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Growth monitoring is an essential element of child health care. Children's healthy growth and development, and detection of variations from typical growth can be confirmed by proper growth monitoring. Objective: This study aimed to evaluate detection and referral processes of cases of stunting among a sample of children aged less than 5 years attending maternal and child Healthcare centers in Cairo. Methods: a quality of performance study carried out to observe children aged less than 5 years attending two primary healthcare centers during their growth monitoring process to assess the quality of documentation (14 items), body measurements (Anthropometric Measurements - 11 items for height and 8 for weight measurements), plotting (3 items), interpretation (4 items) and referral of detected cases (2 items) using observational checklist. Interviewing questionnaire for healthcare workers to assess their knowledge and skills in the process of detection of stunting. Results: Observed growth monitoring process was undertaken for 300 children, 51% boys and 49% girls, 44% were breastfed. Out of the sample 27 (9.3%) were < -2 Z-score height for age, 5 (1.7%) were < -2 Z-score weight for age, 5 (1.7%) were < -2 Zscore weight for height and 4 (1.3%) were < -2 Z-score body mass index for age. By Observational checklist results for growth monitoring process for documentation (28.5%) of items were not done, (53.7%) were good done and (17.8%) were satisfactory done. For measuring height (9%) of items were not done, (45.5%) were poor done, (9%) were satisfactory done and (36.5%) were good done. For measuring weight (25%) of items were not done, (6.2%) were poorly done, (12.5%) were satisfactory done and (56.3%) were good done. For plotting on growth chart (66.7%) of items were not done and (33.3%) were good done. For Interpretation of the growth pattern and referral (100%) of items not done. Conclusion: Growth monitoring shows areas in need for improvement as the detection process including documentation and follow standardized anthropometric measurements, up-to-date and periodic staff training. Developing formal and well organized referral of detected stunted is a mandate. [ABSTRACT FROM AUTHOR]