Comunicar utilizando medios rápidos, es decir, buscando la economía de los medios,

11.4.1. When and How Frequently Should Growth Monitoring Be Done?

How frequently children should be weighed after birth must be decided in the light of the other activities scheduled (e.g. Immunizations), the ability of the mothers to attend the health center or clinic, the time available to the personnel for this purpose, the health worker’s schedule for home visiting, etc, and, for the individual case, the health condition and health risks of the child. Ideally, children should be weighed at least once every month during the first year, every two months during the second year, and every three months thereafter up to five years of age, the first three years being the most critical periods. In addition to this schedule, however, every child should be weighed and the weight plotted on the chart every time he/she is brought to the health service unit for any reason, particularly if the child is sick.

11.4.2. Who Should Do Growth Monitoring and What Activities

Need to Be Carried Out During Growth Monitoring?

11.4.2.1. Health Personnel or Community Health Workers:

In order to do proper growth monitoring, the following activities should be carried out by the health personnel or community health workers:

• Communicating the mothers/care givers about the procedure properly • Weighing infants/children accurately

• Recording the weight in the growth chart used in the service • Inserting any other information required in the chart correctly

• Assessing normal growth and deviations from normal growth on the growth chart • Interpreting deviations in terms of health status

• Translating the information on the growth chart in to appropriate advice and action • Recognizing the need for, and making decisions regarding the referral of patients

to a higher level of health system

• Using the growth chart as an integral part of the health care system • Explaining to mothers the use and significance of the growth chart

In general, in educating mothers/care givers, emphasis should be placed on the factors affecting growth with special reference to the role of diet and the effects of disease on child growth. A better understanding of the process of growth and development may be obtained by using examples taken from the local setting (e.g. the growth of plants and the role of water and fertilizers: the growth of animals).

11.4.2.2. Mothers/Care Givers

Mothers/care givers also have a role in the growth monitoring and promotion activities by: • Improving child care practices (breast feeding, proper weaning, etc.)

• Following the growth of their children • Improving their health seeking behavior.

• Complying with the advices given by the health personnel/community health workers.

11.4.3. How Should the Growth Monitoring Be Done?

• Check the weighing scales each time it is moved by verifying that it reads zero when empty and check the reading for a known weight.

• Adjust the needle to zero before each weighing session.

• Undress the child/ infant to be weighed or make them wear a standard gown. • Use Salter scale (spring balance) for children less than 2 years old and beam

balance for children greater than 2 years.

• Read the values to the nearest 0.1 kg for children 2 years and above and to the nearest 10 grams for children < 2years.

• Plot the weight of the child/ infant on the growth chart and keep the records properly.

• Connect your plot with the previous records on the chart if there are any and interpret the nutritional status of the child.

• Record the data on the growth performance of children on a registration book and report.

• Discuss about the growth performance of the child with the mother/care giver and encourage her to continue if the performance is within the normal range. If you observe any sort of deviations try to find out the possible causes and solutions with the mother/ caregiver and refer the child timely to the next level if the deviation is sever.

• Follow the feedback of the referred cases (as much as possible).

N.B. Mid upper arm circumference could be used to screen children who are not growing

well if we have limited number of staff and shortage of time. Even if it is not as precise as weight for age it could serve as a method of making preliminary screening in children 1-5 years. Cut off points are MUAC > 13.5 cm is normal, 12.5- 13.5cm is indicator of mild to moderate malnutrition and <12.5 cm is an indicator of severe malnutrition.

11.4.4. Where Should the Growth Monitoring Be Done?

1. At Home Level

Growth monitoring and promotion efforts should start at the family level by the mothers/care givers. Caregivers should be concerned about the growth performance of their children. They should be convinced about the interplay between the growth performance and their childcare practices. They should keep their kids hygiene and their living environment, feed their children as far as possible a nutritious food in small frequent feeds, get them immunized and consult community health workers or the nearby health institution at times when their children fails to thrive. They should also strictly follow the advices given by the health personnel/community health workers.

2. At Health Service Institutions/At The Community Health Post Level

Ideally, health personnel/ community health workers should weigh every child at least once every month during the first year, every two months during the second year, and every three months thereafter up to five years of age, the first three years being the most critical periods. In addition to this schedule, however, every child should be weighed and the weight plotted on the chart every time he/she is brought to the health service unit for any reason, particularly if the child is sick.

Children found to be severely malnourished need to be admitted with their caregivers to the nutrition rehabilitation centers attached to health centers. This gives an opportunity for health personnel to demonstrate the preparation of nutritious foods from locally available food stuffs and proper ways of feeding children. Besides, seriously malnourished children will be rehabilitated both nutritionally and behaviorally.

The community health workers need to refer children whose weight for age is less than 60% of the standard and those children who:

• Are less than one year old • Have intractable vomiting • Have severe dehydration

• Are hypothermic (rectal temperature < 350_C)

• Have sign of infection to the health institutions for possible admission to the impatient ward or the nutrition rehabilitation center (NRC).