Parents Corner

Well-Baby Visits

Written by: Julie Loe, B.S., PTA, Director of Pediatric Services

Infant immunization schedule

The following schedule is the recommended time table for immunizations in children following the normal course of development. Children with specific growth or medical concerns should consult with their pediatrician for specifics. If a child should fall behind the schedule every effort should be made to catch them up so as to decrease the risk of contracting illness unnecessarily.

Age           IMMUNIZATIONS (Shots)
==========   ======================
 2 Months    Polio, DTP, Hib, Hep B
 4 Months    Polio, DTP, Hib, Hep B 
 6 Months    Polio, DTP, sometimes Hib
12 Months    MMR
12-15 Months DTP, Hib, Hep B
18 Months    Booster DPT, Polio
 5 Years     Booster DPT, Polio  

Growth Charts: Recording and plotting measurements

Growth charts show how a child's length or height and weight compared to those of other children of the same age in the United States. The growth charts should be a part each child's health record.

At each visit to the pediatrician the child's measurements should be plotted to enable the health team to follow the child's growth pattern over time. An isolated measurement is not indicative of a risk for delayed growth and development.

For children birth to 36 months, 3 measurements should be taken. They should be plotted on the growth charts:

	Weight for age and length.
	Length for age.
	Head circumference.

For children 2-18 years 2 measurements are to be taken:

	Weight and stature for age.
	Weight for stature.

There are also different charts for boys and girls in each age group. It is very important for the date to be recorded so that growth can be attributed to a definite period of time.

Each growth chart has a set of curves, called percentile curves. Growth charts tell you how each attribute relates to each other. The attributes are weight, length, and head circumference, They also tell you how they compare to other children in the United States of the same age and sex. For example, a female child's weight for age is set at the 50th percentile. This means that 50 percent of girls her age weigh less than she does.

Accuracy is essential in order to identify children who may be underweight, overweight, or growth delayed. A series of measurements is necessary to determine the child's own particular growth pattern. Establishing a pattern is necessary to identify a possible problem with growth.

A single measurement in and of itself may only be indicative of genetic or environmental factors. It is helpful to remember the child's ethnic or racial background when interpreting measurement. Regular measurements may detect any dramatic changes in growth patterns or more slow and insidious changes.

The two most important measurements for screening are length for age and weight for length. By examining a child's measurements over time you can identify significant percentile shifts. Significant percentile shifts may be indicative of concern regarding a child being overweight, underweight, or delayed growth.

When a child's percentile shifts more than two percent it is prudent to re-measure to ensure accuracy. For example, a child whose height has shifted from the 90th percentile to the 50th percentile may be exhibiting a growth problem. While the 50th percentile is within the normal range, it may not be normal for that child and further information should be gathered to identify reasons for this percentile shift.

Your pediatrician has growth charts for ages 0-36 months, and 2-18 years, for boys and girls. The growth charts were constructed by the National Center for Health Statistics in collaboration with the Center for Disease Control and printed in May 1988. The charts may be reproduced or obtained from Wyeth-Ayerst Laboratories.

For questions, comments or additional information on this topic, send a feedback note or fax (805) 771-9538.

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