ANTHROPOMETRY
Introduction 2
•Anthropos - "man" and Metron -"measurement”
•A branch of anthropology that involves the quantitative
measurement of the human body.
•It is the single most portable, universally applicable, inexpensive and
non-invasive technique for assessing the size, proportions and
composition of the human body.
•It is used to evaluate both under & over nutrition.
•The measured values reflects the current nutritional status & don’t
differentiate between acute & chronic changes
Parameters of anthropometry 3
Age dependent factors:-
a) Weight
b) Height
c) Head circumference
d) Chest circumference
Age independent 4
• Mid upper arm circumference
• Kanawati index
• Rao & singh index
• Ponderal index
• Dugdale index
• BMI
Weight 5
• The measurement of weight is most reliable criteria of
assessment of health and nutritional status of children
• Minimum unit of 100 grams
• Corrected for any zero error
The weight can be recorded using a :
Electronic weighing scales for infants and children
Spring balance (unreliable)
Salter type
Beam weighing scale (Detecto scale)
6/29/2022
6
7
Growth Velocity :
0-3 months 25-30g/day
4-6 months 20g/day
8
7-9 months 15g/day
10-12 months. 12g/day
1-3 years 8g/day
3-7 years 2kg/year
4yr-puberty 3kg/year
Average birth weight- 3kg
Doubles -5 months
Triples- 1 year
4 times- 2 year
5 times – 3 year
FORMULA 9
a) 3 – 12 months
Expected weight(kg) = age (months) + 9 / 2
b) 1- 6 years
Expected weight(kg) = age (years) x 2 + 8
c) 7 – 12 years
Expected weight(kg) = age (years) x 7 - 5 / 2
Classification of Malnutrition by Indian 10
Academy of Pediatrics
Postfix ‘k’ to the grade if the patient has nutritional edema
Wellcome trust classsification 11
Weight for age edema type
60-80 + kwashiorkor
60-80 - underweight
<60 - marasmus
<60 + Marasmic
kwashiorkor
Grades of Kwashiorkar 12
• Grade 1: Peripheral edema alone
• Grade 2: Facial edema(mooning of face)
• Grade 3: Presacral and abdominal wall edema
• Grade 4: Ascites
Grades of Marasmus 13
• Grade 1: Loose skin folds in axilla and groin
• Grade 2: Loose skin folds in thigh and buttocks
• Grade 3: Loose skin folds in chest and abdomen
• Grade 4: Loss of buccal pad of fat
Length or Height/Stature
Measurement Technique 14
• Upto 2 years of age Recumbent Length is measured with
the help of an Infantometer .
• In older children Standing Height or Stature is recorded. It
is convenient to use an Inbuilt Stadiometer affixed on the
wall which provides a height with an accuracy of +/- 0.1cm.
• Nutritional deprivation over a period of time affects the
stature or linear growth of the child .
Technique of length
measurement 15
• The infant is placed supine on the infantometer.
• Assistant or mother is asked to keep the vertex or top
of the head firmly touching the fixed vertical plank.
• The legs are fully extended by pressing over the knee,
and feet are kept vertical at 90⁰ with toes pointing
upwards, the movable pedal plank of infantometer is
firmly apposed against soles and length is read from
scale.
16
Technique for height
measurement 17
• In older children who can stand , height can be
measured by the rod attached to the lever type machine
or by stadiometer.
• Child should stand with bare feet on the flat floor
against a wall with feet parallel and with heels buttocks,
shoulders and occiput touching the wall.
• Head should be kept in Frankfort plane (line joining floor
of external auditory canal to the lower margin of orbit)
and biauricular plane being horizontal.
18
Anthropometry - Amarendra B. Singh 090201263 6/29/2022
Height Velocity
19
AGE Approximate rate of increase in stature
Birth to 3 months 3.5cm/month
4 – 6 months 2.0cm/month
7 – 9 months 1.5cm/month
10 – 12 moths 1.2 cm/month
1 – 3 years 1 cm/year
4 – 12 years 6cm/year
20
At birth – 50 cm
6 months – 62 cm
At 1 year - 75cm
At 2 year - 87.5cm
At 3 year – 94 cm
At 4 year-100cm (double)
Expected height upto 12 yrs :
length or height (in cms) = age in years x 6 +77 ( Weech formula )
Waterlow’s classification 21
Height for age % of expected
normal >95
1st degree stunting 90-95
2nd degree stunting 85-90
3rd degree stunting <85
HEAD CIRCUMFERENCE/
OCCIPITOFRONTAL 22
CIRCUMFERANCE
• Brain growth takes place 70% during fetal life, 15% during infancy and
remaining 10% during pre-school years.
