The document provides a comprehensive overview of anthropometric measurements used to assess nutritional status in children, detailing techniques for measuring weight, height, and circumferences. It outlines growth velocity norms and expected measurements throughout different age stages, emphasizing the importance of monitoring these metrics for diagnosing malnutrition. Additionally, it discusses tools such as growth charts and the significance of various indices to evaluate body composition and growth patterns in early childhood.

1. ANTHROPOMETRY

2. Introduction
•Anthropos - "man" and Metron "measurement”
•Single most portable, universally applicable,
inexpensive
•Non-invasive technique .
•Reflect the current nutritional status
•Used to evaluate both under & over nutrition.
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3. Parameters of anthropometry
Age dependent factors:-
a) Weight
b) Height
c) Head circumference
d) Chest circumference
Age independent factors:-
a) Mid-arm circumference (1-5 years)
b) Weight for height
c) Mid upper arm/height ratio
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4. Weight
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• The weight can be recorded using a :
 Beam type weighing balance
 Electronic weighing scales for infants and children
 Bathroom type of mechanical scale (very unreliable)
 Salter spring machine (in field conditions)

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6. •Growth Velocity :
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Age Weight Gain
10 days-3months 30g/day
3-6 months 20g/day
6-9 months 15g/day
9-12 months 12g/day
1-3 yrs 3kg/yr
4-12 yrs 2kg/yr
>12yrs 5-6 kg/yr (0.5 kg/month)

7. 7
Age Weight
At birth X
5 months 2X
1 year 3X
2 years 4X
3 years 5X
7 years 7X

8. WEECH’S FORMULA
a) 3 – 12 months
Expected weight(kg) = age (months) + 9 / 2
b) 1- 6 years
Expected weight(kg) = age (years) x 2 + 8
c) 7 – 12 years
Expected weight(kg) = age (years) x 7 - 5 / 2
Expected weight (kg)= age (years) x 3
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9. Length or Height/Stature
Measurement Technique
 Length- child less than 2 years of age
 Measured using infantometer
 If child > 2 years of age, we measure height using Stadiometer
affixed on the wall which provides a direct read out of height with an
accuracy of 0.1 percent
 Height is <length – the ligaments are opposed in standing position
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11.  The linear growth ceases after fusion of epiphyses
 Nutritional deprivation over a period of time affects the linear
growth , acute starvation - weight loss due to wasting.
 adolscence- 20% of body stature & 50% of adult bone mass is
laid down

12. Technique of length measurement
• The infant is placed supine on the infantometer.
• Assistant or mother is asked to keep the vertex or top
of the head snugly touching the fixed vertically plank.
• The leg are fully extended by pressing over the knee,
and feet are kept vertical at 90⁰ , the movable pedal
plank of infantometer is snuggly apposed against soles
and length is read from scale.

14. Technique for height measurement
 Children( stand staight ) - stadiometer.
 Child should stand with bare feet on flat floor
 Child against a wall -feet parallel , heels
buttocks, shoulders and occiput touching wall.
 Head should be kept in Frankfurt plane.
• Wooden spatula or plastic ruler, the topmost point
of the vertex is identified on the wall.

17. Height Velocity
A
At birth 50cms
Gain during 1st year 25cms
Gain during 2nd year 12cms
Gain during 2-5 years < 5cm
Gain during 5-10 years < 4 cm
Adolescence 8cms/yr for girls during 12 to 16 years
10cms/yr for boys during 14 to 18 years
Birth to 3 months 3.5cm/month
3 – 6 months 2.0cm/month
6 – 9 months 1.5cm/month
9 – 12 months 1.3cm/month
2 – 5 years 6 – 8cm/year
5 – 12 years 5cm/year
AGE Approximate rate of increase in stature

18. 1. Expected height (cm ) upto 12 yrs- weechs formula
 height = (age in years x 6) +77
2. Prediction of adult height – to calaculate mid parental height
Boys=(mothers height in cm+13) +(fathers height in cm)/2
Girls =(fathers height in cm-13)+( mothers height in cm )/2

