Merge pull request #87 from rcpch/prerelease

Parent information changes, at request of PCHR committee meeting in March

docs/parents/chart-information-families.md

@@ -7,63 +7,45 @@ reviewers: Dr Marcus Baw, Dr Anchit Chandran
 
 ![RCPCH Growth Chart Logo Text](../_assets/_images/growthchartstitle.png)
 
-##  What do regular measurements tell us?
-
-Weighing and measuring helps us to check that your child is growing and developing as expected.
-
 ### Why do we use growth charts?
 
-The lines on a growth chart are called "*centile lines*". They are based on measurements from many infants and children. They show the optimal range of weights, lengths and head circumferences for healthy children, and how one child compares with others of the same age and sex.
-
-For example, if your child’s weight is on the 25th centile, it means that if you lined up 100 children of the same age and sex in order of weight, your child would probably be number 25; 75 children would be heavier than your child, and 24 would be lighter. Weights, lengths and head circumferences that are anywhere within the centile lines on the chart are considered normal.
-
-Every child is different (they come in all shapes and sizes!), so no two filled-in charts will look the same. Even twins may have different growth patterns.
-
-If a child’s growth pattern looks unusual, your health visitor or doctor may want to have a closer look to see why. This may involve taking more measurements or performing investigations. Most children who have such investigations are found to be perfectly normal, however, it is important to check unusual patterns just to make sure.
-
-##  The UK-WHO growth charts
-
-The UK-WHO growth charts are based on data from 2 different sources, depending on a child's age:
-
-### *Birth - 4 years* uses WHO data
-
-The World Health Organisation (WHO) collected measurements from healthy *term* babies (born after 37 weeks of pregnancy or more) in 6 different countries. These were healthy, breast-fed babies whose mothers did not smoke, had good access to healthcare and nutrition. Their measurements were recorded over time. The *centile curves* drawn using these measurements show how healthy babies are expected to grow - regardless of ethnic origin, or breast / formula-fed. For *preterm* babies (born before 37 weeks pregnancy), measurements are plotted on growth charts based on the birthweights of British infants who were born prematurely.
-
-### *4 years - 20 years* uses UK1990 data
+The UK-WHO growth charts show how your child compares with other children of the same age and sex. They are drawn using measurements from many infants and children: from ages two weeks to 4 years, they use measurements of healthy breastfed babies collected by the World Health Organization (WHO) in six different countries. These charts show how healthy babies are expected to grow, whatever their ethnic origin and however they are fed.
 
-Many measurements of British children, aged between 4 and 20 years, were collected in the 1980-90s. These centiles show similar healthy growth trends for these ages.
+At birth, and for babies born more than 3 weeks early, the charts use the birth weights of British infants and from age 4 to 20 years, measurements of British children collected in the 1980-90s. These charts show how children used to grow and gain weight when obesity was less common.
 
-##  Weighing and measuring
+## What do the charts show?
 
-Up to 2 years of age, children should be weighed without any clothes or nappy on, as this can make a big difference to the weight. Be aware that different scales sometimes give different readings, particularly if they are not electronic. If you notice this, try to take your baby/child to the same place for weighing each time.
+Children come in all shapes and sizes, so no two filled-in charts will look the same, but the chart helps us to check that your child is growing and developing as expected. Each centile line on the chart describes the number of children expected to be below that line, so half of all healthy children will be below the 50th centile, but only 9% below the 9th . Only one in a hundred children will be outside the two outer lines (0.4th and 99.6th centiles). As more measurements are collected and plotted, the chart also shows a child’s growth pattern.
 
-Up to the age of 2 years, your child is measured for length (i.e. lying down) rather than height. Special equipment is needed to measure length accurately, which will be recommended by a health care professional if needed. Your child should not be wearing a nappy when their length is measured.
+## When and how to weigh
 
-After 2 years of age, your child’s standing height should be measured. Your child’s shoes should be removed during the measurement. It is important to measure height accurately using a rigid rule with T piece or stadiometer.
+Weigh babies and children up to 2 years of age without clothes or nappy, as this can make a big difference to the weight.
 
