Assessment of Growth and

Nutritional Status
(and its abnormality)
Madarina Julia & S. Yudha Patria
Department of Child Health
Faculty of Medicine
Gadjah Mada University
INTRO
• What is physical GROWTH and DEVELOPMENT ?
• Who will be growth & developed ?
• When will growth & development occur ?
• What measurement is as determinant for growth ?
• How do we meassure ?
• What standard is used?
Which is GROWTH or DEVELOPMENT ?

• Enlargement of head circumferential

• Production of antibodies following vaccination
• Differentiation of neural tissue from exodermal
• Increase length of eyeball between birth – 6 yo
• Eruption of teeth
• GROWTH:
increase in size of the body dimension, parts, or tissues toward
maturity

• DEVELOPMENT:
changes human body of attaining mature state 
- differentiation
- functions
- maturation
- adaptation
Growth & Development

• Basic science of child health

• Major determinants of child health-illness
• React & refer to adjust genetic-environment factors in human
body
• Not the same processes, but interrelated
Periods of Childhood
• Prenatal:
embryonic-, middle fetal-, late fetal-
• Infancy:
neonatal, infant, late infancy
• Childhood:
preschool year, school year
• Adolescence:
prepuberty, puberty, post-puberty
Case Studies
As a doctor, you may need to answer…

Doctor, do you think

my son is too short?
Is he growing fine?
Or…

Am I too skinny?
Too fat?
Sometimes… It is easy to answer
However,
most of the
time… it is not
• What is physical GROWTH and DEVELOPMENT ?
• Who will be growth & developed ?
• When will growth & development occur ?
• What measurement is as determinant for growth ?
• How do we meassure ?
• What standard is used?
Anthropometric measurement

• Body weight (mostly)

• Body length / height (mostly)
• Head circumference
• Mid-upper arm circumference
• BMI
• Growth velocity
• Body proportion
Other anthropometric measurements

 Skin-fold thickness
 Waist circumference
 Waist-to-hip ratio
 Sitting height
 Arm span
• Bi-acromial diameter
• Bi-iliac (bicristal) diameter, etc.
Normal distribution
Body Height (BH)/age
BH/age
Height Velocity

Simm & Wether, 2005

Normal Growth Velocity

• Prenatal : 1,2 – 1,5 cm/wk

• Infant : 23 -28 cm / yr
• Childhood : 5 – 6,5 cm/yr
• Puberty : 8,3 cm/yr (girls)
9,5 cm/yr (boys)
Rasio U / L

Rose, et al. 2005

Am I too short?
 Children grow
 Length/ height increases as a child
gets older
 A child’s length or height has to be
compared with those of children of
the same age
 Indicator: length/ height-for-age z-
score (LAZ and HAZ)
 Length <2y, height >2y
Z-scores or standard deviation scores (SD- scores):
Indicates how far a measurement is (less or more) form the
median/ average (mean), 95% of the time it is within 2SDs

Less Higher
than normal than
normal normal
Edi, 18 mo
Anna, 1 y
Dewi, 4 y 6 mo
Sita, 5 mo
Prita
Growth curve (BH/age)
Am I too skinny or fatty?
 Weight in relation to stature or length
 Indicator: weight for length/ height (WLZ
or WHZ), and
 BMI for age (BMIZ)

BMI= body mass index

Weight (kg)/ squared
height (m)
Ali
Bambang
Salsa
Salsa, 4 y 6 m
Putri
Putri, 5 mo
Bimo
Lina
Agus
Who is heavier?
Weight-for-age
 Sometimes, we can only measure weight so
we can only get indicator weight-for-age
 However, a child can be heavy because he/
she is tall (tall and skinny) or fatty (fatty and
short)
 This indicator is not ideal for assessing growth
and nutritional status, it can only be used for
screening
Interpretation of growth and nutritional status
Interpretation and causes of abnormal
growth/ nutritional status:
Length/ height for age

 z-score > +2: too tall → beware of endocrine or genetic

abnormalities: Marfan syndrome, Kline-felter
syndrome, precoccious puberty, GH secreting tumor,
etc.)
Interpretation and causes of abnormal
growth/ nutritional status:
Length/ height for age
 Z-score < -2: too short
 Stunted: chronic undernutrition/ poor-health
 Genetic or endocrine causes of short stature: hypothyroidism/
congenital hypothyroidism, achondroplasia, GH deficiency, familial
short stature, constitutional delay of growth and puberty, etc.
Interpretation and causes of abnormal
growth/ nutritional status:
Weight for length/ height or BMI for age

 Z-score < -2: wasted

 Acute undernutrition:
 Marasmus
 Marasmic-kwashiorkor
 Kwashiorkor
marasmus
 the appearance of skin and bones due to loss
of muscle and fatty tissue.
 The child’s face looks like an old man following
loss of facial subcutaneous fat, but the eyes
may be alert.
 The ribs are easily seen.
 There may be folds of skin on the buttocks and
thighs that make it look as if the child is
wearing baggy pants.
marasmus
 Kwashiorkor…
 The child’s muscles are wasted, but the wasting may
not be apparent due to generalized oedema (swelling
from excess fluid in the tissues).
 The child is withdrawn, irritable, obviously ill and will
not eat.
 The face is round (because of oedema) and
 …Kwashiorkor

 The hair is thin, sparse and sometimes discoloured.

 The skin has symmetrical discoloured patches where
the skin later cracks and peels off.
 A child with kwashiorkor will usually be underweight,
but the oedema may mask the true weight.
kwashiorkor
kwashiorkor
Marasmic-
kwashiorkor
Interpretation and causes of abnormal
growth/ nutritional status:
Weight for length/ height or BMI for age

 Z-score > +2: overweight or obese

Suggested Readings

• Valadian & Porter. Physical growth and development – from

conception to maturity

• Moshang,T. Pediatric endocrinology- requisites in

pediatrics

• WHO, Growth standard Charts