A weight recorded in a column of numbers hides what a weight plotted on a chart shows immediately. Crossing centiles downwards over two visits is the earliest sign of most of the serious things that happen to small children, and it is invisible unless the dots are on the paper.
Plot weight, length or height, and head circumference for every child under two, at every contact, on the same chart the family keeps. Use the WHO standards for the under-fives, and use the same chart each time - switching between charts introduces steps that look like real change. Measure length lying down until two years and height standing after; recording one as the other creates a false drop of a centimetre or more at exactly the age when a real drop would matter.
And show the parent the line. A family that can see the curve flattening will bring the child back; a family told the weight is 8.2 kg will not.
- Plot weight, length or height and head circumference at every visit under two years.
- Use one chart consistently, and the WHO standards for under-fives.
- Measure length lying down to age two and height standing after; never mix them mid-series.
- Treat downward centile crossing across two visits as a finding, not a variation.
- Turn the chart towards the parent and show them the line.
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