PEDIATRICS Vol. 108 No. 3
September 2001,
pp. 821-821
The Weight-by-Date Chart: A Personalized Tool for Following
Hospitalized Children
To the Editor.
Monitoring changes in weight on a daily basis is critical to the
care of children hospitalized for a wide range of conditions. This is
especially important for children being treated for failure-to-thrive, dehydration, and feeding disorders, and also for many with chronic conditions of the gastrointestinal, pulmonary, cardiac, and other major
organ systems. Change in weight over time remains one of the most
important clinical measures of nutritional status,1 an
important parameter in most hospitalized children,2 and
the most accurate measure of fluid status.3
To facilitate the tracking of daily weight in hospitalized children, we
have created a software program that generates an individualized
growth chart suitable for plotting weight-for-age on a daily
basis. The "Weight-By-Date" program may be freely
downloaded from the following website:
www.bostonchildhealth.org/PrimaryCare/weight_by_date.html. It may then
be installed on any personal computer running Windows 95 or higher.
When opened, the program presents a dialogue box in which the user may
enter the patient's name, medical record number, gender, date of
birth, starting date and number of days to be plotted on the
x axis, and desired weight range to be plotted on the
y axis. The weight-by-date program generates a growth chart with the specified parameters, as well as percentile lines for any
major percentiles (including 
2 and 3 standard deviation [SD])
included in the plotted area. These percentile lines were obtained from
reference data4 corresponding to the revised growth charts
published by the Centers for Disease Control and Prevention and the
National Center for Health Statistics in June 2000.5
The following example illustrates the use of the weight-by-date chart.
A 5-month-old male infant was admitted to the inpatient pediatrics
service for failure-to-thrive and suspected cow's milk allergy. His
name, medical record number, date of birth (12/9/99), and gender were
entered into the weight-by-date dialogue box. The program asks the user
to select the number of days to be plotted on the x axis;
the default of a 10-day plot was accepted. The program also asks for
the starting date, and again the default was accepted, which is the
date the plot was generated (the admitting date, 4/12/00). Because the
patient's admission weight was 4.20 kg, the weight range on the
y axis was specified as 4.0 to 6.0 kg; in this case, each
grid line on the y axis represents 0.02 kg. The patient was
placed on an elemental formula, and after his admission a
radioallergosorbent test for cow milk was reported as positive.
Weight-by-date plot is shown in Fig 1.
The child gained weight rapidly, as can be seen by the plot, with a
slope exceeding that of the reference curves. By the ninth day of
hospitalization, his weight exceeded the 3 SD curve of
weight-for-age.
We encourage any clinician who might find this program useful to
download and use it. As of yet, there are no data with which to
evaluate its impact on patient care.
Alan Meyers, MD, MPH
Alec Wysoker, BA
Division of General Pediatrics
Boston University School of Medicine
Boston Medical Center
Boston, MA 02118
REFERENCES
-
Hubbard VS, Hubbard LR. Clinical assessment of nutritional status.
In: Walker WA, Watkins JB, eds. Nutrition in Pediatrics: Basic
Science and Clinical Applications. 2nd ed. Hamilton, Ontario: BC
Decker; 1996:17
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Sermet-Gaudelus I,
Poisson-Salomon AS,
Colomb V,
Simple
pediatric nutritional risk score to identify children at risk of
malnutrition.
Am J Clin Nutr.
2000;
72:64-70 [Abstract/Free Full Text]
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Centers for Disease Control and Prevention. The management of acute
diarrhea in children: oral rehydration, maintenance, and nutritional
therapy. MMWR Morb Mortal Wkly Rep. 1992;41(No. RR-16):13
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Centers for Disease Control and Prevention. CDC Growth Charts:
United States. Data Files. Available at:
http://www.cdc.gov/nchs/about/major/nhanes/growthcharts/datafiles.htm
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Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, et al. CDC Growth
Charts: United States. Advance data from vital and health
statistics, No. 314. Hyattsville, MD: National Center for Health
Statistics; 2000
Pediatrics (ISSN 0031 4005). Copyright ©2001 by the American Academy of Pediatrics
