1. GROWTH MONITORING:
ANTHROPOMETRIC
MEASUREMENTS PLOTTING
AND INTERPRETATION
PRESENTERS: KEAGAN KIRUGO
EMMANUEL WEKESA
SUPERVISORS: PROF FRANCIS E.
ONYANGO
DR.BONIFACE OSANO
DR. GRACE IRIMU

2. CONTENT
 Definition
 Background information
 Measures of indicators
 Indicators of growth
 Plotting on growth charts
 Interpretation of growth curves
 references

3. DEFINITIONS
 Growth: Increase in cell size and number with
a resultant increase in height or girth or both.
 Growth monitoring: Following the growth rate
of a child in comparison to a standard by
frequent periodic anthropometric
measurements in order to assess growth
adequacy.
 Anthropometry: Measurement of a person’s
physical parameters and comparing them with
a standard.
Marcia Griffiths and Joy Del Rosso, Growth
Monitoring and Promotion Of Healthy Young
Child Growth, Nov 2007: Definitions, pg 5

4. BACKGROUND
INFORMATION
There are two categories of malnutrition: Acute
Malnutrition and Chronic Malnutrition
 Acute malnutrition is categorized into Moderate Acute
Malnutrition (MAM) and Severe Acute Malnutrition
(SAM), determined by the patient’s degree of wasting.
All cases of bi-lateral oedema are categorized as
SAM.
 Chronic malnutrition is determined by a patient’s
degree of stunting, i.e. when a child has not reached
his or her expected height for a given age
 Children whose birth weight is less than 2.5 kilograms
and children reported to be ‘very small’ or ‘smaller
than average’ are considered to have a higher than
average risk of early childhood death

5. BACKGROUND
INFORMATION 2
 Nationally, 35 percent of children under five
are stunted, while the proportion severely
stunted is 14 percent. stunting is highest (46
percent) in children age 18-23 months and
lowest (11percent) in children age less than 6
months. 18-23 months have the highest
proportion of severely stunted children (22
percent) and those less than 6 months have
the lowest proportion (4 percent). A higher
proportion (37 percent) of male children under
five years are stunted, compared with 33
percent of female children

6. ANTHROPOMETRIC
MEASUREMENTS
1.WEIGHT
Equipment: Weighing scale
Procedure: Pretesting is essential.
 Scale is hung onto a stable support such as a tree by the
upper hook.
 Ensure the dial is at the eye-level.
 Weighing parts are hung on the scale and the pointer of the
scale adjusted to ‘0.’
 The child is undressed such that (s)he is devoid of heavy
clothing.
 The child is dressed with the weighing parts.
 Straps attached to the scale by the lower hook.
 Ensure feet are not in contact with the ground.
 Another measurement is taken with the final value obtained
by calculating the average. Difference +/-0.1

7. MEASURING WEIGHT

8. 2.LENGTH <24m
 A measuring rod is fixed on a stable, flat,
horizontal surface.
 Child is straightened with the dorsal surface in
contact with the surface and oriented along the
measuring rod.
 Head bar is placed touching the top of the child’s
head.
 Eye-angle-external ear canal should be vertical.
 Straightening of the child’s knees. Footboard
placed in contact with the feet.
 The reading is taken. Second reading is then
taken and the average obtained. Difference of
0.5cm is allowed.

10. 3.HEIGHT
 The child who is > 24 months and is able to stand,
stands barefoot with the feet together against the
measuring. In addition any hair accessories that would
hinder measurement should be removed.
 The heels, buttocks, shoulder blades and occiput
should lightly touch the measuring device.
The head is aligned so that the external eye angle–
external ear canal is horizontal, this means that the
eyes should be looking straight ahead.
 The child is told to stand tall and is gently stretched
upwards by pressure on the mastoid processes with
the shoulders relaxed
The sliding head piece is lowered to rest firmly on the
head

12. 4.HEAD CIRCUMFERENCE
 This is a good measure of brain growth especially in
the first two years of life.
 It is of great value in follow-up of low birth weight
infants, and children with Central Nervous System
abnormalities like suspected post meningitic
hydrocephalus.
 The charts aren’t included in the countries growth
monitoring cards.
 normal head circumference at birth is 34 – 36 cm.
 Head circumference increases by 2cm/month for the
first 3 months, then by 1 cm/month from 3 – 6 months,
then by 0.5c/month from 6 – 12 months. (12 cm for 1st
year of life)

