anthropometric manual - appendix a: procedures for … appendix a: general procedure for plotting...

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APPENDIX A: GENERAL PROCEDURE FOR PLOTTING HEIGHT AND WEIGHT ON PAPER GROWTH CHARTS FOR INFANTS AND CHILDREN A. Equipment Necessary for Plotting Growth of Children

1. CDC growth charts ( available on the CDC website: www.cdc.gov) 2. Graph Ease, Accuplot or PrecisePlot (which are flat plastic “see-through” instruments

with right angle lines that you lay on top of the growth chart to help you plot accurately plotting) or a straight edge ruler.

B. Calculating Age

Because infants and children’s measurements are plotted based on their age, it is important to know the age of the child at the time of the measurement. Often the child will be measured “today” (during the visit) when the child’s age at the visit and at the time of the measurement are the same. However, if the measures were done prior to the visit it is essential to correctly indicate the age of the child at the time of the measurement. Calculating the child’s age at the time of the measurement:

1. Record the date measurements were taken (month/day/year) 2. Record the child’s birth-date (month/day/year) 3. Subtract the birth-date from measurement date 4. Rewrite the age in years, months and days. 5. Round the child’s age.

Example 1: Child’s date of birth: September 15, 2009 Date of measurement: April 4, 2010

To calculate:

year month day Date of measurement 2010 04 04 Date of Birth 2009 09 15

First, will need to borrow one month (30 days) because the days in the date of birth are greater than the days in date of measurement.

year month day Date of measurement 2010 04 03 04 34 Date of Birth 2009 09 15

Next will need to borrow one year (12 months) because the months in the date of birth are greater than the months in the date of measurement.

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year month day Date of measurement 2010 2009 03 15 04 34 Date of Birth 2009 09 15

This results in 6 months (15 - 9 = 6) and 19 days (34 - 15 = 19)

Example 2: Child’s date of birth: January 10, 2007 Date of measurement: April 9, 2010

To calculate:

year month day Date of measurement 2010 04 09 Date of Birth 2007 01 10

First, will need to borrow one month (30 days) because the days in the date of birth are greater than the days in date of measurement.

year month day Date of measurement 2010 04 03 09 39 Date of Birth 2007 01 10

3 years 2 months 29 days

This results in 3 years, 2 months and 29 days

Rounding Children’s age: The next step in calculating a child’s age at the time of measurement for plotting on a growth cart is to round the child’s age. For infants and children <2 years, age should be rounded to the nearest month; For children >2 years, round to the nearest quarter year.

Infants and children less than two years old round and record as follows:

Days Month 1 to 15 round down 16 to 31 round up

Examples:

Actual age: Recorded age: 9 months 10 days 9 months 7 month 18 days 8 months

Appendix A: Procedure for plotting height and weight on paper growth charts for infants and children

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Children two and older round and record as follows:

Months Year 0 to 1 0 2 to 4 ¼ 5 to 7 ½ 8 to 10 ¾ 11 to 12 1

Examples:

Actual age: Recorded age: 3 years, 6 months and 19 days 3 ½ years 2 years, 1 month and 28 days 2 ¼ years

C. Calculate Body Mass Index (BMI) For women and children over age two and measured standing, BMI must be determined. There are several possible approaches to calculating BMI. A BMI chart that will work for women can be found on page 55. There are BMI calculators available in many places including the CDC website (www.cdc.gov). Otherwise, BMI can be calculated using the following formulas: BMI = Weight in Kilograms Height in Centimeters Height in Centimeters x 10,000 OR BMI = Weight in pounds Height in inches Height in inches x 703

D. Steps For Plotting On Growth Charts

Age has been calculated (see section B above for instructions) BMI has been determined (by calculation or by looking at BMI chart)

E. Choose appropriate growth chart and plot Length-for Age and Height-for-Age:

1. Select the growth chart appropriate for the age and gender of the child. Use the Birth-36 months growth chart to plot recumbent length measurements and the 2 - 20 years growth chart to plot standing height measurement.


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2. Find the child's length/height on the axis used for length/height on the left side of the grid (in inches or centimeters). Superimpose the "Accuplot" or similar aid on the growth chart, with the horizontal (left to right) line aligned with the child's length or height. If you are using a straight edge ruler, mark a line on the length/height.

3. Find the age of the child in months or years at the bottom of the chart. Using the

Accuplot and keeping the horizontal line aligned with the child's length or height, move the Graph Ease to the right or left until the vertical (top to bottom) line is aligned with the child's age. (If you are using a straight edge ruler, mark a line on the child’s age.)

4. Mark the intersection, this point represents the child's length-for-age or height-for-age,

and shows how her length or height compares to other U.S. children of the same age and gender.

5. The date of measurement, and the measurement must be recorded in the designated

area of the growth chart.

(See the example of the "length-for-age" chart on the next page.)

Maria Sanchez is 20 months old (1 year 8 months) and is 34 1/4 inches long, which is indicated by the intersection of the two lines.

Because of her age and gender, her measurements are plotted on the length-for-age chart for girls between birth and 36 months.

6. Note the percentile curves that lie below and above the mark. In some instances, the

mark may fall directly on a percentile curve.

Maria falls between the 90th and 95th percentiles for length-for-age (see plot on the next page).

7. If the graph shows a sharp increase or decrease in growth in comparison to a

previous measurement, recheck plotting and, if necessary, repeat the measurement immediately to make sure the measurement is accurate.