• Head circumference are routinely recorded until 5 years of age.
• If scalp edema or cranial moulding is present , measurement of scalp
edema may be inaccurate until fourth or fifth day of life .
•The head circumference is measured by placing the tape over the
occipital protuberance at the back and just over the supraorbital ridge in
front.
Error in HC Measurements 23
• Scalp swellings
• Cephalhematoma
• Extravasation of IV fluids administered through scalp
veins
• Overriding of skull bone sutures in newborn
If there abnormal size of the patient’s head then head
circumference of parents and siblings should be
measured.
24
WRONG METHOD
25
Anthropometry - Amarendra B. Singh 090201263 6/29/2022
Expected head circumference
26
in children
Age Head circumference growth
(cm/month)
At birth 33 – 35
0-3 months 2
4-6 months 1
6-12 months 0.5
1-2 years 2 cm/year
>2 years 0.5cm/year till adult value of
54-56cm is attained
Dyne’s formula 27
Head circumference length ratio
Used for estimating the head circumference in the first
year of life :
5th to 95th centile-
length in cm + 9.5 +/- 2.5
2
Microcephaly refers to HC of less than 3SD below
the mean.
28
Macrocephaly refers to HC more than 2SD
above the mean
29
Chest circumference 30
• It is usually measured at the level of nipples,
preferably in mid inspiration.
• In children
</= 5years - lying down position
> 5 years - standing position
Relationship between head size with
Chest Circumference: 31
At birth: head circumference > chest circumference by
upto 3 cms
The difference is more in preterms and SGA babies
At around 9 months to 1 year of age: head circumference
= chest circumference
In microcephaly chest exceeds the head in circumference
earlier than 9 months and in hydrocephalus head
continues to remain larger than chest even after 1 year of
age.
After 1 year chest grows more rapidly compared to
the brain.
32
Growth of chest is affected in :
• PEM
• Thoracic cage abnormalities (congenital, acquired
and nutritional)
• Progressive neurologic disorders like SMA
• Congenital anomalies of lungs like agenesis,
sequestration, diaphragmatic hernia and congenital
lobar emphysema.
33
• In malnourished children, chest size may
be significantly smaller than head
circumference because growth of brain
is less affected by undernutrition.
• Therefore there will be considerable
delay before chest circumference
overtakes head circumference.
MID-UPPER ARM
CIRCUMFERENCE 34
• During 1-5 years of age it remains reasonably static
between 13.5 -17cms among healthy children .
• It is conventionally measured over the left upper arm , at
a point marked midway between acromion (shoulder) and
olecranon (elbow). The child is asked to stand with the
arm hanging loose at the side.
35
36
MUAC
13.5-17 cm Normal nutrition
12.5-13.5 cm Moderate
undernutrition
<12.5 cm Severe
undernutrition
6/29/2022
• Bangle test – quick assessment of arm circumference. A fiber
glass ring of internal diameter of 4 cm is slipped up the arm, if
it passes above the elbow, it suggests that upper arm is less
than 12.5 cm and child is malnourished. 37
• Shakir tape – is a fiber-glass tape with
red – less than 12.5 cm
yellow – 12.5- 13.5 cm
green – greater than 13.5 cm
color shading so that paramedical workers can assess
nutritional status without having to remember the normal
limits of mid arm circumference.
6/29/2022
QUAC stick – Quaker Upper Arm Circumference
Stick 38
It is developed on the principle that acute starvation
severely
affects mid-arm circumference while height is unaffected.
• It is a meter rod with two sets of markings.
• The expected height against various sizes of MAC is
inscribed.
• The malnourished child would be taller than the
anticipated height derived from the mid-arm
circumference.
Kanawati Index 39
• Useful to detect and grade PEM in children in
the age group 4 months to 4 years.
• Obtained by dividing mid arm circumference by
head circumference
PEM Grading Value
Normal >0.32
Mild >0.28 – 0.32
Moderate >0.25 – 0.28
Severe <0.25
Skinfold thickness 40
• Measured with Harpenden’s caliper
• Triceps, subscapular region or anterior superior
iliac spine
• The skinfold with subcutaneous fat is picked up
with thumb and index finger, and caliper is applied
beyond the pinch.
