Anthropometric measurements refers to study of measurement of human part, such as height weight, head circumference, chest circumference and mid arm circumference.
Weighing the infant or child
Preparation
- Check if the scale/measuring devices used are appropriate for age and safety of the child.
- Check if the scales are measuring and weighing in kilograms.
Note: All weighing machines should be serviced annually. - Prepare the child by giving age-appropriate explanation and where necessary use distraction.
- Consider the child’s gender, culture, and privacy.
- If child is frightening and uncooperative and making accurate measurement is impossible, postpone measuring until the child is relatively calm.
- Remove the nappies, shoes, or slippers.
- Infants should ideally be weighed nude and weighed on baby scales until the age of 2 years.
- Children over 2 years should be weighed in light clothing without shoes on standing or sitting on scales.
Disable children unable to sit or stand should be weighed in light clothing on a hoist scale if available. If not available, the weight can be calculated by weighting the parent and the child together and then parent separately.
Types of weighing scale
- Conventional beam balance scale
- Hanging scale (in community setting)
- Ground scale
- Electronic weighing machine
Procedure
- Explain theprocedure to the child and care giver.
- Wash hands
- Place the scale on a flat even surface.
- Clean the scale with swabs (hospital policy).
- Place the paper on a scale.
- Weigh the infants with no clothing, older child in underwear or lightweight gown.
- The child must be kept completely on the scale and then weight fully borne
- Always hold one hand within inch of the child for safety.
- Note the reading on the scale.
- Pick up the child or have the older child step off the scale.
- Remove and discard paper cover.
- Record the weight on paper to be transferred to permanent document.
- Clean the scale according to the hospital policy.
- Report weight as appropriate.
Nurse’s responsibility
- For infants and children who continue to be inpatients, weight should be measured at least weekly.
- More frequent monitoring may be indicated depending on the age or clinical condition, for example, neonates, cardiac, renal patients, and critically ill patients.
- Weigh the hospitalized child at the same time using same scale, same amount of clothing each time child is weighed.
- All measurements should be plotted on growth chart and reviewed by the medical team in order to determine the need for further assessment or intervention.
- Weight must be recorded in medical, nursing, and drug charts where appropriate the patient held record.
- In the outpatient clinic, the measurements should be directly entered the child’s medical notes.
- It is good practice to compare the measurements to the previous recording as this could detect any possible error in measurement or acute change in medical condition.
- For any reasons clothing has not been removed or a child weighed with additional equipment, for example, splint and cast, this must be recorded in nurse’s chart.
Post procedure care
The child should be redressed and left comfortable.
- After use, the measuring equipment should be cleaned with detergent and hot water followed by an alcohol impregnated wipe.
- Perform hand hygiene.
- If the equipment is contaminated with blood, it should be cleaned with soap and water followed by the hypochlorite solution.
- Record the child’s weight with date and time.
Measuring Height
For children under 2 years, it is advisable to measure the recumbent length while the child lies supine with legs fully extended at hips and knees and feet at right angles to legs.
In older children, standing height is measured by making the child stand against a vertical scale or wall.
Preparation
- The length board should be placed on a flat.
- Explain the procedure to the mother and the child as appropriate.
- Remove shoes and thick sports socks in the case of older children.
Procedure for Anthropometric measurements
- Measuring length
- Cover the length board with a thin cloth or soft paper for hygiene and for the baby’s comfort.
- Explain to the mother that she will need to place the baby on the length board herself and then help to hold the baby’s head in place while you take the measurement.
- Show her where to stand when placing the baby down, that is opposite to you, on the side of the length n=board away from the tape.
- Also show her to place the baby’s head (against fixed headboard) so that she can move quickly and surely without distressing the baby.
- Ask her to lay the child on his back with his head against the fixed headboard, compressing the hair.
- Quickly position the head so that an imaginary vertical line from the ear canal to the lower board of the eye socket is perpendicular to the board.
- Ask the mother to move behind the headboard and hold the head in this position.
