Article

KNEE HEIGHT AS A PREDICTOR OF ACTUAL HEIGHT FOR 7-12 YEARS OLD

CHILDREN
Fernando

Background: Because accurate measures of actual height are essential to assess growth health
children. Children must be able to work together and can be positioned according to the standard
that is standing upright, so that measurements can be done easily and accurately. However,
measurement difficulties will arise when measuring children with limited mobility, for short
periods of time such as post-surgical treatment, or long-term conditions such as children who need
permanent walking aids because of their limitations, or because of a permanent disease. Prediction
of length from knee height in population has not yet been investigated.
Objectives: This study aims to predict children's height through height knee measurements in
children aged 7-12 years
Methods: Subjects (n=300), aged 7-12 years, were participants. The measurement of knee height
is done by the child sitting upright with his feet up on the floor, so that the knees and ankles form
90% angles, using calibrated Vernier caliper, nearest 0,5 mm. Equations were made based on knee
height measurement.
Results:
Conclusions:

INTRODUCTION
Height is the main indicator of a child's health. Height measurement is the most basic thing
for monitoring a child's growth (1). Measuring height in children has been carried out routinely
using classical anthropometric measurement methods, such as measurement of standing height or
recumbent length (1). In children who are in a period of growth, linear growth measurements done
directly. And the results of these measurements can be compared with the standard growth curve
(WHO 2006).

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 Moreover, height is used as one of the values to calculate body proportions by calculating
the Body Mass Index (BMI) or Body Weight / Height (Length) Body (W/H). Height is also
important for identifying growth in nutritional disorders, and endocrine disorders, metabolic
disorders, genetic disorders, psychosocial disorders, chronic diseases, examining the consequences
of an illness, calculating and determining nutritional needs, calculating drug dosages, assessing
fluid balance, and determining medical equipment and resuscitation.2,3 Another use is being able
to determine energy requirements using a formula (Schofield) and estimating pulmonary function
and glomerular filtration rate (LFG) (1,4).
Accurate measurement is important to determine the height of a child (5). Children must
be able to work together and can be positioned according to the standard that is standing upright,
so that measurements can be done easily and accurately. The method of measuring height is several
ways. The most common method is to measure the length or height directly using a length board
or height board (stadiometer). This measurement results in the actual height of a child. However,
measurement difficulties will arise when measuring children with limited mobility, for short
periods of time such as post-surgical treatment, or long-term conditions such as children who need
permanent walking aids because of their limitations, or because of a permanent disease. More than
500,000 children are reported to need wheelchairs to help with their mobility, and they need greater
intensive care because of their limitations. About 10 million children in the US suffer from chronic
diseases. Maintaining nutritional status based on height measurements for these children is
important for maintaining health, quality of life, and management of their health.
General measurements, such as body length (stature) cannot be done because they cannot
stand upright. So that in these circumstances where height cannot be easily directly measured,
measurement is needed with other methods that can describe / estimate the length or the estimated
height (proxy measures). Height prediction is important as a substitute for these general
measurements. Long bones are known as the best indicators of height determination (7). The
equation or formula determines the estimated height using segmental limbs that has been
developed in an effort to answer the challenge of getting accurate height measurements, especially
in children with impaired mobility. Segmental lengths commonly used in children with mobility
disorders are knee height, upper arm length, tibial length. All measurements must be made twice
and on the left side of the body. Taken an average of these 2 measurements. Measurements are
made using special equipment. For example Stevenson et al., Made a regression equation of the

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length of segmental limbs of the population of cerebral palsy children (8). Gauld et al. Made
similarities from a healthy population of school children in Australia. In their study the age was
adjusted to the age group, and the accuracy value was shown in R2. They use the length of the
ulna as the basis of measurement (4). Unfortunately, the measurement results with actual height
are not done. Of the three alternatives, it turns out that the knee height is the easiest to identify and
some researchers say the most producible knee height (8,9).
Knee Height measurements are recommended because of the availability of measurement
standards, easy work, and high level of measurement precision. KH measurements have been
suggested as routine anthropometric measurements in normal children and adults. There is now a
knee height reference curve for normal children (10). Stevenson found no difference in the
relationship between knee height and height based on age, sex or race (8).
The equation for estimating height from anthropometric measurements in the form of other
knee height has been developed in other countries, but no such equation has been made for children
in Indonesia. So that researchers want to research to make the equation using knee height
measurements to estimate a child's height.

METHODS
The research subjects were children aged 7-12 years who attended elementary school in
the city of Bandung, who agreed to participate in the study after being given an explanation and
informed consent. The inclusion criteria are children aged 7-12 years who attend elementary
school in the city of Bandung and children can stand tall. Exclusion criteria are elementary school
children who cannot stand upright, elementary school children with limited mobility.
The study was conducted in 5 elementary schools in the city of Bandung. The study will
be conducted from December 2018 to January 2019. The form of this study is observational
analytic using cross sectional methods.
The target population is children aged 7-12 years, while those who become affordable
populations are children aged 7-12 years who attend school in the city of Bandung. The selection
of schools for samples was taken based on the order of confirmation of willingness from the school
which had previously received an invitation to participate in this study, then the selection of sample
children in several elementary and special schools was carried out by consecutive sampling.

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 The number of samples according to the sample size obtained from the sample size formula
to calculate the correlation with r = 0.4, significance level α 5% (Zα = 1.96) and 80% power test
(Zβ = 0.84). Based on the formula the sample size above the minimum sample size for each group
is 47 people, rounded up to 50 people. The sample will be divided into 6 groups, so a sample of
300 normal children is needed.
Operational Definition of Research. Normal Stature: Height between +2 elementary school
to -2 elementary school according to average height based on population age and sex standards.
Children aged 7-12 years: are children aged 7-12 years who attend elementary school located in
the city of Bandung. Knee Height: is the distance between the heel and anterior thigh above the
femoral condylus. The knees and ankles form an angle of 90% with the subtabular join in a neutral
position. The measurement is done by the child sitting upright with his feet up on the floor, so that
the knees and ankles form 90% angles. In this case, the distance from the floor to the anterior thigh
is measured, the measurement is taken from the distance of the floor or from the footwear to the
anterior part of the thigh, proximal to the patella. The caliper is held parallel to the tibia and is
gently pressed so that the tissue is pressed until the skin pales.

Statistical Analysis
Data were analyzed using SPSS 22. Inter and intra observer errors were evaluated using a
sub-sample of 30 children by observer 1 and observer 2. Each observer had measured TB, knee
height 2 times. Variation coefficient (% CV) for each measurement indicator is calculated. The
minimum Cronbach alpha cutoff for a measuring instrument is 0.60. Some authors use a 0.70
cutoff to classify internal consistency as adequate, and 0.80 as good.