Measuring Weight, MUAC

Length and Height

Objectives
After completing this session participants will be able to :
• Use the available weighing and measuring equipment
• Weigh a child
• Measure length
• Measure weight
• Compute age in months using calendar method and formula
• Identify malnourished children
Age in months Computation
Determine Age and Sex

• Record age and sex

• Girls and boys grow and
develop differently
• Record Age in months
Determine Age in Months
• Date of examination minus date of birth in the following
arrangement: year/month/day
2021 03 14 date of examination
2018 11 21 date of birth

• Borrow 12 months from 2021

• Convert 2 years to 24 months
Therefore: Age in months = 25 months
Date of Examination: January 14, 2021
Date of birth: November 21, 2018

2020 00 +12 14+30=44

2021 01 14 2018 11
21
02 years 01 month 23 days

Age in months: 25 months and 23 days

Date of Examination: January 31, 2021
Date of birth: December 01, 2019

2020 01 +12

2021 01 31 2019 12
01
01 year 01 month 30 days

Age in months: 14 months old

CALENDAR METHOD
 CALENDAR METHOD

February 2021
No. Month 2021 2020 2019 2018 2017 2016
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
 CALENDAR METHOD

February 2021
No. Month 2021 2020 2019 2018 2017 2016
1. January 1 13 25 37 49
2. February 0 12 24 36 48
3. March 11 23 35 47 59
4. April 10 22 34 46 58
5. May 9 21 33 45 57
6. June 8 20 32 44 56
7. July 7 19 31 43 55
8. August 6 18 30 42 54
9. September 5 17 29 41 53
10. October 4 16 28 40 52
11. November 3 15 27 39 51
12. December 2 14 26 38 50
Finding Age in Months using Calendar
Method
1.) Angela R. Ramirez 3.) Philip S. Layno
Brgy. San Antonio Brgy. Awasian
Bday: May 28, 2018 Bday: August 18, 2020
Age in months: 33 months old Age in months: 5 months old

2.) John A. Cruz

Brgy. Bongtud
Bday: October 26, 2017
Age in Months: 40 months old
Anthropometry
• The study and technique • Basic information and
of taking measurements body measurements
needed to assess an
of the human body individual’s
• Method to assess growth anthropometric status
based on measures of include:
 Age
physical characteristics of
 Sex
the body (e.g. weight,
 Weight
height, etc.)
 Height/Length
• Cannot detect  Mid-Upper Arm
micronutrient Circumference
malnutrition
Recommended Measuring Equipment

For Weight: Salter Scale

Beam Balance Scale/
Platform Scale

For Length: Infantometer

For Height: Microtoise

Steel Tape and
Triangular Rulers
For Weight
Salter Scale:
- a spring type weighing scale for
use in the growth monitoring of
young children; compact, small,
easier to read, carry and
transport; more durable and has
lasting spring that could insure
accuracy

Beam Balance/Platform Scale:

- beam-type weighing scale used
for older children; more accurate
and durable but heavier and less
easier to transport
For Length
Infantometer:
- a wooden length board used to take recumbent or lying down
length of infants and PS below 2 y.o.

For Height
Microtoise:
- used to take standing height
of children 2 y.o. and above

Steel tape and Triangular rulers:

- used when microtoise is not available
Weight
• a key anthropometric
measurement

• assesses body mass

• a sensitive indicator of
current nutritional status

• uses reference values for

age or height or both of
the population
Tools used in taking weight
 Beam balance – most accurate

 Spring/ Bathroom – less accurate since

spring loosen up with frequent use

 Espada/ Butcher’s Steelyard –accurate if

child does not move too much

 Salter – commonly used in 0-59 months old

children
2. Using Beam Balance/Platform Scale:

• Place the platform scale firmly

on a level or flat surface.
• Check accuracy of the scale by
bringing the sliding lever to zero
and make sure that pointer is
exactly at the middle.
• The use of standard weight every
10 children weighed is
recommended to ensure
accuracy of the scale while
being used.
Measuring Weight
• Measure at eye level
• Measure to the nearest 0.1
• A hanging scale, a plastic basin, malong or others
may be used as long as it is secured by at least 4
ropes
• The carrier should be close to the ground
• Best if the child would not have clothes on for
weighing, ensure s/he will not be cold
• Always record immediately
Measuring Weight
Standardize scales daily or whenever they are moved:
• Set the scale to zero
• Weigh three objects of known weight (e.g. 5, 10, and 15 kg) and
record the measured weights
• Repeat the weighing of these objects and record the weights again
• Check the scales or replace them when there is a difference of
0.01 kg or more between duplicate weighing

NOTE: A measured weight differs by 0.01 kg or more from the known standard
Exercise!