- Check if the child lies straight along the board and does not change the position. Shoulders should touch the board, and the spine should not be arched.
- Hold down the Childs leg with one hand and move the foot board with other.
- Read the length accurately
- Remove the baby from the board and hand over to mother.
- Record it on paper.
- Measuring height
- Child stand with feet together and shoulder back. Ideally the heels, buttocks, shoulders and back of head should touch the back plate/wall.
- Place the headboard gently on top of the head and position look straight ahead with the lower border of the bony orbit (eye sockets) and the auditory canal in the same horizontal line. This is called Frankfurt plane.
- Ask the child to take a deep breath while supporting the head in the correct position and applying gentle upward pressure.
- Ensure the heels remain on the ground.
- Ask the child to breathe out and relax and record the measurement.
- Read the height to the last complete millimeter; do not round up or down.
- Plot height on appropriate centile chart. Use simple dots to mark the height.
Head circumference
Preparation
- Explain the procedure to the mother.
- Ask the mother to hold the baby or keep the baby in supine position on the bed.
Procedure
- Wash hands
- Clean the tape with alcoholic wipe (depending on hospital policy).
- The tape should be passed around the head, positioned just above the eyebrow ridges, above the ears and around the occipital prominence at the back of the head.
- The tape should be pulled snugly to compress hair and the measurement record to the nearest 0.1cm.
- As equal to HC, shape of head is important too.
- A boat shaped head suggests scaphocephaly.
- Asymmetrical: plagiocephaly.
- Flattened occiput-may be feature of Down syndrome.
- Frontal/parietal bossing or box-like head is suggestive of rickets.
Normal values
- At birth: 35 cm
- 3 months: 40 cm
- 6 months: 43 cm
- 1 year: 45 cm
- 2 years: 48 cm
- 7 years: 50 cm
- 12 years: 52 cm
Chest circumference
Procedure
- For measuring chest circumference, place the tape at the level of nipple in a plane at right angle to the spine.
- Record the measurement in mid respiration.
General instructions
- As rapid head growth occurs during the first 2 years of life, HC should be measured monthly in infants who continue to be inpatients.
- Generally speaking, if brain does not develop normally, as in mental retardation, the head size is likely to be small. Occasionally, however, the small size of the head may be secondary to premature union of the skull structures, the so-called craniosynostosis or craniostenosis.
- Large head may be the result of hydrocephalus, rickets, chondrodystrophy or syphilis, or familial macrocephaly, which is harmless.
Head/chest circumference ratio
- At birth, HC is larger than chest circumference by about 2 cm.
- By 6-12 months, both are equal.
- After first year, chest circumference tends to increase by 2.5 cm.
- By the age of 5 years, it is more or less 5 cm greater in size than HC.
Mid- arm circumference
Procedure
- Let the arm hang naturally by the side of the body.
- Then place the tape firmly without compressing the tissue around the upper arm at a point midway between tip of the acromion process and olecranon process.
- Read the measurements.
General instructions
- The maximum circumference of the upper arm is measured when the arm is hanging by the side of the body.
- MAC is said to remain constant between 16.25 and 16.75 cm.
- Any child in this age group with a circumference below 80% (about 12.5 cm) of the reference international standard is said to be considered suffering from malnutrition.
Shakir’s tape method
It is a simple and age-independent tool for assessing malnutrition. This special tape has colored zones: red, yellow, and green, corresponding to the readings of MAC.
Bangle test
It is usually done in children below 5 years of age. The child’s arm is inserted into a bangle with an inner diameter of 4 cm. If the bangle crosses the elbow, then we can consider that MAC is decreased. This test can be applied when there are no other resources available for measuring MAC. However, it is not an accurate test.
Procedure for measuring triceps skin fold thickness.
Hold a fold of skin thumb and index finger and measure the midarm over triceps area on the left side.
Quadriceps skinfold thickness
Hold the fold of the skin in the midpoint of the anterior surface of the thigh, midway between patella and the inguinal fold.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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