Objectives Growth monitoring (GM) and promotion is a routine part of primary healthcare for children in >80% of countries. In India, 57.5 million children are measured every month by frontline workers to assess their growth and to trigger preventive or curative services. Standard guidance for anthropometry suggests that quality can be compromised by the choice of measurement equipment, placement of equipment, and positioning of children during measurement. Little is known about the quality

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... measurement processes during GM. We compared child height and weight measurement processes with standards for anthropometry to assess GM quality. Methods We observed the process of measuring weight and height of <5 years-old-children (N = 681) in 4 states using a checklist based on standards for anthropometry. We summarized data along critical measurement falter points that could affect quality. Open-ended interviews were conducted with caregivers to assess how they value GM. Results Most children (75%) were weighed using age-appropriate weighing scales (baby-weighing scales, salter scales, and on adult scales with a caregiver). However, for Salter scales, only 44% of children were placed in a sling/pants appropriate for their age. More than 30% of children wore heavy clothing and 45% were not calm during weighing. Over 60% were weighed in a sitting/standing position on a baby-weighing scale. More than 50% of infants were not measured using age-appropriate height equipment. Height equipment was placed on a stable surface while measuring a majority of children, but a large proportion of children were incorrectly positioned on the equipment. Caregivers valued GM and reported having children weighed to learn about any changes; nearly half the caregivers considered weight as a marker for child growth. Conclusions Multiple measurement-related falter points were observed during GM. Most were measured incorrectly, increasing the potential for under-or over estimation of their weight/height and consequent misclassification for screening and referrals. As routine GM appears to be an assurance of child growth to caregivers, it is imperative to strengthen the quality of measurements, focusing on the falter points to ensure better data for programs and for caregiver use. Funding Sources Bill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute.