The bell curve on the right illustrates the principle of z-scores. After his parents began feeding him prescriptively, his growth faltered, returning almost to his z-score baseline. While Josh was being demand-fed, his weight had been slowly but steadily increasing toward the mean, by over one z-score from his discharge weight.
The z-score plotting shows a clearer picture, one that would have been instructive to the physician. Formerly harmonious feedings became a struggle, and Josh’s growth rate seemingly decreased. At age 2½ months, assessing his growth to be inadequate, the physician advised Josh’s parents to feed a certain amount of formula on a certain schedule. From hospital discharge, Josh was fed on demand by his parents. Josh’s early weight-for-age growth chart plottings are hard to see and have no significance in terms of magnitude. Josh’s growth plottings offer an example of a child growing below the growth chart. To assign magnitude and detect patterns, we can convert their growth values to z-scores, or standard deviations above and below the mean. While values plotted in these outlying areas show the child’s growth to be extreme, the plottings carry no information about the magnitude of that extremity and give misleading information about patterns of change. The dilemma arises with respect to tracking children whose weight or body mass index (BMI) plots in the uncalibrated areas above or below the percentile curves on growth charts. Accurately plotted growth allows exploring the underpinnings and antecedents of growth distortion and guides intervention. Growth plotted over time on standard growth charts provides an overview of the child’s physical, nutritional, emotional, and developmental well-being. Tracking growth for very small or very large children Plotting their z-scores against their age gives an accurate picture of their weight patterns. To understand and assess their growth, their weight needs to be converted to z-scores. Understanding and using z-scores to track children’s growthīy Ellyn Satter, MS, MSSW, Dietitian and Family TherapistĬhildren who are very large or very small can’t be accurately tracked on the standard growth charts.
0 kommentar(er)
