Professional Documents
Culture Documents
Kasahara
UP.PGll
Pediatrics
,a::
a.
:?
i:
ry
PEDIATRIC
HEAUTH GARE
!::
coMMlrTEE 2010-2012
Maria Teresa S. Llorin-Belleza, MD, MPH
Erlinda Susana S. Guisia-Gruz, MD
Leonila F. Dans, MD
Janice Stephanie V. Gimenez-Mendoza, MD
Ma. Eva l. Jopson, MD
Eufrosina Marina A. Melendres, MD
Mary Antonette G. Madrid, MD
Ghristian T. Galigagan, MD
Vice Ghair
TABLE OF CONTENTS
...............
Message from the Committee Adviser......
TABLE
.........
Foreword
Abbreviations
Annotations
List of
Appendix 1.
Appendix
2.
.'...........'..5
Counseling
of
"""".."14
Care
....'.....'..'16
.........17
Screening
....'.....'..'.........19
Appendix 5. Screening for EyeA/isual Defects
.--.".22
Appendix 6. Preventive Dental Care...........
...--.--23
Appendix 7. Breastfeeding and Complementary Feeding
--.....25
Appendix 8. Child Maltreatment.................
.""'.-----.".."..".27
Appendix 9. "7 Steps to Protect Children".....
.......31
Figure 1. Windows of Achievement .............
Appendix
4.
Figure
2.
Figure
3. Z-Score lnterpretation
Literacy.'........'.......'..".""."32
....'.33
.....----.'.' 34
Girls....".
..........35
Figure5. WeightforAgeforGirls: Birthto2years........
Figure 6. Length forAge for Girls: Birth to 2years
'......---........36
Figure 7. Weight for Length for Girls: Birth to 2years
'.'..........-37
Figure 8. BMI forAge for Girls: Birth to 2 years
'.......'...........'..38
.."..................39
Periodicity Table ..........
..-.-....'............"41
Figure 9. Weight for Age for Girls: 2 to 5 years
Figure 10. Height forAge for Girls: 2 to 5 years
'..'..----....'.'."""42
Figure
4.
years
Figure 12. BMI forAge for Girls: 2 to 5 years.
Figure 13. Weight for Age for Girls: 5 to 10 years ..........
Figure 14. Height forAge for Girls: 5 to 19 years...........
Figure 15. BMlforAge for Girls: 5 to 19 years...........
Figure 16. Head Circumference forAge for Boys.......
Figure 17. Weight forAge for Boys: Birth to 2years
Figure 18. Length forAge for Boys: Birth to 2 years........
Figure 11. Weight for Height for Girls: 2 to 5
....".."'.'
OF COilITENTS
..................43
......44
...........45
...........46
..............47
...............48
.................49
..........50
years........
.............52
Figure 21 . Weight for Age for Boys: 2 to 5 years.
......................53
Figure 22. Height forAge for Boys: 2 to 5 years
.......................54
Figure 23. Weight for Height for Boys: 2 to 5 years.
..................55
Figure 24.BMl forAge for Boys: 2 to 5 years.
......56
Figure 25. Weight forAge for Boys: 5 to 10 years...........
..........57
Figure 26. Height forAge for Boys: 5 to 19 years...........
...........58
Figure 27.BMl forAge for Boys: 5 to 19 years...........
..............59
Figure 28. US CDC-NCHS Growth Chart for Boys............
........60
Figure 29. US CDC-NCHS Growth Chart for Gir|s............
........61
Figure 20. BMlforAge for Boys: Birth to 2
Annotations
Figure 32. lmmunization Table 2012...........
Figure 33. Food Pyramid...........................
Bibliography
lmmunization
.................66
..........7O
............71
..................72
MESSAGE
MESSAGE
he preventive aspect of pediatric health care is
an often neglected area in the care for children.
Aside from immunization and nutrition, which
pediatricians are allaware of, there is actually much more to be
done is this area of advocacy. ln a country like us where the
cost of health care is beyond the reach of the majority, a child
getting sick often leads to catastrophic outcomes due to lack of
iOequate health care. Thus, preventing rather than curing
these diseases will be an excellent and practical approach'
0u.",.-
"*
based data to
in
child health,
and
leaders
of
training
programs, to focus not only on curative aspects of health care for the developing
child, but on primary prevention as well. Using this handbook routinely as a guide
on the latter aspect of child health supervision, will surely assure youthatyou
are providing a comprehensive care for every patient that you see in your practice.
Let me end with this timeless words from Mother Teresa of Calcuta: "We
are not called to do great things. We are only called to do small things, but with great
love". The Committee on Preventive Pediatric Health Care, once again, has
produced this 6th edition of the handbook, I am sure, with great love. To the
members of the Committee, thankyou forsharing this great love.
