NORCERT 8 Mains-2025
Child Health Nursing (Pediatrics)
Easy
In a child experiencing chronic malnutrition, which growth parameter plotted on a growth chart is typically the last to show a decline?
Appeared in: NORCERT 8 Mains-2025
Explanation
- Head circumference is the last parameter to decline due to the physiological 'brain-sparing' effect, where the body prioritizes blood flow and nutrient delivery to the brain.
- Since head circumference is an indicator of brain growth, it is preserved until malnutrition becomes severe and prolonged.
- A faltering in head circumference growth is a late and ominous sign, suggesting that the body's compensatory mechanisms have failed and there is a risk of neurological impairment.
Why Other Options Were Wrong
- Option A: Weight-for-length is an indicator of acute malnutrition (wasting), not the last parameter to be affected. It reflects a recent and severe loss of weight.
- Option B: Height/Length is an indicator of chronic malnutrition (stunting). While it is affected later than weight, it declines before head circumference.
- Option C: Weight is the most sensitive growth parameter and is the very first to decline in any form of malnutrition, whether acute or chronic.
Related Visual
- Visual 1: Diagram - A flowchart illustrating the sequence of growth faltering in malnutrition, starting with Weight (wasting), followed by Height (stunting), and ending with Head Circumference (severe deprivation).
- Visual 2: Growth Chart - An example of a WHO growth chart for a child with chronic malnutrition, showing the weight curve flattening first, then the height curve, while the head circumference curve remains relatively stable before eventually faltering.
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Sequence of growth faltering in pediatric malnutrition as background academic context rather than a clinical decision trigger.
- Regular and accurate monitoring of all growth parameters (weight, height, head circumference) is a fundamental nursing responsibility for early detection of malnutrition and timely intervention.
- A faltering head circumference is a critical red flag that necessitates immediate, aggressive nutritional rehabilitation and investigation for underlying causes to prevent irreversible cognitive damage.
- In the Indian context, where malnutrition is prevalent, nurses play a key role in educating mothers about supplementary feeding after 4-6 months to prevent the initial growth faltering seen in many infants.
How to Approach the Question
- First, identify the keywords in the question: 'chronic malnutrition' and 'last to show a decline'. This directs you to think about long-term effects and the body's priorities.
- Recall the physiological principle of 'brain-sparing'. The body's highest priority during starvation is to protect the brain.
- Connect this principle to the given growth parameters. Head circumference is a direct measure of brain growth.
- Establish the sequence of decline: The body first sacrifices weight stores (acute), then slows down skeletal growth/height (chronic), and only in the most severe, prolonged state does it fail to support brain growth (head circumference).
- Evaluate the options based on this sequence. Weight and weight-for-length are early indicators. Height is an intermediate indicator. Therefore, head circumference must be the last to decline.
Concept Tested & Keywords
- Concept Tested: Sequence of growth faltering in pediatric malnutrition
- Stem keywords: chronic malnutrition, child, growth parameter, growth chart, last to show a decline
- Lead-in keywords: last to show a decline
- Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
- Negative lead-in flag: false
Question ID
QkrOwZSX-40A7QNmuSlhlL
Practise the full NORCERT 8 Mains-2025
Attempt every question from this paper in a timed mock, then review the full solution for each one.
More Normal Growth and its Disorders Questions
- The infant's weight becomes triple from birth weight in:
- Number of teeth in a 3-year old child is:
- When does the infant's weight get double in relation to birth weight?
- The term 'Cephalocaudal' means:-
- At what time, an average term baby doubles the birth weight? (Choose the appropriate option from below)
- During physical assessment of children, asymmetry of the skull indicates?
- Which of the following is NOT true regarding the birth weight of a newborn?
- Normal head circumference of a newborn at birth ranges from?
- The trend of development that follows head to foot is called?
- An infant has a 3 kg weight at birth. What is the expected weight after 1 year?
More NORCERT 8 Mains-2025 Questions
- A patient admitted in the ICU is receiving feeding through a Ryles tube. The nursing officer is about to give the next feed, which is scheduled for e…
- What clinical condition is shown in the image below?
- What is the most significant diagnostic test that needs to be done prior to a lumbar puncture?
- Identify the device shown in the image.
- The nurse is monitoring a child with burns during treatment. Which assessment provides the most accurate guide to determine the adequacy of fluid res…
- Which of the following assessment techniques should be avoided in a child with Wilms' tumor?
- In a conscious and stable patient, what instructions should be given while removing the central venous catheter to minimize complications?
- A nurse is caring for a schizophrenia patient who is experiencing auditory hallucinations. Which intervention is MOST appropriate?
- A belief that persists despite evidence to the contrary is characteristic of what?
- A schizophrenic patient with renal failure is admitted to the psychiatric ward for dialysis. When the time for the procedure arrives, the patient ref…