-From age 4 years, your child’s Body Mass Index (BMI) can be calculated from their weight and height:
+Be aware that different scales can give different readings, particularly if they are not electronic. If you notice this, try to take your baby/child to the same place for weighing each time.
 
-![formula_BMI](https://latex.codecogs.com/svg.image?BMI&space;=&space;weight/height^2)
+Your baby should be weighed in the first week as part of the assessment of feeding. It is normal for a baby to lose weight in the first few days after birth. Most babies regain their birth weight by 3 weeks of age. Regaining weight after birth helps to show that your baby is healthy, and that feeding is going well.
 
-BMI is a crude measure of fatness or thinness, and high levels suggest the child may be carrying too much fat. The cut-offs for a high BMI in children are different from those used in adults and depend on age. Some medical conditions or treatments your child receives may mean the BMI centile is not the best way to measure your child. A low BMI can be due to a relatively low amount of lean (muscle) tissue as well as fat. Your GP or other health professional caring for your child will be able to discuss your child’s BMI with you.
+After that, your baby will usually be weighed only when seen routinely, unless there is concern.
 
-## How often to weigh
+Some parents like to have their babies weighed often, but this can be misleading and cause unnecessary worry. For example, if one week your baby was weighed just after a big feed but the next week they were weighed before a feed, it could look as if they had not gained weight. Longer gaps between weights are more likely to show the true weight change. Your health visitor or doctor may recommend more frequent weights for children if there are concerns about slow weight gain or weight loss, but it is still important not to weight too often:
 
-It is normal for a baby to lose some weight in the first few days after birth. Your baby should be weighed in the first week as part of the assessment of feeding. Most babies get back to their birth weight by 2 weeks of age. This is a sign feeding is going well, and your baby is healthy.
+| Age | No concerns | If there is slow weight gain or weight loss, no more often than: |
+| --- | --- | --- |
+| Up to 3 months | Age 5-10 days and at 8 and 12 weeks with immunisations | Weekly |
+| 3-6 months | Age 16 weeks with immunisations | Fortnightly |
+| 6-12 months | Age 1 year with immunisations | Monthly |
+| Over 12 months | | Every 6-8 weeks |
 
-After 2 weeks, your baby will usually be weighed only when seen routinely, unless there is concern. Weighing your baby too often can cause unnecessary concern; the list below shows how often, as a maximum, babies should be weighed to monitor their growth. However, most children will not need to be weighed as often as this.
+Remember that if you want advice, you can always phone your health visitor or visit the clinic, without having your child weighed.
 
-Many parents like to have their babies weighed more often. However, it is not always helpful and can cause unnecessary worry. For example, if one week your baby was weighed just after a big feed, but the next week they were weighed after a long nap and before a feed, it could look as if they had not gained weight. Longer gaps between weights are more likely to show the true weight change.
+## Measuring height and length
 
-The recommended time between weighing increases as babies age because they grow more slowly.
+Up to the age of 2 years length, rather than height, is measured, lying down without shoes or nappy. Special equipment is needed for this, and it is difficult to measure length accurately, so this will not be done every time your child is seen. Usually, your Health Visitor or GP will only measure length if they are worried about your child’s growth or weight gain.
 
-Your health visitor or doctor may recommend more frequent weighing for children if there are concerns about their growth or health, or if they have certain medical conditions. If there are serious concerns about slow weight gain or even weight loss, a child could be weighed as often as:
+After 2 years of age, height is measured, standing up with shoes removed. It is important to measure height accurately, using proper measuring equipment. A tape measure or a book against the wall is not accurate enough. It is not usually necessary to measure height if your child is growing as expected. Once they go to school, in England, they will be measured with their classmates for the National Child Measurement Programme in their reception class and their last year in primary school.
 