13. 5. MUAC
 Ask the mother to remove any clothing covering the child’s left arm.
 Calculate the midpoint of the child’s left upper arm: first locate the
tip of the child’s shoulder with your finger tips.
 Bend the child’s elbow to make the right angle.
 Place the tape at zero, which is indicated by two arrows, on the tip
of the shoulder and pull the tape straight down past the tip of the
elbow
 Read the number at the tip of the elbow to the nearest centimeter.
Divide this number by two to estimate the midpoint.
 Mark the midpoint with a pen on the arm
 Straighten the child’s arm and wrap the tape around the arm at the
midpoint.
 Inspect the tension of the tape on the child’s arm. Make sure the
tape has the proper tension and is not too tight or too loose
 When the tape is in the correct position on the arm with correct
tension, record the measurement to the nearest 0.1cm

15. INDICATORS OF GROWTH
MUAC criteria to identify malnutrition of
children under five years in the community
 Severely Malnourished less than 11.5cm
Moderately Malnourished 11.5cm to 12.4cm.At
Risk of malnutrition 12.5cm to 13.4cm
 The admission criteria for infants below 6
months are substantially different than for
infants over six months

16. Head circumference
 Using an un-stretchable tape at the largest
head perimeter

17. HEIGHT FOR AGE(HAZ)
 The height-for-age index is an indicator of linear
growth retardation and cumulative growth deficits
Children whose height-for-age Z-score is below
minus two standard deviations (-2 SD) are
considered short for their age (stunted) and are
chronically malnourished. Children who are below
minus three standard deviations (-3 SD) are
considered severely stunted. Stunting reflects
failure to receive adequate nutrition over a long
period of time and is also affected by recurrent and
chronic illness. Height-for-age, therefore,
represents the long-term effects of malnutrition in
a population and is not sensitive to recent, short-term
changes in dietary intake(stadiometre or
length board)

18. WEIGHT FOR HEIGHT(WHZ)
 The weight-for-height index measures body mass
in relation to body height or length and describes
current nutritional status. Children whose Z-scores
are below minus two standard deviations (-2 SD)
are considered thin (wasted) and are acutely
malnourished. Wasting represents the failure to
receive adequate nutrition in the period
immediately preceding the and may be the result
of inadequate food intake or a recent episode of
illness causing loss of weight and the onset of
malnutrition ie acute malnutrition. Children whose
weight-for-height is below minus three standard
deviations (-3 SD) are considered severely
wasted

19. WEIGHT FOR AGE(WAZ)
 Weight-for-age is a composite index of height-for-
age and weight-for-height. It takes into
account both acute and chronic malnutrition.
Children whose weight-for-age is below minus
two standard deviations are classified as
underweight. Children whose weight-for-age is
below minus three standard deviations (-3 SD)
are considered severely underweight
 Does not distinguish acute or chronic
malnutrition or fluid retention

21. g

22. INTERPRETATION OF GROWTH
CURVES
 This is determining whether the child is growing
appropriately or not, this is done by watching the
direction of the child’s growth pattern.
 Normal growth curve; a healthy child’s growth
curve is parallel to the printed curves on the chart.
important consideration on premature infants
where growth failure can be over diagnosed, this
can be avoided by subtracting the weeks of
prematurity from postnatal age when plotting the
growth measurements. the direction of the growth
curve is more important than the position of the
curve on the chart.

23.  A horizontal growth curve(static);this indicates
danger, this means the child is not growing, a sign
of disease, especially malnutrition, this makes
them prone to recurrent infection as they can not
resist disease, a thorough history should be taken
to establish the cause of growth failure, then
intervene; relevant and practical guidance to the
mother within her means to ensure continuation of
normal growth. thereafter growth monitoring helps
to determine the adequacy of catch-up growth
(successful nutritional rehabilitation associated
with growth spurt)

24.  Downward growth curve; indicates a very
dangerous situation where the child is losing
the weight, this requires extra care
immediately, could indicate malnutrition,
tuberculosis, AIDS or other medical conditions.
Investigations and treatment necessary. Any
infant who does not gain weight for a month or
a child in 2 months should receive urgent
attention, an indicator of the child being
malnourished.

25. REFERENCE
 K. Mukelabai, N.O. Bwibo, R. N. Musoke,
Primary Health Care A Manual for Medical
Students And Other Health Workers (3rd Ed),
Chapter 6: Growth monitoring and promotion
during early childhood, pg 60 – 65
 Kenya National Bureau of Statistics (KNBS),
2008-09 Kenya Demographic and Health
Survey (KDHS)
 Ministry of Health, MCH Booklet (2010 Ed)