الفهرس 
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Abstract
Growth is an indication of the health state; children should be followed up at regular intervals.
The aim of follow-up of growth is to determine any deceleration in growth before nutritional disorder develops and to take precautions. If nutritional disorder develops, it leads to permanent changes including retardation in cognitive development, learning difficulty, behavioural disorders and retardation in language development and reading age.
Weight and height of school children are the most common anthropometric measurements to investigate a child’s growth rate. Weight is the simplest and most reliable anthropometric measurement and its retardation may be used as an indicator of childhood infection. On the other hand, height summarizes various measures of nutritional conditions in the first two decades of a human’s life. Inadequate nutrition (either over or under) during this critical period contributes to significant morbidity and mortality.
Body mass index has been recommended as the most appropriate single indicator of overweight and obesity in children and adolescents outside of research setting. On the other hand, mid upper arm circumference is a simple, inexpensive, and accurate measurement that may be used to identify overweight and obese children.
Blood pressure elevation is a well-established risk factor for cardiovascular disease, morbidity and mortality in adult populations. Hypertension is a public health concern because it is common in many populations. The assessment of blood pressure and prevention of
hypertension in children and adolescents has become a worldwide priority.
Childhood blood pressure is predictive of adult blood pressure. Therefore, measurement of blood pressure is considered to be an integral part of the clinical examination.
In our study data was collected after obtaining written consents from Directorate of Education in Menoufia and Berket Elsabae Educational administration, consents from parents or guardians, informing mothers about objective of the study, its benefits, the absence of any risk associated with the participation of their children and approval of local institutional ethical committee of Menoufia educational affairs. 8693 Egyptian children from birth to 19 years where studied from December 2015 to March 2017.
They were selected from primary health centers, vaccination centers, primary schools and secondary schools in Berket Elsabae City, Menoufia Governorate. Among these children, 8642 children fullfilled the inclusion criteria.
In our study we included term infants, exclusive breast feeding at least 4 months, introduction of complementary foods by the age of 4 months, and continued partial breastfeeding up to at least 12 months, Well-nourished children showing full round and filled up facial cheeks, no edema on the feet and well developed calf muscles, ,completed vaccination history, no perinatal history of medical importance, absence of significant morbidity, being well or apparently normal and absence of fever or documented underlying disease at the time of examination.
We excluded premature infants, artificially fed infants, chronic disease and chronic drug administration such as Congenital Heart
Disease and anti-hypertensive drugs, mother with smoking or alcohol abuse before and after delivery, previous NICU, PICU or hospital admission and Children with no complete measurements.
This study combined a longitudinal component from birth to 12 months and a cross-sectional component from 1-19 years. In the longitudinal component, mothers and newborns were screened and enrolled at birth then visited at home and in vaccination centers monthly. In the cross-sectional component, children aged 1 – 19 years were measured once.
All the children were be subjected to history taking as (Name, date of birth, date of examination, age at examination, maternal data: mother name, maternal disease, history of diseases / drugs, history of hospital admission and vaccination history), general examination as general look, pallor and measurement of weight, height, head circumference, mid arm circumference and blood pressure.
Weight was measured between 0-19 years but analyzed only between 0-10 years. Recumbent length was measured between 0-2years height was measured between 2-19 years, blood pressure was measured and body mass index was calculated between 0-19 years. Head circumference was measured between 0-5 years and mid arm circumference was measured between 3 months and 5 years. After that data was statistically analysed
•For growth parameters
In order to determine the standard deviation (−3 to +3) of weight, height, head circumference, mid-arm circumference and BMI for boys and girls, the L, M, and S method was used.
Z score and was calculated according to the following formula:
P = M [1 + LSZ] 1/L, L ≠ 0
• For blood pressure
In order to derive the reference standard curves (smoothed percentiles), logarithmic and semi-logarithmic transformations of systolic and diastolic blood pressures were statistically analyzed. And the correlation with weight and height was run.
In both growth parameters and blood pressure the statistical analysis was carried out using statistical package SPSS, version 20, for windows (SPSS Inc.,Chicago,Illinois,USA).
After statictical analysis of data our results showed that a total of 8642 Egyptian children 4443 boys (51.4%) and 4199 girls (48.6%) from birth to 19 years of age were examined in this study and the study has showed that:
• Regarding growth parameters
When compared with the world health organization charts it was found that Egyptian children were heavier and shorter than the WHO charts. So the BMI of Egyptian children was found to be higher than the WHO charts. The MUAC of Egyptian children was found to be larger or equal to the WHO charts. HC of Egyptian children Egyptian +2 SD lines are located above +2 SD lines in the WHO charts in the first 2 years of life then converge with them from 2-5
years. While the Egyptian -2SD lines were found to be lower than the WHO -2SD lines in the first 2 years of life then converging with them from 2-5 years.
• Regarding BP
Our study demonstrates that BP increase with age and this is consistent with previous population based studies. There was a sharp increase in DBP from 17 to 19 years probably due to stress associated with this age group.
from our study we concluded that Z-scores for Egyptian infants and children presented in this study provide nationally representative reference essential for individual and population health care and research. The availability of this national reference Z-score for Egyptian children will facilitate more accurate assessment of nutritional status of Egyptian children under different clinical conditions rather than using references from other populations
According to the results of our study we recommend that Z score method should be used to follow infant’s growth as it is more accurate than normal percentiles, now the new national Z score tables and charts for growth parameters presented in this study can be used instead of the WHO charts or other local charts for proper assess the nutritional status and blood pressure local chart presented in this study should be used for early and accurate recognition of blood pressure abnormalities as it is representative for children and adolescents in Egypt.