understand all the definitions of, you know, what is wasting, what is stunting, what is underweight, you know, so people who are working in different programs, working on malnutrition, they should know basically what are all these, you know, definitions, all right. So let us start with your WHO multi-center growth reference. This was a study which was done between 1997 and 2003, okay. And what they found is basically, they took about six different countries, okay. So they took data from children, say in six different countries, for example, they took USA, they took Norway, they took Ghana, they took Brazil, they took Oman and they took India. India was part of this multi-center study, which was done on children, okay. So that is important, six different countries which were involved, including US, including India, okay. And basically, this growth charts were created from the study and they wanted to show that how children should grow, okay. And of course, I will describe how the study was done, but essentially it was basically to show how children should grow all over the world. It establishes breastfeeding as a biological norm, means that all the children were breastfed, okay. So they wanted to show children were breastfed how this children would grow in all over the world, not just in India or in US. And then they wanted to create the international standards for all the healthy children as human milk support not only a healthy growth, but also optimum cognitive development and long-term health, okay. So this was very, very critical for all over the world to have this kind of WTO growth chart, which would tell us how children would grow, okay. So this was, this basically study, it was done, longitudinal data was taken for 0 to 24 months of age, longitudinal means they monitored this children, you know, on a regular basis, which I will explain how they monitor on a regular basis. And they basically took height and weight of the children starting from birth till two years of age. So they took longitudinal data, so same children they followed, you know, up to two years of age. And then at 18 months to 17 months old children, they took cross-sectional data. Cross-sectional data means they went in there, they took a, you know, number of children, they selected number of children and they took a cross-sectional data means they took data that at that particular point. Just one time, okay, that is your cross-sectional data. Longitudinal data means you would keep collecting data of the same child over and over and again over period of two years, okay. So that is the difference between longitudinal data and the cross-sectional data. So for this WTO growth chart, what they had done, they selected few children. So those children they took, you know, data of from birth to 24 months of age. And for cross-sectional what they did, basically they did one time data collection for children between 18 months to 71 months of age, okay. So that was one important aspect of the study. And then basically there were three things which was common for all the children. All these were breastfed infants, okay. So the optimal nutrition was given to the children, they had appropriate complementary feeding. Then they had an optimum environment. What was, what do you mean by optimal environment? Means sanitation was good, no microbiological contamination in the environment, okay. So they came from a very good background where there was not much problem with sanitation, okay. There was no exposure to smoke and also optimum health care for all these children had immunization, you know, as per recommendation and they all had pediatric routine care, okay. So all these things were, all these variables were kept common, okay. And then what was eligible criteria for individual? So no health environment, economic constraint on growth, okay. Because they all come, they came from a very good health background, they all had immunization vaccines, they all had good sanitation, there was no exposure to smoke. And then they had no economic constraint, of course, you know, looking at the sanitation, you know, they wanted to make sure the sanitation is good, how would children grow, okay. Then second aspect was mother was willing to follow feeding recommendation, okay. So exclusive predominant breastfeeding for first four months and introduction of complementary feeding by six months of age. This was, you know, basically from 1997 to 2003. And all the children were termed single birth, okay. So only single term baby were selected. And there was no, there was lack of significant perinatal morbidity. Perinatal morbidity means children were not sick, you know, when children were born. So there was lack of very significant morbidity means not, you know, no ICU admissions and all those were exclusive, you know, it was basically removed from the studies, okay. And another important aspect is no smoking mothers before and after delivery, okay. So they wanted to make sure that there is no exposure to smoke because smoking will also cause problems with growth, you know. And the study designed the sample that what they had done was basically, as I said, birth to 24 months of age was a longitudinal study. Mothers and newborns were screened and they were enrolled at birth, okay. Then weight and length and head circumference were taken 21 times over 24 months, okay. Arms circumference was taken 10 times between 3 to 12 months of age. And skin fold thickness was taken 6 times between 14 to 24 months of age, okay. Then of course, in cross sectional study, of course, in longitudinal study they had also taken weight and length of children, but in a cross sectional study, they also took basically weight, length, head