Growth assesment in children

Methods and tools used to assess growth in children.
Basic ppt for undergraduate students

1. Normal Growth and Anthropometrical Assessment in children DR. DEEPAK KUMAR ASSOCIATE PROFESSOR (PAEDS)

2. GROWTH It is unique for children Denotes a net increase in size or mass of tissues Begins at conception Terms ‘growth & development’ used together, but are different They progress together They can depart under abnormal situations

3. GROWTH MEANS INCREASE IN SIZE DUE TO.. Increased number of cells Increase in their size Increase in intercellular substances

4. Development Maturation of functions, related to maturation and myelination of nervous system and indicates acquisition of skills for optimal functioning of individual

5. LAWS OF GROWTH It is a continuous process Growth rates may be steady, accelerating or decelerating 2 phases of high growth velocity Early postnatal period Puberty

6. GROWTH VELOCITY CURVE

7. LAWS OF GROWTH Order of growth in humans is always Cephalocaudal Distal to proximal

8. Steps required to assess growth Outline the parameters Identify and select the tools Compare the parameter with standard Check whether the growth is- Normal/Borderline/Abnormal Check whether intervention required or not

9. ASSESSMENT OF GROWTH DONE BY: Anthropometry Includes – weight, height, head circumference, chest circumference, mid-arm circumference etc. Skin fold thickness – measuring subcutaneous fat Radiography - appearance and fusion of various epiphyseal centres Dental age

10. ANTHROPOMETRIC ASSESSMENT Anthropometry is a simple valuable tool & the gold standard for evaluating the nutritional status of the child

11. PARAMETERS Weight Length/Height Sitting height Arm Span Head circumference Growth velocity Mid arm circumference Body ratio Body mass index

12. WEIGHT Recorded with – beam type weighing scale Minimum unit- 100g Always correct for ZERO ERROR DETECTO SCALE SALTER SCALE

13. Basket or pan type (infants upto 10kg) Digital type weighing scale

14. Method Check environmental conditions Bare minimum clothings Ensure machine is on firm, even surface Check zero Infants- place on the centre of the machine, subtract diaper weight Child- tell them to stand in centre, ensure they are not holding anything On follow-up, try to use same scale.

15. Normal weight gain pattern At birth 10% loss is expected, regained after 10 days. Thereafter 20-30 gm gain per day 2X at 5 months, 3X at 1 years and 4X at 2 years 3-12 m - (age in m + 9) / 2 1-6 years - 2 x (age in yrs) + 8 7-12 years - (7x age in years – 5) / 2

16. Stature Length (< 2 years) Height Length – Infantometer Height - Stadiometer

17. Infantometer ( Herpenden’s )

18. Method Remove caps, Braids, Ornaments Remove diapers Call assistant Tell assistant to be at head end Place the child supine gently over the board Tell assistant to hold the head (Frankfort plane) Hold the legs with one hand and move the foot piece with other Apply gentle pressure on knees to straighten legs Ensure soles to rest rest flat over foot end

19. Stadiometer

20. Method Remove the hair ornaments, caps ... Stand bare feet, 60 degree apart Back of head, Shoulder blades, Buttocks, Calves, Heels – touching the wall/board Arms hang freely, looking straight Stand face to face, move down the board over head and measure

21. Pattern Newborn- 50 cm 75 cm – 1 years, 90 cm – 2 years Thereafter, 4-5cm per year 2-12 years Expected ht- (age in years x 6) + 77

22. HEAD CIRCUMFERENCE Bony land marks – superior orbital ridge (ant), external occipital protuberance (post) Normal HC at birth- 34cm 2 cm / month in 1 st 3 months 1 cm / month in next 3 months 0.5 cm / month in 6 months

23. Pre-cautions

24. CHEST CIRCUMFERENCE For measuring CC Place the tape at the level of nipple in a plane at right angle to the spine. Record the measurement at mid-respiration. At birth HC>CC (by 2-2.5cm). By 6-12 mo HC=CC After 1 st yr CC > HC

25. MID ARM CIRCUMFERENCE Measured at the mid point between acromian process and olecranon process Age independent criteria 1 – 5 years : Arm Circumference fairly constant >13.5 cm - Normal 12.5 – 13.5 cm : moderate malnutrition <12.5 cm : severe malnutrition

26. MAC - Shakir’s Tape It is a plastic tape with colored zone – green, yellow & red Red indicates severe malnutrition <12.5cm Yellow indicates moderate malnutrition (12.5-13.5cm) Green indicates normal >13.5cm

27. SKIN FOLD THICKNESS Measured with Herpenden’s caliper Gives an indication of subcutaneous fat and indirectly the caloric reserve in the body Triceps skin fold thickness Sub scapular skin fold thickness Biceps skin fold thickness

28. BODY MASS INDEX To assess the nutritional status of children above 5yrs of age <5 th percentile-underweight >85 th percentile-overweight >95 th percentile-obesity BMI = weight (kg) / height ² (m²) x 100

29. All Measurements taken, are they normal or abnormal ?

30. INTERPRETATION OF ANTHROPOMETRIC PARAMETERS GROWTH CHARTS INDICES PERCENTILES PERCENT OF MEDIAN SD SCORE

31. GAUSSIAN CURVE

32. Growth tables- arranged in months (0-12 months) arranged in years (1-18 years) Increasing percentiles – 3 rd to 97 th Growth charts- WHO growth charts ( 3, 15, 50, 85, 97)

33. Measurement is less than 3 rd percentile or more than 97 th – evaluate/ referal Below 15 th and above 85 th to be monitored Head circumference < 3 rd SD – microcephaly > 2 SD - Macrocephaly

34. Evaluation of Dental growth Sexual Maturity (SMR) Genitalia, Pubic and axillary hairs, Breast size and contours.

35. Thank You Images are taken from Dr Piyush Gupta’s clinical methods in pediatrics a nd freely available images on google .