 Welcome to the spoken tutorial on WHO wait for age percentile growth charts. In this tutorial, we will learn about plotting on wait for age percentile growth charts. Interpreting plotted points for growth indicators Identifying problems on growth charts Percentile growth charts are discussed in another tutorial of the same series. Basics of growth charts and plotting are explained in that tutorial. The first type of percentile growth chart, length for age, is also explained. It is important that you watch it before watching this tutorial. Please visit our website for more details. Now let's learn more about the second type of percentile growth chart. It is the wait for age growth chart. Wait for age reflects body weight according to the child's age. On wait for age charts, the y-axis shows weight in kgs. The horizontal lines mean an increase in weight by 0.2 kgs or 200 grams. The x-axis shows age. It starts with 0 which is at birth. Age is plotted in completed months and years from 0 to 2 years of age. Let's go through the steps to plot wait for age in this chart. First, mark the exact age i.e. months and years on the x-axis. Then mark the weight on the y-axis with a point. Extend it over the connected horizontal line till the marked point for age. Extend the marked point for age over the connected vertical line. The point where the two extended lines intersect is called a plotted point. For every child, points should be plotted over weekly or monthly measurements. Always connect adjacent points with a straight line. This will help to identify any growth problems in the child. Let's use an example to understand plotting points on this chart. This graph shows Amit's wait for age plotted thrice over 6 months. Amit weighed 4.4 kgs at 1 month of age. It is almost at the 50th percentile. It means he is of average weight 1 month after birth. He weighed 6.5 kgs at 3 months of age. It is a little above the 50th percentile line. It means he is of average weight at 3 months of age. He weighed 8.8 kgs at 6 months of age. It is at the 85th percentile line. It means Amit is of above average weight at 6 months of age. It means 15% of children of his age weigh more than him. 85% of children of his age weigh less than him. Next, let's learn more about the average weight of a child. It is along the 50th percentile line in the wait for age growth chart. The average birth weight of a girl is 3.2 kgs. At 1 month a girl's average weight is 4.2 kgs. At 3 months it is 5.8 kgs. The average weight of a 6 month old girl is 7.3 kgs. At 1 year it is 9 kgs. At 2 years it is 11.5 kgs. The average birth weight of a boy is 3.3 kgs. At 1 month a boy's average weight is 4.4 kgs. At 3 months it is 6.4 kgs. The average weight of a 6 month old boy is 8 kgs. At 1 year it is 9.6 kgs. At 2 years it is 12.2 kgs. Now let's look at the average weight gain for a boy in this table. This column shows the average weight gain per day for a boy. This column shows the average weight gain per week for a boy. In the first week the weight gain is 28.5 grams per day. Total weight gain in the first week is 200 grams. In the fifth week the weight gain is 42.8 grams per day. Total weight gain in the fifth week is 300 grams. In the ninth week the weight gain is 28.5 grams per day. Total weight gain in the ninth week is 200 grams. When interpreting growth charts be alert for situations that suggest risk. A sharp decline in the growth line of a child indicates a growth problem. Even if a child is overweight he should not have a sharp decline in his growth. Losing too much weight rapidly is not healthy for any child. The overweight child should maintain his weight while increasing in length. On the other hand a rapid incline in the growth line is healthy sometimes. This chart shows Arun's weight on the 50th percentile line till 6 months of age. This was because of adequate and effective breastfeeding. Then his weight dropped to the 15th percentile line in the 7th month. He did not get adequate complementary food after completing 6 months. He was also ill and had diarrhea. Then in the 8th and 9th months his weight started increasing. In these months he got adequate breast milk and complementary food. Therefore his growth chart shows an incline. The average birth weight of an Indian child is 2.7 kgs. So an incline in the growth line is important in the first few months. Correct breastfeeding techniques also cause a sharp incline in the charts. This chart shows that Supriya's birth weight was on the 50th percentile line. Then in first month her weight dropped to the 15th percentile line. This happened because of ineffective breastfeeding. Her mother was taught the correct breastfeeding technique for deep latching. Within a month Supriya's weight increased to the 50th percentile line. However a sharp incline is risky for babies who are fed animal milk or formula. If they gain weight rapidly then they can become overweight at one year of age. Another growth problem for any child is a flat growth line or growth stagnation. A flat growth line also called stagnation usually indicates a problem. If a child's length or weight stays the same over time she is not growing. Even one month's stagnation in growth represents a possible problem. The only exception is with an overweight child. This child can maintain the same weight over time while the length increases. This will bring the child to a healthier weight for his length. Another problem is slow growth. Here Pooja's average weight gain is only 500 grams per month. Her birth weight was average at the 50th percentile line. However here we can see that she became undernourished in just three months. She needs effective breastfeeding to come back to the 50th percentile line. Please follow the growth chart to evaluate a child's growth. Take adequate measures if the growth falters due to any reason. This brings us to the end of this tutorial. Welcome to the spoken tutorial on WHO Length for Age Percentile Growth Charts. In this tutorial we will learn about two types of percentile growth charts. Growth indicators, the plot points for growth indicators. Let us begin by understanding what are percentile growth charts. They are charts designed to help you follow a child's growth. They were developed through the World Health Organization's MGRS. MGRS means Multicentre Growth Reference Study. 