-- daily if less than 1 month old
-- weekly between 1–6 months old
-- fortnightly between 6–12 months
-- monthly from 1 year of age
+## Body mass index
 
-Remember that if you want advice you can always phone your health visitor or visit the clinic, without having your child weighed.
+From age 4 years, your child’s Body Mass Index (BMI) can be calculated from a measure of both weight and height. This measures how much weight your child is carrying, allowing for their height. It is calculated by dividing their weight (in kilograms) by their height (in metres), squared. The cut-off for a high BMI varies with age, but if a child’s BMI is above the cut-off, this generally suggests that they are overweight. A child with a low BMI is more likely to have a lean build rather than too little fat. Your GP or other health professional caring for your child will be able to discuss your child’s BMI with you.
 
-Beyond the age of two years, children need only be weighed if there are worries about their health, growth or poor weight gain. Once they go to school, in England, they will be measured with their classmates for the National Child Measurement Programme in their reception class and their last year in primary school.
+The NHS has a website which can calculate Body Mass Index <https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/> for children over 2 years of age.

docs/parents/faqs-parents.md

@@ -3,50 +3,26 @@ title: Frequently Asked Questions
 reviewers: Dr Anchit Chandran
 ---
 
-### Q: I didn’t breastfeed, or I stopped early – are these charts still right for my baby?
+### I didn’t breastfeed, or I stopped early – are these charts still right for my baby?
 
-**A: Yes they are!**
+The charts show how healthy babies with no problems grow. Babies grow most naturally when fed on breastmilk and this chart helps you check that your baby is still growing in the same healthy pattern.
 
-The charts show how breastfed babies grow if they are healthy and there are no problems. Babies grow most naturally when fed on breast milk. If you use infant formula milk, you want to ensure your baby is still growing in the same healthy pattern as they would on breast milk. This chart helps you see if that is happening.
+### My baby was born prematurely. Is this taken into account?
 
-### Q: My baby was born prematurely. Is this taken into account?
+If your baby was born 4-8 weeks early, weight and head circumference will be plotted on the preterm section of the charts, until they are 2 weeks past their due date. After this, weight and other measurements will be plotted on the main chart using an arrow, with the tail at your baby’s actual age and the head at their ‘corrected’ age, allowing for the number of weeks your baby was born early. For babies who are born more than 8 weeks early, there is a special chart that automatically allows for prematurity which will be used until they are two years old.
 
-**A: Yes it is!**
+### How do I know my baby’s weight is OK in the first 2 weeks?
 
-If your baby was born early, weight and head circumference will be plotted on preterm charts until they are 2 weeks past your due date. This will help you and the health professionals tell how your baby is doing compared with other preterm babies. After this, weight and other measurements will be plotted on the main chart. Two centile values will be provided – one plotted at your baby’s actual age and the other at his/her ‘corrected’ age (taking into account the number of weeks your baby was born early).
+Your baby’s weight at about 2 weeks of age should be compared with their birth weight. If your baby loses more than a tenth of their birth weight, or takes more than 3 weeks to get back to their birth weight, your midwife or health visitor will check how your baby is feeding, make suggestions that may help, and may recommend a check-up by your GP or refer you to a breast feeding specialist. Your midwife or health visitor will then weigh them again to follow their progress.
 
-### Q: How do I know my baby’s weight is OK in the first 2 weeks?
+### My child was ill and lost some weight, what should I do?
 
-**A: Through your responsible clinician.**
+Children often lose some weight when they are not well. Once your child recovers from the illness, their weight should go back to the centile it was on before the illness within 2–3 weeks.
 
-Weighing in the early days is important. Regaining weight after birth helps show your baby is healthy, and feeding is going well.
+### My baby’s weight was on one centile, but now it's nearly down to the next line – is this normal?
 
