Technique f assessment of growth

TECHNIQUE OF

ASSESSMENT OF

GROWTH

1. WEIGHT

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.

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.

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)

Weech’s Formula For Estimating Weight In Children (Kg)

At birth : 3-3.25 Kg

3 to 12 months:Age in months + 9 21 to 6 Years:(Age in years X 2 ) + 8

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

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.

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

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.

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.

Weech’s formula for the estimation of height in children.At birth: 50 cm1 year: 75 cm2 to 12 years: (age in years X 6) +77cm OR (age in years X 2) + 30 inches

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.

Years CM

3 months 40 cm

1 Year 45 cm

2 Years 48 cm

5 Years 50 cm

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.

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.

6. TISSUE GROWTH ASSESMENT

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

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.

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

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.

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.

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.

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

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.

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.

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

DATA COLLECTIONAssessment 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.

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.

ASSESSMENT TOOLS

Standardized tools are used for screening developmental changes in a systematic way. Several

assessment tools are used.

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

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

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.

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.

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.

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.

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