circumference, arms circumference and skin fold thickness. How many total number of children were taken for this study is 8,440 children were taken from 6 different countries, okay. 300 newborn per site, so 1,743 total followed up to 24 months of age from the longitudinal study and 1,400 children per site, so total about 6,647 children aged between 18 to 70 months through the cross sectional survey, okay. So this was the study, this was the designing of the study. So here this is what they found, okay. Now this is the weight for age chart, okay. Now I have explained this chart in detail in the coming tutorial, okay. So you will learn in detail about what this chart is and what is there on, you know, horizontal line over here, what is there on vertical line over here. So of course, I have gone very much detail, but I will quickly press through it because I want you to understand this charts very clearly so that, you know, when you are in the field and when you are plotting this children on the growth chart, you need to know how children grow, okay. Unfortunately in India, our children are not growing well and this is the reason that I want to kind of personally, you know, take this session and explain to you how children grow as per WHO growth chart, okay. So this is your weight for age. So weight, this is your, this on Y axis, you have a weight, okay, weight of a child, okay. So it is basically 2, 3, 4, 5, you know and then there are all this, you can see those dark lines. So each dark line basically is separated by 1 kg, so 2, 3, 4 and in between you can see those light colour lines, those each line is about 200 gram increment, okay. So if a child falls into say 2 kg and there is, if they fall say 1 line above the dark line, that would be 2.2, 2 kilogram, 200 grams. So there are 4 lines between those 2 dark lines and each light line is about 200 grams, okay. On X axis, you see, you know, your months and your year, okay. So this is your birth. So what I recommend is to kind of put the date of birth over here and then basically you put your one month, you know, date over here, second month date over here. So I ask healthcare workers to put all these dates beforehand so that they know, you know, when Chulunna measured where to plot them, okay. And this is your one year and this is your two years, okay. Now this is the girls chart, pink colour is a girls chart and this particular chart is from birth to two years of age. There are different kinds of chart available, okay. You have birth to only 6 months. Now I like those charts from birth to 6 months for say Anganwadi workers or Asha workers because they are still learning, they may have difficulty kind of calculating what is the weight, you know, plotting of weight charts. So when they take 0 to 6 months, they are given in weeks, you know, the weak increment of weight gain in per week and it becomes very easy, it becomes very easy for them to plot, okay. So this particular over here I have shown chart from birth to two years of age. There is one more chart which is available which is from 6 months to 2 years, okay. There is one more which is from birth to 5 years of age. So there are all these different charts, whichever program that you work in. So if you are taking care of just maybe, you know, small children, then you have to, you can just take 0 to 6 months if you are taking care of older children, you can take from birth to 5 years, you know, so it depends upon which chart that you are using, okay. Or which program that you are working in, alright, okay. So here now, see for example, this particular that you can see 5 lines over here, right. So you see green line, you see yellow line, okay. Then you see last line which was your 97th percentile and your 3rd percentile. So this is basically percentile growth chart means percentage of children who fell on this line, you know, or who are marked on this line, okay, or who grew on this particular line, okay. So for example, as per the WHO study, what they found that all the children, if everything was good, if health was good, if mothers were breastfeeding babies, if sanitation was good, if, you know, if immunization was given, most of the children were growing at the same rate, okay, whether they came from India or they came from US or whether they came from Oman or whether they came from Norway, it does not matter, okay. All these children, till 5 years of age, they grew at the same rate, and that is why you, you know, most of the countries in the world, we are using WHO growth chart. So same chart we are using, you know, in India, in US we use this growth chart for younger children, you know, after that we use other growth chart, but for younger children, we are using WHO growth chart in US also, okay. So here again, I am going to come back to the growth chart again. So 50% of the children, okay, 50% of children, that is your average children, they basically kind of grow along this green line, okay. So average children, 50% of a children should be growing at this rate, okay. 85th percentile means 15% of children, about 15% would be growing at this rate, okay. So in India, how many children are growing at 85th percentile, very few, you know, and then this one means 97%ile, 97%ile means 97% children would be below this line, okay, and 3% children will be above that line, okay. So only 3% of children in the world are above that 97%ile, okay. Similarly if you come down, okay, here is a 15%ile. So 15%ile means 15% of the children will be basically on this yellow line, okay, and your third person, I mean 3% of children are basically on this line or below that line, okay. So normally what would happen when you go in the community, you should see only 