19. WEIGHT-FOR-HEIGHT
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Weight-for-height =
Weight of the patient (kg) X 100
Weight of normal child of same height
The nutritional status can be expressed as follows on the basis of
weight-for-height:
Weight-for-Height * Nutritional Status
>90%
85-90 %
75-80 %
<75 %
Normal
Borderline Malnutrition
Moderate Malnutrition
Severe Malnutrition
*Reference standard NCHS data

20. Growth chart
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• Also called “road to health” chart
• graphical display of a child’s physical growth and
development
• WHO chart is recognized internationally.
• WHO chart has two reference curves whereas chart
used in India as per ICDS scheme has five reference
curves.
• chart is different for girls and boys.

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23. Uses of growth chart
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1. Growth monitoring
2. Diagnostic tool
3. Planning and policy making
4. Educational tool
5. Tool for action
6. Evaluation
7. Tool for teaching
8. Tool for information

24. HEAD CIRCUMFERENCE
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• Brain growth takes place 70% during fetal life, 15%
during infancy and remaining 10% during pre-school years.
•Routinely recorded until 5 years of age.
•Measured by placing the tape over the occipital
protuberance at the back and just over the supraorbital
ridge and the glabella in front.

25. Expected head circumference in children
Age Head circumference (cm)
At birth 34 – 35
2 months 38
3 months 40
4 months 41
6 months 42 – 43
1 year 45 – 46
2 years 47 – 48
5 years 50 - 51
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26. Head Circumference Growth Velocity
•During first year there is 12 cm increase in head circumference ,
while 1 – 5 year age , only 5 cm gain occur in head size.
•Adult head size is achieved between 5 to 6 years .
the following formula (Dine’s formula) is used for estimating the
head circumference in the first year of life : -
( length in cm + 9.5 ) ± 2.59
2
Till 3 months 2 cm/month
3 months – 1 year 2cm/3 month
1 – 3 year 1cm/ 6 month
3 – 5 year 1cm/ year
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27. The term Macrocephaly refers to OFC (Occipitofrontal head
circumference) of more than 2SD above the mean while
Microcephaly refers to OFC more than 3SD below the mean for
age , sex , height and weight.
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28. Microcephaly Macrocephaly
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29. MID-UPPER ARM CIRCUMFERENCE
• 9-11cm at birth.
• During 1-5 Yrs of age it remains reasonably static between 15-
17cms among healthy children .
• It is conventionally measured over the left upper arm , at a point
marked midway between acromion (shoulder) and olecranon
(elbow) with arm bent at right angle.
• The child is asked to stand or sit with the arm hanging loose at
the side.
• If it is less than 12.5 cm it is suggestive of severe malnutrition.
• If it is between 12.5 -13.5 cm it is indicative of moderate
malnutrition.
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30. 30
It is developed on the principle that acute starvation severely
affects mid-arm circumference while height is unaffected.

31. • Bangle test – quick assessment of arm circumference. A fiber
glass ring of internal diameter of 4 cm is slipped up the arm, if
it passes above the elbow, it suggests that upper arm is less
than 12.5 cm and child is malnourished.
• Shakir tape – is a fiber-glass tape with
red – less than 12.5 cm
yellow – 12.5- 13.5 cm
green – greater than 13.5 cm
shading so that paramedical workers can assess nutritional
status without having to remember the normal limits of mid
arm circumference.
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32. CHEST CIRCUMFERENCE
• It is usually measured at the level of nipples,
preferably in mid inspiration.
• Xiphisternum
• In children
<= 5years - lying down position
> 5 years - standing position
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33. CHEST CIRCUMFERENCE
MEASURMENT
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34. Relationship between head size
with Chest Circumference:
• At birth: head circumference > chest
circumference by upto 3 cms.
• At around 9 months to 1 year of age: head
circumference = chest circumference,
• but thereafter chest grows more rapidly
compared to the brain.
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35. • The head circumference is greater than
chest circumference by more than 3 cms
in :
a) preterms
b) small-for-date , &
c) hydrocephalic infants
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36. BONE AGE
• Bone age is useful in monitoring the growth in
children for conditions like hypothryoidism,
CAH & GH deficiency
• Comparison of bone age with chronological
age is useful in diagnosis of growth disorders.
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37. PRINCIPLE OF BONE AGE
• Assesment is based on
a.time of appearance of ossification centre
b. epiphyseal- diaphyseal union
X ray of bone is taken to assess time of
appearance of ossification centre and union.
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38. CA vs BA
1. CA>BA
- Delayed bone age
- constitutional delay
- constitutional dwarfism
- chronic systemic disease
- Hypothyroidism
- Male hypogonadism
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39. 2. CA<BA
- Advanced bone age
- Obesity
- Precocious puberty
- Congenital adrenal hyperplasia
- Hyperthyroidism
- Chondrodystrophy
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40. 40
BODY MASS INDEX (BMI)
•A BMI-for-age of > 85th percentile is suggestive of Overweight.
•A BMI-for-age of > 95th percentile is or when it is associated
with triceps or skinfold thickness-for-age of > 90th percentile, it
is diagnostic of Obesity.