8,500 selected children from six different countries were measured. The countries were India, Brazil, Ghana, Norway, Oman and the USA. The children were from different cultural backgrounds. Three things were kept constant among them. All the selected children were breastfed. They all were vaccinated. They all had access to a clean environment. It showed that children from different countries grew in a similar way. This means the environment played a major role in their growth. Good nutrition, health and sanitation is required for proper growth. The average weight and length for each age and gender were established. Growth charts compare a child's length and weight with other children. These children are of the same age and gender as the child. These charts provide an early warning that a child has a growth problem. In this tutorial we will discuss two types of percentile growth charts. Each growth chart is used to measure a specific growth indicator. Growth indicators are used to assess growth. They take a child's age and measurements together into consideration. The first growth indicator is length for age. The second one is weight for age. These indicators are plotted on growth charts over weeks, months or years. This helps us to identify any growth problems. It is important to use growth charts as per the child's gender. The growth charts used in this tutorial are from the World Health Organization. They are for children in the 0 to 2 years age group. These growth charts are available on their website www.who.int. Please select the appropriate charts as per the child's gender. Download and print them. Next let's learn more about the first type of percentile growth chart. It is the length for age growth chart. It is used to plot the length for age growth indicator. This indicator can help identify children who are stunted or short. Such children might have had prolonged under nutrition or repeated illness. Children who are tall for their age can also be identified. In these charts the horizontal reference line at the bottom is the x-axis. It shows age. Exact age is plotted in weeks and months from birth until 2 years of age. The vertical reference line at the left side is the y-axis. It shows length in centimetres. The thin grey horizontal lines represent an increase in length by 1 centimetre. Let's go through the steps to plot length for age in these charts. First mark the exact age, months and years on the x-axis with a point. Then mark the length on the y-axis with a point. Extend it over the connected horizontal line till the marked point for age. Extend the marked point for age over the connected vertical line. The point where two extended lines intersect is called a plotted point. For every child points are plotted over weekly or monthly measurements. Check whether a plotted point seems sensible. If necessary, re-measure the child. For example, a baby's length should not be shorter than at the previous visit. If it is, then one of the measurements was wrong. Let us use an example to understand plotting on this chart. This graph shows Anita's length for age plotted 3 times over a few months. At this point Anita was 3 months of age and 64 centimetres in length. Now, here at this point Anita was 70 centimetres in length at 6 months of age. Finally, here at this point she was 78 centimetres in length at 1 year of age. Now, let's learn more about the 5 curved coloured lines on growth charts. These 5 curved lines show selected percentiles. They are 3rd, 15th, 50th, 85th and 97th percentiles. The 3rd and 97th percentiles are shown by red coloured lines. The 15th and 85th percentiles are shown by orange coloured lines. The 50th percentile is shown by a green coloured line. These percentiles indicate the rank of the child's measurement. Let's understand each percentile line with specific examples. In this graph, Madhav's length is plotted on the 3rd percentile line. It means that 97% of children of his age are taller than him. Only 3% of children of his age are shorter than him. In this graph Anu's length is plotted on the 15th percentile line. It means that 85% of children of her age are taller than her. Only 15% of children of her age are shorter than her. In this graph Priya's length is plotted on the 50th percentile line. The length of 50% of children is on this percentile line. Therefore Priya's length is the average length among the children of her age. In this graph Rohan's length is plotted on the 85th percentile line. It means that 15% of children of his age are taller than him. 85% of children of his age are shorter than him. In this graph Fatima's length is plotted on the 97th percentile. It means that 3% of children of her age are taller than her. 97% of children of her age are shorter than her. Next let's discuss the average length of a child from birth to 2 years of age. It is along the 50th percentile line in the length for age growth chart. Average birth length of a girl is 49 cm. At 1 month the average length of a girl is 54 cm. At 3 months it is 60 cm. At 6 months it is 66 cm. At 1 year it is 74 cm. At 2 years the average length of a girl is 86.5 cm. Average birth length of a boy is 50 cm. At 1 month the average length of a boy is 55 cm. At 3 months it is 61.5 cm. At 6 months it is 67.5 cm. At 1 year it is 76 cm. At 2 years the average length of a boy is 88 cm. The second percentile growth chart is called the wait for age growth chart. It is discussed in another tutorial in the same series. Growth problems are also discussed in the same tutorial. Please visit our website for more details. This brings us to the end of this tutorial. Thank you for joining.