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
WDY
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
WDY
WDY
WDY
WDY