This document discusses methods for assessing growth in children. It defines growth as the increase in size of organs and body mass through physical maturation. Growth can be measured through physical anthropometry, assessment of tissue growth, bone age, and dental age. Physical anthropometry includes measurements of weight, length/height, head circumference, chest circumference, mid-upper arm circumference, and body mass index. Tissue growth is assessed through skin fold thickness measurements. Bone age examines the ossification of carpal bones in wrist X-rays. Dental age charts the eruption timeline of primary and permanent teeth. Normative growth charts and calculations are provided for evaluating growth across these various domains.

1. GROWTH
ASSESSMENT
Laxmi Dahal
Lecturer
4/28/2023 1

2. Definition of Growth
•Growth: increase in size of organs and
body.
•It is quantitative change and refers to
physical maturation of the body.
4/28/2023 2

3. Rate of growth of different tissues
4/28/2023 3

4. Growth can be measured in terms
of:
A. Physical anthropometry
B. Assessment of tissue growth
C. Bone age
D. Dental age
4/28/2023 4

5. A. Physical anthropometry
Age dependent anthropometry-
1. Weight
2. Length or Height
3. Head circumference
4. Chest circumference
4/28/2023 5

6. Age independent anthropometry
1. Mid Upper arm circumference(1-5 yrs)
2. Weight for height
3. Weight for age
4. Height for age
5. Body mass index
4/28/2023 6

7. WEIGHT
Measurement:
•Child should be naked or in minimal clothing.
•Ideal is to use sliding beam balance scale or
electronic scale.
•Weighing scale is checked for zero, center the
infant on scale tray and older children is weighed
standing.
4/28/2023 7

8. Sliding beam balance
4/28/2023 8

9. Electronic scale
4/28/2023 9

10. Detecto scale
4/28/2023 10

11. Bath room type scale
4/28/2023 11

12. Salter spring machine
4/28/2023 12

13. Calculation of expected weight
Weech’s formula:
• 3-12 months
Expected weight (kg)= Age(months)+9
2
• 1-6 yrs
Expected weight (kg)= 2y+8
• 7-12 yrs
Expected weight (kg)= 7y – 5
2
4/28/2023 13

14. Age weight
At birth 1x
5 months 2x
1 yr 3x
2 yr 4x
3 yr 5x
5 yr 6x
7 yr 7x
10 yr 10x
4/28/2023 14

15. Age Weight gain
10 days- 3 months 30 g / day
3-6 months 20 g / day
6-9 months 15 g / day
9-12 months 12 g / day
1-3 yrs 3 kg / yr
4-12 yrs 2 kg / yr
>12 yrs 5-6 kg/yr
4/28/2023 15

16. Growth Chart- Weight for Age
4/28/2023 16

17. 4/28/2023 17

18. 4/28/2023 18

19. 4/28/2023 19

20. 4/28/2023 20

21. Calculations of:
Weight for Age:
W/A= (Wt of child/Wt of normal
child of same age) × 100
4/28/2023 21

22. IAP Classification
Nutritional Status Weight for age(%) for
50th pecentile of
Harvard Standard
Normal >80
Grade I 71-80
Grade II 61-70
Grade III 51-60
Grade IV <50
4/28/2023 22

23. Gomez Classifaction
Nutritional Status Weight for age(%) for
50th pecentile of
Harvard Standard
Normal >90
Grade I 76-90
Grade II 60-75
Grade III <60
4/28/2023 23

24. Welcome Trust
Weight for age Edema Present Edema Absent
60-80% Kwashirkor Undernutrition
<60% Marasmic
Kwashiorkor
Marasmus
4/28/2023 24

25. Length/Height
• Length = < 2yrs = Infantometer
• Height = > 2yrs = Stadiometer
4/28/2023 25

26. Height/length
<2 yrs infantometer
• Two people required
• Head against fixed vertical head board
• Firmly press knee together
• 0-85 cms
4/28/2023 26

27. Infantometer
4/28/2023 27

28. >2yrs-stadiometer
• Bare footed with feet parallel
• Heels , buttocks , shoulders &
occiput touching the wall
• Head erect with eyes aligned
horizontally
4/28/2023 28

29. Stadiometer
4/28/2023 29

30. Approximate gain in stature between
0 and 12 years of age
Age Rate of increase in
stature
Birth to 3 months 3.5 cm/month
3-6 months 2.0 cm/month
6-9 months 1.5 cm/month
9-12 months 1.3 cm/month
2-5 yrs 6-8 cm/yr
5-12 yrs 5cm/yr
4/28/2023 30

31. Growth Chart-Height for Age
4/28/2023 31

32. 4/28/2023 32

33. Calculate Height for Age
Height for Age = (Ht of child/Ht of normal child of same
age) × 100.
4/28/2023 33

34. Weight for height
Calculated as:
weight of child(kg) X100
Expected weight for a healthy
child of same height
4/28/2023 34

