Class 4-Pediatric Anthropometry

ANTHROPOMETRY

• Presented by: Dr. Tariq Jagnarine

  • Qualifications: BSc. MD, MMED, Family Medicine, CCFP, MSc. Endocrinology/Diabetes, MSc. IPH/P

INTRODUCTION

• Origin of the term: "Anthropos" meaning "man" and "Metron" meaning "measurement"

• Definition: A branch of anthropology focused on the quantitative measurement of the human body.

• Nutritional Anthropometry:

  • Defined as the measurement of variations of physical dimensions and gross composition of the human body at different age levels and nutritional degrees (Jellife, 1966).

SIGNIFICANCE OF ANTHROPOMETRY

• Primary measures of nutritional status in children:

  • Helps distinguish between stunting and wasting.

  • Identifies Protein-Energy Malnutrition (PEM) and obesity.

  • Monitors changes post-nutrition intervention.

  • In clinical settings, identifies undernutrition (CED) or overnutrition.

  • Essential for public health screening.

ANTHROPOMETRIC MEASUREMENTS (NEWBORN & YOUNG CHILDREN)

• Key Measurements:

  • Weight

  • Recumbent length

  • Head Circumference

  • Chest Circumference

  • Mid Upper Arm Circumference (MUAC)

ANTHROPOMETRIC MEASUREMENTS (ADULTS)

• Key Measurements:

  • Weight (in Kg)

  • Height (in cm)

  • Mid Upper Arm Circumference (MUAC in cm)

  • Waist Circumference (in cm)

  • Hip Circumference (in cm)

  • Fat fold thickness (in mm)

WEIGHT MEASUREMENT

• Recording Options:

  • Beam type weighing balance

  • Electronic scales for infants and children

  • Mechanical scales (bathroom type - unreliable)

  • Salter spring machine (for field conditions)

INDICATION

• Weight as an indicator of nutritional status:

  • Weight deficit indicates short-term undernutrition that can be reversed.

  • Best identification of PEM indicated by weight deficiency across all groups.

MEASURING WEIGHT USING BEAM BALANCE SCALE

• Procedure:

  • Participants must remove heavy garments and shoes.

  • If subjects don’t comply, note any retained items.

  • Stand in the center of the platform with even weight distribution.

  • Adjust weights until the beam balances, then record weight to nearest 0.1 or 0.2 kg.

GROWTH VELOCITY

• Weight Gain by Age:

  • Birth to 3 months: 30g/day

  • 3 to 6 months: 20g/day

  • 6 to 9 months: 15g/day

  • 9 to 12 months: 12g/day

  • 1 to 3 years: 3kg/year

  • 4 to 12 years: 2kg/year

  • Over 12 years: 5-6 kg/year (0.5kg/month)

EXPECTED WEIGHT AT VARIOUS AGES

• Weight multipliers by age:

  • At birth: X 5 months

  • 1 year: X 2

  • 2 years: X 4

  • 3 years: X 5

  • 7 years: X 7

  • 10 years: X 10

LENGTH OR HEIGHT MEASUREMENT TECHNIQUE

• Length Measurement in children under 2:

  • Use infantometer.

• For children over 2 years:

  • Use stadiometer affixed to the wall (accuracy of 0.1%).

  • Note: Height is less than length in standing position due to ligament opposition.

TECHNIQUE OF LENGTH MEASUREMENT

• Infant is placed supine on the infantometer with conditions:

  • Vertex touching the fixed vertically aligned plank.

  • Legs are extended, feet vertical at 90°.

  • Movable pedal plank pressed against soles for measurement.

HEIGHT MEASUREMENT TECHNIQUE

• For children:

  • Stand straight and bare feet on flat ground.

  • Align against a wall with buttocks, shoulders, and head touching the wall.

  • Maintain head at the Frankfurt plane and use a spatula/ruler to determine height.

HEIGHT VELOCITY

• Growth statistics by age:

  • At birth: 50 cm

  • Gain during 1st year: 25 cm

  • Gain during 2nd year: 12 cm

  • Gain during 2-5 years: <5 cm

  • Gain during 5-10 years: <4 cm

  • Adolescence: 8 cm/year for girls (12-16 years), 10 cm/year for boys (14-18 years)

WEIGHT-FOR-HEIGHT

• Calculation:

  • Weight-for-height = (Weight of patient in kg) x 100 / (Weight of normal child of the same height)

• Nutritional status classification:

  • 90%: Normal

  • 85-90%: Borderline Malnutrition

  • 75-80%: Moderate Malnutrition

  • <75%: Severe Malnutrition

CLASSIFICATION OF MALNUTRITION

• Chronic Malnutrition:

  • Stunting indicated by low/normal weight-for-age, low height-for-age, normal weight-for-height.

• Acute Malnutrition:

  • Wasting indicated by low weight-for-age, normal height-for-age, low weight-for-height.

GROWTH CHARTS

• Alternative name: "Road to Health" chart displays child physical growth and development.

• WHO charts used internationally with different curves for boys and girls.

HEAD CIRCUMFERENCE

• Important for brain growth: 70% during fetal life, 15% during infancy, and 10% during preschool years.

• Typically recorded until 5 years of age.

• Measurement technique: Place tape over occipital protuberance and glabella.

EXPECTED HEAD CIRCUMFERENCE IN CHILDREN

• At birth: 34-35 cm

• 2 months: 38 cm

• 3 months: 40 cm

• 4 months: 41 cm

• 6 months: 42-43 cm

• 1 year: 45-46 cm

• 2 years: 47-48 cm

• 5 years: 50-51 cm

HEAD CIRCUMFERENCE GROWTH VELOCITY

• Increase by 12 cm during the first year.

• 5 cm gain from 1 to 5 years.

• Formula used for estimating in first year: (length in cm + 9.5) ± 2.59

• Growth rates:

  • Till 3 months: 2 cm/month

  • 3 months - 1 year: 2 cm/3 months

  • 1 - 3 years: 1 cm/6 months

  • 3 - 5 years: 1 cm/year

MACROCEPHALY & MICROCEPHALY

• Macrocephaly: OFC >2SD above mean.

• Microcephaly: OFC >3SD below mean for age, sex, height, and weight.

CHEST CIRCUMFERENCE

• Measurement taken at nipple level, preferably in mid-inspiration.

• Children's measurement:

  • <= 5 years: lying down

  • 5 years: standing up

HEAD AND CHEST CIRCUMFERENCE RELATIONSHIP

• At birth: head circumference is greater than chest circumference by up to 3 cm.

• At around 9 months to 1 year: they become equal, thereafter chest circumference grows more rapidly.

MID-UPPER ARM CIRCUMFERENCE (MUAC)

• Typical measurement: 9-11 cm at birth; remains 15-17 cm during 1-5 years.

• Measured on the left arm at midpoint between acromion and olecranon, with arm bent at 90°.

• Cutoff values for malnutrition:

  • <12.5 cm: severe malnutrition

  • 12.5 - 13.5 cm: moderate malnutrition

BODY MASS INDEX (BMI)

• 85th percentile: suggestive of overweight.

• 95th percentile or associated with high skinfold thickness: diagnostic of obesity.

CLASSIFICATION OF BMI IN CHILDREN

SKINFOLD THICKNESS

• Measurement techniques:

  • Measured using Herpenden’s caliper.

  • Sites: Triceps or subscapular region.

• Fat thickness indicators:

  • 10 mm: healthy children (1-6 years)

  • <6 mm: suggestive of moderate to severe malnutrition.

THANK YOU!

• Quote: "Take care of your body. It's the only place you have to live."

• Jim Rohn