Growing Up With Us...
©
A Newsletter For Those Who Care For Children
Volume 18, Issue 3
HOW CHILDREN GROW: ANTHROPOMETRIC MEASUREMENTS
Author: Jan M. Foote, DNP, ARNP, CPNP
March 2012
Editor-in-Chief: Mary M. Dunlap, MAED, RN
UDDEN INFANT DEATH SYNDROME
BEHAVIORAL OBJECTIVES
AFTER
READING THIS NEWSLETTER THE
LEARNER WILL BE ABLE TO:
1. Discuss general growth trends during childhood.
2. Identify proper anthropometric instruments and techniques.
Growth and development are terms often used together
to describe the sum of changes occurring during childhood.
Growth is the quantitative increase in size of the body - the
dimensions, organs, and tissues, which occur as part of a
child’s progress toward maturity. Anthropometry is external
measurement of an individual’s growth. Development is the
qualitative maturation of systems and organs, acquisition of
skills, and increasing ability to adapt more readily to stress
and new situations. Children should follow a trajectory of
increasing physical size and complexity of function.
This newsletter will review the importance of
measurement accuracy and reliability; general growth rates;
and proper anthropometric measurement of weight, linear
growth (length and stature), and head circumference.
GROWTH TRENDS
Children generally have predictable patterns of growth.
Birth size is a reflection of the intrauterine environment.
Postnatal growth is influenced by gender, heredity,
environment, nutrition, and disease. Healthy, well-nourished
and nurtured children tend to grow toward their genetic
potential, therefore growth rates may vary during the first 2
years of life. Premature infants and those born small for
gestational age usually “catch up” by age 2. Infancy and
adolescence are periods of rapid growth, whereas growth is
relatively slower and steady in middle childhood. General
guidelines for weight gain, linear growth, and head
circumference are shown in the table.
ANTHROPOMETRIC MEASUREMENTS
Effective growth monitoring requires precise
anthropometry. Measurements need to be both accurate and
reliable to be of value. Accuracy is the closeness of the
measured value to the true or actual value. Reliability is how
close repeated measurements agree with each other.
Sources of measurement error include faulty instruments,
casual techniques, diurnal variation, posture and movement
of children, and measuring only once.
Accuracy and reliability are improved by using proper
measurement instruments and techniques, performing
measurements by the same trained observer at the same
time of day (when possible), and measuring at least twice
(ideally 3 times) and recording the mean value. If repeated
measurements differ significantly (e.g., infant weight > 30
grams, child weight > 100 grams, height and length > 0.3-0.5
cm, head circumference > 0.2 cm), measure the child again
and average the measurements closest in agreement; note
that the measurement technique and/or instrument may
need to be refined. If the average value is in an unexpected
range, confirm by carefully weighing or measuring the child
again before analyzing his/her growth pattern.
Average Increases in Growth Parameters
Age
Weight Gain
Term neonates lose 5-10% Birth weight: regain by 10-14 days,
birth weight in first few
double by 4-6 months, triple by 12
days
months
0-3 months
30 g/day
3-6 months
20 g/day
6-9 months
10-15 g/day
9-12 months
10-12 g/day
12-18 months
200 g/month
18-36 months
180 g/month
3-10 years
2-2.5 kg/year
11-14 years (female)
4 kg/year
11-14 years (male)
5 kg/year
Age
Linear Growth Velocity
Length increases ~ 50% by 1 year
0-6 months
2.5 cm/month
6-12 months
1.25 cm/month
12-24 months
10-12.5 cm/year
24-36 months
8 cm/year
36-48 months
7 cm/year
4 years until puberty
5-6.5 cm/year
Pubertal (earlier and
Slight decline may precede puberty,
shorter time period in
then increases and peaks at 8-14
females than males)
cm/year before decelerating
Age
Head Circumference
0-3 months
2 cm/month
3-6 months
1 cm/month
6-12 months
0.5 cm/month
Remaining period
Total of 10 cm (75% brain growth
achieved by 3 years, 90% by 6 years)
WEIGHT: Weigh infants and young children using a clean,
calibrated electronic or beam-balance scale placed on a
level surface. After placing a soft paper or cloth on the scale,
zero the scale. Place the nude child (no diaper) on the
center of the scale bed. Hover one hand over the child at all
times to prevent falling. Weigh to the nearest 10 grams (0.01
kg) or lowest ounce increment. Return the scale to zero
before weighing the child again.