35. 4/28/2023 35

36. WHO CLASSIFICATION
PARAMETERS MODERATE
MALNUTRITIO
N
SEVERE
MALNUTRITIO
N
EDEMA ABSENT PRESENT
WEIGHT/HEIG
HT
Z SCORE -2 to -3 Z SCORE < -3
HEIGHT/AGE Z SCORE -2 to -3 Z SCORE < -3
4/28/2023 36

37. 4/28/2023 37

38. 4/28/2023 38

39. Head circumference
• Birth – 18 yrs
• Non stretchable fiber glass tape
• Should encircle most prominent part of occiput &
supra orbital frontal area
• Accuracy of 0.1 cms
• Infant : length (cm ) + 9.5 +/- 2.5
2
4/28/2023 39

40. Head Circumference
4/28/2023 40

41. Expected head circumference in
children
Age Head Circumference (cm)
At birth 35
2 months 38
3 months 40
4 months 41
6 months 42-43
1 yr 45-46
2 yr 47-48
5 yr 50-51
4/28/2023 41

42. Approximate gain in head
circumference between 0 and 5 yrs
Age Growth velocity of head
circumference
0-3 months 2 cm/month
3-6 months 1 cm/month
7-12 months 0.5 cm/month
1-3 yrs 1 cm/6 months
3-5 yrs 1 cm/yr
4/28/2023 42

43. Chest Circumference
• Measured at the level of nipples on mid
inspiration.
• < 5 yrs – Lying down position
• > 5 yrs – Standing position
• At birth – HC is 3cm more than CC
• At 1 year – HC = CC
• After 1 year – CC > HC
4/28/2023 43

44. Chest Circumference
4/28/2023 44

45. Upper Segment : Lower Segment
• Length between vertex and pubic symphysis is
upper segment.
• Length between pubic symphysis and the
heel is lower segment.
• Ratio is decreased in rickets.
4/28/2023 45

46. Normal upper segment/ lower
segment ratio in children
Age Upper segment/lower
segment ratio
At birth 1.7:1
6 months 1.6:1
1 yr 1.5:1
2 yr 1.4:1
3 yr 1.3:1
4 yr 1.2:1
7 yr 1.1:1
10 yr 1:1
18 yr 0.9:1
4/28/2023 46

47. Arm span
• Distance between tips of
middle fingers of both the
arms when out stretched at
right angles.
• In < 5yrs of age arm span is 1-
2cm less than height.
• By 10-12 yrs both become equal.
• After 12 yrs arm span exceeds
height (but difference is <3cm)
4/28/2023 47

48. Mid Upper arm Circumference
• Measured on left upper arm midway
between acromion and olecranon
process with arm hanging by side of body.
• Shakir tape
• Bangle test
• At birth: 9-11 cm
• 1-5years: 16-17 cm
4/28/2023 48

49. 4/28/2023 49

50. Shakir Tape
MUAC (cm) Inference
>13.5 Normal
12.5-13.5 Borderline
<12.5 Under nutrition
4/28/2023 50

51. Body Mass Index
•Calculated as:
weight(kg)
[Height(m)]2
•Nutritional intervention is required if BMI
<15 or less then 5th percentile in children.
4/28/2023 51

52. Growth Chart - BMI
4/28/2023 52

53. B. Assessment of Tissue Growth
1. Triceps skin fold thickness
2. Biceps skin fold thickness
3. Subscapular skin fold thickness
4. Suprailiac skin fold thickness
Digital LCD Body Fat caliper
4/28/2023 53

54. Assessment of Tissue Growth
• Skin fold thickness gives estimation of fat.
• Can be measured by Lange’s of Harpenden’s
Skin fold calipers.
4/28/2023 54

55. 4/28/2023 55

56. C. Bone Age
• evaluate growth and maturity and to diagnose and
manage pediatric disorders.
• For 1-8 yrs, bone age is determined by examining
carpal bones in X-ray of left wrist.
• No. of osification centres in wrist = Age(yrs)+1
Age X-ray
New born Knee, Ankle
3-9 months Shoulder
3 yrs Wrist
12-16 yrs Elbow, Hip
4/28/2023 56

57. 4/28/2023 57

58. 4/28/2023 58

59. D. Dental Age
Age Eruption
At birth Nil
6-8 months Central incisors
10 months Lateral incisors
12-15 months 1st molar
15-21 months Canine
21-24 months 2nd molar
The teeth in the upper jaw erupt earlier than the lower jaw
except lower central incisors
4/28/2023 59

60. 4/28/2023 60

61. Permanent Teeth
Age Eruption
6 years 1st molar
7-8 years Central and lateral incisors
9 years First premolar
10-11years 2nd Premolar
11-12 years Canines
12-13 years 2nd molars
17-22 years 3rd molars
4/28/2023 61

62. THANK YOU
4/28/2023 62