GROWTH MONITORING:ANTHROPOMETRIC MEASUREMENTS PLOTTING AND INTERPRETATION

PRESENTERS: KEAGAN KIRUGO

EMMANUEL WEKESA

SUPERVISORS: PROF FRANCIS E. ONYANGO

DR.BONIFACE OSANO

DR. GRACE IRIMU

CONTENT

Definition Background information Measures of indicators Indicators of growth Plotting on growth charts Interpretation of growth curves references

DEFINITIONS Growth: Increase in cell size and number with

a resultant increase in height or girth or both. Growth monitoring: Following the growth

rate of a child in comparison to a standard by frequent periodic anthropometric measurements in order to assess growth adequacy.

Anthropometry: Measurement of a person’s physical parameters and comparing them with a standard.

Marcia Griffiths and Joy Del Rosso, Growth Monitoring and Promotion Of Healthy Young Child Growth, Nov 2007: Definitions, pg 5

BACKGROUND INFORMATIONThere are two categories of malnutrition: Acute

Malnutrition and Chronic Malnutrition Acute malnutrition is categorized into Moderate Acute

Malnutrition (MAM) and Severe Acute Malnutrition (SAM), determined by the patient’s degree of wasting. All cases of bi-lateral oedema are categorized as SAM.

Chronic malnutrition is determined by a patient’s degree of stunting, i.e. when a child has not reached his or her expected height for a given age

Children whose birth weight is less than 2.5 kilograms and children reported to be ‘very small’ or ‘smaller than average’ are considered to have a higher than average risk of early childhood death

BACKGROUND INFORMATION 2

Nationally, 35 percent of children under five are stunted, while the proportion severely stunted is 14 percent. stunting is highest (46 percent) in children age 18-23 months and lowest (11percent) in children age less than 6 months. 18-23 months have the highest proportion of severely stunted children (22 percent) and those less than 6 months have the lowest proportion (4 percent). A higher proportion (37 percent) of male children under five years are stunted, compared with 33 percent of female children

ANTHROPOMETRIC MEASUREMENTS1.WEIGHT

Equipment: Weighing scaleProcedure: Pretesting is essential. Scale is hung onto a stable support such as a tree by the upper

hook. Ensure the dial is at the eye-level. Weighing parts are hung on the scale and the pointer of the

scale adjusted to ‘0.’ The child is undressed such that (s)he is devoid of heavy

clothing. The child is dressed with the weighing parts. Straps attached to the scale by the lower hook. Ensure feet are not in contact with the ground. Another measurement is taken with the final value obtained by

calculating the average. Difference +/-0.1

MEASURING WEIGHT

2.LENGTH <24m

A measuring rod is fixed on a stable, flat, horizontal surface.

Child is straightened with the dorsal surface in contact with the surface and oriented along the measuring rod.

Head bar is placed touching the top of the child’s head. Eye-angle-external ear canal should be vertical. Straightening of the child’s knees. Footboard placed in

contact with the feet. The reading is taken. Second reading is then taken and

the average obtained. Difference of 0.5cm is allowed.

3.HEIGHT

The child who is > 24 months and is able to stand, stands barefoot with the feet together against the measuring. In addition any hair accessories that would hinder measurement should be removed.

The heels, buttocks, shoulder blades and occiput should lightly touch the measuring device.

The head is aligned so that the external eye angle–external ear canal is horizontal, this means that the eyes should be looking straight ahead.

The child is told to stand tall and is gently stretched upwards by pressure on the mastoid processes with the shoulders relaxed

The sliding head piece is lowered to rest firmly on the head

4.HEAD CIRCUMFERENCE

This is a good measure of brain growth especially in the first two years of life.

It is of great value in follow-up of low birth weight infants, and children with Central Nervous System abnormalities like suspected post meningitic hydrocephalus.

The charts aren’t included in the countries growth monitoring cards.

normal head circumference at birth is 34 – 36 cm. Head circumference increases by 2cm/month for the

first 3 months, then by 1 cm/month from 3 – 6 months, then by 0.5c/month from 6 – 12 months. (12 cm for 1st year of life)

5. MUAC

Ask the mother to remove any clothing covering the child’s left arm. Calculate the midpoint of the child’s left upper arm: first locate the

tip of the child’s shoulder with your finger tips. Bend the child’s elbow to make the right angle. Place the tape at zero, which is indicated by two arrows, on the tip of

the shoulder and pull the tape straight down past the tip of the elbow Read the number at the tip of the elbow to the nearest centimeter.

