ANTHROPOMETRY

Age dependent factors:-

Weight
Height
Head circumference
Chest circumference
Age independent factors
Bangle test
Shakirs tape
Quac stick
BMI
MID UPPER ARM CIRCUMFRENCE

*
The measurement of weight is most reliable criteria of assessment
of health and nutritional status of children
The weight can be recorded using a :

Electronic weighing scales for infants and children

spring balance (unreliable)

* *
•Growth Velocity :
•FIRST FEW DAYS-LOSES WEIGHT
•BY 10 DAYS REGAIN THEIR BIRTH WT

• 0-3 months (30g/day)

• 3-12 months - 400 mg/month
• 3-6 months (20g/day)
• 6-9 months (15g/day)
• 9-12 months (12g/day)
• b/w 3 and 7 years (2kg/yr)

Average birth weight- 3kg

Doubles -5 months
Triples- 1 year
4 times- 2 year
5 times - 3 year

*
Infant
Expected weight(kg) = age (months) + 9 / 2
1- 6 years
Expected weight(kg) = age (years) x 2 + 8
7 – 12 years
Expected weight(kg) = age (years) x 7 - 5 / 2

*
 IAP CLASSIFICATION
FOR Malnutrition
Grade of PEM W/A

Normal >80%

Grade 1 pem 71-80

Grade 2 pem 61-70

Grade 3 pem 51-60

Grade 4 pem <50

WELLCOME TRUST Classification for
Malnutrition

W Odema present or not Pem

>80% Nil Normal

60-80 Nil UNDERNUTRITION

60-80 Present Kwashiorkor

<60 Present Marasmic kwashiorkor

<60 Nil Marasmus

Upto 2 years of age Recumbent Length is measured with the help
of an Infantometer .

In older children Standing Height or Stature is recorded. It is

convenient to use an Inbuilt Stadiometer affixed on the wall.

Nutritional deprivation over a period of time affects the stature or

linear growth of the child .

*
The infant is placed supine on the infantometer.

Assistant or mother is asked to keep the vertex or

top of the head snugly touching the fixed vertical
plank.

The legs are fully extended by pressing over the

knee, and feet are kept vertical at 90⁰ , the
movable pedal plank of infantometer is snuggly
apposed against soles and length is read from
scale.

*
Height Velocity

Birth 50CM

1 – 3 months 3.5cm/month

4 – 6 months 2cm/month

7 – 12 months 1.5cm/month

13 – 24months 1 cm/month

4 – 12 year 6cm/year

*
At birth – 50 cm
At 1 year- 75cm
At 2 year-90cm
At 4 year-100cm

Expected height >2yrs =6x age in years +77 ( weech’s formula )

*
Waterlow Classification for Stunting

H/A Grade of stunting

>95% No stunting

90-95 1

85-89 2

<85 3
Waterlow Classification for wasting

W/H Grade of wasting

>110 Overweight

91-110 Normal

81-90 1

70-80 2

<70 3
• The head circumference is measured by placing the tape
over the occipital protuberance at the back and just over
the supraorbital ridge in front.

*
Age Head circumference
growth (cm/month)
At birth 34cm

0-3 months 2cm/month

3-6 months 1cm/month

6-12months 0.5/month

*
Adult head size is achieved between 5 to 6
years .
Dyne’s formula is used for estimating the head
circumference in the first year of life
length in cm+9.5 +/_ 2.5
2

* *
It is usually measured at the level of nipples, preferably in
mid inspiration.

In children
<= 5years - lying down position
> 5 years - standing position

*
At birth: head circumference > chest circumference by upto 3
cms.

At around 9 months to 1 year of age: head circumference =

chest circumference,

but thereafter chest grows more rapidly compared to the brain.

*
During 1-5 Yrs of age it remains reasonably static between 15-17cms
among healthy children .

It is conventionally measured over the left upper arm , at a point

marked midway between acromion (shoulder) and olecranon (elbow)
with arm bent at right angle.

*
The child is asked to stand with the arm hanging loose at the
side.

If it is less than 11.5cm it is suggestive of severe malnutrition.

*
Bangle test – quick assessment of arm circumference. A fiber
glass ring of internal diameter of 4 cm is slipped up the arm, if it
passes above the elbow, it suggests that upper arm is less than 12.5
cm and child is malnourished.

Shakir tape – is a fiber-glass tape with

red – less than 12.5 cm
yellow – 12.5- 13.5 cm
green – greater than 13.5 cm
shading so that paramedical workers can assess nutritional
status without having to remember the normal limits of mid arm
circumference.

* *
Anthropometry - Amarendra B. Singh 090201263 * *
Measured with Herpenden’s caliper
Triceps or subscapular region

The skinfold with subcutaneous fat is picked up

with thumb and index finger, and caliper is applied
beyond the pinch.

Fat thickness
>10mm - healthy children 1-6 years
<6mm - is indicative of moderate to
severe degree of malnutrition

* *
Weight/height²(m)
>22-overweight
>25-obesity

* *
•The UPPER SEGMENT (vertex to upper edge of symphysis pubis)
to LOWER SEGMENT (symphysis pubis to heels) ratio at birth is
1.7 to 1.0 .
1 yr- 1.5:1
2yrs-1.2:1
7-9- 1:1

•This gradually becomes 1.0 to 1.1 in healthy adults.

* *
•It is the distance between the tips of middle fingers of
both arms outstretched at right angles to the body,

•In under-5 children , arm span is 1 to 2 cm smaller than

body length.

•During 10-12 years of age , arm span = height.

•In adults arm span is more in adults by 2 -3cm.

* *
GROWTH CHARTS
Growth Charts

.Growth charts are a visible display of child’s physical growth

and development

.Also called as the “THE ROAD TO HEALTH” chart.