3% children below this red line, only 3% children, okay. But unfortunately in India, we have so many underweight children and so many children who are stunted that we have almost, I would say, you know, as benefactors, 5 data, 32% children are underweight, 32%, normally we should have just maybe less than 3, even less than, you know, 2.7% or below this third percentile, we have almost 32% children, that's actually terrible, you know. So what we are trying to do, we are trying to increase the birth weight of the children because remember I told you that the birth weight, average birth weight of children in India is only 2.7, so let's see what happens when a child is born at 2.7, okay, so again I want you to focus on this growth chart, okay. Now I want to show you what should be the average birth weight, so this is your birth, okay, average means your green line, so just follow your green line, okay. Now look at this green line for a girl child, it's 3 and it's one line above, so it's 200, so the average birth weight of a girl child all over the world is 3.2 kilogram, okay. Where do our children fall? We have 2 and 7, so if you look at the 7, that would be falling over here, you know, so I would say between 3rd percentile and 15th percentile, so they are not even on 15th percentile when they are born, okay. Now we want to bring those children because there is something called growth catch up, okay. So when you want to do a growth catch up, you have to remember that the children have to grow much more than what WHO is recommending, right. Because if you don't, just with one infection or one diarrhea, they may just fall, they would be growth faltering, they would not, you know, they would come under minus 3 or I would say 3rd percentile and they would show up on underweight, you know, as per Z score, I will discuss what is Z score, but you know, we need to have good amount of growth catch up. Unfortunately what is happening is the children are not growing as per WHO standards, okay and I will show you how they grow per month and we have to make sure that if you can't do a growth catch up, at least don't let them fall, okay. Because if we let them fall, this children will basically will show up into your NFHs 5 or NFHs 6 data and says all the children are underweight, but they are born underweight. What did you do while they were falling off, right. So that's what I wanted to explain to you, okay. So here, so now you have, suppose you have a girl child born in your family, okay and she is beautiful, 3.2 kg weight gain, okay, absolutely average as per WHO standard, okay. Now look at the one month of age. So at one month of age, what is, where is that green line intersecting? You can see that green line is intersecting at 4.2 kg. You can see over here, it is intersecting at 4.2. So in one month, that girl child who was born who was 3.2 kg need to gain at least 1 kg to be able to follow her growth chart, right, to be able to follow her growth trajectory on 58% child. Remember I told you children should not fall down, okay. In fact, our goal should be that child should gain as much weight as possible on mother's milk. If she is born even average and if she is growing beautifully, if she has amazing milk transfer, those children will put on lot of weight more than 1 kg. And that's what we have seen in our program. I will show you some of my growth chart which I have already shown you before. But think about first 3 months are the most important time period for growth of that child, okay. Because again I had discussed in my first 1000 day session that how when these children they grow early on in their life, they have a higher IQ and of course they are not stunted, okay. There they become tall because if you look at it, see how, look at the growth trajectory. The weight they grow so fast, right, okay. So that was your one month weight which was 1 kg. Now let's see, child you did really well with all the different holes and baby's mother is breastfeeding properly and you know baby gained 1 kg. Now let's see what happens in the second month. So from first month to second month, basically the weight gain is from 4.2 to almost 5.1. I would say even 5.2. So again in second month, girl child is gaining about 1 kg average, okay. What we are told, we have a cut off of 500 gram weight gain. So whenever I speak to all the healthcare workers including medical officers, including so many doctors, because they say cut off is 500 gram, they keep the targeted 500 gram. So they feel if the baby is gaining 500 gram, they are fine. No it is not, you know, please understand from this growth chart, plot it yourself, plot the child who you know you can get this growth chart from WHO website, plot it, plot it yourself because if you plot it you will know how children grow, okay. So if a child who is born 3.2 kg, which is born absolutely normal, in one month if child gains only 500 gram, will child will immediately fall down from 58 percentile, okay. And the same child again instead of gaining 1 kg has gained just 500 gram because that's the target weight which all the healthcare workers understand. They feel 200 gram, okay, so again if child falls from just gain say 500 gram from 1st month to 2nd month, child will fall to again 15 percentile. And then eventually within 3-3.5 months the child is going to be under 3rd percentile. This is the issue that really I am facing in the field, I have to unlearn all this learning that healthcare workers have gone through and I have tell them no, your cut off should not be 500 gram, your cut off should be 900 gram or maybe 1 kg children should grow weight as per WHO standards, you know why should we allow children to falter at all, you know. So