1. MEASUREMENT OF GROWTH ANTHROPOMETRY

2. GROWTH An increase in size of all tissues in the body.
Growth is affected by :
Genetic
Hormonal
Nutritional status
Environmental factors

3. GROWTH Parameters : Anthropometric measurements
1. weight, height, head circumference
2. 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

5. GROWTH
In 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

6. GROWTH
Three 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)

7. WEIGHING INFANT

8. INTRODUCTION Greet the mother & introduce yourself
Explain the procedure to the mother
Identify infant’s data :
name, address, sex, date of birth
birth weight, birth length

9. WEIGHING INFANT
Infant is weighed nude or in a clean diaper on calibrated 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

10. WEIGHING INFANT Reposition and repeat weighing the infant (3 x)
Compare weights
Weight shoud agree within 0,1 kg or ¼ lb
If infant is too active, postpone the measure
Have parent stand on scale, tare, then read infant weight

11. MEASURING INFANT LENGTH

12. MEASURING INFANT LENGTH
Length 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

13. MEASURING INFANT LENGTH
His 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

14. MEASURING INFANT LENGTH
While 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

15. MEASURING INFANT LENGTH
Frankfort 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

16. MEASURING INFANT LENGTH
Measure length to 0.1 cm
Record measurement on chart
Reposition & remeasure
Measurements should agree to 1 cm

17. HEAD CIRCUMFERENCE

18. HEAD CIRCUMFERENCE
Head 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

19. HEAD CIRCUMFERENCE Read the measurement to the nearest 0.1 cm
Write measurement on the chart
Reposition tape & remeasure
Measures should agree within 0.2 cm

20. WEIGHING CHILDREN & ADOLESCENTS

21. 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& repeat
Measures should agree within 0.1 kg

22. MEASUREMENT OF HEIGHT

23. MEASUREMENT OF HEIGHT
Use 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

24. MEASUREMENT OF HEIGHT
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
Measurer’s eye are parallel with the headpiece
Read to nearest 0.1 cm
Reposition & remeasure
Agree within 1 cm
Record on the growth chart
WDY

25. SITTING HEIGHT

27. SITTING HEIGHT
Use a calibrated vertical stadiometer with right angle headpiece
Ask the child to sit on a stool
The 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

28. SITTING HEIGHT Upper body segment : height on scale- stool height
Lower body segment :
standing height-upper body
segment
Calculate the upper to lower segment ratio
Record the ratio on the appropriate curve

29. UPPER TO LOWER SEGMENT RATIO
Indications
Growth Assessment
Differentiates 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 floor
Upper segment: Top of head to top of pubic symphysis
Calculation: TotalHeight - LowerSegmentHeight
Interpretation: Normal upper to lower ratio
Birth  upper to lower ratio: 1.70 (Greatest ratio)
Postpuberty  upper to lower ratio:

30. Familial short stature Constitutional growth delay
Perawakan pendek
Idiopatik
Patologis
Variasi normal
Familial short stature
Constitutional growth delay
Proporsional
Disproporsional
Prenatal
IUGR
Faktor ibu
Penyakit plasenta
Infeksi
Teratogen
Sindrom dismorfik
Kelainan kromosom
Postnatal
Malnutrisi
Penyakit Kronis
GIT, CP, ginjal, hematologi
Infeksi
Obat obatan
Kelainan psikososial
Kelainan endokrin
Displasia skeletal
Riketsia

31. ACHONDROPLASIA

32. 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
Draw the range in the growth chart

33. CALCULATION OF MIDPARENTAL HEIGHT

34. PLOTTING MEASUREMENTS
Select the appropriate chart for the age, sex & measurements
Calculate the child’s age
Plot the weight measurement on the growth chart appropriate for age & sex
Use a plotting aid such as a straightedge
Use the information in the clinical assessment process
Share the information with the family

35. Grafik pertumbuhan : perempuan 0-36 bulan
PB/U dan BB/U

36. Grafik pertumbuhan : laki-laki 0-36 bulan
PB/U dan BB/U

37. WDY

38. WDY

39. WDY

40. الحمد لله رب العالمين
WDY

46. STADIOMETER