/*yt g^t*/'
MIGUELL. NOCHE JR, MD, FPPS, FPSAAI
Adviser
Committee on Preventive Pediatric Health Care
LIST OF ABBREVIATIONS
FOREWORD
he Committee on Preventive Pediatric Health Care
is
BMI
CP
DOH
DBP
DSWD
HEADSSS
LVH
MR
PASOO
PEP
SBP
TIPP
UPCHK
age
UP PGH
'
'
5TU PPD
AAPD
Targetedscreeningfortuberculosis
Contraindications to deworming.
committee
mention
members for their indefatigable and selfless contributions. special
B.T.
Loida
Dr.
Jr.
and
Noche,
L.
Miguet
Dr.
adri'rsers,
;;; t; ori
CerebralPalsy
Departmentof Health
Diastolic Blood Pressure
Department of Social Welfare and Development
Home, Education/Employment, Activities, Drugs,
Sexuality,
Suicide, Safety/Spirituality
Left Ventricular Hypertrophy
Mental Retardation
Philippine Association for the Study of Overuueight and
Obesity
Pre-Exposure Prophylaxis
Systolic Blood Pressure
The lnjury Prevention Program
University of the Philippines - College of Human
Kinetics
University of the Philippines - Philippine General
Hospital
for
US CDC-NCHS
WHO
"=t""r"d
only for their invaluable input but also for inculcating in us the
VifLnu"u", not
passion to be committed advocates of preventive health care'
lndeed, it is the fervent hope of the committee that this Handbook will
for
continue to assist pediatricians as well as other health professionals caring
promotion
of wellness
the
espouse
to
students
medical
encourage
and
children
and prevention of disease among Filipino children'
-il*&'t/4
Chairman (J
DISCLAIMER
"The recommendations contained in this document are intended to GUIDE
practitioners in the conduct of anticipatory care/guidance and periodic health
examinations of infants, children and adolescents. ln no way should the
ANNOTATIONS
ANNOTATIONS
1.
5,
Breastfeeding (AppendixT)
Newborn Care and Procedures at
Birth
Anticipatory Guidance
to
.
.
Prevention
of
smoking, alcohol
8.
6.
of a
7.
opportunity
observing
acid supplementation)
to the Pediatrician
available
.
.
.
.
Latching-on and
48
2)
4.
Developmental, psychosocial,
"The Philippine
AmbulatorY
closely
in
need
1):
.
.
for Boys (2 to
9.
- appropriate.
Respect for an older child's privacy and
minimizing the child's discomfort are
basic in pediatric physical examination.
Additional procedures to be performed
foradolescentpatients are mentioned
in Appendix 3.
findings must be
be age
5 years), BMI
forAge for
Boys (5 to 1 9 years).
measuro
recumbent length and subtract 0.7 cm
to convert itto height.
ANNOTATIONS
ANNOTATIONS
Weight-for-length/height
is
(BMl)
b.
c.
d.
our
Nephrology Society
routine
recommends
of the Philippines
the
lf in doubt, a referral to
patients.
f.
height percentile.
Find the SBP on the left columns
of the table and the DBP on the
right columns.
Find the corresPonding BP
percentile on the vertical column
to the rightof the age column.
Prehypertension
in
children
is
defined
be considered Pre-hYPertensive.
on physical activity, diet
management and weight
Hypertension is defined as
average SBP and/or DBP equal to or
greater than the 95* percentile on 3 or
more occasions. Hypertensive patients
must be referred to the subspecialist for
further investigation and management.
Health professionals
Counseling
need
are
in
for
all
in hospitals in the
Philippines shall be made to undergo
infants born
recommends screening
A N N O TAT IO N S
ANNOT'ATIONS
18. Vitamin
absent/dull
or
asYmmetric ROR
Rabies Act
of 2007
mandates
the creation of a National Rabies
Prevention and Control Program.
One of the proPosed activities of
1 dose only
(One capsule
is given anytime between
6-11 months
but usually
given at 9
months of age
during the
measles
irnmunization)
Deworming must
Previous hypersensitivity to
The DOH has a National Filariasis
0.3m1 once a
day to start at
two months of
age until 6
months when
complementary
foods are given
immunization.
the
Appendix 3.
Republic Act no. 9482, the Anti
day lor 5
months
1 tsp once a
day for 3
months or 30mg
once a week for
6 months with
supervised
administration
20.
0.6 ml once a
retinoblastoma (36).
in
antihelminthic drug
subsequent
not be done
referral
ON
FULLSTOMACH.