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Example WIC participant Maria Sanchez DOB 11/20/2003 Date Age Weight Length 7/20/2005 20 months 25# 34 ¼”


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Weight-For-Age:

1. Select the appropriate weight for age growth chart, which is based on the infant/child’s

age and gender.

2. Find the weight of the child on the axis used for weight on the left side of the grid. Using the Graph Ease aid or straight edge ruler, line up the horizontal line with the child's weight (if using a straight edge ruler, mark the weight with a line).

3. Find the age of the child in months or years at the bottom of the chart, and keeping the

horizontal line aligned with the child's weight, move the Graph Ease right or left, until the vertical line is aligned with the child's age. (If you are using a straight edge ruler, mark a line on the child’s age).

4. Mark the intersection, this point represents the child's "weight-for-age," and shows how

her weight compares to that of other U.S. children of the same age and gender.

Note the percentile curves that lie below and above the mark.

5. For follow-up assessments, if the graph shows a sharp increase or decrease in growth compared to previous measurements, recheck plotting. If necessary, repeat the measurement immediately to make sure the measured value is accurate.

(See the following example of how to plot “weight-for-age” on the next page.) Maria Sanchez is 20 months old (1 year and 8 months) and weighs 25 lbs. Her weight is on the 50th percentile.


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Example WIC participant Maria Sanchez DOB 11/20/2003 Date Age Weight Length 7/20/2005 20 months 25# 34 ¼”


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Weight-For-Length and Weight-for-Height

1. Locate the appropriate growth chart according to whether the infant or child is a girl or a boy, and whether the child’s length was measured (use weight-for-length) or height was measured (use weight-for height, ages 2-20 years).

2. Find the length or height of the infant or child along the bottom axis of the chart and line up the vertical line of the Accuplot with the infant’s or child's length/height. If using a straight edge ruler, mark a line on the child’s length or height.

3. Find the weight of the infant or child on the left or right side of the chart and move the Graph Ease up or down until the horizontal line matches the "weight" line. If using a straight edge ruler mark a line on the infant or child's weight.

4. The intersection represents the infant’s weight-for-length or child's weight-for-height, and shows how her weight compares to that of other U.S. children of the same gender and length/height. 5. Note the percentile curves that lie below and above the mark.

6. For follow-up assessments, if the graph shows a sharp increase or decrease in growth compared to previous measurements, recheck plotting. If necessary, repeat the measurement immediately to double-check the accuracy of measuring techniques.

(See the example of how to plot “weight-for-length” on the growth chart on the next page.)

Maria Sanchez is 20 months old (1 year and 8 months). She is 34 1/4 inches long and weighs 25 lbs. Her weight-for-length falls very near the 25th percentile.

Because of her age and gender, her measurements are plotted on the length-for-

age chart for girls between birth and 36 months.


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Example WIC participant Maria Sanchez DOB 11/20/2003 Date Age Weight Length Weight/length = ~ 25th percentile 7/20/2005 20 months 25# 34 ¼”


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ACCURACY

Accurate plotting is very important since the way you interpret the plot will affect the nutrition counseling you offer, as well as determine nutrition risk eligibility for WIC. Human error, such as inaccurate placement of the Graph Ease intersection on the grid, inaccurate measurements, or errors in recording, can result in inaccurate interpretation of the data. If incorrect information is plotted on a growth chart, it may look like the child has a growth problem, when in fact one doesn't exist; or an actual problem might be missed. It is always good practice to recheck your plots, and if indicated, the measurements. See the example of the "weight-for-height" chart on the next page. Notice the difference a recording error can make.

o A 2-year old girl, Marie, is weighed and measured standing. Marie weighs 34 pounds and is 42 inches tall. Note that the 2-20 year growth charts for girls were used.

When the information was recorded, her weight was entered as 43 pounds instead of 34 pounds (the numbers were turned around). When the data is plotted on a growth chart (see next page), her weight-for-height is between the 85th and 90th percentiles. Had her weight been correctly entered, she would have fallen between the 5th and 10th percentiles, which is the correct position. A common error such as this gives an incorrect picture of the child's growth, resulting in counseling which will be inappropriate. Remember: If plotting shows a sharp increase or decrease in growth compared with previous measurements, recheck the values entered and the plotting. If necessary, re-measure the child. Measure, record and plot carefully!


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Equipment Checklists

All equipment must be used for the purpose for which it was designed. Infant Scale Checklist High quality beam balance or electronic digital Weighs to 40 lb Weighs in 1/2 oz increments Tray large enough to support the infant Can be easily ‘zeroed’ and checked Can be calibrated Infant Length-board Checklist A firm, inflexible, flat horizontal surface with a measuring tape in 1/8 inch increments Tape is stable and easily read An immovable headboard at a right angle to the tape A smoothly moveable footboard, perpendicular to the tape Child and Women Scale Checklist High quality beam balance or electronic digital Weighs in 1/4 lb increments Stable weighing platform Can be easily ‘zeroed’ Can be calibrated No stature device attached Child and Women Stadiometer Checklist A vertical board with an attached metal tape, or metal tape firmly mounted on a stable wall An easily moveable horizontal headboard that can be brought into contact with the most superior part

of the head If not attached, the head board must be a right angle that is 6” wide A wide and stable platform or firm uncarpeted floor as the base Easily read, stable tape readout in 1/8 inch increments

Printed on recycled paper

Appendix B: Equipment Checklists

anthropometric manual - appendix a: procedures for … appendix a: general procedure for plotting...

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