focus on breastfeeding practices, focus on those skills, focus on those how to hold the baby, all those 45 pounds that I mentioned and your child will grow not just 1 kg, they will grow 1.2 to 1.5 kg, right, so this is what I want to tell you, okay. Now look at the 3rd month, this is a girl child again, okay. So child was 5.2 kg, did very beautiful, so 5.2, now in 3rd month, now child is about 5.8 kg, so about 5.9, okay. So now think about it from 4.2, I would say, sorry 5.2 to now 5.9, okay. So again child grew about 800 grams, okay. So again remember how children grow, she grew so fast in first 2 months, 1 kg, 1 kg, now 800 gram, now she will slowly slowly slow down this child, okay. So if you can really focus on those first 3 months and get the weight up, you know, believe me they grow fast on the length also, okay, alright. So then again look at the average weight at 3 months of age, the girl child average weight is about say between 5.9, 5.8 to 6 kg, so around I would say around 5.8, 5.9, okay, approximate weight, alright. Now same child at 6 months, what is the average weight of a 6 months old child? About 7.3, 7.4, 7.3, 7.4 kg is the average weight of a girl child, now if you ask anybody in the field what should be the average weight of a 6 months old child, most of them they say around 5 kg. So if you have a 6 months old child who is only 5 kg, they are basically already less than 3rd percentile, okay. So that is what they are, you know, approximate this in 5, 5.5 kg, you know. So we want to make sure, remember that the girl child approximately, you know, the weight at 6 months is around 7.3 to 7.4 kg, okay. Now same child at 1 year of age is about, I would say about 9 kg, so here this is the intersection, you can see this is the dark line and you are touching the 9 kg, okay. So now you can see from 6 months to 1 year there is not much weight gain as it was between 0 to 3 months of age, okay. So remember if you want to gain, if you want to catch up on weight gain, first 3 months, focus on first 3 months, follow up those babies every, you know, after birth I would recommend to follow these babies every 48 hours, okay. As long as babies, you know, as soon as baby gain 40 grams, you know, 35, 40 grams, you know, you know it that mother knows how to breastfeed, right. Mother knows those all important counseling points, right. If baby is not gaining 35 to 40 grams, that means there is a high risk of this child faltering, okay. And till that mother gains, baby gains 35 to 40 grams, you are not going to give up because if you do not follow up with the mother, if you do not kind of fill out those breastfeeding assessment form, that means, you know, we have not done a job at all. How do you allow a child to falter, right. So that is important part and I am kind of a little bit strict in my program about how children should grow specifically in first 3 months and then my focus comes after 6 months because after 6 months, what happens is what we saw initially that all these children were just basically stagnating, means they were just not growing, so they were just going in straight line, they were just stagnating, they may not be falling off the growth curve but they were just stagnating, right. And that was because children were getting predominantly carbohydrate food, they were just getting rice, rice, rice, rice, rice kichiri, rice roti, rice and dal, it was just rice and dal whatever they were getting was extremely watery monotonous dal that they were getting, okay. So here at 6 months, if we want to improve children's weight, please focus on nutrient dense food, you know, talk about consistency, talk about the amount, talk about the food that they will get, start with protein rich food, you know, do not be obsessed with vegetables and fruits, you know. Yes, you can give vegetables but start with protein first, give food which is high in protein and then add vegetables in it, okay. And do think of giving those protein powders that mothers have made at home and if you do home visit, make sure that mothers have prepared those, you know, legume and seed powder or, you know, those peanut and seed powders and, you know, a lot of this bean powder that we have prepared. If mothers start using those powders and if she knows the consistency, how she should prepare, then believe me, you will not see the results. And if children who are non-veg, focus on, you know, of course, eggs and chicken and you know, liver, liver is one of the most nutrient dense food. So do not have your own bias on children, okay. You may have different religious bias but that is for your sake. You cannot, you know, impose those biases on children who are growing so and it is so essential for them to grow, their brain is growing, okay, all right, all right. So now you have one-year-old child that I already discussed is one-year-old should have about 9 kg average weight, okay. Now look at this just in 9 kg in one year, so from one year to two years of age, this child will not grow much, okay. So from 9 kg to just about 11.5 kg, okay, so that is about just 2.5 kg. So in the whole year, baby will gain just 2.5 kg, okay. So when you get children at one year of age and if they are say very low on weight, very difficult to bring them up because if they have not grown in first year of life, the children then they stagnate not only in weight but they also stagnate in length, okay. So make sure that, you know, you focus on weight first till one year of age, I would say focus on the weight part till 6 months of age because after 6 months of age, you will realize that if children are not gaining length that means they are getting nutrient, you know, not nutrient dense food, they are getting