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Weigh older children who can stand alone using a
calibrated platform scale. Zero the scale. The child, wearing
only light clothing and no shoes, stands in the center of the
scale. Weigh to the nearest 100 grams (0.1 kg) or lowest
pound increment. For accuracy, repeat the procedure.
Children who cannot stand alone need a special scale (e.g.,
wheelchair, sling, beam chair, or bed scale). If the child has
a device, which cannot be removed (e.g., IV armboard,
cast), weigh a similar device and subtract from the child’s
weight and/or document the presence of the device.
LINEAR GROWTH: Recumbent length is measured in
infants and children up to 24-36 months of age and older
children who cannot stand alone. Using a tape measure is
inaccurate and unreliable. Use a calibrated length board
(infantometer) with a clean, flat and firm horizontal surface;
stationary headboard and
movable footboard at 90°
angles to the horizontal
surface; and attached ruler.
Remove clothing, shoes,
and hair ornaments upon
the crown of the head.
Figure 1: Foote, J. M. (2009). See How Remove or loosen the
diaper so the body can be
They Grow in LENGTH poster.
fully extended. Place the infant/child supine on a thin cloth or
soft paper upon the length board. Two persons are always
required for accurate and reliable measurement. One person
holds the crown of the head against the headboard with the
head positioned midline and in the Frankfort plane
(imaginary line from the lower border of the orbit of the eye
through the highest point of the auditory meatus [opening of
the ear canal] that runs parallel to the headboard). Extend
the body flat and fully along the length board. The second
person places one hand on both knees to fully extend both
legs and, with the other hand, moves the footboard against
the heels of both feet with toes pointing straight up. Read the
measurement to the last completed millimeter (0.1 cm) or
1/16th inch. Reposition the child between repeated
measurements.
Height (stature) is measured in children 2
years and older who are able to stand alone.
Wall charts or flip-up horizontal bars (floppyarm devices) attached to scale devices are
not accurate or reliable instruments. Use a
calibrated stadiometer (vertical surface to
stand against; flat surface to stand upon and
movable headboard at 90° angles to the
vertical surface; and attached ruler). Remove
shoes, heavy outer clothing, and hair
ornaments/styles upon the crown of the head.
The child stands fully erect on the flat surface
with the occiput, scapulae, buttocks, and
heels (or if unable, at least two contact points)
against the vertical surface. Weight is evenly
distributed on both feet with heels together.
Shoulders are relaxed with arms hanging
down freely. Position the head in midline and
in the Frankfort plane. Move the headboard
down onto the head and read the
measurement at eye level to the last
completed millimeter (0.1 cm) or 1/16th inch.
Reposition the child between repeated measurements.
Figure 2:
Foote, J. M.
(2009). See
How They
Grow in
HEIGHT
poster.
A second person may be needed to help some children
maintain proper position. Some children with special needs
may require alternative procedures, such as arm span or
segmental measurements.
Between 24 and 36 months of age, plot the measurement
(length or height) on the appropriate growth chart because
recumbent length is greater than standing height. Using the
incorrect growth chart gives a false perception of the child’s
growth.
HEAD CIRCUMFERENCE: Routine
measurement of head circumference, a
reflection of brain growth, is performed in
children up to 36 months and older children
whose head size is questionable. Use a
clean, non-stretchable tape measure to
obtain the frontal-occipital circumference
(FOC) or occipital-frontal circumference (OFC), which is the
greatest circumference of the skull. Ensure that hair
ornaments or hair styles do not interfere with the
measurement. Place the tape measure on the forehead
slightly above the supraorbital ridge (just above eyebrows),
above the ears, and around the maximal occipital
prominence of the back of the skull. The plane of the tape
must be the same on both sides of the head. Pull the tape
measure taut and read to the nearest millimeter (0.1 cm) or
1/16th inch. Remove the tape measure and repeat to ensure
accuracy. When frequent head circumferences are indicated
(e.g., post shunt placement), placing pen marks on the
child’s head, indicating where to measure, lessens the risk of
discrepancies.