Mebendazole
single dose every 6 months
(Appendix 5).
supplementation as
61):
Albendazole
12 months to 24 months:
200 mg, single dose every 6
months
mg,
is
ANNOTATIONS
.
develoPing oral
ANNOTATIONIS
is
exposure (118).
PPS Policy
Fluorides in
the
Statement on
Prevention of Dental
recommendations
fluoride varnish
(1
on the use
of
7).
toward higher-fat
administrators
23.
beYond.
nutritional
requirements of
infants
(6,7,8,7O,7
of
feeding (AppendixT).
Early on, children must be taught
in
promoting school-
in school(74).
higher-energy
or
foods (78).
8).
the
principle
and
to
adolescents is contained
3.
physical
activities (89).
Age-approPriate PhYsical
102,103).
influence
adolescence
(1
(11
6).
Unit
child to
to Noise
of a
Neonatal Exposure
susceptibility
to
07).
Organization
defines child maltreatment as "all forms
(1 1 5).
context of a relationship of
experiences
(1
08,1 1 3).
12
APPENDIX
ANNOTATIONS
"Lead Poisoning in Children" presents
background information on lead
iroisoning
of lead poisoning
in
children (64).
of
at risk. The
SocietY of
29.
Appendix
is
of > 5 mm is considered
positive in the presence of any or all
of the following: history of close contact
with a known or susPected case of TB,
clinical findings suggestive of TB,
chest x-ray suggestive of TB, and
immunosuppressed condition. ln the
erythema)
is
recommends
1.
.
.
.
.
of
breastfeeding.
(4,8,12,13)
positive (140).
(50,51).
It is during the prenatal visits when the health care professional may
vital
opportunity
chromosomal
prenatalvisits (64).
Pregnant women must be informed about the deleterious effects of
smoking, alcohol intake and exposure to known teratogens during pregnancy
(1,23).Theymustlikewise beadvised and encouraged to take folic acidrich foods and supplements on top of the recommended healthy diet for a
pregnant woman (20,21 ,22). Tetanus Toxoid immunization must be started or
continued during pregnancy (50).
Pediatricians, obstetricians, midwives, nurses and other health care
professionals/workers must work together to promote the welfare of the
mother and the unborn child both in normal and high-risk pregnancies.
14
APPENDlX
APPENDIX
Appendix 2.
Discharge and Follow-up of Healthy Term Newborns
Appendix 3.
Adolescent Health Care
following
r
.
.
.
.
.
.
.
.
is to (39):
particularly
2.2
2.3
2.4
LaboratoryTests
3.1
behavior.
3.2
3.3
3.4
discharge.
yet done and other tests that may be clinically indicated, such as
1.
serum bilirubin.
lmmunization Update:
Td, MMR and HepatitisA, Hepatitis B, HPV lnfluenza
Second dose of Varicella if notyetgiven
'16
APPENDIX
APPENDIX
LANGUAGE DELAY
5.2
5.3
5.4
.
.
.
.
.
PSYCHOSOCIAL DELAY
.
.
.
.
.
No socialsmile by 3 months
Not laughing in playful situation by 6 months
year
Appendix 4.
Developmental Surveillance and Screening
2.
3.
4.
5.
development
maintaining a developmental history
making accurate and informed observations of the child
identifying the presence of risk and protective factors
documenting the process and findings
MOTOR DELAY
.
.
.
.
.
Cannotstandononelegby 3years
COGNITIVE DELAY
.
.
.
.
'
'
'
'
'
2 months
6 months
Notalertto mother
Not searching for dropped objects
12 months
No object permanence
No interest in cause-and-effect games
18 months
2years
3 Years
4ltyears
5 Years
Sl"years
SCHOOLAGE CHILDREN
Slowto rememberfacts
Slowto learn newskills, relies heavilyon memorization
Poor coordination, unaware of physical surroundings and prone to
accidents
May be awkward and clumsy, and has trouble with fine motor skills
APPENDIX
APPENDIX
I
a
I
a
Appendix
5.
o
o
o
I
I
.
.
I
I
course
infants with metabolic disorders
family history of retinoblastoma
family history of congenital cataracts
history of maternal infection (rubella) or genitourinary infection
(STDs)
history of "squinting"
history of visual difficulties
vitamin A Deficiency or history of night blindness
children with other impairments (CP, Down's, MR, hearing
impairment etc.)
