Technique of assessment of growth

1. TECHNIQUE
OF
ASSESSMENT
OF
GROWTH

2. 1. WEIGHT

3. It is one of the best criteria for assessment of growth and a
good indicator of health and nutritional status of child.
Weight of the full term neonate at birth is 2.5 to 3.8 kg.
There are about 10% loss of weight during first week of life,
which regains by 10 days of age.

4. Then, weight gain is about 25 to 30 gram per day for the first 3 months
and 400 g per month till one year of age.
After that, the weight gain follows an average pattern.
The infants doubled their birth weight by 5 months of age, trebled by
one year, four times by two years, 5 times by 3 years, six times by 5
years, 7 times by 7 years and 10 times by 10 years of age. Then weight
increases rapidly during the puberty followed by gradual maturation to
adult size.

5. Routine Estimate Of Weight Of A Baby
Having Birth Weight 3 Kg
Age (years) Weight (Kg) Calculation
3 15 (5 X 3)
5 18 (6 X 3)
7 21 (7 X 3)
10 30 (10 X 3)

6. Weech’s Formula For Estimating Weight In Children
(Kg)
At birth : 3-3.25 Kg

7. 3 to 12 months:
Age in months + 9
2
1 to 6 Years:
(Age in years X 2 ) + 8

8. 7 to 12 Years:
(Age in years X 7) + 5 + 5
2
Weight For Height is calculated by:
Weight of child X 100
Weight corresponding to height of child

9. Body Mass Index (BMR Index)
• It is used to determine if children are overweight, obese or
underweight.
BMI = (weight/height²) X 100
• If the value is less than 0.15, it indicates malnutrition. This
remains constant upto 5 years of age.

10. Height Or Linear Growth Or Length
• Height refers to the measurement taken when the child stands upright.
It occurs as a result of skeletal growth and it is a stable measurement of
general growth. Maximum rate of growth in length occurs before birth.
• Maximum rate of growth in length occurs before birth.
• When height is measured in supine(lying) position, it is called length.
• Special length can be measured such as sitting height

11. Digital Scale For Checking Weight And Length
Till the child is 24 to 36 months of age, measure recumbent length. Keep the child
in fully extended position by holding the head in midline, grasping the knees
together gently, and extending the knees by gently pushing down on the knees on a
bed or a measuring board.
Measure the length by placing the child on a paper or colorless cloth – covered
surface. Mark the end points of the top of the head and heels of the feet and measure
between these points. Keep the head in midline. Position the feet with the toes
pointing upwards.

13. 2. HEIGHT
• It refers to the measurement taken when the child stands
upright..
• Remove the shoes, make the child stand as straight as possible,
head in midline looking straight. Child stands with the back to
the wall with shoulders, buttocks and heel touching the wall.

14. Weech’s formula for the estimation of height in children.
At birth: 50 cm
1 year: 75 cm
2 to 12 years: (age in years X 6) +77cm
OR
(age in years X 2) + 30 inches

16. 3. Head Circumference
• It is measured by using a tape that does not stretch. Measure the head
circumference until the child is 3 years of age and in any age when the head size
is questionable. The maximal circumference of the head is measured by placing
the tape measure over the eyebrows or supraorbital ridges and pinna of the ear
anteriorly and over the occipital prominence posteriorly.
• Newborn’s head circumference (33-35 cm) is larger than the chest circumfernec
by 2-3cm.
• Head and chest circumferneces exceeds head circumference by 5-7cm.

18. Years CM
3 months 40 cm
1Year 45 cm
2Years 48 cm
5Years 50 cm

19. 4. CHEST CIRCUMFERENCE
It is measured at the level of nipple line at midrespiration. Place
the tape measure at right angles to the vertebral column.
Newborn’s chest circumference is 31-33cm.

20. 5. ABDOMINAL CIRCUMFERNECE
Keep the child in recumbent position. Place the tape measure at
the level of umbilicus at right angles to the vertebral column.
Check the measurements as indicated. Abdomen of children upto
3 years of age who have chronic intestinal problems are
measured.

21. 6. TISSUE GROWTH ASSESMENT

22. 1. MIDARM CIRCUMFERENCE AND
SKINFOLD THICKNESS
Arm circumference is an indirect measure of muscle mass. Measure the midpoint of
the arm with a tape or paper. Place the tape vertically from acromion process of
scapula along the posterior aspect of upper arm to the olecranon process. Half of the
measured length is the midpoint. Check the circumference in that area
• Normal: Above 13.5 cm
• Moderate PEM: 12.5-13.5 cm
• Severe PEM: below 12.5 cm

23. 2. SKINFOLD THICKNESS
• It is the measure of the body fat.
• It is measured with special calipers such as lauge calipers.
• Common sites are triceps, subscapula, abdomen, upper thigh
and suprailiac.

24. 3. KANAWATI INDEX(KI)
Useful for detecting protein energy malnutrition in children between 4 months and 4
years.
KI = Mid arm circumference
Head circumference
Normal : > 0.32
Mid undernutrition: > 0.28-0.32
Moderate undernutrition: 0.25 – 0.28
Severe undernutrition: > 0.25

25. 4. ARM SPAN
When both arms are spread apart, the distance between the tips of the
middle fingers is measured as arm span.
In young children, it is 1-2 cm less than the height.
It equals the height at 10 years and afterwards it is about 1-2 cm more
than the height.

