Girls Uk 2-20 Yr. Childhood And Puberty Close Monitoring (Cpcm) Growth Chart printable pdf download

GIRLS UK

Clinical assessment of

Body mass index

2-20yr

pubertal progress

Please place sticker (if available) otherwise write in space provided.

(BMI) chart

Age in years

Tanner stage assessment requires

Childhood and puberty

Name:

________________________________________

considerable expertise; so unless

GIRLS

you have been adequately trained

close monitoring CPCM)

NHS / CHI No:

you should use the “puberty phases”

2-20 years

approach (see chart instructions

growth chart

over). For a detailed description of

Hospital No:

each stage consult a standard

paediatric reference book (see

Date of Birth:

for

further information).

Adult height predictor

This allows prediction of the child’s adult height based on

Assessment by clinical examination

their current height, including a regression adjustment to

should be undertaken only with

This chart is mainly intended for use in children and young

allow for the tendency of very tall and short children to be

parental and child consent and

people whose growth requires close monitoring, or whose

less extreme in height as adults. Four girls out of five will have

with adequate privacy.

measurements are outside the usual centile range. It is based

an adult height within ±6 cm of this predicted height.

on the UK 1990 growth reference from 4-20 years and at

The charts below show the age

birth, and the WHO growth standard from 2-4 years (as per

ranges for each of the five Tanner

Body mass index BMI) centile chart

the UK-WHO 0-4 years charts). For children aged under 2

stages of breast and pubic hair

Where over- or underweight is a concern BMI can be

years whose growth needs detailed assessment, the neonatal

development.

calculated and plotted on the BMI chart. BMI is calculated by

and infant close monitoring chart (NICM) is available. This 2-

dividing weight (in kg) by the square of height (in metres e.g.

Once the Tanner stage has been

20 chart has a number of novel features including some

1.32 m, not centimetres e.g. 132 cm). A simple way to do this

determined, make a small dot on

puberty phase specific centile lines. For further information

on a calculator or mobile phone is:

the relevant stage line at the child's

about the development of this chart and supporting

1. Enter the weight; 2. Divide by height;

age. The horizontal dotted lines

references see .

3. Divide the result by height.

show the stage centiles for age. If

Birth centile plotting scale

the point is between the 2nd and

The result should be plotted on the BMI chart provided. To

98th centiles then development is

The chart starts at age 2 years, but there is a scale to the left

allow the monitoring of severely obese children, the BMI

within normal limits. If the point is

of the chart where birth weight, length and head

chart displays high lines at +3, +3.33, +3.66 and +4 SD, and

circumference for term infants can be plotted.

above the 98th centile development

-4 and -5 SD for those severely underweight.

is precocious, and if below the 2nd

Children with extremes of height or weight

Pubertal assessment

centile it is delayed. In these cases

In addition to the usual nine centile lines, the height charts

For most purposes the puberty phase approach will be

further

investigation

may

also show lines -4 and -5 SD below and +4 SD above the

sufficient, based on the history and clinical examination as

required. Please note that unlike

mean. The additional weight lines are -4, -5, and +3 SD

below. Where more detailed assessment of the progress of

height and weight centiles, the

respectively. Children whose growth lies on these outer lines

puberty is required see the chart flap for Tanner staging.

stage centile position may change

are likely to have additional clinical problems, and if not

The three vertical black lines (puberty lines) on the right hand

substantially from one age to the

already receiving medical attention should be referred. For

side of the chart (8-20 years) indicate the normal age limits

next.

for the phases of puberty described below:

exceptionally heavy or light children BMI should be calculated

and plotted.

Breast stage

Pre-puberty

In Puberty

Completing Puberty

Transit point

(Tanner stage 1)

(Tanner stage 2-3)

(Tanner stage 4-5)

99.6th

Parent height comparator mid-parental centile)

Precocious

from UK-WHO

If any of the following:

If all of the following:

98th

The mid-parental centile is the average adult height centile to

If:

to UK90 data.

91st

be expected for all children born of this child’s parents. It

No signs of pubertal Any breast enlargement

Starting periods

75th

incorporates a regression adjustment to allow for the

development

so long as nipples also

(menarche) with

tendency of very tall and short parents to have children with

enlarged

breast, pubic and

less extreme heights. Comparing the mid-parental centile

axillary hair

with the child’s current height centile can help assess whether

Any pubic or axillary

development

25th

the child’s growth is proceeding as expected. The larger the

hair

9th

discrepancy between the two, the more likely it is that the

2nd

What does a measurement in a shaded area mean?

child has some sort of disordered growth. Most children’s

Delayed

0.4th

The chart provides extra guidance about the lower limit

height centiles (nine out of ten) are within ± 2 centile spaces

8 9 10 11 12 13 14 15 16 17 18 19 20

(0.4th centile) for late-maturing girls in pre-puberty and the

of the mid-parental centile, and only 1 percent will be

Pubic hair stage

upper limit (99.6th centile) for early-maturing girls

discrepant by more than 3 centile spaces.

completing puberty. If height and weight falls within a

99.6th

Precocious

Mid-parental target height

shaded area on the chart, pubertal assessment will be

98th

The mid-parental target height is obtained by plotting the

required. For girls in pre-puberty, height or weight within the

91st

mid-parental centile on the height chart at age 20 and

lower shaded areas are likely to be normal, particularly if

75th

reading off the corresponding height. Four girls out of five

height is not markedly discrepant from the mid-parental

will have an adult height within ±7 cm of this target height.

centile and BMI is within normal limits. Similarly, girls

However predicted adult height (above) is usually closer to

completing puberty who have measurements in the upper

25th

the child’s final height.

shaded area are usually normal.

9th

2nd

Delayed

0.4th

Measurement 1

Measurement 2

Measurement 3

Measurement 4

8 9 10 11 12 13 14 15 16 17 18 19 20

Recording Date

Menarche

Weight

99.6th

Length/Height

Precocious

98th

BMI

91st

Location

75th

Health worker name

Measurement 5

Measurement 6

Measurement 7

Measurement 8

Recording Date

25th

Weight

9th

Length/Height

2nd

Age in years

Delayed

0.4th

BMI

8 9 10 11 12 13 14 15 16 17 18 19 20

Location

Van Buuren S. Growth charts of human development;

Statistical Methods in Medical Research.

Health worker name

DOI: 10.1177/0962280212473300

Girls Uk 2-20 Yr. Childhood And Puberty Close Monitoring (Cpcm) Growth Chart

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