6 mos,
Non-reactive pupil
Absent 1Dull/ asymmetric
ROR; leukocoria
Blank stare
lnspection:
White" lustrous conjunctlva
Clear cornea
Ocular Motility:
Equal/central corneal reflexes
(Hirschberg test)
Steady and aligned eyes
Ophthalmoscopy: Red orange
reflex (Bruckner test)
Vision Test LEA Symbols-at least
20t40 (0.5)
lnspection:
White shiny conjunctiva
Clear cornea
Ocular Motility:
Alternate cover test or
/central corneat reflex
Steady and aligned eyes
Ophthalmoscopy: Red Orange
Reflex
Poor response or
asymmetric
Droopy/ discharge
Red eye
Opacities
LEA<2Q!32 (0.63) or
Snellen <20140 oi >1 line
difference between eyes
Dry or frothy conjunctiva
Opacities
APPENDIX
Ocular Motility:
Alternate cover test or Symmetricall
/central corneal reflex
I
Steady and aligned eyes
I
Ophthalmoscopy: Red Orange I
Reflex; Normal Fundus
I
APPENDIX
Appendix 6.
Preventive Dental Gare
The vision testing using LEA Chart or its equivalent is preferably done at
distance and near starting 3 years of age. The vision testing procedure
s as follows:
.
.
.
.
r
.
a
a
a
a
a
O
21
6 months
to less than
2 years old
10-20mm
0.5 - 1.0g
APPENDIX
APPENDIX
Appendix 7.
Breastfeeding and Gomplementary Feeding
4.
Breastfeeding
Benefits of Breastmilk
Safe, sterile and always available
with perfect nutrients to fully sustain the growth and development
of the baby from birth to six months of age; after 6 months, still a
'.
good source
.
.
of
5.
B.
2.
.
.
.
.
Advantages of Breastfeeding
a
Promotes emotional bonding between baby and mother
T
3.
.
.
.
.
complementary foods
against infection
'
Support the breast with the hand of the opposite arm in a C-hold
position: thumb above, 4 fingers underthe breast.
Stimulate the infant to open the mouth wide by stroking the corner
of the baby's lips; check that the chin touches the breast and
thelower lip is turned outward.
Ensure thatthe baby grasps the entire nipple plus once inch of the
surrounding areola.
Allow the baby to suck 15 to 30 minutes per breast to extract both
foremilkand hindmilk.
tol0timesor moreadaytoensure
hour
8 days
2 weeks
3 months
6 months
6 cups
4 pieces
1 Tzcups
5 pieces
(matchbox
size for meat), or
2 cups cut into
small pieces
4 pieces a week
1 Tz cups 3x a
week
Mitk
Fats (olive oil, corn oil, butter)
Fluids
Correct BreastfeedingTechniques
Support the baby's head and the entire body throughout the
feeding; the head, back and hips should be facing the breast and
aligned in a straight manner.
Maintain the position of the baby in such a way he is "face to face",
Egg
4 hours
2 glasses
7 teaspoons
7 glasses water;
1 glass fresh fruit
juice
C.
Complementary Food
APPENDIX
APPENDIX
Start with lugaw or cereals, fruits or vegetables in any order,
givingoneto two teasPoons a daY.
Stutt"*itn pureed foods at 6 months of age' lntroduce "finger
foods" around 8 months of age; lumpy or chopped foods at
l0months of age; table food at '12 months of age'
Feed 6 8 mont-h old infant 2 3 times a day; 9 24 month old
.
'.
.
ln the
for the maltreatment it suffers, but rather that it may be more difficult to parent
because it:
ApPendix 8'
Child Maltreatment
TheWorldHealthorganizationpresentsanecologicalmodel
describinj the risk factors tor cnitO maltreatment. The complex interaction
oi tactori in the individual, social relationships, community and society must
(108)'
be understood to effectively deal with problems of child maltreatment
The risk factors are not themselves diagnostic but in situations where resources
are limited, children and families ldentified as having severa/ of these
lndividual Factors:*
ln Parent and Caregiver
has difficuity bonding with a newborn child as a result, for example, of
difficult pregnancY
I
was a maltreated child
t
t""t u*"r"ness of child development or has unrealistic expectations
that "prevent understanding of the child's needs and behavior
uses physical punishmentto discipline children
shows lack of self-control when upset or angry
involved in criminal activitY
is depressed
experiences financial d ifficu lty
;;;;r;J;;;r;
World
H ea lth O rg an
izatio n'
orimpulsivity)
supportthe child
Relationship factors
lack of parent-child attachment and failure to bond
a
family breakdown that results in unhappiness, tension, mental ill health
I
violence in the family
I
gender roles or roles in intimate relationships that are disrespectful
I
lack of support networkto assist in stressful situations
I
discrimination against the family because of ethnicity, nationality,
religion
involvement in criminal or violent activities
Community Factors
I
tolerance to violence
a
lack of inadequate housing
I
poverty
I
high levels of unemployment
I
*rhis is a partial list. fhe complete list of factors is available in the wHo publication "Preventing
of this
ent: A guide-io iixing action and generating evidence-" (108). Contents
6iiin Uint
"t prinua fritn peiniisiii rrom tne wH6 Press, inowtedge Management and sharins'
Do not add salt to the infant's diet before one year of age'
children.Feedslowlyandpatiently.DONOTforce-feed;make
feeding a pleasurable experience.