probably calorie dense food if they are just gaining on weight but not gaining on length that means children are getting too much of calories which are not necessarily nutrient dense probably they are getting empty calories, okay. So after 6 months I tell all my, you know, team members to focus on length, you will realize if children are growing tall that means they are getting good nutrient dense food, okay. Alright, so this was your weight for age chart. Now I will go with the next chart. This is weight for age for boys, okay, as per WHO this is again percentile growth chart and I want you to look at now the boys chart that how they grow, okay. This is your age, okay, this is your months, this is your weight, okay, same exactly same chart as girls chart but the weight gain is different, okay. So here look at the average birth weight of a boy child, okay. The average birth weight should fall on this green line, okay. So average weight for a boy child at birth is about 3.3 kilogram, okay. So 3.3 kilogram is basically that is what is the average weight. Do we have 3.3 kg babies born in rural areas, tribal areas, urban slums or even to, you know, literate, literate muckers? No, we do not actually. I am very unfortunate, very rarely we see 3.3 kg babies in India, okay. Why? Because mother's nutrition is not done properly. They are just eating lot more cow-headed rich food, they are not eating protein rich food, they are not eating good fats, you know and unfortunately they put on lot of weight. It is not that, you know, mothers coming from elite areas they do not put on, they put on lot of weight but it is all not going to the baby, okay. So if you want a healthy baby and this is again I have explained very beautifully in Kailash's story where his wife was only 34 kg, put on good amount of weight on baby, mother had gained about 12 kg, 11.5 kg and then baby was 3.1 kilogram. Imagine higher than the Indian average and she came from a tribal area where she had previously had miscarriages, two miscarriages. I would not even say premature delivery, I would call it because babies were born after 7.5 months and you know obviously because of a poor nutrition, right. So this is what I am saying is that try to increase or improve mothers nutrition and we have gone through all these tutorials in my previous session on pregnancy nutrition, you know, adolescent nutrition, pre-primary nutrition. So again think of what all things that mother need to eat, focus on protein again and you know you will not have a issue, okay. So here let us see, so now your baby is born say 3.3 kg, okay. Now at one month of age that child weight at average is about 4.5 kg, okay, 4.5 kg. So from 3.3 to almost 4.4, 4.5 that is about 1.1 kilogram, okay. So if it is per month, this is 1.1 kilogram, so how much it should be for per day, right. It would be around 30 gram, more than 30 gram actually, you know, it will be more than 30 gram, it is 1.1 kg. So almost up to 40, 40 gram, 38 gram per day, follow this children up, okay. I want you to follow this up children from birth till baby start gaining minimum 35 grams, minimum, okay. I would be very happy if you keep the target up to 40 grams, because that is what my target is, right. My target in my program is 40 gram, so if children gain 40 gram weight gain per day, that is when I tell mothers, okay, you are fine, I do not need to see you for next one month, okay. So do that, okay. Now again if you look at from one month to two months of age, okay, this children from 4.5, so they are now gaining almost 5.5 kg, okay, 5.6, in fact 5.6 kg. So again children are gaining almost 1.1 to 1.2 kg a month. If it is 1.2 kg, it is 40 gram weight gain per day, okay. Now in India, we have a cut off of 500 gram per month. So can you please calculate, if you divide 500 gram over 30 days, okay, what will be the weight gain per day? It is only 17 grams approximately, 17 grams, where is 17 grams per day and where is 40 gram weight gain? Just think of it, I mean think, you have to think about it and then you know make a decision that what you want to do, you want to keep the target that low, that you allow the child to keep faltering, faltering, so by the time child is 3 months old, they already come into under nutrition and you know all those basically the Z score, it comes into standard deviation, lesson minus 2 standard deviation, okay. I will talk about standard deviation, but we do not want that, okay. Please allow the child to grow, you know, do not have those preconceived notion that, okay, you know, this much is enough, no child, you have to give full potential to the child to grow, okay. Now same child at 3 months of age, what is the average weight of a 3 month old boy child? It is about 6.4 kg, you can see over here, this is a 6 kg and there are 2 lines up and that is 6.4, so the average weight of a 6 month old child is 6.4. Now do you remember what was the birth weight of the child? The birth weight of the child was average 3.3, so from 3.3, now this child's average at 3 months is 6.4, right, so that is almost I would say double, so you are doubling the weight of a child in almost 3 months and not 5 months, okay, because that is what I was taught in pediatrics in US that, you know, children double their weight in 5 months, okay. Yes, over there our children are born very big, the average weight is 3.5, 3.7, okay, so if your average weight is 3.5, 3.7 or even 3.5, then you can say you are doubling your weight by 3 months, I would be very happy, but your children are not growing at 3.5 kg birth weight, your children are growing at 2.7, so if you have 2.7, if you double your weight is 5.4, so let what happens, if you have a double your weight gain 2.7 