How Spanish primary care tracks your child's growth and weight

Key rules

• Routine visits: Growth is measured at scheduled check-ups in public primary care, and the schedule varies by region.
• Percentiles: Your child's measurements are plotted on percentile charts, with BMI percentiles used from age 2.
• Flagged child: A flag leads first to advice and follow-up in primary care, with hospital referral only if needed.
• Foreign records: Bring original measurements and dates from abroad so they can be plotted on your region's charts.

How your child's growth is tracked

Your child's growth is checked at the routine visits of the regional Child Health Programme (Programa de Salud Infantil). A pediatrician or pediatric nurse at your public health centre does the checks. You don't need to ask for them, but you do need to attend.

At each visit they measure weight, length or height, and head circumference. Visits are frequent in the first year and then become less frequent. The timeline below shows the usual pattern. The exact schedule depends on your region.

Where your child sits on the chart

The measurements are plotted on percentile charts. A percentile compares your child with other children of the same age and sex. Being on the 50th percentile means half of children are smaller and half are larger.

Young children are generally plotted on WHO standards. Many regions use Spanish reference charts for older children. From age 2, the pediatrician also uses BMI percentiles.

What matters most is the direction of the curve over time, not a single reading. Ask where your child sits and how the curve is moving.

Results go into the electronic record and the child health book. Keep and bring the child health book to visits.

If you moved from another country

Bring the original measurements and their dates. The pediatrician usually records them in your child's file and plots them on the charts your region uses. They are normally re-plotted, not converted from one chart to another. Practice varies by clinic and region, so ask your health centre how it handles foreign records.

If your child is flagged

A flag is a reason to look closer, not a diagnosis. Follow-up starts in primary care.

Overweight or obesity. The pediatrician and nurse review diet, physical activity and sleep. They give counselling for the whole family, set goals and arrange extra weight checks. If they suspect another cause, they screen for it. If the case is severe or isn't improving, your child is referred to a hospital specialist in pediatric endocrinology or nutrition.

Poor growth (short stature or faltering weight). The pediatrician reviews the growth curve, family heights and possible causes, and orders basic tests. If needed, they refer your child to a hospital specialist in endocrinology or gastroenterology.

Most children are not sent straight to hospital. When a referral happens depends on your region, so ask who will arrange it and when.

The decision, checklist and FAQ below go through next steps in more detail.

Choosing between options

What happens next after your child is flagged for a growth or weight concern?

• Follow-up in primary care: Your child is flagged for overweight or obesity.

• Review of the growth curve and basic tests: Your child has short stature or faltering weight.

• Referral to a hospital specialist: The case is severe, is not improving, or a medical cause is suspected. Your child goes to hospital pediatric endocrinology, nutrition or gastroenterology.

Primary care comes first. Referral to a hospital specialist follows only if the case is severe, does not improve, or a cause is suspected.

Timeline and deadlines

• First check-up with weight, length and head circumference: in the first weeks after birth

• Early infant check-ups: at 1, 2, 4, 6 and 9 months

• Check-up at the end of the first year: at 12 months

• Toddler check-ups: at 15 and 18 months

• Later routine check-ups, with BMI percentiles from age 2: every year or every two years until the pediatric age limit

Checklist

• Book and attend every routine check-up in your child's health programme, so weight, height and head size are measured and plotted on the percentile chart.

• Ask the pediatrician or nurse where your child sits on the growth chart and how the curve is moving.

• Bring your child's health book, plus any measurements and dates from another country, if you moved to Spain.

• Ask which growth charts your region uses, so you know how foreign measurements are re-plotted.

• If your child is flagged for overweight or obesity, talk through diet, physical activity and sleep with the pediatrician and nurse, and agree goals.

• Book the extra weight checks the pediatrician sets after a flag.

• If your child is flagged for poor growth, bring family heights and be ready for basic tests.

• Ask whether a hospital referral is needed if there is no improvement, and who will arrange it.

Frequently asked questions

Will the pediatrician use my child's growth records from another country?

Yes, Spanish public pediatricians generally enter weight, length or height and head circumference from foreign records into your child's health record. They re-plot the numbers on the charts used in the region rather than converting foreign percentiles.

Which growth charts does Spanish primary care use?

Young children are generally plotted on WHO standards, and many regions use Spanish references such as Fundación Orbegozo or Carrascosa tables for older children. Body mass index (BMI) percentiles are used from age 2. Ask your health centre which charts your region uses.

Where are my child's measurements kept after each visit?

Results are stored in the electronic health record and in the child health book (the paper booklet of check-ups). Ask for the book if you were not given one, so you can show it to a new doctor if you move region.

Will my child go straight to a hospital specialist if flagged?

No, a flagged child is first followed up in primary care. Referral to a hospital specialist comes if the case is severe, not improving, or has a possible underlying cause. The point at which this happens varies by region.