wasanunwantedbaby
is
Child
Societal Factors
a
socioeconomic inequality or instability
a
I
I
APPENDIX
Protective Factors
Factors that appear to facilitate resilience include:
secure attachment of the infant to the adult family member
high levels of parentalcare during childhood
non-association with delinquent or substance-abusing peers
a warm and supportive relationship with a non-offending parent
a lack of abuse-related stress
t
.
r
r
'
maitreatment simultaneously
in different social contexts.
at
child
different stages of human development and
child's behavior and whether the child can tell you with confidence how the
time was spent.
Tell the adults who care for your child that you and your child are
educated about child abuse. Be that direct.
Step 3. Talkaboutit.
Teach your children what parts oftheir bodies others should not touch.
.
.
Appendix 9.
gtep {. Learn the facts. Majority of sexual offenders of children are family
members, friends and neighbors people that the child and the child's family
trust.
Boys, in almost the same frequency as girls, are also being sexually
abused.
APPENDIX
Few girls report the abuse but boys tend not toreportat all.
4.
StayAlert.
stake.
Have the courage to report suspected abuse. Do not close your eyes
and pretend that it will go away. lt will not go away. lf the child is not
helped, the abuse will continue.
You can bring the child to the child protection Unit of pGH, pcMC and
East Avenue Medical Center.
It is the duty of hospital administrators, doctors, nurses, government
28
APPENDIX
Step 6. Learn howto reacttothe knowledgeof abuse.
Offersupport:
. Believe the child and make sure the child knows you believe
'.
Use your voice and your vote to make your community a safer place for
children. Ask what schools or organizations in your community have child abuse
prevention policies and help with their creation. Demand that the government
]:ut their resources into protecting children from sexual abuse and into
responding to reports of sexual abuse.
You can download educational materials on child sexual abuse prevention for
parents on www.darkness2light.org
FIGURES
1.
2.
3.
4.
5.
6.
7.
8.
9.
Windows of Achievement
Developmental Milestones of Early Literacy
Z Score lnterpretation
Head Circumference forAge for Girls
Weight forAge for Girls: Birth to 2 years
Length for Age for Girls: Birth to 2 years
Weight for Length for Girls: Birth to 2 years
BMI forAge for Girls: Birth to 2 years
Weight forAge for Girls: 2to 5 years
10. Height forAge for Girls: 2to 5 years
11. Weight for Height for Girls: 2to 5 years
12. BMI forAge for Girls: 2 to 5 years
13. Weight forAge for Girls: 5 to 10 years
Height for Age for Girls: 5 to 19 years
15. BMI forAge for Girls: 5 to 19 years
16. Head Circumference forAge for Boys
17. Weight forAge for Boys: Birth to 2years
18. Length forAge for Boys: Birth to 2years
19. Weight for Length for Boys: Birth to 2 years
20. BMI forAge for Boys: Birth to 2 years
21. Weight for Age for Boys: 2 to 5 years
Height for Age for Boys: 2 to 5 years
23. Weight for Height for Boys: 2to 5 years
24. BMI forAge for Boys: 2to 5 years
25. Weight forAge for Boys: 5 to 10 years
Height for Age for Boys: 5 to 19 years
27. BMI forAge for Boys: 5 to 19 years
28. US CDC-NCHS Growth Chart for Boys
29. US CDC-NCHS Growth Chart for Girls
30. BP Levels for Boys by Age and Height Percentile
31. BP Levels for Girls by Age and Height Percentile
32. lmmunizationTable 2012
33. Food Pyramid
14
22
26
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r
r
r
looks at pictures
vocalizes, pats pictures
prefers pictures offaces
(,
N
as transitional object
r
r
r
r
r
r
r
r
r
"..,ol"#r*;,i*;Jt;ilji?#EsrH{rlilir*5.l;i$rrh'r".;#,ffii#,lir{j*;sr-*..
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FIGURES
Figure 3. Z- SCORE INTERPRETATIONo'
Compare the points plotted on the child's growth charts with the z-score lines to
determine whether they indicate a growth problem. Measurements in the shaded
boxes are in the normal range.
EE
go
oi!
