11.5.1  Objectives of growth monitoring

Growth monitoring and promotion have the following objectives:

  • To measure individual health and to instigate effective action in response to growth faltering (slowing down)
  • Teach mothers, families and health workers how diet and illness can affect child growth and thereby stimulate individual initiative and improved nutrition and healthcare practices
  • To provide regular contact with primary health services.

Poor linear growth (underweight and stunting) usually occurs in the first 24 months of life. If the child is not optimally fed during this time, they could lose 11cm from the potential height that they would have reached as an adult. Once stunting has happened, it is very difficult to catch up. By the time a child is two or three years old, catch-up growth is less likely to occur; such children have probably failed to grow and are potentially stunted for the rest of their lives. You learned how to assess whether a child is stunted in Study Session 4 of this Module.

Table 11.5 outlines the main reasons for malnutrition in children during their first five years.

Table 11.5  Determinants of child malnutrition during the first five years.
Age of malnourished childDeterminant factors
BirthMaternal factors (including nutrition), gestational age
Four-six monthsInfant feeding practices, maternal ability to care for the child
Six months to two yearsComplementary feeding practices, exposure to infections, disease and poor household food as the child gets older
Two-five yearsInadequate access to household food; infections and social deprivation

In Ethiopia we use underweight for monitoring growth, as it indicates acute changes in the nutritional status of the child. If you determine that the child is malnourished (underweight), you should be able to analyse the causes, identify resources, suggest alternative solutions and arrive at decisions together with the mother or caregiver as to what should be done about the child. This process of assessment analysis and action is known as the ‘triple A’ cycle which is described below.

11.5 Growth monitoring and promotion

11.5.2  The ‘Triple A’ cycle approach