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Growth monitoring
  1. 51 Eastmoor Park
  2. Harpenden
  3. AL5 1BN, UK
  4. David{at}

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    Editor,—Garner and colleagues recently presented a much needed review of growth monitoring.1 This is a component of primary health care on which so much finance and health workers' time is being expended. No doubt this review will stimulate more necessary trials.

    However, they did not touch on one important aspect of growth monitoring—that is, whether health workers using growth charts comprehend the weight for age graph.

    Piaget (1896–1980) considered the line graph to be one of the more difficult subjects to teach. Graphic representation of numbers is not taught in primary schools in developing countries and colleagues with knowledge of primary education suggest that primary school teachers in these countries would not be able to teach it. Experience with postgraduate doctors in the 1970s suggested that a proportion could not complete a weight chart and even more would have problems in interpreting it.2 A similar problem has arisen with midwives in the use and interpretation of the partograph to plot the progress of labour.

    Fortunately, an alternative method of weighing may overcome this difficulty. This method involves weighing in or near the home, not in the clinic, with a Direct Recording Scale. With this, the parent sees a large spring stretching up their child's chart, located in the scale, as they release the child's weight into the weighing trousers below the scale. With a ball pen, they then create the next point on the child's growth curve through a hole in the pointer at the top of the spring. In this way, even unschooled parents can create their child's growth curve. This, in time, leads them and their relative to understand the weight for age curve.3 4 In one study among the pastoral Maasai in Kenya, action was taken by the parents to give an additional drink of milk to children whose weight for age curve was faltering (Meegan M. Personal communication, 1999).


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