41. • Ponderal index : - it is another parameter which
is similar to BMI and is used for defining newborn
babies with intrauterine growth retardation.
PI = (Body weight in grams) × 100
length (cm)³
• In malnourished small-for-date babies (asymmetric
IUGR), ponderal index is <2, while it is usually more
than 2.5 in term appropriate-for-gestation babies and
hypoplastic small-for-date babies.
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42. PROPORTIONAL TRUNK AND LIMB
GROWTH
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•The mid-point of the body in newborn is at umbilicus whereas in an
adult the mid-point shifts to the symphysis pubis due to greater
growth of limbs than trunk.
•Upper Segment to Lower segment ratio at birth is 1.7 to 1.0 .
•Gradually becomes 1.0 to 1.1 in healthy adults.
• In infants upper segment (crown to symphysis pubis) can be
measured by using infantometer.
• The lower segment is obtained by subtracting the upper segment
from total length.

43. ARM SPAN
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•It is the distance between the tips of middle fingers of both arms
outstretched at right angles to the body, measured across the back
of the child.
•In under-5 children , arm span is 1 to 2 cm smaller than body
length.
•During 10-12 years of age , arm span = height.
•In adults arm span is more in adults by 2 cm.

44. •Abnormally large arm span is seen in patients with
1) Klinefelter’s Syndrome
2) Coarctation of aorta
•Arm span is short compared to height in patients with :
1) Short limbed dwarfism
2) Cretinism
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46. CLINIC VISITS
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• Monthly in infancy
• Once in two months in the second year
• Once in three months thereafter till 5
years.

47. Teeth Eruption Time Table
Upper Teeth When tooth emerges When tooth falls out
Central incisor 8 to 12 months 6 to 7 years
Lateral incisor 9 to 13 months 7 to 8 years
Canine (cuspid) 16 to 22 months 10 to 12 years
First molar 13 to 19 months 9 to 11 years
Second molar 25 to 33 months 10 to 12 years
Upper Primary Teeth Development Chart

48. Lower Teeth When tooth emerges When tooth falls out
Second molar 23 to 31 months 10 to 12 years
First molar 14 to 18 months 9 to 11 years
Canine (cuspid) 17 to 23 months 9 to 12 years
Lateral incisor 10 to 16 months 7 to 8 years
Central incisor 6 to 10 months 6 to 7 years
Lower Primary Teeth Development Chart

49. Primary tooth eruption facts:
• For every 6 months of life, approximately 4 teeth erupt.
• Girls generally precede boys in tooth eruption.
• Lower teeth usually erupt before upper teeth.
• Teeth in both jaws usually erupt in pairs.
• Primary teeth are smaller in size and whiter in color than the permanent teeth.
• By the time a child is 2 to 3 years of age, all primary teeth should have erupted.

50. Skinfold thickness
• Measured with Herpenden’s caliper
• Triceps or subscapular region
• The skinfold with subcutaneous fat is picked up with
thumb and index finger, and caliper is applied beyond
the pinch.
• Fat thickness
>10mm - healthy children 1-6 years
<6mm - is indicative of moderate to
severe degree of malnutrition
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