ANTHROPOMETRIC MEASUREMENT AND GROWTH

MONITORING IN NORMAL CHILDREN

Anthropometric Measurement
A part of well baby clinics
To detect growth faltering
To measure the prevalence of under nutrition
and over nutrition
To identify groups with increased nutritional
and health need.
Growth chart application
CDC Growth charts
WHO growth charts, 2005



Is my child growing well ?
Is my child growing well ?
Is my child short ?
What should be done to make my child
taller ?
Is children growth in different manner
If the parents are short, will all my
children became short ?
Evaluation of growth
Anthropometry: reliability
training
equipment
Plotting
Absolute height
Evaluation of growth
Height velocity
Measurement at 6 mos interval
Deceleration / crossing centiles age 3-12 yrs: indicates
pathologic until proven otherwise
Normal velocity indicates normal growth

Weight / height relationship
W/H ratio: suggestive endocrine causes
W/H ratio: suggestive systemic disease




Growth Phase
Infants
Deceleration
50% during 1
st
year
25% of 1
st
year growth
during 2
nd
year
Childhood
Constant 5-7 cm / year
Puberty
Acceleration
Deceleration
Halt
Interaction between GH and
sex steroids
Growth monitoring
Effective growth monitoring needs
Precise measurement
Accurate plotting on a chart
Correct interpretation
Plan of investigation
School entry measurement best
opportunity to detect growth disorder

Periodic assessment of child growth
Maintain or improve growth and health
Growth monitoring should not be a stand alone
activity, but part of broader community based
programme to improve primary health care,
education and sanitation.

Growth monitoring


NORMAL GROWTH :
When weight and height/length track along similar
percentiles or growth channels



Canadian Pediatric Society, Dietitians of Canada and Health Canada. Nutritional for healthy
infants, Minister of Public Works and Government Services, 1998
Hal-hal yang perlu dipantau dalam
pertumbuhan seorang anak
2 tahun pertama kehidupan:
Tinggi badan (TB/U), Berat badan (BB/U), BB/PB,
body mass index (BMI/U), dan lingkar kepala
(LK/U)
Usia 2-10 tahun:
TB/U, BB/U, dan BMI/U
Usia > 10 tahun:
Hal-hal diatas (2-10 th)
Penilaian perkembangan status pubertas anak
McGraw-Hill Copyright 2002
Measuring Body Weight
Electronic digital scales, calibrated
in metric units are recommended.
Chair scales are available for those
who are not capable of standing.
Weight Measurement

Weight Measurement

Measuring Growth in Length and
Stature
Recumbent length is measured from birth until a
child is able to stand
Measured from the vertex (highest point on skull) to the
soles of the feet

Length Measurement

Height Measurement
Measuring height
Measuring height is subject to error as a
result of
poor technique,
variations between instruments and observers,
diurnal variation
plotting mistakes
Single height measurement
Will identify only stature
Very short/tall child

Will not identify process of growth
Children growing slowly (CHD)
Turner syndrome
Acquired disorder : hypothyroidism, coeliac disease
Children growth crossing centiles
How many times height should be
measured ?

Consensus
Routinely up to 2 years
0.5, 1, 2, 4, 6, 9, 12, 18, 24 mos
Every 6 month up to 6 years
Every year up to 18 years
Additional parameter for
evaluation of growth

Target height
Boy = Fh+(Mh+13)
2
Girl= (Fh-13)+Mh
2
Mid parental height
Genetic height potential
Prediction of final height
5 Directory of Growth
1. Catch-up growth
2. Normal growth
3. Growth faltering
4. Flat growth
5. Loss of growth
Algorithm of Growth Monitoring
Weighing
Plotting
Make curve
Interpretatio
n
Increase
Not Increase
Identification of the problem
Solution
Evaluation
Not Increase
Catch-up Growth
Normal Growth
Growth Faltering
Flat Growth
Loss of Growth
Increase



Indices derived from growth
measurement
Constructed from two or more raw
anthropometric measurement and are simple
numerical ratio
Weight / Height
2
(BMI)
W for A : H for A : W for H
Essential part of the interpretation of
anthropometric measurement
CDC GROWTH CHARTS
CDC Growth Charts
Based on American population 1977
White
Hispanic
Black
Asian
First growth charts without BMI charts,
then in 2002 BMI is included




WHO growth charts
Based on 18 cities in the world
First part 2005
Only for 1 5 years boys and girls
Nutricia workshop, 16 sept 2006 Malang
IMT WHO dan CDC
Nutritional
Status
IMT WHO
2006
(0-5 th)
IMT WHO 2007
(5-19 th)
IMT CDC
2000
(2-20 th)
Obesitas > +3 > +2 SD > P 95
Overweight +2 SD s/d +3
SD
> +1 SD P 85 p 95
Normal -2 SD s/d +2
SD
-2 SD s/d +2 SD P 3 - < p 85
Rekomendasi Klasifikasi Status Gizi
Status Gizi BB/TB
(% median)
BB/TB
WHO 2006
IMT CDC
2000
Obesitas > +3 > P 95
Overweight > +2 SD hingga +3 SD > P 85 P 95
Normal >90% -2SD hingga +2 SD
Gizi Kurang 70-90% -2 SD hingga -3 SD
Gizi buruk < 70% < - 3SD
Indikator Pertumbuhan
Z-score TB/PB menurut
usia
BB menurut
usia
BB/PB atau BB/TB BMI menurut usia
>3
>2
>1
0 (median)
Di bawah
-1
Di bawah
-2
Di bawah
-3






Pendek
(stunted)
Sangat pendek
(severely
stunted)






BB kurang
(underweight)
BB sangat
kurang
(severely
underweight)
Sangat gemuk
(obese)
Gemuk
(overweight)
Kemungkinan
risiko overweight


Kurus (wasted)
Sangat Kurus
(severely wasted)
Sangat gemuk
(obese)
Gemuk
(overweight)
Kemungkinan
risiko overweight


Kurus (wasted)
Sangat Kurus
(severely wasted)
Interpretasi Indikator Pertumbuhan WHO
Child Growth Standards

2014 03 01
2013 02 01
1 01 usia kronologis
01
Usia 1 th / 12 bln