-N
E
!
c
='E
E8'
GROWTH INDICATORS
>\\
=5
Length/Height
- for - Age
Above 3
See note
Above 2
BMI-for-Age
Obese
Obese
Overweight
Overweight
Possible risk of
overweight
(See note 3)
Possible risk of
overweight
(See note 3)
@1
Z.SCORE
vr
See note 2
Above'l
tn
J
Below - 2
Stunted
(See note 4)
Underweight
Wasted
Wasted
Below - 3
Severely stunted
(See note 4)
Severely
Underweight
(See note 5)
Severely wasted
Severely wasted
C'l
GI
L
o
rts
I
o
tJ
tr
1.
A child in this range is very tall. Tallness is rarely a problem, unless it is so excessive that it
may indicate an endocrine disorder such as a growth-hormone-producing
in this range of assessment if you suspect an endocrine disorder (e.9. if parents of normal
height have a child who is excessively tall for his or her age.
o
L
o
qE
.J
2.
J.
A child whose weight-for-age falls in this range may have a growth problem, but this is better
assessed from weighlfor-length/height or BM l-for-age.
A plotted point above 1 shows possible risk. A trend towards the 2 z-score line shows definite
risk.
4.
This is referred to as very low weight in lMCl training modules. (lntegrated Management of
Childhood lllness, ln-service training. WHO, Geneva,1977.)
u
=
o
I
rJ
L
\,
tto
o
.I
o
o
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o
rn
o
6
Weight-for-age GIRLS
Birth to 2 years (z-scores)
.TI
@)u';**'l;ell
(6'
-o
(6-
(o
o
o
o
-L
w
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o
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a
n
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Length-for-age GIRLS
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a
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o
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m
@
Weight-for-age BOYS
5
to
I 0 years (z-scores)
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Organization
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l\)
I
o
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a
Height-for-age
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to 1 9 years (z-scores)
BOYS
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7
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0)
2007WHO Reference
o
7
m
FIGURES
FIGURES
to 2S years: Girl*
$taturs-for-agG and Weight-for-f, ge percentiles
nlaME
RECORD
12 13 14 1$ 16 17 ',l$ 19
Mother'$ Slature
*-,,,",,-,-*
Fathet's Stature
20
cm
-*-*-** BMIi
A{
Daie
s0.
80.
-74.
bz
,,/
165
160
s
T
A
99ih
50llr
s
T
A
T
.62
50rh
86 87 89 91 93 94
95
901h
951h
'106
115
as0
9Slh
122
rs0
501h
90 91 93 95 90 S8
98
-ad
//
90ih
95th
.80-
/,
/.
w '70: -30
-25
,4
-20
4 fr
tb
2g
4 5 87
-5,
30
9Sh
2A
50th
UU
-,/
9$lr
T
90{h
9silr
50rh
*35
901h
*s0 -70
95rh
*45
-30
t.
.GE (YHr IRS
I
40
9&h
sgth
'/
ffi
10
/ A/l//
-10
kd
56
,25
',r'
E
I
50tlr
//
I 10 11 12 13 14 15 16 17 18 19
tdpr4wwodc,gov/growlhchddi
61
9S1h
*50
50rh
-40
9ftlr
-15
-10
ko
20
90rh
9Sth
ub
210
5fth
70
-92
114
111
BO
180
'34
106
00 220
:85
fi
80 e1 83 85 67 68 B9
$4 95 97 99 100 10? 103
98 SS 101 103 104 106
88 89 91 93 S5 96
102 1c3 1S 107 109 110
50
-36
95th
9Srh
s0th
991h
B
E
95rh
o5
.64
95rh
-54
lsrcentile ol Helght
84 85 B7 88 90 92 92
97 99 100 1t2 104 t!$ 10s
101 1t2 10,1 106 108 109 110
150
-56
90lh
95lh
5.
-r
Percentile
{Y;'1 *
I
50rh
-74'
170
31ai
tro"
/o'
0iaslolic Bi {mmilg}
$yslofie 8P {mn}{g}
3P
Itr
'tz'
or Wslght (lb)
95th
9Slh
tb
ffi
5orh
90th
9Srh
99rh
97
1'11
sl 92 94 ss s$ ss
100
92 A 95 97 93 100
106 107 1S 111 113 114 115
101
Pereenillo ol ilelght
39
53
58
66
33 10 41 42 43
54 t5 56 57 58
59 $$ 60 61 e2
66 67 68 6S 70
44 44 45 46 47
59 59 60 01 62
63 S3 64 05 S6
71 7t ?2 73 74
47 48 49 50 51
62 63 64 65 66
66 67 S8 69 l0
74 75 tS 77 78
50 61 S2 53 54
65 6S 6? 6S 69
697Ar72737474
77 78 7S 80 81
44
5$
63
?1
48
03
87
75
5',1
66
71
78
55
S9
35
$0
54
S2
36
51
55
63
3?