Divide this number by two to estimate the midpoint. Mark the midpoint with a pen on the arm Straighten the child’s arm and wrap the tape around the arm at the

midpoint.  Inspect the tension of the tape on the child’s arm. Make sure the

tape has the proper tension and is not too tight or too loose When the tape is in the correct position on the arm with correct

tension, record the measurement to the nearest 0.1cm

INDICATORS OF GROWTH

MUAC criteria to identify malnutrition of children under five years in the community

Severely Malnourished less than 11.5cm Moderately Malnourished 11.5cm to 12.4cm.At Risk of malnutrition 12.5cm to 13.4cm

The admission criteria for infants below 6 months are substantially different than for infants over six months

Head circumference

Using an un-stretchable tape at the largest head perimeter

HEIGHT FOR AGE(HAZ) The height-for-age index is an indicator of linear

growth retardation and cumulative growth deficits Children whose height-for-age Z-score is below minus two standard deviations (-2 SD) are considered short for their age (stunted) and are chronically malnourished. Children who are below minus three standard deviations (-3 SD) are considered severely stunted. Stunting reflects failure to receive adequate nutrition over a long period of time and is also affected by recurrent and chronic illness. Height-for-age, therefore, represents the long-term effects of malnutrition in a population and is not sensitive to recent, short-term changes in dietary intake(stadiometre or length board)

WEIGHT FOR HEIGHT(WHZ)

The weight-for-height index measures body mass in relation to body height or length and describes current nutritional status. Children whose Z-scores are below minus two standard deviations (-2 SD) are considered thin (wasted) and are acutely malnourished. Wasting represents the failure to receive adequate nutrition in the period immediately preceding the and may be the result of inadequate food intake or a recent episode of illness causing loss of weight and the onset of malnutrition ie acute malnutrition. Children whose weight-for-height is below minus three standard deviations (-3 SD) are considered severely wasted

WEIGHT FOR AGE(WAZ)

Weight-for-age is a composite index of height-for-age and weight-for-height. It takes into account both acute and chronic malnutrition. Children whose weight-for-age is below minus two standard deviations are classified as underweight. Children whose weight-for-age is below minus three standard deviations (-3 SD) are considered severely underweight

Does not distinguish acute or chronic malnutrition or fluid retention

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INTERPRETATION OF GROWTH CURVES

This is determining whether the child is growing appropriately or not, this is done by watching the direction of the child’s growth pattern.

Normal growth curve; a healthy child’s growth curve is parallel to the printed curves on the chart. important consideration on premature infants where growth failure can be over diagnosed, this can be avoided by subtracting the weeks of prematurity from postnatal age when plotting the growth measurements. the direction of the growth curve is more important than the position of the curve on the chart.

A horizontal growth curve(static);this indicates danger, this means the child is not growing, a sign of disease, especially malnutrition, this makes them prone to recurrent infection as they can not resist disease, a thorough history should be taken to establish the cause of growth failure, then intervene; relevant and practical guidance to the mother within her means to ensure continuation of normal growth. thereafter growth monitoring helps to determine the adequacy of catch-up growth (successful nutritional rehabilitation associated with growth spurt)

Downward growth curve; indicates a very dangerous situation where the child is losing the weight, this requires extra care immediately, could indicate malnutrition, tuberculosis, AIDS or other medical conditions. Investigations and treatment necessary. Any infant who does not gain weight for a month or a child in 2 months should receive urgent attention, an indicator of the child being malnourished.

REFERENCE

K. Mukelabai, N.O. Bwibo, R. N. Musoke, Primary Health Care A Manual for Medical Students And Other Health Workers (3rd Ed), Chapter 6: Growth monitoring and promotion during early childhood, pg 60 – 65

Kenya National Bureau of Statistics (KNBS), 2008-09 Kenya Demographic and Health Survey (KDHS)

Ministry of Health, MCH Booklet (2010 Ed)