Demo-Return Demo
Exercise:

Is this Correct
or Incorrect?
Incorrect.
• Scale not at eye level.
• Child is dressed.
Length/Height

• assesses linear dimension

composed of legs, pelvis,
spine and the skull

• an indicator of past
nutritional status either stunted, normal or severely
stunted
Length:

- measurement in a recumbent
or lying down position often
used for children below two
(2) years old who cannot stand

Standing Height:

- stature and is measured for

children two (2) years old and
above
 How to measure Recumbent Length

Non-stretchable
tape measure

Sliding footboard

Vertical lying
board

Fixed headboard
Parts of the Infantometer
 Measuring Length/Height
Measure length Measure height
• Less than 87 cm (or less than 3 feet) • 87 cm or taller
• Less than 2 years • 2 years and older
• Or those too weak to stand • Capable of standing up

NOTE:
For children >2 y/o or
≥87cm who are unable to
stand, the LENGTH is
measured and 0.7cm is
deducted from the
measurement.
 Measuring Length
• Requires a partner
• Use a length board with:
 a fixed head board and
 a movable foot plate
• Place on a level floor
• Remove the child’s socks and shoes
• Remove lower garments/diapers
• Remove any worn hair ornaments
How is this position?

29
Incorrect! Incorrect Hand Position.
Hands Pressing against Ears.
Thumbs Pressing on Shoulders.

30
How is this position?

31
Incorrect!
Incorrect Child Head Position.
Chin against Chest.

32
Feet flat, heels against board

33
How is this position?

34
Correct

35
How is this position?

36
Incorrect

37
Exercise!

Demo-Return Demo
 Measuring Height

• Requires a partner to help position

child
• Child MUST look straight ahead with
his/her head parallel to the baseboard
• Legs are straight
• Feet firmly planted on the foot plate
• Read length/height to the nearest 0.1
cm
 Measuring Height
• Requires a partner
• Use a height board with
 a vertical backboard,
 a fixed base board, and
 a movable head board
• Place on a level floor
• Remove the child’s socks and shoes
for accurate measurement
• Remove any worn hair ornaments
Exercise!

94.2 cm
What is the
height?
Determining the Appropriate
Height/Length

Round off the height/ length to the nearest 0.5cm mark.

1) 73.2 cm --------------- 73 cm
2) 95.5 cm ---------------- 95.5 cm
3) 77.7 cm ---------------- 77.5 cm
4) 89.8 cm ---------------- 90 cm
5) 90.4 cm ---------------- 90.5 cm
Is this position correct or incorrect?

44
Incorrect

45
Is this position correct or incorrect?

46
Incorrect

47
Correct or Incorrect?
Incorrect
• No partner.
• Child's neck is not
straight. Head not
facing forward
• Feet are not flat on
the foot plate.
Exercise!

Demo-Return Demo
Determining the Z-score

What is the Z-score?

• It is a way to compare a child’s weight-for-
length (WFL) or weight-for- height (WFH)
to an “average”

• Use the WHO Child Growth Standards

Table
 0-23 months (boys and girls)
 24-60 months (boys and girls)
Remember!
Normal MAM SAM

WFH Z = Weight for Height Z-score

Steps in determining the Z-score
Do this after measuring weight and height/length
1. Take note of child’s sex
2. Determine the child’s age (in months preferably)
3. Use the correct WHO Child Growth Standards Table
4. Round off measured length or height for child's sex and age
in month to the nearest 0.5 cm
 Steps in determining the Z-score
Do this after measuring weight and height/length:
Locate the length/height on the correct WHO Growth Standard Table

Example: a 25 month old boy with length 66.0 cm and weight 6.3 kg. Use the CGS form for BOYS ages 24-60
month:

NOTE: see if it is under category

“Severely Wasted”, “Wasted”,
“Normal”, “Overweight” or
“Obese”
 Steps in determining the Z-score
Do this after measuring weight and height/length:

Example: a 25 month old boy with length 66.0 cm and weight 6.3 kg.