52
56
64
05&
38
53
t7
65
34
49
54
61
81
53
68
72
B0
i3
68
72
80
$4
09
13
81
55
70
i4
82
!6
71
7'
83
57
72
76
84
55
7A
74
82
55
i0
t4
82
56
11
15
83
57
i2
16
84
58
73
11
85
59
74
78
B6
56
71
75
83
5?
V2
76
84
58
12
l7
85
59
13
?S
8S
60
14
?9
87
60
75
79
81
57585960e1fi62
72 75 ?4 70 76 76
7E 77 18 79 80 81
n4 85 86 87 88 88
58
i3
77
s5
59
73
78
86
69
14
i9
86
61
75
80
88
61
76
81
88
62
77
81
89
39
54
$8
66
44
59
63
71
48
63
67
75
'2
E7
71
7S
65
70
82
57
72
76
84
59
74
7B
86
61
76
80
B8
77
81
89
63
78
82
90
FIGURES
FIGURES
Aoe Perclntile
(Y"40 t
11
liastollc BP {mnHg}
Systdic 8P {mmHg)
Percentile
oftleight
95th
50ilr
90rh
95tl
99th
5oth
90rh
ssrh
50111
90th
9grh
50rh
gfin
95rh
9Sth
50rh
90ll'
951h
ggth
17
90rh
95ih
9gtir
Percnlile oi Height
59
't4
78
86
59
74
78
86
60
75
79
81
60
75
80
87
01
76
81
88
63
78
82
g0
60
75
79
81
8B
89
60
61
ot
75
79
87
61
76
80
88
62
77
81
89
61
62
75
76
80
81
76
80
88
77
81
89
77
t6
81
82
89
s0
63
64
7&
79
82
83
S0
91
64
78
79
83
83
90
o1
s5
66
oo
60
80
81
84
85
86
93
g3
62 63
77 78
8',1 82
89 g0
63
78
82
90
64
79
83
91
65
80
84
92
67
82
87
s4
79
83
91
05
80
B4
92
60
81
85
93
58
83
8?
95
79
84
92
66
80
85
93
67
82
86
94
82
$0th
90
95lh
99ih
79
83
91
90rh
85
107
114
111
112,
50lh
901h
95lh
93
50rh
82
90rh
87
95tlr
94
sgih
69
70
50ih
84
84
90rh
88
89
95ilr
97
99rh
501h
90th
951h
9Srh
103
s9rh
67
96
90
95ih
90th
81
83 84 85 86 BB 89
9? 97 98 100 101 .02
8B 98 90 91 92 94 94
101 102 103 104 106 '01 108
105 10e 107 108 110 ',11 112
80
66
sSrh
50{h
50rh
S2
99ih
95rh
91
B4
951h
90th
OOrh
83
Percentile of Helghl
95 85 87 88 e9 91 91
98 99 100 10'1 103 104 105
102 103 1U 105 107 ',,08 1!9
109 |1t 111 112 114 115 116
86 87 88 89 91 9? 93
100 100 $2 103 104 100 106
104 104 10i 107 108 109 10
50ilr
64
79
Pscentile
50th
OJOJW
77
82
90
63
78
82
90
Ag
(Year)
?8
ubcoc
62
83
92
61
76
80
88
59
74
78
80
60
75
79
87
951h
0iastolie BP
$y$lolie Bp {mmf,lg}
6F
50tlr
00ih
95rh
s9lh
50lh
gfrh
95ih
9911r
41
55
59
6i
46
61
48
{t2
66
73
50
64
6B
76
B1
53
67
11
18
54
68
72
B0
30
70
74
B1
53
67
7t
7$
55
69
7t
B0
56
70
74
82
54
68
72
79
56
70
74
B1
57
71
75
82
55
69
13
80
56
7t
74
82
5B
72
76
B3
55
69
73
81
5f
11
75
83
58
72
76
84
57
71
75
B'
51
71
75
g2
57
71
75
83
58
72
76
83
59
73
71
81
60
71
73
8i
58
72
76
83
5B
72
76
83
58
7?
