GROWTHAn increase in size of all tissues in the

body.

Growth is affected by :

1.Genetic

2.Hormonal

3.Nutritional status

4.Environmental factors

GROWTHParameters : Anthropometric measurements 1. weight, height, head circumference2. proportion : - sitting height- Upper / lower segment ratio

WEIGHT is determined especially by growing of 3 tissues: skeletal muscle, adipose tissue and bone

HEIGHT is determined by growing of the bone

GROWTHIn acute protein and energy

malnutrition, protein from skeletal muscle and fat from adipose tissue will be used. Weight will decrease, but not height.

In chronic protein and energy malnutrition, bone metabolism will disturb and could cause linear growth disturbance

GROWTHThree indices are commonly used in

assessing the nutritional status of children:• Weight-for-age (W/A)• Length-for-age or Height-for-age (H/A)

• Weight-for-length or Weight-for-height (W/H)

There are 2 type of assessment:

One time assessment

Growth monitoring (trend assessment)

INTRODUCTIONGreet the mother & introduce yourselfExplain the procedure to the motherIdentify infant’s data : name, address, sex, date of birth birth weight, birth length

WEIGHING INFANTInfant is weighed nude or

in a clean diaper oncalibrated beam or electronic scale

Older infant is weighed wearing a clean, disposable diaper

Remove infant’s clothing and be sure the diaper is clean and dry 

Center the infant on the scale tray 

Weigh infant to nearest 0.01 kg or 1/2 oz

Write the weight on the infant’s chart

WEIGHING INFANTReposition and repeat

weighing the infant (3 x)

Compare weightsWeight shoud agree

within 0,1 kg or ¼ lbIf infant is too active,

postpone the measure Have parent stand on

scale, tare, then read infant weight

MEASURING INFANT LENGTHLength is measured with

a suitable measuring board

Use a calibrated length board with a fixed headpiece & movable footpiece which is perpendicular to the table surface

Measure infant without shoes & wearing light underclothing/diaper

MEASURING INFANT LENGTHHis back in the centre

of the length board→ child is lying straight & his shoulders & buttocks are flat.

The child’s eyes should be looking straight up.

Both legs should be fully extended & the toes should be pointing upward with feet flat against the footpiece

MEASURING INFANT LENGTHWhile the 2nd measurer

hold the infant’s head, the measures aligns the infant’s trunk & legs and bring the footpiece firmly against the heels.

The measurer place one hand on infant’s knees to maintain full extension of the legs

MEASURING INFANT LENGTHFrankfort horizontal

plane is parallel to the fixed headpiece

Frankfort horizontal plane is a line extending from the most inferior point of the orbital margin to the left tragion.

The tragion is the deepest point in the notch superior to the tragus of the auricle

MEASURING INFANT LENGTH

Measure length to 0.1 cm

Record measurement on chart

Reposition & remeasure

Measurements should agree to 1 cm

HEAD CIRCUMFERENCEHead circumference is

measured over the most prominent part of the occiput and just above supraorbital ridge

Use a flexible, non stretchable tape

Position the tape just above the eyebrows, above the ears & around the biggest part on the back of the head

Pull tape snugly to compress the hair

HEAD CIRCUMFERENCERead the

measurement to the nearest 0.1 cm

Write measurement on the chart

Reposition tape & remeasure

Measures should agree within 0.2 cm

WEIGHING CHILDREN & ADOLESCENTS

A child >36 months is weighted standing on a scale

Use a calibrated beam balance/electronic scale

Child must be able to stand without assisstance

Child stands on center of scale platform

Reposition& repeatMeasures should agree

within 0.1 kg

MEASUREMENT OF HEIGHTUse calibrated vertical

stadiometer with right angle headpiece

Ask the child to take off the shoes

The child stands with heels, buttocks, shoulders & head touching a flat upright surface

Stand with heel together, legs straight, arms at sides, shoulders relaxed

The head should be positioned in the Frankfurt plane

MEASUREMENT OF HEIGHTAsk the child to take a

deep breath, then let it out & relax his shoulders

Bring the perpendicular headpiece down to touch the crown of the head

Measurer’s eye are parallel with the headpiece

Read to nearest 0.1 cmReposition & remeasureAgree within 1 cmRecord on the growth

chart

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SITTING HEIGHTUse a calibrated vertical

stadiometer with right angle headpiece

Ask the child to sit on a stoolThe back of the head,

thoracic spine & buttock should rest against the wall

The head should be positioned in Frankfurt plane

Ask the child to take a deep breath, then let it out & relax his shoulders

Bring the perpendicular headpiece down to touch the crown of the head

Read to nearest 0.1 cm

SITTING HEIGHTUpper body segment : height on scale- stool

height Lower body segment : standing height-upper

body segmentCalculate the upper to

lower segment ratioRecord the ratio on the

appropriate curve

UPPER TO LOWER SEGMENT RATIOIndications

Growth AssessmentDifferentiates collagen bone disease (skeletal dysplasia) from

primary spine (e.g. Scoliosis)Technique: Measurement

See Sitting Height for an alternative method of calculating segment heights

Lower segment: Top of pubic symphysis to floorUpper segment: Top of head to top of pubic symphysis

Calculation: TotalHeight - LowerSegmentHeightInterpretation: Normal upper to lower ratio

Birth upper to lower ratio: 1.70 (Greatest ratio)Postpuberty upper to lower ratio: 0.89 - 0.95

Perawakan pendek

Patologis Variasi normalFamilial short stature

Constitutional growth delay

Idiopatik

DisproporsionalProporsional

Displasia skeletal

Riketsia

Prenatal

IUGR•Faktor ibu•Penyakit plasenta•Infeksi•TeratogenSindrom dismorfikKelainan kromosom

Postnatal

MalnutrisiPenyakit Kronis•GIT, CP, ginjal, hematologi•InfeksiObat obatanKelainan psikososialKelainan endokrin

ACHONDROPLASIA

CALCULATION OF MIDPARENTAL HEIGHT

Display father’s height and mother’s height on the growth chart

Boys : mother’s height+12.5 cm+father’s height

2

Girls : father’s height-12.5 cm+mother’s height

2Draw the range in the growth chart

PLOTTING MEASUREMENTSSelect the appropriate chart for the age, sex

& measurementsCalculate the child’s agePlot the weight measurement on the growth

chart appropriate for age & sexUse a plotting aid such as a straightedgeUse the information in the clinical

assessment processShare the information with the family

Grafik pertumbuhan : perempuan 0-36 bulanPB/U dan BB/U

Grafik pertumbuhan : laki-laki 0-36 bulanPB/U dan BB/U

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