 Note the Z-score

 Record
 25 month old boy
 L 66.0 cm
 W 6.3 kg
 WFH Z between -3 and <-2 SD

A> MAM
Exercise!
A 32 month old girl’s height is 95.3 cm and her weight is 10.0 kg.
What is her WFH Z-score?
Do the steps:
1. Secure correct WHO Child Growth
Standards Table for age and sex.
2. Round off height to nearest 0.5 cm.
3. Round off 95.3 cm to 95.5 cm.
4. Locate 95.5 on Table.
5. Locate 10 kg along line i.e. < 10.7 kg
6. Classify nutritional status “severely
wasted” and record.
7. Record Z-score “< -3SD”
8. A> SAM
Measuring the MUAC
Remember!

Normal MAM SAM

WFH Z = Weight for Height Z-score

Measuring the Mid Upper Arm Circumference
(MUAC)
• Measured in children older than 6 to 60 months of age
• A simple measure of muscle wasting
• An independent measure of SAM
• Strongly predicts risk of dying from SAM
Measure the MUAC

Palpate the tip of

Always measure the the shoulder
left upper arm’s
midpoint between
shoulder and elbow
Landmarks – always measure from behind using the
left arm
1. Palpate the tip of the shoulder
2. Palpate the tip of the bent elbow
3. Measure the distance between these two
landmarks.
4. Divide this measurement by 2.
5. This is the midpoint of the upper arm.
6. Assistant marks the spot.
Example:
Measured distance is 15 cm.
15 cm ÷ 2 = 7.5 cm
Mark this point.
Measure the MUAC at this level.
Testing for Edema
Edema – a large amount of fluid gathers so that the tissues look
swollen or puffed up

Bilateral edema is the sign of kwashiorkor, a severe form of acute

malnutrition.

These children are at high risk of dying and need to be treated in a

therapeutic feeding program urgently.
Testing for Edema
To Both Feet:
• Apply normal thumb pressure
for at least three seconds
• If a shallow print persists on
both feet, record as (+) edema

Edema on both feet (i.e. bilateral) is nutritional edema.

What is wrong here?

64
Exercise!

Demo-Return Demo
Classification of Acute Malnutrition for children over
6 to 59 months based on WFH / WFL, MUAC, Edema
 Classification of Acute Malnutrition for
Infants less than 6 months based on WFH / WFL and Edema
You can now identify SAM.
Next, identify the SAM child for OTC or ITC.
 The Appetite Test
• A critical part of the assessment of the
child
• Helps distinguish whether the child
needs a referral to Out patient
Therapeutic Care (OTC) or In patient
Therapeutic Care (ITC)
• Loss of appetite is the best sign of
severe metabolic malnutrition
• Appetite is tested using Ready to Use
Therapeutic Food (RUTF)
Testing appetite
1. Explain to the caregiver on why the
test will be done.
2. Instruct caregiver to wash hands
properly.
3. Sit caregiver and child in a quiet space.
YOU will observe the entire process.
4. Have the caregiver offer a small
amount of RUTF on his/her finger or
directly to the child from the sachet.
Testing appetite
5. Offer water or breastfeed
after the child takes RUTF.
6. If the child is not taking it,
gently encourage intake. Do
not force feed.
7. Record amount that child has
eaten.
Testing appetite
Pass Fail
The child takes 3 - 4 mouthfuls or The child takes less than 3 - 4
more of RUTF mouthfuls of RUTF. S/he is
considered to lack sufficient
appetite for OTC and should be
referred to the ITC.
Referral Form to ITC or OTC
 Exercise!

• 48 months old boy

• WFH Z is < -2 SD to – 3 SD
• MUAC 13.5 cm
• Grade 3 edema
• What is your assessment? SAM

• Next Step? Perform appetite test.

Admit to ITC.
 Summary
• Identification of SAM is an important skill for all who work in health and
nutrition, from the barangay to the hospital level.
• The classification of malnutrition to moderate or severe is dependent on
anthropometric measurements and testing for edema.
• It is important to accurately measure weight and height, determine the
appropriate Z-score, alternatively to measure the MUAC.
• Testing appetite is critical in deciding whether a child needs OTC or ITC
treatment.
• Correct identification of SAM can save that child’s life.