-If your baby loses a lot of weight or regains their birth weight slowly, it's a sign to look a little closer. In this case, your midwife or health visitor will calculate the weight loss as a percentage of their weight. A baby who loses 10% (a tenth) or more of their birth weight will require a visit from the midwife or health visitor, who checks how baby is feeding.
+It is normal for your child’s weight centile drop by up to one centile space (the distance between two centile lines) between measurements, but it is less common for a child’s weight to cross two spaces; if this happens your health visitor or doctor may want to measure their length, ask about their eating and may do some investigations.
 
-For both breast and formula-fed babies, your midwife or health visitor will suggest tips to help the baby feed more effectively to improve weight gain and may recommend medical assessment. If issues are identified, a referral to specialist feeding services or a doctor may also be required. Making changes to how your baby is fed may take a little time for weight to improve. Your midwife or health visitor might weigh them again to track progress.
-
-### Q: My baby’s weight was on one centile, but now it's nearly down to the next line – is this normal?
-
-**A: Yes, it's normal!**
-
-It's normal for the dots of your child’s weight to ‘wiggle’ up and down a bit, or to move gradually from being near one centile to the next one (up or down).
-
-It's less common for a child’s weight to cross two lines; if this happens, your health visitor may keep a closer eye on your child for a while.
-
-### Q: My child was ill and lost some weight, what should I do?
-
-**A: Wait a few weeks and weigh them again.**
-
-Children often lose some weight when they are not well. Once your child recovers from the illness, their weight should go back to the centile it was on before the illness within 2–3 weeks. If this does not happen, speak to your health visitor. The health visitor may measure your child’s length or height or investigate other issues.
-
-### Q: When should length or height be measured?
-
-**A: Length before 2 years, height after 2 years.**
-
-For babies and children under 2 years, length rather than height is measured. This can be helpful if there is any concern about weight gain. However, it's difficult to measure length accurately, so this will not be done every time your child is seen. It's not usually necessary to measure length or height if your child is growing as expected.
-
-### Q: My baby's head size has risen to the top of the centile chart – should I be worried?
-
-**A: No, it's common!**
+### My baby's head size has risen to the top of the centile chart – should I be worried?
 
 British children have relatively large heads compared to the WHO standard, particularly after the age of 6 months. It's fairly common for the head centile to be at the very top of the chart or even above it. This should only cause concern if the head centile goes on rising after the first few weeks, or if there are other concerning signs or symptoms.

mkdocs.yml

@@ -1,4 +1,4 @@
-site_name: RCPCH Digital Growth Charts Platform 
+site_name: RCPCH Digital Growth Charts
 site_description: Documentation for the RCPCH Digital Growth Charts Platform
 site_author: The Royal College of Paediatrics and Child Health
 # site_url: https://rcpch.github.io/digital-growth-charts-documentation/
@@ -34,7 +34,7 @@ nav:
     - 'integrator/client-specification.md'
     - 'integrator/faqs-for-integrators.md'
     - 'integrator/whos-using-dgc.md'
-  - Clinicians: 
+  - Clinicians:
     - 'clinician/how-the-api-works.md'
     - 'clinician/chart-information-health-staff.md'
     - 'clinician/date-age-calculations.md'
@@ -86,12 +86,12 @@ theme:
   name: material
   custom_dir: rcpch-theme
   features:
-    - content.action.edit # explicitly adds edit button (Material4MkDocs9.0) 
-    - content.action.view # explicitly adds view button (Material4MkDocs9.0) 
+    - content.action.edit # explicitly adds edit button (Material4MkDocs9.0)
+    - content.action.view # explicitly adds view button (Material4MkDocs9.0)
     - content.code.copy
     - content.code.select
     - navigation.expand
-    - navigation.footer # explicitly adds footer prev/next (Material4MkDocs9.0) 
+    - navigation.footer # explicitly adds footer prev/next (Material4MkDocs9.0)
     - navigation.instant
     - navigation.tabs
     - navigation.tabs.sticky