MEASUREMENT OF GROWTH ANTHROPOMETRY

GROWTH An increase in size of all tissues in the body. Growth is affected by : Genetic Hormonal Nutritional status Environmental factors

GROWTH Parameters : Anthropometric measurements 1. weight, height, head circumference 2. proportion : - sitting height - Upper / lower segment ratio WEIGHT is determined especially by growing of 3 tissues: skeletal muscle, adipose tissue and bone HEIGHT is determined by growing of the bone

GROWTH In acute protein and energy malnutrition, protein from skeletal muscle and fat from adipose tissue will be used. Weight will decrease, but not height. In chronic protein and energy malnutrition, bone metabolism will disturb and could cause linear growth disturbance

GROWTH Three indices are commonly used in assessing the nutritional status of children: • Weight-for-age (W/A) • Length-for-age or Height-for-age (H/A) • Weight-for-length or Weight-for-height (W/H) There are 2 type of assessment: One time assessment Growth monitoring (trend assessment)

WEIGHING INFANT

INTRODUCTION Greet the mother & introduce yourself Explain the procedure to the mother Identify infant’s data : name, address, sex, date of birth birth weight, birth length

WEIGHING INFANT Infant is weighed nude or in a clean diaper on calibrated beam or electronic scale Older infant is weighed wearing a clean, disposable diaper Remove infant’s clothing and be sure the diaper is clean and dry  Center the infant on the scale tray  Weigh infant to nearest 0.01 kg or 1/2 oz Write the weight on the infant’s chart

WEIGHING INFANT Reposition and repeat weighing the infant (3 x) Compare weights Weight shoud agree within 0,1 kg or ¼ lb If infant is too active, postpone the measure Have parent stand on scale, tare, then read infant weight

MEASURING INFANT LENGTH

MEASURING INFANT LENGTH Length is measured with a suitable measuring board Use a calibrated length board with a fixed headpiece & movable footpiece which is perpendicular to the table surface Measure infant without shoes & wearing light underclothing/diaper

MEASURING INFANT LENGTH His back in the centre of the length board→ child is lying straight & his shoulders & buttocks are flat. The child’s eyes should be looking straight up. Both legs should be fully extended & the toes should be pointing upward with feet flat against the footpiece

MEASURING INFANT LENGTH While the 2nd measurer hold the infant’s head, the measures aligns the infant’s trunk & legs and bring the footpiece firmly against the heels. The measurer place one hand on infant’s knees to maintain full extension of the legs

MEASURING INFANT LENGTH Frankfort horizontal plane is parallel to the fixed headpiece Frankfort horizontal plane is a line extending from the most inferior point of the orbital margin to the left tragion. The tragion is the deepest point in the notch superior to the tragus of the auricle

MEASURING INFANT LENGTH Measure length to 0.1 cm Record measurement on chart Reposition & remeasure Measurements should agree to 1 cm

HEAD CIRCUMFERENCE

HEAD CIRCUMFERENCE Head circumference is measured over the most prominent part of the occiput and just above supraorbital ridge Use a flexible, non stretchable tape Position the tape just above the eyebrows, above the ears & around the biggest part on the back of the head Pull tape snugly to compress the hair

HEAD CIRCUMFERENCE Read the measurement to the nearest 0.1 cm Write measurement on the chart Reposition tape & remeasure Measures should agree within 0.2 cm

WEIGHING CHILDREN & ADOLESCENTS

WEIGHING CHILDREN & ADOLESCENTS A child >36 months is weighted standing on a scale Use a calibrated beam balance/electronic scale Child must be able to stand without assisstance Child stands on center of scale platform Reposition& repeat Measures should agree within 0.1 kg

MEASUREMENT OF HEIGHT

MEASUREMENT OF HEIGHT Use calibrated vertical stadiometer with right angle headpiece Ask the child to take off the shoes The child stands with heels, buttocks, shoulders & head touching a flat upright surface Stand with heel together, legs straight, arms at sides, shoulders relaxed The head should be positioned in the Frankfurt plane

MEASUREMENT OF HEIGHT Ask the child to take a deep breath, then let it out & relax his shoulders Bring the perpendicular headpiece down to touch the crown of the head Measurer’s eye are parallel with the headpiece Read to nearest 0.1 cm Reposition & remeasure Agree within 1 cm Record on the growth chart WDY

SITTING HEIGHT

SITTING HEIGHT Use a calibrated vertical stadiometer with right angle headpiece Ask the child to sit on a stool The back of the head, thoracic spine & buttock should rest against the wall The head should be positioned in Frankfurt plane Ask the child to take a deep breath, then let it out & relax his shoulders Bring the perpendicular headpiece down to touch the crown of the head Read to nearest 0.1 cm

SITTING HEIGHT Upper body segment : height on scale- stool height Lower body segment : standing height-upper body segment Calculate the upper to lower segment ratio Record the ratio on the appropriate curve

UPPER TO LOWER SEGMENT RATIO Indications Growth Assessment Differentiates collagen bone disease (skeletal dysplasia) from primary spine (e.g. Scoliosis) Technique: Measurement See Sitting Height for an alternative method of calculating segment heights Lower segment: Top of pubic symphysis to floor Upper segment: Top of head to top of pubic symphysis Calculation: TotalHeight - LowerSegmentHeight Interpretation: Normal upper to lower ratio Birth  upper to lower ratio: 1.70 (Greatest ratio) Postpuberty  upper to lower ratio: 0.89 - 0.95

Familial short stature Constitutional growth delay Perawakan pendek Idiopatik Patologis Variasi normal Familial short stature Constitutional growth delay Proporsional Disproporsional Prenatal IUGR Faktor ibu Penyakit plasenta Infeksi Teratogen Sindrom dismorfik Kelainan kromosom Postnatal Malnutrisi Penyakit Kronis GIT, CP, ginjal, hematologi Infeksi Obat obatan Kelainan psikososial Kelainan endokrin Displasia skeletal Riketsia

ACHONDROPLASIA

CALCULATION OF MIDPARENTAL HEIGHT Display father’s height and mother’s height on the growth chart Boys : mother’s height+12.5 cm+father’s height 2 Girls : father’s height-12.5 cm+mother’s height Draw the range in the growth chart

CALCULATION OF MIDPARENTAL HEIGHT

PLOTTING MEASUREMENTS Select the appropriate chart for the age, sex & measurements Calculate the child’s age Plot the weight measurement on the growth chart appropriate for age & sex Use a plotting aid such as a straightedge Use the information in the clinical assessment process Share the information with the family

Grafik pertumbuhan : perempuan 0-36 bulan PB/U dan BB/U

Grafik pertumbuhan : laki-laki 0-36 bulan PB/U dan BB/U

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الحمد لله رب العالمين WDY

STADIOMETER