Measuring a Child’s Growth
Dr. Samah Barafah
Growth
Means:
Increase in size
Assessed by growth chart
The growth chart or "road-to-health" chart was first designed by David Morley and was later
modified by WHO.
Importance :
Use to assess growth of a child from birth up to 5 years of age.
A different Growth Record is needed for boys and girls because boys and girls have different
weights and lengths beginning at birth
Growth parameters : To assess the child growth
we need 3 parameters:
weight
height
and head circumference also called OFC (Occipito-
Frontal Circumference).
Growth chart: Is a chart include curves of normal ranges of weigh ,height / length and HC- each
separated- in which the lowest normal is 3th presented while the highest normal is 97%
Growth chart :
With single visit and single measurement can identify the normal or abnormal growth
While with serial measurement can identify the normal or abnormal growth rate.
For the assessment WHO has provided charts for both boys and girls based on:
o length/height-for-age
o weight-for-age
o weight-for-length/height
o BMI (body mass index)-for-age
Overview:
The child should follow his own percentile on repeated visit.
A flat curve( horizontal line) ------------------Abnormal (arrested growth)
Up ward curve ------------------------------------ Normal
Down ward curve ---------------------------------Abnormal
centile :
This is a curve on the special chart where we have to plot the person on it.
This curve represents the percentage of normal people on that curve
.
Majority of normal persons should lie within or on these lines we can call it the Road
of Health.
Remember the lowest curve is 3th centile and the highest is
97th centile.
Growth chart centile is applied mainly for children as they are
growing and after puberty there will be no more increase in the
height and head circumference ( due to ossification of the bone
and no more increase in the bone length) but may be variation in
weight
Failure to thrive:
Failure to gain weight within the first 2 years of life.
Body mass index:
This formula to assess whether the patient is normal, overweight or obese.
Tall stature:
When the height above 97th centile and the majority of causes is genetic (familial) as in
Klienfilter’s syndrome.
Short stature:
This when the height or length of child below the 3th centile .
The most common is constitutional or familial .
The pathologic one that you may see is Dwarfism and
another condition called Turner’s syndrome.
Microcephaly:
Small head which is below 3th of head circumference.
There are many causes for it and the most common is
secondary to cerebral atrophy.
Macrocephaly:
Big head and refer to head circumference above
the 97th centile and the most common one that we are seeing is
secondary to hydrocephalus
Growth
parameters
weight
Types of weighing scales
1) spring scales
2) hanging scales;
3.beam balance scales;
4.digital scales: are highly accurate and easily transportable.
There are many types of scales currently in use. The UNISCALE (made by UNICEF) and is used to
demonstrate weighing techniques.
Weight:
Approach
Fix the scale on zero and sure that is balanced (if you are using the
balancing type)
Ask to remove heavy cloths and shoes
If the child > 2years ask him to stand steady on the machine
, if < 2 years be sure the child is quit on the machine and with light cloths.
Adjust the scale and record the weight by (Kg).
Apply it on the growth chart
Below 3 th %under weight
Above 97th % over weight
If the child is 2 years or older, you will
weigh the child alone
Below 2 years:
If the child is less than 2 years old or is unable to stand, you will do tared weighing.
Length / Height:
Depending on a child’s age and ability to stand, measure the child’s length or height. A child’s
length is measured lying down (recumbent). Height is measured standing upright.
If a child is less than 2 years old, measure recumbentlength.
If the child is aged 2 years or older and able to stand, measure standing height.
Equipment
An Infantometer
To measure length is a length board which should be placed on a flat, stable surface such as a
table
Ask the mother to lay the child on his back with his head against the fixed headboard,
compressing the hair.
Ask the mother to move behind the headboard and hold the head in this position.
Hold down the child’s legs with one hand and move the footboard with the other.
pull the footboard against the child’s feet. The soles of the feet
should be flat against the footboard, toes pointing upwards.
Read the measurement and record the child’s length in centimetres.
Stadiometer:
To measure height, use a height board mounted at a right angle between a level floor and
against a straight, vertical surface such as a wall or pillar
In older children: above 2 years we should measure the standing height using either vertical
fixed scale or simply by asking person to stand against a wall and then make marking on
the highest point of the vertex on the wall (make sure that the person stand comfortably
with heels, buttocks and head back touching the wall and the feet paralleled)
round the height by cm
Apply the result on the height/ length growth chart for sex required
Below 3 th%----------short stature
Above 97th%---------tall stature
Body mass index(BMI):
BMI is a number that associates a person’s weight with his or her
height/length growth indicator when it is plotted on a graph against
a child’s age.
Body mass index(BMI):
Calculate the body mass index BMI by:
Weight(Kg)
BMI =
(Height)2m
Classify the person according to the following ranges:
BMI
Less than 5 th%----------underweight
5 th%--- less than 85 th%----------Healthy weight
85 th%-- less than 95 th%----------overweight
More than 95 th%------------ Obese
Head circumference:(HC)
Head circumference represents the growth of the brain
For measuring HC:
Place the tape over the occipit which is the most prominent part
posteriorly and encircle it around the head to include the prominent
frontal area anteriorly
Plot the result on the HC growth chart for required sex.
Below 3 th%----------small head (microcephaly)
Above 97th%--------Large head (macrocephaly)
Thank and reassure the patient.
MUAC: med upper arm circumference
MUAC: med upper arm circumference
The MUAC test can identify children between six months and five years old who have malnutrition.
Steps:
Ensure that the child is not wearing any clothing on his or her arm.
Find the mid-point of the upper arm. The mid-point is between the tip of the shoulder and the elbow.
Mark with a pen the mid-upper arm point.
wrap the tape around the arm
Read and record the measurement
If a child has a MUAC of less than 12.5 cm (coloured yellow or red on the tape) a referral form must be
filled out so that the child can receive treatment.
Colour Nutritional status MUAC (cm) MUAC (mm) Action
Refer to the nearest
health facility that
Red Severe <11.5cm <115 mm
provides therapeutic
feeding.
Refer to the nearest
health or nutrition
Yellow Moderate 11.5-12.4 cm 115-124 mm centre that provides
supplementary
feeding (if available).
Encourage the carer
to continue with
healthy hygienic care
and feeding
Green Healthy >12.5 cm >125 mm
practices, and to
return if the child
becomes sick or
weaker.
