The document discusses growth and measurement in humans across different life stages. It covers topics like weight and body composition providing health clues, anthropometric parameter evaluation for growth and development assessment, and obtaining standardized measurements for height, weight, frame size, and body mass index. Differences in growth patterns by organ system are examined, along with variations in infants and children, adolescents, pregnant women, and older adults. Measurement techniques are outlined for various populations.

1. .Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
Chapter 6
Growth and Measurement

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Growth and Measurement
• Weight and body composition offer much
information about an individual’s health status and
often provide a clue to the presence of disease when
they are out of balance
• Focus is on the evaluation of individual’s
anthropometric parameters and the examination for
growth, gestational age, and pubertal development
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Physical Examination Preview
• From the history, assess the patient’s size, including
the following:
• Recent growth, weight gain, or weight loss
• Chronic illnesses affecting weight gain or loss
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Physical Examination Preview
(Cont.)
• Obtain the following anthropometric measurements,
and compare them to those in standardized tables:
• Standing height
• Weight
• Frame size
• Calculate the body mass index.
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Anatomy and Physiology
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Anatomy and Physiology
• Growth is the increase in size of an organ or person.
• Growth depends on sequence of endocrine, genetic,
constitutional, environmental, and nutritional
influences.
• Through the biologic process of development and
maturation, individual organ systems acquire
function.
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Growth Differences by Organ
System
• Brain: peak fetus, early infancy
• Skeleton: peak fetus, infancy, adolescence
• Muscle: peak fetus, adolescence
• Adipose: peak infancy, adolescence
• Lymphoid: peak age 10 to 12 years
• Neural: peak age 4 to 14 years
• Genital: peak adolescence
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Figure 6-02. Growth rates for the body as a whole and three types of tissues. Lymphoid type: thymus,
lymph nodes, and intestinal lymph masses. Neural type: brain, dura, spinal cord, optic apparatus, and head
dimensions. General type: body as a whole; external dimensions; and respiratory, digestive, renal, circulatory,
and musculoskeletal systems. Genital type: includes the reproductive organ system. (From Wong, 1999;
modified from Harris et al, 1930.)
Differences in Growth by Organ
System (Cont.)

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Infants and Children
• Fetus
• Head growth predominates
• Infant
• Trunk growth predominates
• Weight gain at rapid but decelerating rate
• Child
• Legs are fastest growing
• Weight gained at steady rate
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Figure 6-03. Changes in body proportions from 8 weeks of gestation through adulthood.

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Children and Adolescents
• Sexual maturation of girls: early (before 7 years) or
delayed (beyond 13 years); signs of breast
development and pubic hair, age at menarche
• Sexual maturation of boys: early (before 9 years) or
delayed (beyond 14 years); signs of genital
development and pubic hair
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Adolescence
• Trunk and legs elongate.
• 50% of ideal weight is gained.
• Of adults who become obese
• 30% are obese during childhood
• 70% are obese during adolescence
• Skeletal mass and organ systems double
in size.
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Pregnant Woman
• Progressive weight gain is expected.
• Fetus is 6 to 8 lb of weight gained.
• Rest of gain is from increase in maternal tissue and fluids.
• Fluid volume: 2 to 3 lb
• Blood volume: 3 to 4 lb
• Breast enlargement: 1 to 2 lb
• Uterine enlargement: 2 lb
• Amniotic fluid: 2 lb
• Maternal fat and protein stores: 4 to 6 lb
• Weight gain is slow in first trimester and rapid in second trimester and
slows in third trimester.
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Older Adult
• Stature declines in older adult, beginning at 50 years of
age.
• Thinning intervertebral discs
• Development of kyphosis with osteoporotic vertebral
compression
• An increase in overweight and obese older adults has been
documented over the past 15 to 20 years.
• A decrease in weight for height and body mass index has
been found in longitudinal studies among individuals over
age 60.
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Older Adult (Cont.)
• A loss of 5% body weight over several years often occurs.
• Accompanied by an increase in body fat as skeletal muscle
declines
• Most likely due to decreased exercise and reduced anabolic
steroid secretion
• An age-associated reduction in the size and weight of
various organs has been identified.
• Liver
• Lungs
• Kidneys
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Examination and Findings
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Weight and Standing Height
• Weight
• Height
• Frame size
• Determined to assess the appropriateness of a person’s
weight for age, height, and gender when using weight
tables
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Body Mass Index
• The most common method used to assess nutritional
status and total body fat
• For adult men and women, the following are
classifications of weight for height by BMI values
(kg/m2):
• Undernutrition―under 18.5
• Appropriate weight for height―18.5 to 24.9
• Overweight―25 to 29.9
• Obese―30 to 39.9
• Extreme obesity―40 and higher
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Infants
• Recumbent length
• Weight
• Head circumference
• Chest circumference
• Gestational age
• Size for gestational age
• Classification Weight Percentiles
• Appropriate for gestational age (AGA) 10th to 90th
• Small for gestational age (SGA) Less than 10th
• Large for gestational age (LGA) Greater than 90th
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Children
• Stature and weight
• BMI is now standardized for use in children and
adolescents, and it is calculated the same way as for adults
• Underweight ‒ BMI for age under the 5th percentile
• At risk of overweight ‒ BMI for age greater than the 85th
percentile
• Overweight ‒ BMI for age greater than the 95th percentile
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Children (Cont.)
• Upper/lower segment ratio
• A higher upper-to-lower body segment ratio than expected
may be associated with dwarfism or bone disorders
• Arm span
• Arm span that exceeds height is associated with Marfan
syndrome
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Figure 6-08. Measuring the stature of a child.

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Pregnant Women
• Weight gain
• Weight gain during pregnancy should be calculated from
the woman’s prepregnancy weight.
• To provide guidance in weight gain during pregnancy, first
determine the prepregnancy body mass index (BMI).
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Older Adults
• Measurement procedures for the older adult are the
same as those used for the general population.
• Compare the individual’s weight for height, and
triceps skinfold thickness by gender and age.
• Approximately 60% of adults over age 65 years are
overweight with a BMI greater than 25, and 20% are
obese with a BMI greater than 29.
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