• Fat thickness
>10mm - healthy children
<6mm – indicate under nutrition
>20mm - obesity 6/29/2022
WEIGHT-FOR-HEIGHT 41
•Weight-for-height =
Weight of the patient (kg) X 100
Ideal weight for actual height
Weight-for-Height Grade of wasting
>90% Normal, 0
81-90 % I
71-80 % II
<=70 % III
42
Weight for height ratio:
•Upto 110 – Normal
•111 to 120 – over weight
•121 to 140 – obesity
•Above 140 – super obesity
Mid Parental Height 43
• Reveals whether the child’s linear growth is in
accordance with the parental height
• 13cm is mean difference in height between adult man
and woman
• Useful to differentiate between genetic and pathologic
causes of short and tall stature
• Boys - father’s ht + mother’s ht + 6.5cm
2
• Girls - father’s ht + mother’s ht - 6.5cm
2
Age independent indices 44
• Rao & Singh’s weight-height index:
= [weight (kg) / (height)2 cms ] * 100
normal index is more than 0.15
• Dugdale ratio: weight/height
Above 0.79 is normal
• Jelliffe ratio: head circumference/chest circumference
Classification 45
• When malnutrition has been chronic, the child is “stunted”,
weight-for-age is low/normal
height-for-age is low
weight-for-height is normal.
• In Acute malnutrition, the child is “wasted”,
weight-for-age is low
height-for age is normal
weight-for-height is low
BODY MASS INDEX (BMI) 46
• Weight (kg)/height (m2)
• <15 – under nutrition
• >22 - overweight
• >25 - obesity
Ponderal Index 47
• Similar to BMI and is used for defining newborn babies with
intrauterine growth retardation.
PI = (Body weight in grams) × 100
length (cm)³
• In malnourished small-for-date babies (asymmetric IUGR),
ponderal index is <2, while it is usually more than 2.5 in term
appropriate-for-gestation babies and between 2 – 2.5 in
hypoplastic newborns.
PROPORTIONAL TRUNK AND
LIMB GROWTH 48
• The mid-point of the body in newborn is at
umbilicus whereas in an adult the mid-point
shifts to the symphysis pubis due to greater
growth of limbs than trunk.
• The UPPER SEGMENT (vertex to upper edge of
symphysis pubis) to LOWER SEGMENT
(symphysis pubis to medial side of heels)
1.7:1 at birth .
1.6:1 at 6 months 49
1.5:1 at 1 year
1.4:1 at 2 year
1.3:1 at 3 years
1.2:1 at 4 years
1:1 at 7 to 10 years
0.9 to 1 in adults
For 6 months to 7 years:
U/L = 1.6 – (age in years x 0.1)
• Infantile upper segment to lower segment ratio
(trunk abnormally large or limbs abnormally small) 50
is seen in :
1. Achondroplasia
2. Cretinism
3. Short limbed dwarfism
4. Sexual precocity
5. Bowed legs
6/29/2022
• Advanced upper segment to lower segment ratio
(trunk abnormally short or limb abnormally long) is 51
seen in:
1. Arachnodactyly
[Link]
[Link]
[Link] Syndrome
[Link]’s Syndrome
[Link]
[Link] deformities (rickets, pott’s spine)
6/29/2022
ARM SPAN 52
•It is the distance between the tips of middle fingers of both
arms outstretched at right angles to the body,
•In under-5 children , arm span is 2 cm smaller than body
length
• 5-10 years, arm span is 1 cm less than body length
•During 10-12 years of age , arm span = height.
•In adults arm span is more in adults by 2 -3cm.
Abnormally large arm span is seen in patients with:
1)Arachnodactyly (Marfan syndrome) 53
2)Eunuchoidism
3)Klinefelter’s Syndrome
4)Coarctation of aorta
Arm span is short compared to height in patients
with:
1)Short limbed dwarfism
2)Cretinism
3)Achondroplasia
Limitations of Anthropometry 54
Inter-observers errors in measurement
Limited nutritional diagnosis
Problems with reference standards, i.e. local versus
international standards.
Arbitrary statistical cut-off levels for what considered
as abnormal values.
55
Thank you 6/29/2022
