Explain growth monitoring. How are growth charts plotted and interpreted for children under five?

1. 1 · Open in two lines. Growth monitoring is regular weighing of a child and plotting the weight on a growth chart to detect faltering early. It is the cheapest early-warning system for malnutrition.
2. 2 · Standards and indices. WHO Child Growth Standards (2006); weight-for-age, height-for-age and weight-for-height.
3. 3 · Z-scores. Formula, cut-offs of −2 and −3 SD, and a worked example (9.4 kg at 24 months gives −2.24: moderate).
4. 4 · Draw a growth chart. [Diagram: age in months on the x-axis, weight on the y-axis, median and −2 and −3 SD curves, a child's line rising and then going flat]
5. 5 · Steps of plotting.
   • Chart by sex; age in completed months.
   • Weigh accurately; plot the dot; join it to the last dot.
6. 6 · Interpretation. Rising and parallel is good; flat is faltering; falling is danger; below −3 SD needs a check for SAM.
7. 7 · In the community. Explaining the line to the mother on the MCP card at the anganwadi turns monitoring into growth promotion.
8. 8 · Close in one line. A growth chart catches malnutrition months before it can be seen.

Scoring tip: Draw the chart neatly with labelled axes and the −2 and −3 SD curves; the line's direction is what examiners want explained.