kg, double your weight is 5.4 and if you are telling everybody that at 5 months your child is growing, child should be double the weight, that is your 5.4, so let us see what happens at 5 months, if I have a child who is just 5.4, this is your 5 kg and this is your 2 line up, child is already less than 3rd percentile, this is what I just wanted to kind of bring it to your notice that lot of this, you know, saying which are, which kind of floats around in pediatrics, it is not valid, okay, yes, if you have a 3.5 kg birth weight, you can say double the weight in 3 months, but if you have a 2.7 kg and in most of the areas that I work in, all these tribal areas, they are low birth weight babies, like for example, there is one district I am working right now, 30% children are low birth weight, means they are less than 2.5 kg, I am probably average about 1.8 to 2 kg, now how can I say this children will double their weight in 3 months or even, I would like to have them double the weight in one month for this child, right, so this is what I wanted to bring it to your notice, alright, now let's see 6 months old child, boy child, okay, now the weight of this child at 6 months is 8 kg, so boy child 8 kg at 6 months, what was the weight of a girl child at 6 months, 7.4 kg, okay, 7.3, 7.4, okay, it was a number, alright, now you have a same child 1 year old, what is the average weight of a boy child at 1 year of age 9.5 kg, okay, so make sure that your children at least your average children should be 9.5, your good amount of children should be above this mean also, because this is all normal, right, this is all a normal range, you want children to be as big as possible early on in life, on mother's milk and good food, you know, not on junk food, okay, and your children are going to grow there is no doubt about it, okay, so make sure that you try to bring your children on at least mean or above mean, okay, alright, then the same child, now baby is 1 year of age and is about 9.5 kg and then you have a second year child, 2 year old child, okay, what is the average weight around 12.2 kg, so 2 year old boy child, the average weight of 2 years of age is about 12.2 kg, okay, please remember this because I don't see this kind of good weight gain, of course after 6 months of age weight gain is important but what is more important is height, okay, so if children are not growing well in terms of length because obviously under 2 years we call it length, that means the children are not getting nutrient dense food, they are if they are gaining weight but not length, that means they are getting energy dense food, energy dense food means they are probably getting lot more carbohydrate, lot more sugar, lot more jaggery, you know, lot more any of those nutrients which are which I would call it, I won't even call it nutrient, they are they are empty calories, okay, so they are putting on weight but you know for height to grow you required micronutrient dense food, you need protein, you need good fats, you need magnesium, potassium, remember the growth nutrients, right, so think of those growth nutrients, add those growth nutrients in the form of food, okay, so food to food fortification, I don't believe in giving too much of that fortified food, give food to food fortification, natural food and children will grow, okay, alright, so that's your weight for age 1. Now look at the length, so similarly now you have a length for age, again this is a percentile, so if you look at on the right hand side you have this percentile, third percentile, 15 percentile, 58 percentile, okay, before I come back to this length for age, I want to go back to your weight for age because I want to show you that if your child is born small, okay, if your child is born 2.5, 2.7, then you will need good amount of growth catch up, okay and we have seen good amount of growth catch up in most of our babies if they were trained properly on milk transfer, okay, so for example now you have a 2.7 kg child born over here who is between 15th percentile and third percentile, okay, now you want to try to bring this child up on 58th percentile because I do believe in growth catch up, okay, so what happens when this child, if child has to come to mean to average, okay, then what would it be? It would be basically child will be gaining lot more than 40 grams a day per day, okay, they would be gain, they need to grow even like 45 to maybe almost 50 and within one or two months they would catch up and they would come, so again if you have a small child young, you know like us I would say you know less than 2, you know 3.2 kg, then do think of catch up growth and those you can calculate how much weight can they need per day to catch up to at least up to mean, okay, alright, so this is your length for age, again you know look at this average length for a boy child is about 50 centimeter over here, you can see 50 centimeter, each line is 1 centimeter, okay, so at your green line intersect at 50 centimeter at birth and then you have 6 months, you know again about I would say 66, 67.5, okay, so this all you know your average, you want to just look at it, I am not going to go too much in detail because we have a tutorial, so you will go in detail through those tutorials, okay, the second percentile chart for length for age, average birth length for a girl child is 49 centimeter, so remember that 49 centimeter at birth for a girl child, 50 centimeter at birth for a boy child, okay, now this is a standard deviation chart, okay, now I am going to come back to standard deviation growth chart in my next part because now it is getting extended, so I will come back to the standard normal distribution in the next part, thank you so