Assuring Pediatric Nutrition in the Community

FREQUENTLY USED GUIDELINES:
Assessing Nutritional Status - Weight, Stature, and Head Circumference

Weight and stature and nutritional status
Obtaining weight measurements
Obtaining stature measurements
Using weight and stature in assessments
Head circumference
Factors other than weight and stature to consider

What do weight and stature tell me about a child’s growth and nutritional status?
Weight change is the first indication of over- or undernutrition; stature (length or height) is slower to respond. A decrease in height/length velocity is often indicative of chronic undernutrition.

How should I obtain weight measurements?
Weigh infants nude (without a diaper), and weigh children in stocking feet and light clothing. Plot weight-for-age on Centers for Disease Control (CDC) growth charts. Trends over time reflect an individual’s growth pattern.

How should I obtain stature measurements?
Use recumbent length for infants and children under 3 years of age, and plot this measurement on the "0 to 36 months" growth chart. Infants should be measured nude on a length board with a fixed headboard and movable footboard. For accurate measurement, two trained people are needed to position the infant on the board properly.

Use standing height for children who are between 2 and 20 years of age and can stand on their own. Height should be measured with a stadiometer (moveable headboard attached to a measuring board) or with a wall-mounted steel tape with a moveable headboard. Children should be measured with heels, buttocks, and shoulders touching the wall, looking straight ahead, and with bare feet.

How do I use weight and stature measurements to make assessments?
Plot measurements on growth charts to compare the growth of an individual child to the growth of other children his/her age, weight and/or stature. Percentile values (e.g., at the 50th percentile, between the 10th and the 25th percentiles) are used to describe this comparison. It is critical that measurements be made with the same techniques used to obtain the reference data. Use weight for length or body mass index to assess weight and stature proportionality.

What does head circumference tell me about a child’s nutritional status?
Head circumference is one of the last indicators to be affected by undernutrition in infants and is generally not related to nutrition in children over age 3 years. A decrease in head circumference percentiles, when accompanied by decreases in weight and height percentiles in a child under 3 years of age, could signal a significant nutritional insult.

What factors other than weight and stature should I consider when making an assessment of growth?
For many children, weight and stature measurements do not provide a complete picture of growth and nutritional status. For example, a measurement of weight is not very useful without considering the child’s height and body composition. Weight and stature should be used in conjunction with tools to assess body composition as part of a complete nutrition assessment.

Example: This child's weight for length is low, indicating possible nutritional risk. When body composition is considered, however, this child is growing appropriately. He has low muscle tone and reduced muscle mass, and it would be expected that he would weigh less than typically developing peers of the same length.

Factors such as the child’s health status and growth history also influence growth and should be taken into consideration.

Example: This child's weight is at the 10th percentile for age. This may be indicative of nutritional risk. When stature is included in the assessment and weight for lenght is plotted, it is evident that weight is appropriate for length. Longitudinal data indicates that weight and length have been at the 10th percentile throughout infancy, therefore the data suggest that this child is growing appropriately.