It has 2 reference curves.

The upper reference

curve represents the median(50
th
percentile)
for boys & lower reference curve(3
rd

percentile) for girls which is slightly lower
than for boys. Thus, this chart can be used
for both sexes.
The space between 2 curves is called as
ROAD TO HEALTH. If the growth line runs
above 3
rd
percentile & parallel to the Road to
Health then it is taken as normal.
Direction of growth chart is more important than
the location of dots on the line. Flattening or
falling of child weight curve indicates growth
failure which is the earliest sign of PEM & it may
preceed clinical signs by weeks or even months.
Such a child needs special care. The objective of
child care is to keep the child above 3
rd

percentile.
REFERENCE CURVE-
For the purpose of comparison, growth charts
are provided with reference curves. These
reference curves are based on extensive cross-
sectional data of well nourished healthy children
assembled by US National Centre for heath status
which are considered the best available for
international use.
50
th
percentile corresponds to the value of
50
th
child if a group of 100 children are
arranged in ascending or descending order,
according to their weights. Here equal
number of children will be above & below this
reading. Similarly, the 3rd percentile means
that only 3 % of the children have values
below this reading.
Space is also provided in the growth chart
to record: Identification & registration
number, birth weight, age, H/O siblings,
immunization, introduction of supplementary
foods, episodes of sickness, child spacing,
need for special care etc.
The growth chart is easily understood by the
mother as well as the health care workers. It
provides the mother with a visual record of
health & nutritional status of the child.
The topmost curve corresponds to 80% of
the median (50
th
percentile of the reference
standard of WHO curve). The lower lines
represent 70%, 60%, 50% of the standard.
GRADE-I: If a childs weight is between 70%
& 80%, it is said to be grade-1 malnutrition.
GRADE-II: If the weight is between 70 & 60
%, then it indicates grade-2 malnutrition.
GRADE-III: If the weight is below 60% &
above 50%.
GRADE-IV: If the weight is below 50%.

ANY WEIGHT BETWEEN TOP TWO LINES
(BETWEEN 80% & 100%) IS CONSIDERED
NORMAL.
A child is born on 1
st
march, 2007. His birth
weight is 3 kg. Then his weight was recorded
in the month of September, 2007 which was
found to be 6.5 kg. In the month of July 2008
he developed acute diarhhoea his weight
dropped to 9 kg from previous months
weight of 9.5kg. Thereafter, his weight
steadily increased & was recoded as 10.5 kg
in October 2008. In June 2009 the weight of
child was recoded to be 12 kg & in Jan 2010
the weight of child was found to be 14 kg.
Birth weight of an infant was 2kg.(DOB 10
FEB, 2008). His weight grew steadily & was
recorded to be 5 kg in the month of July,
2008. His weight was recorded in the months
of August, September, October, November &
December(2008) & was found to be 6.5 kg in
all these months & then in the month of Jan,
2009 it was found to be 7 kg.
DOB 15 APRIL,2007
Weight on 1
st
May, 2007: 2.5 kg
Weight in the month of September, 2007: 5kg.
March, 2008: 7.5 kg
July, 2008: 8.5kg
September, 2008: 8 kg
December, 2008: 10 kg
March, April, May 2009: 9.5 kg
July, 2009: 10.5 kg
Aug, 2009: 10kg
Sept, 2009: 10.5 kg
Jan, 2010 : 11.5 kg


DOB: 1
st
June, 2006
Weight on 15
th
June, 2006: 2.5 kg
December, 2006, jan2007, Feb. 2007: 4.5 kg
April, 2007: 3.5 kg
June, 2007: 4.5 kg
Sept, 2007: 6.5kg
Jan,2008: 7.5kg
March, 2008: 7kg
June, 2008: 7.5 kg
Dec, 2008: 7.5 kg
Feb, 2009: 6.5 kg
April, 2009: 7kg
DOB 105
th
Jan 2006
Birth weight: 3kg
June, 2006: 5kg
Oct, Nov, Dec, 2006: 8.5 kg
An episode of diarrhoea developed in Feb,
2007: 8kg
April, 2007(an episode of ARI): 7kg
July, 2007: 7.5 kg
September, 2007: 8kg
December, 2007: 9kg