Reference centiles are commonly used as a means of identifying whether
some measure of interest on an individual lies within a 'normal' rang
e. Individuals outside the range may be at risk for some problem outco
me. The information needed to screen for problem outcomes is often mul
tivariate in nature. We develop a multivariate approach to centile est
imation which allows for updating of centiles based on the prior path
of the individual as well as adjustments to the centiles according to
individual covariate values. It is also possible to consider several v
ariables jointly as a screen for problem outcomes.