ANTHROPOMETRY
Q&A: 26*
ANTHROPOMETRY (GROWTH):
Why there is no need to measure HC after 5 years?
Head circumference attains adult size around 5-6 years. So HC cannot denote child's growth after 5 years - thus insignificant measure for growth monitoring after 5 years.
When HC should be measured after 5 years?
In case of Cerebral Palsy - HC should be measured for MICROCEPHALY (even when the child is >5 years old)
Why no microcephaly in SAM?
Due to Head sparing effect
(Note that your case can have HC >CC or HC = CC due to this head sparing effect)
Types of WHO Growth chartsQ&A: 26*
Difference between growth and development
Growth denotes a net increase in size or mass of tissues , while development denotes maturation of functions and acquisition of skills.
Growth is due to multiplication of cells while development is due to maturation and myelination of nervous system.
Growth is measured by Anthropometry and Growth charts, while Development is measured by Developmental milestones
Growth is due to multiplication of cells while development is due to maturation and myelination of nervous system.
Growth is measured by Anthropometry and Growth charts, while Development is measured by Developmental milestones
ANTHROPOMETRY (GROWTH):
When to plot a growth chart for preterm baby?
First allow the baby till it attains term age.
Then start to plot growth chart from term age
What is significant weight loss?
More than 10% in last 6 months
Tell Weight calculation formula (Weech formula)
Weech formula for weight
Difference between length and height?
For baby less than 2 yrs - we call it length, since baby cannot stand and vertical height cannot be measured. Instead, we will use "INFANTOMETER" to measure length of the baby
For child more than 2 years, we can make the child to stand and measure height using "STADIOMETER"
What is Frankfurt plane?
Frankfurt plane is a line joining the lower margin of orbit and the upper margin of external auditory canal
It should be kept parallel to the ground, before measuring the height of the child.
What is Crown Rump Length?
Length from Top of head to bottom of buttocks
Tell Height/Length calculation formula (Weech formula)
For length (i.e < 2 years)
Compare with approximate normal lengths
Newborn 50 cm
1 year: 75 cm
2 years: 86-87 cm
For Height (i.e >2 years)
After 2 years: 6 cm/year growth
Or
Weech formula
Expected height = (Age in years x 6) + 77 cm
Difference between length and height?
For baby less than 2 yrs - we call it length, since baby cannot stand and vertical height cannot be measured. Instead, we will use "INFANTOMETER" to measure length of the baby
For child more than 2 years, we can make the child to stand and measure height using "STADIOMETER"
What is Frankfurt plane?
Frankfurt plane is a line joining the lower margin of orbit and the upper margin of external auditory canal
It should be kept parallel to the ground, before measuring the height of the child.
What is Crown Rump Length?
Length from Top of head to bottom of buttocks
Tell Height/Length calculation formula (Weech formula)
For length (i.e < 2 years)
Compare with approximate normal lengths
Newborn 50 cm
1 year: 75 cm
2 years: 86-87 cm
For Height (i.e >2 years)
After 2 years: 6 cm/year growth
Or
Weech formula
Expected height = (Age in years x 6) + 77 cm
MAC and its measurement?
Mid arm circumference
First, in order to measure MAC - identify midarm (palpate acromian and olecranon, mark them with sketch pen and measure distance between them; locate halfway between them and mark it - this will be the midpoint of arm)
Now measure circumference at the point which you marked**
Normal values of MAC:
Newborn 9-11 cm
First year 16 cm
Remains constant between 1-5 years (normal value: 16-17 cm)
Age to measure MAC
Between 1-5 years
(not to be calculated for less than 1 year baby)
How to measure CC?
Measured at level of nipples at MID INSPIRATION.
Done in supine position in children below 5 years (or) in standing position in children above 5 yeats
Relation between HC and CC
HC > CC before 9 months with a difference of 3 cm
HC=CC at 9 months and
CC>HC after 9 months
Mid arm circumference
First, in order to measure MAC - identify midarm (palpate acromian and olecranon, mark them with sketch pen and measure distance between them; locate halfway between them and mark it - this will be the midpoint of arm)
Now measure circumference at the point which you marked**
Normal values of MAC:
Newborn 9-11 cm
First year 16 cm
Remains constant between 1-5 years (normal value: 16-17 cm)
Age to measure MAC
Between 1-5 years
(not to be calculated for less than 1 year baby)
How to measure CC?
Measured at level of nipples at MID INSPIRATION.
Done in supine position in children below 5 years (or) in standing position in children above 5 yeats
Relation between HC and CC
HC > CC before 9 months with a difference of 3 cm
HC=CC at 9 months and
CC>HC after 9 months
Why there is no need to measure HC after 5 years?
Head circumference attains adult size around 5-6 years. So HC cannot denote child's growth after 5 years - thus insignificant measure for growth monitoring after 5 years.
When HC should be measured after 5 years?
In case of Cerebral Palsy - HC should be measured for MICROCEPHALY (even when the child is >5 years old)
What is Microcephaly and Macrocephaly?
HC less than -3 SD : Microcephaly
HC more than 3 SD: Macrocephaly
Microcephaly - Types and Differences?
Primary and Secondary Microcephaly
 |
| This picture is taken from Aruchamy textbook of Paediatrics |
Microcephaly and Macrocephaly in UG cases
Microcephaly - Cerebral Palsy, Down's syndrome
Macrocephaly - Thalassemia*
Due to Head sparing effect
(Note that your case can have HC >CC or HC = CC due to this head sparing effect)
Maternal Zika virus - Complication:
MICROCEPHALY in baby
What is KANAWATI INDEX?
 |
| This picture is taken from Aruchamy textbook of Paediatrics |
What is PONDERAL INDEX and its inference?
Ponderal index = [Weight (kg)/ Height (cm) in cubes] x 100
Normal >2.5
Borderline PEM 2-2.5
Severe PEM <2
Normal Newborn Measurements
Normal >2.5
Borderline PEM 2-2.5
Severe PEM <2
Normal Newborn Measurements
Weight >2.5 kg
Height = 50 cm
HC = 34-35 cm
CC = 31-32 cm
MAC = 9-11 cm
Criteria for Obesity in Paediatrics
More than 95th percentile BMI in WHO BMI chart
Anthropometric measures and diseases
1) Weight for age - decreased in acute and chronic malnutrition
2) Height for age - decreased in short stature (or) chronic malnutrition
3) Weight for Height - less than -3 SD is definite indicator of SAM, between -2 to -3 SD is MAM
4) HC - Microcephaly (CP or Down's) or Macrocephaly (Thalassemia)
5) CC - CC is less than HC for a SAM baby more than 9 months (due to head sparing effect in SAM)
6) MAC - MAC <11.5 cm is SAM, MAC 11.5-12.5 cm is MAM
Learn that there are two types of charts (z score chart and percentile chart). Only z score charts can be used for diagnosis*. All WHO criteria for SAM, MAM, Underweight, stunting are based on Z score chart.
2. But, some colleges recommend percentile chart - so use them. Still, know that percentile charts are of no use in diagnosis and they are considered outdated at some institutions.
3. Z score chart is based on Standard deviations. Percentile chart is based on percentiles
4. Remember - 3rd percentile is a cutoff which is usually higher than -2 SD*. So, a child below 3rd percentile - can be well above -2 SD
5. If you find some parameter below 3rd percentile, use Z score growth chart to find whether it's SAM or MAM or underweight or stunting
6. If you find a parameter (say Weight for Height) below 3rd percentile but above -2 SD, the child is actually NORMAL.