7$
84
59
73
tl
84
60
74
78
B5
61
75
79
86
59
73
7V
8{
5s
73
71
84
59
13
71
85
60
74
l8
86
61
75
79
80
62
76
80
87
64
68
76
96
52
'109
bb
113
7A
120
98
54
111
6$
f i5
72
122
80
99
55
93 33 95 98 97 99
95rh
39 40 41
53 54 55
57 58 59
65 65 60
44 45 40
58 50 60
626364$65
1A 1A 71
48 49 50
ti? 63 64
e$ 67 68
74 14 75
51 52 52
65 6E 67
E9 7t 71
76 77 f8
38
52
56
64
41
57
6'1
69
41
61
65
73
89 90 S1 93 94 95
103 103 10t 106 107 :09
fi7 10i 1!8 110 111 :12
104 105 106 10S 109 110
108 109 110 111 113
"14
115 11e 11t 11S 120 '21
119
91 92 93 94 96 91
{mnllg}
Percantile of Height
69
73
39
53
57
64
44
58
62
69
72
50
(;1
6B
78
53
67
11
70
42
56
60
67
47
61
72
51
ti5
69
76
54
68
72
79
50
70
14
81
58
72
76
83
59
73
77
B4
6l
?4
7E
86
61
75
79
87
62
76
80
88
FIGURES
Blood Pressure Levels for Girls by Age and Height Percentile {Continued}
Age
Percenlile
tYear)
50lh
90rh
95rh
99ih
50rh
9Oflr
95th
s9rh
l3
50th
90rh
95ih
99th
50ih
90th
9srh
s9ih
15
s0h
90rh
95rh
s9lh
50rh
90rh
9srh
9gth
17
Percentile of tleight
50ih
9Orh
s51h
99rh
* Prconlile ot lleioll t
sth 10th ?5th 50th 75lh 90ih
60
74
78
85
61
75
79
86
02
76
80
87
63
77
8'1
88
64
78
82
83
s4
78
82
s0
64
78
82
s0
63
77
81
e8
ti4
b3
78
82
90
65
79
83
91
79 80
83 84
90 91
66 67
80 81
84 85
91 92
90
oo
80
B4
91
oo
81
85
92
{j5
DO
62
62
76
76
80
80
87
88
78
85
61
75
19
63
77
77
81
81
88
89
04
78
82
83
64
78
82
90
64
65
78
79
82
83
90
65
79
83
s0
95th
62
76
80
87
63
77
81
88
64
78
82
89
8S
74
79
83
91
80
84
91
DTwP)
Given intramuscularly (lM)
61
15
79
87
62
76
80
88
63
77
81
89
60
74
18
86
61
75
79
87
s0
oia$tolic BP {mnHg}
Syst0lic BP {rnmHg)
8P
IMMUNIZATION ANNOTATIONS
03
77
81
64
64
78
7B
82
82
89
.q0
65
65
79
70
83
83
90
s1
00
00
Hepatiiis
A,
81
85
Downloaded
08
81
82
85
Ub
93
93
pr
07
68
81
81
s2
85
85
86
,92
o1
s3
fror
ihe:
Fourth Report on lhe Diagnosis, Evaluation and Treatmert of High Blood Pressure in Children and Adolescents'
PEDIATRICS Vol. 114 No. 2 Augusi 2004, 554-573 wi'th the prmission fmril
National Heart, Lung and Blood lnbtitute {NHLBI)
NATIONAT INSlITUTES OF HEATTH
U. S. Department of Health and Human Services
of the EPI or
Other
93
or
Hepatitis BVaccine
Given lntramuscularly (lM)
The'lst dose is given within the 1" 12 hours of
life, and may be counted as part of the 3-dose
primary series. Subsequent doses may be
84
67
DTaP,
80
g?
89
,,The
BCG,
Given at
'.
.
of close contact to
known or
considered positive,
induration of >5mm
suspectedcongenitalTB
history
and the
dose.
3'o
"'
prefened.
MEASLES
Given subcutaneously (SC)
recommended using
al
is
administered
1"'
dose is given
be
is
Given at
Recommended Vaccines
HepatitsAVaccine
Given lntramuscularly (lM)
Hepatits A is recommended for all children >12
months. A 2'o dose of the vaccine is given 6 to
12 months
influenza
strains in the next yea/s Southern Hemisphere
vaccine. These are the current strains as in the
it
is
Bivalent
HPV: 0, 1, 6 months
lnfluenza
Given lntramuscularly
or
Subcutaneously
(rM/sc)
All
children
6 months
to
doses should
vaccine.
7-1 8
th e
VARICELLAVACCINE
(MMRV)
be given as
an
*lJse
the same
to 12 years of age. A
2no
dose of MMRV is
is 2
years.
is
age in addition
to
be
age 12
to 15 months.
is
f'"H-e'
IN
BcG
MONTHS
WEEKS
BIRTH
YEARS
i:l
t0 i2 14 16 18 20 22,o
14 16 18 20 2 q
e 10 n
8 10 12
13-1
-l
tiiit
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TI Dr*P/
or"p*
I ra"p
ll
DTwP/DTaP
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r"*-_-]
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