Child Growth Charts in India: Standards, Monitoring Schedule & What Percentiles Mean
Key Takeaways
Growth charts are very useful tools in monitoring the growth and development of a child over time. In India, WHO growth standards are used to measure the growth and development of children in the age group of 0-5 years, whereas the IAP revised growth standards are used to monitor the growth and development of children from 5-18 years of age. The most important thing that you can do is take your child’s measurements over time and chart them on the respective growth chart.
Child growth charts in India are conducted according to two different standards based on the child’s age group. This guide will assist you in understanding the right chart according to your child’s measurements, age (from birth up to 18 years), how often to get checked, and how to actually read a percentile.
What growth chart is used in India?
For children in the age range of 0-5 years, India uses the WHO Child Growth Standards. Children in the age group 5-18 years are measured using the revised IAP Growth Charts released in 2015. Growth charts measure physical growth in children using variables such as height, weight, and Body Mass Index. The IAP growth chart India (Indian Academy of Pediatrics) is responsible for official growth charts.
Standards Used in India
A growth chart compares your child’s measurements with those of children of the same age and sex. It also helps doctors monitor their growth over time.
India uses two main growth-chart standards. Each covers a different stage of childhood.
Ages 0 to 5 years: WHO Growth Standards for Children
The WHO Child Growth Standards cover the growth period of a child from birth to 5 years. These standards are based on the growth of children growing under optimal conditions.
These studies have analysed breastfed infants from many countries to describe what children look like when they meet their nutritional requirements and are healthy.
The WHO standards involve:
- weight-for-age
- length-for-age
- height-for-age
- weight-for-length or weight-for-height
- head circumference
- BMI for age
Length is measured for younger children who need to be measured while lying down. Height is measured in older children who can be made to stand still.
Ages 5 to 18 years: Revised IAP Growth Charts
In children who are 5 to 18 years old, India follows the IAP growth charts of 2015.
These growth charts have been made using data from children in India. This was a study based on the data of 33,148 children and adolescents from various parts of India. The data were collected from various studies carried out in 14 cities.
The charts include the measurement of:
- height for age
- weight for age
- BMI for age
BMI is body mass index. It is measured using height and weight for body size.
These new IAP growth charts have replaced the older growth charts of 2007.
Why does India use two different growth charts?
WHO Child Growth Standards cater to children under 5 years of age, providing information on growth under specified health and nutrition conditions.
To monitor growth in older children, the revised IAP growth charts utilise measurements obtained from the Indian population. This allows tracking growth throughout younger years and teenage years.
The two sets of standards are complementary but do not contradict each other; they describe different phases of development and utilise different reference samples.
Recommended Monitoring Schedule
Children develop very rapidly when they are young; thus, regular measurements are necessary for doctors to be able to track changes.
Frequency of measurement depends on the age of your child. Follow this chart to determine the frequency of growth checkups.
| Age range | Recommended check frequency |
| 0–2 years | Height, weight, and head circumference at every immunisation visit |
| 2–5 years | Growth measurements every six months |
| 5–18 years | Height, weight, and BMI once or twice a year |
This frequency is often used for growth monitoring recommendations for Indian children. If your child has health concerns, your pediatrician can recommend more frequent examinations to you.
What happens during a growth check?
During a growth check, your doctor might determine your child’s:
- Weight
- Height or length
- Cephalic circumference, for young children
- Body Mass Index, for older children
The results of the measurements will be noted on a growth chart, specific to age and sex.
The doctor will compare the results of the current visit to those of earlier visits. This will help to reveal if your child is growing properly.
It is hard to interpret one measurement. Hence, it requires several measurements to have a clearer idea.
Understanding the Percentiles
What a percentile means
To understand how to read a growth chart, you need to understand percentiles. The growth percentile meaning is an indicator of how the child’s measurement compares to that of other children of the same age and gender. Growth curves normally plot percentiles ranging between the 3rd and the 97th.
In other words, a child who is in the 50th percentile in terms of height means that the child’s height is greater than the height of roughly half the reference population children. The 50th percentile is the average of the population, but not necessarily a goal to be attained by every child.
A child who is at the 10th percentile is as healthy as a child who is at the 90th percentile.
A single reading isn’t the full picture.
It is just a data point on your child’s journey of development.
The child who falls below the 3rd percentile or above the 97th percentile does not necessarily suffer from growth problems. Healthy kids have been known to develop following either end of the graph.
The key issue here is the change in the growth pattern of your child’s measurements through time.
What actually raises concern
A single growth reading rarely tells the whole story. Doctors pay closer attention to changes across multiple visits.
For example, a child who moves from the 75th percentile to the 25th percentile over time may need further assessment. The same applies to a child whose weight or height rises sharply across several percentile lines.
Crossing two or more percentile lines can signal a change in growth. However, it does not automatically mean something is wrong. Some children experience normal growth spurts, while others may need medical attention.
Your paediatrician will assess the child’s height-weight chart by age, previous measurements, family growth patterns, and overall health. They will also check whether the measurements were taken correctly.
The key is to look at the growth trend, not one isolated number. If your child’s growth curve changes sharply or growth appears to stall, speak to your paediatrician.
When to Talk to a Doctor About a Growth Reading
A growth chart serves as a screening method to track your child’s growth. It also helps doctors to look for trends that require more attention.
Discuss your concerns with your pediatrician if:
- Your child’s growth graph crosses many percentiles between visits.
- Your child’s height or weight measurements are no longer on track.
- Your child loses weight or displays a drop in his/her growth measurements.
- Your child continually has measurements falling below the 3rd percentile.
- Your child continually has measurements falling beyond the 97th percentile.
A doctor may review your child’s diet, health history, family growth patterns, and physical development. They may also recommend additional tests when needed.
However, you should not wait for the next routine appointment if your child has unexplained weight loss, persistent growth concerns, or other worrying symptoms.
Also remember, a growth chart cannot tell you the cause of a growth change. It can only help show when a closer look may be needed.
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