ASSESSMENT OF GROWTH
Growth is well established as an important and sensitive
indicator of health status, therefore it is critical that
measurements are both accurate and reliable. Although single
measurements may identify conditions such as short stature,
obesity, or microcephaly, observing a change in the growth rate
or pattern over time is of greater value. Serial measurements
should be plotted on age-specific and gender-specific growth
reference standards. Plot weight per length (under age 2) and
body mass index (2 years and older) to help assess body
proportions and nutritional status. The Centers for Disease
Control and Prevention (CDC) recommends using the World
Health Organization (WHO) growth standards to monitor growth
for children ages 0 to 2 years because they establish growth of
the breastfed infant as the norm and provide a better description
of physiologic growth in infancy. The CDC growth charts are
recommended for children 2 years and older. Special growth
charts exist for some conditions (such as prematurity and Down
syndrome) and some ethnic groups. Although some may be
predisposed to being smaller or shorter, healthy children should
follow a similar growth trajectory.
Atypical, accelerated, decelerated, or abnormal growth
patterns are useful warnings of possible underlying
pathology (e.g., nutritional, genetic, endocrine, metabolic,
psychosocial, or other chronic diseases) and warrant further
evaluation.
Growing Up With Us, Inc.
PO Box 481810 • Charlotte, NC • 28269
Phone: (919) 489-1238 Fax: (919) 321-0789
Editor-in-Chief: Mary M. Dunlap MAEd, RN
E-mail: [email protected]
Website: www.growingupwithus.com
GUWU Testing Center
www.growingupwithus.com/quiztaker/
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Name:_____________________________________________________
Date:___________________________________
Employee ID#:____________________________________________
Unit:____________________________________
POPULATION/AGE-SPECIFIC EDUCATION POST TEST
GROWING UP WITH US... Caring For Children March 2012 Competency: Demonstrates Age-Specific Competency by correctly answering 9 out of 10
questions related to How Children Grow… Anthropometric Measurements.
HOW CHILDREN GROW… ANTHROPOMETRIC MEASUREMENTS
1. Normal childhood growth is dependent on:
a.
b.
c.
d.
adequate nutrition and emotional environment.
normal genetic makeup.
absence of chronic disease.
all of the above.
2. Growth is rapid and the most variable during:
a.
b.
c.
d.
the first 2 years of life.
middle childhood.
just before puberty.
after puberty.
3. An infant should be weighed with:
a.
b.
c.
d.
only a dry diaper on.
all clothing and diaper removed.
shoes removed.
shoes and heavy outer clothing removed.
4. Which of the following is a sign of underlying pathology?
a.
b.
c.
d.
Accelerated or decelerated linear growth velocity
Rapid or slow weight gain or loss
Rapid or poor head growth
All of the above
5. A child with a cast on the arm cannot be weighed until the cast is removed.
a. True
b. False
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Name:_____________________________________________________
Date:___________________________________
Employee ID#:____________________________________________
Unit:____________________________________
POPULATION/AGE-SPECIFIC EDUCATION POST TEST
GROWING UP WITH US... Caring For Children HOW CHILDREN GROW… ANTHROPOMETRIC MEASUREMENTS
6. To obtain an accurate and reliable length measurement, all of the following apply EXCEPT:
a.
b.
c.
d.
two persons are always required.
extend the body and both legs fully.
a tape measure may be used.
measure more than once and record the average.
7. Which of the following is the most useful to determine the appropriateness of a child’s growth?
a.
b.
c.
d.
Determine the child’s current weight-for-age and height-for-age percentiles
Compare growth parameters to previous measurements to assess the child’s growth pattern
Ask parents if the child is outgrowing his/her clothing
Observe the child’s size
8. A child between 2 and 3 years of age may be measured in the recumbent or standing position. How
should you determine which growth chart to use to plot the child’s linear growth measurement?
a.
b.
c.
d.
Use the growth chart in the medical record
Determine if the child is closer to age 2 or 3
Type of measurement (length or height)
Either growth chart may be used
9. Head circumference should be measured more than once with a non-stretchable tape measure at the
point of maximum frontal-occipital circumference.
a. True
b. False
10. If repeated measurements differ significantly, or the average value falls in an unexpected range, you
should:
a.
b.
c.
d.
assume that the previous measurement was erroneous.
check your measurement instrument and technique carefully.
repeat the measurement again.
B and C
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