26. Bone Age Or Skeletal Maturity
• Radiological examination of bones is used for the assessment of
maturity.
• Usually, radiological examination of wrist and elbow is done to assess
bone age (1-13 years).
• For infants (3-9 months), radiograph of shoulder is useful.

27. Dental development
• The foundation of the child’s tooth structure are formed early in fetal life itself.
• At birth, all deciduous and the first permanent teeth (6 years) are developed in the child’s jaw and covered by a
fleshy gum.
• Individual variation is there in the ages of dentition.
• All 20 deciduous teeth appear by 2 ½ years of age.
• Prior to the eruption of permanent teeth – 6 years molars – a dormant period occurs during which all the permanent
teeth grow and mature and the roots of baby teeth gradually get absorbed and disappear.
• Permanent teeth erupts in the order of MIPCM (Molars I, Incisors, premolars, canines, molars I and II).
• Molar is the first one to erupt.
• Growth chart is designed to show the changes in the height and weight as the child grows.

28. Name Lower Upper(Age in years)
Central incisors 6-7 7-8
Lateral incisors 7-8 8-9
Canine 9-10 11-12
1st premolar 10-12 10-11
2nd premolar 11-12 11-12
1st molar 6-7 6-7
2nd molar 11-13 6-12
3rd molar 17-21 17-21

29. ASSESSMENT OF DEVELOPMENT
• Development is a process of acquiring variety of competencies for the optimal
functioning in the society.
• Development is a qualitative as well a quantitative change.
• If developmental delay is recognized early, intervention to reduce long term
sequel can be started.
• It is important to monitor growth and development at every stage.
• A child is said to have developmental delay if the child does not reach the
expected developmental milestones for the age.

30. Purposes of developmental assessment
• To determine if any developmental delay exists.
• To identify strengths and needs.
• To develop strategies foe intervention.
• To serve as a basis for reporting to parents.
• To determine the progress on significant developmental
achievements.

31. ASSESSMENT OF DEVELOPMENT
• Compare the achievements listed for normal children with developmental history and physical examination
findings.
• Children are observed for their activities.
• Seven areas of development are:
 Physical
 Psychosexual
 Cognitive
 Temperament
 Social
 Emotional
 Moral

32. DATA COLLECTION
Assessment of development can be done by comparing the
achievement listed for normal children with the history and
physical findings of the child.
If any impairment, disability or handicap, which are disorders
of development, exist, they should be noted in the history.
For preterm babies, the corrected age must be taken into
account.
Do not look at the weakness alone. Look for the strengths also.

33. Parents also can be made to assist the nurse while
doing the assessment.
They can observe the child daily and give relevant
information to the nurse as needed.
Behavior made by the child should be recorded
accurately and specifically.
Assessment of development is done on a serial
basis.
After the baseline data are collected, compare it
with subsequent examinations.

34. ASSESSMENT TOOLS
Standardized tools are used for screening
developmental changes in a systematic way. Several
assessment tools are used.

35. 1. GESELL DEVELOPMENT SCHEDULE
This scale by Gesell provides an estimate in four major areas of development, such as
motor, adaptive, language and personal social.
During the first year, development is assessed every week, then every two weeks till two
years and every six months till five years of age.
Scale gives development quotient (DQ) for each area separately and it also gives overall
DQ.
DQ = Maturity age X 100
Chronological age
Child with DQ between 65 and 75 is at risk for development delay. It can be applied for
handicapped children satisfactorily

36. 2. The Denver Developmental Screening Test (DDST)
(Age Range 2 Weeks To 6 Years)
It was originally developed by Frankenburg and Dodds, which is revised recently. It
is simple, economic and useful test for screening developmental delaymduring
infancy and preschool period. It is a screening tool. It is not an intelligence test.
Assessment is done in four areas. Social, fine motor, language and gross motor
skills. While using the test, make each child comfortable. Explain the tasks at the
child’s level of understanding. Make sure the child listens and pays attention to each
task.
After scoring the test, interpret the results and inform the parents

38. 3. The Brazelton Neonatal Behavioral Assessment Scale
It was developed by T Berry Brazelton for assessing newborn behavior
during the first month of age. It records individual differences in the
baby. This tool can be used for normal as well as high – risk neonates
such as premature babies.

39. 4. The Bayley scale of infant development
It is used to evaluate children between 6 and 30
months of age. Three general areas such as mental,
psychomotor and behavioral development are
evaluated.

40. 5. Trivandrum development screening chart (TDSC)
This test is developed at Trivandrum (Child Development Centre,
Medical College Hospital). It is a simplified version of Bayley scale of
infant development. Since the norms for TDSC are taken from Bayley
scale, which is a universally accepted developmental scale for children
up to 30 months of age, it can be used in other states also.

41. 6. The Denver Articulation Screening Examination (DASE)
Language and speech development can be assessed by
evaluating child’s verbal ability by direct observation and
by testing. DASE is a tool to test the child’s ability to
imitate vocal sounds. This test is easy to administer as the
child is only asked to repeat 30 sound elements.

42. 7. Developmental Assessment Scale for Indian
Infants(DASII)
This tool is also based on Bayley scale of infant development.
This scale was developed by Ms. Pramila Phatak of Baroda
University. Age range is till 2.5 years. DASII consists of two
scales – mental scale and motor scale