.It was first designed by DAVID MORLEY and was later

modified by WHO.
 The purpose of growth assessment is to determine
whether a child is
growing normally or has a growth failure or trend towards a
growth
problem that should be addressed.
Uses of growth Charts

 Growth monitoring.
 Diagnostic tool to identify high risk children.
 Planning and policy making.
 Educational tool for educating mothers
 Tool for action regarding intervention that is needed.
 Evaluation of effectiveness of corrective measures and
impact of a program.
Assessment of growth.

 Longitudinal assessment: measuring the same child at

regular intervals.

 Cross-sectional:Involve large number of children of same

age.

 Growth Charts are primarily designed for longitudinal

follow up of a child to interpret the changes over time.
Types of growth Charts.

1. NCHS growth Charts (1977)

. National Center for Health Statistics.
Is based on the data obtained from US children
.
2. CDC growth Charts (2000)
Also based on the data obtained from US children who were
formula fed.
3. WHO growth charts(2006)

4. IAP growth charts

 WHO conducted the 'Multicentre Growth Reference Study “(MGRS)
and published new growth Charts for infants and children up to 5yr of
age in 2006.

The MGRS was a community –based , multi-country project

conducted in Brazil,Ghana,India,Norway,Oman and The United States.

Children included in the study were raised in environments that

minimized constraints to growth such as poor nutrition and infection .
 In addition their mothers followed healthy practices such
as breast feeding their children and did not smoke during
and after pregnancy.

 The WHO growth chart provide data on ‘ how child should

grow’.

 The new standards make breastfeeding the biological

norm and establishes the breastfed infants as the
normative growth model.
Scales of measurement.

 Z score
 Percentiles.

Z score /SD score

. The deviation of the value for an individual from
the median value of the reference population, divided by the
standard deviation for the reference population.
Z score= (observed value)-(median reference value)/SD
of reference population.
Percentile Charts

 Anthropometric and other measurements from a large no of

normal children when arranged in ascending order will give a bell
shaped curve.
 The curve will be symmetrical and most of the observation will be
falling around the centre of the curve.This is called as Gaussian
distribution.
 Most of the observations are towards the middle of the curve and
there will be only a few observations at the tail ends.
The rank position of an individual on a given reference distribution
stated in terms of what percentage of the group the individual
equals or exceeds.
 -SD is the degree of dispersion of the observation away from the
mean.

-2/3rd of the observation fall within one SD above or below the

mean.

-95% of the observation falls within 2SD and 99.7% fall within 3SD
.
-Values beyond 2SD are rare and beyond 3 SD are grossly abnormal.
 Growth indicators are used to assess growth:
 Length/height for age
 . Weight for age
 . Weight for height
 BMI for age
 . Head circumference.
How to plot..

 X axis.
 shows age
 . Plot points on vertical lines corresponding to
completed age .
 Y axis
 . Shows length/height,wt ,BMI or HC
 . Plot points on or b/w horizontal lines corresponding
to length/height,wt or BMI as precisely as possible
 Plotted point:- The point on a graph where the line
extended from a measurement on the x-axis intersects
with a line extended from a measurement on the y-axis.

 An upward curve is ideal

 A flat and downward curves are not desirable.
Height age and weight age.

 The appropriate anthropomeric measure is plotted on the

correct growth chart.
 A line is drawn from the plotted point to 50th percentile
and then Vertically downwards from 50th percentile to
touch x –axis which is the corresponding HA and WA .
 CA=HA=WA- NORMAL.
 Z score. Rounded percentile
 0 50
 . -1 15
 -2 3
. -3. 1
 1. 85
 2. 97
 3. 99
 Percentile Z score

W/H. Wasting <3rd <-2

H/A. Stunting <3rd <-2

W/H. Underweight <3rd <-2

 India has adopted the new WHO growth standards in Feb.2009.
 A joint “mother and child protection card” has been developed which
has space for recording:
- Family identification and registration.
-birth record
-pregnancy record
-institutional identification
-care during pregnancy
-preparation for delivery
-details about immunisation
 -brest feeding and introduction of supplementary food.
 -mile stones of the baby .
WHO GROWTH CHARTS
Target Height
 Target height is marked with a horizontal arrow at 18yrs

 Target height in boys= father’s height+mother’s

height+13/2

 Target height in girls=father’s height+mother’s height-13/2

 Target range is marked as. 6cm above or below the target

height

 If the target height and the child’s height both <3rd

percentile-consider familial short stature.
IAP GROWTH CHARTS
 Body mass index
 . Wt(kg)/ht2(m)
 BMI at or above the 95th centile for age or more than
30kg/m2 is obesity
 BMI for age:-
 Overweight:>+1 SD (equivalent to BMI 25kg/m2 at
19yrs)
 Obesity:>+2 SD (equivalent to BMI 30kg/m2 at
19ys)
 Thinness:<-2 SD
 . Severe thinness:<-3SD
CLASSIFICATIONS.
 IAP classification of malnutrition
Grade of PEM W/A

Normal >80%

Grade 1 pem 71-80

Grade 2 pem 61-70

Grade 3 pem 51-60

Grade 4 pem <50

Wellcome trust classification of
malnutrition
W Odema present or not Pem

>80% Nil Normal

60-80 Nil UNDERNUTRITION

60-80 Present Kwashiorkor

<60 Present Marasmic kwashiorkor

<60 Nil Marasmus

Waterlow classification of stunting

H/A Grade of stunting

>95% No stunting

90-95 1

85-89 2

<85 3
Waterlow classification of wasting

W/H Grade of wasting

>110 Overweight

91-110 Normal

81-90 1

70-80 2

<70 3
Thank you