Adapted by the State of California CHDP Nutrition Subcommittee from the online training module:

“Accurately Weighing & Measuring Infants,Children and Adolescents: Technique”

U.S. Department of Health and Human ServicesHealth Resources and Services Administration

Maternal and Child Health Bureau

http://depts.washington.edu/growth/

August 2012

How to AccuratelyWeigh and Measure Children

for the CHDP Well-Child Exam

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By the end of this presentation you will be able to:

Accurately weigh a child Accurately measure a child Manage common problems

encountered

Objectives

2010 Prevalence Rates

16.6 15.6 12.9 14.8 16.1

18.813.8

11.913.2

17.3

05

10152025303540

Hispanic White Asian Black All Groups

Per

cent

age

Overweight: 85 - < 95 % BMI Obese: ≥ 95 % BMI

2010 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM 160 reports

Overweight & Obese ChildrenCalifornia children ages 2 to < 5 years

2010 Prevalence Rates

19.4 17.6 13.9 17.8 18.7

24.720.3

12.6

21.1 23.3

0

10

20

30

40

50

Hispanic White Asian Black All Groups

Per

cent

age

Overweight: 85 - < 95 % BMI Obese: ≥ 95 % BMI

2010 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM 160 reports

Overweight & Obese ChildrenCalifornia children ages 5 to < 20 years

Height, length, and weight alert providers to:

• Growth problems• Feeding problems• Emotional or social problems• Illness

Measurements You TakeAre Important

BMI for 5 year old boy•Weight: 43.5 lb •Height: 43.0 in•BMI = 16.5

• BMI-for-age =75-84th percentile

• Normal range

If height is inaccurate:•Weight: 43.5 lb •Height: 42.5 in•BMI = 17.0

• BMI-for-age = 85-94th percentile

• Overweight range

Accurate Measuring Is Critical

BMI % Growth Chart

Obese

Overweight

Normal*

Underweight

Lab Tests(cholesterol &

glucose)

In-depthMedical

Assessment

Note in chart:“Counsel & Follow-up”

Take and PlotMeasurements

• Weight• Height• Age• BMI

Your MeasurementsGuide Providers

*Further tests may be warranted depending on

family history

Normal

Abnormal

Your MeasurementsGuide Many Others

BMI % Growth

Chart

WIC

Schools

Parents

PedNSSData

Your Measurements

• Weight• Height• Age• BMI

HeadStart

What challenges do you face?

How do you handle them?

Use a private area or exam room for the following:

Removal of clothing and donning gown Taking measurements Discussing results

Respect Privacy

Before you begin:1.Determine equipment needed for

infant and child

2.Make sure equipment is clean, safe, and in good condition

3.Using a balance scale? Set to zero

4.Using a digital scale? Press the zero key to zero the indicator

Measure Lying or Standing?

Length (Lying)Use Birth – 24 monthsWHO growth chart Unable to standwithout assistance*

Stature (Standing)Able to stand without assistanceUse 2 – 20 yearsCDC growth chart

Measuring Infant’s Length Equipment Needed: Measuring boardMovable foot pieceRigid headboardMarked to 1/8”

Need assistant

Measuring Infant’s Length

Measuring tape or yardstick attached to table tops

Measuring between 2 pencil marks on exam table

InappropriateMethods of Measuring

Measuring Infant’s Length 1. Measure infant wearing only clean, dry

diaper. No shoes.

2. Lay infant on back.

3. Assistant or parent holdshead firmly against the headboard.

4. With one hand, hold infant knees down, straightening the hips and knees.

Measuring Infant’s Length

5. With the other hand,move the footboarduntil it is resting firmlyagainst infant heels.Toes point directly up.

6. Measure length to nearest 1/8”.

7. On CHDP PM 160,record measurement to nearest 1/4”.

Measuring Height (Stature) Equipment Needed:

Vertical stadiometer (height rod): Movable horizontal headboard Marked to 1/8” Attached to a firm, vertical surface (without baseboard)

Measuring Height (Stature)

Measuring tapes

Yardstick or poster attached to wall

Height rod attached to scale

InappropriateMethods of Measuring

Measuring Height (Stature) 1. Remove shoes and outer clothing

(jackets, hats).

2. Child stands on a bare, flat surface with heels slightly apart; back as straight as possible.

3. Heels, buttocks, head and shoulders blades touch thewall or measuring surface.

4. Eyes should be straightahead, arms at side,and shoulders relaxed.

Measuring Height (Stature) 5. Ask child to stand as tall as possible,

keeping heels on the ground.6. Slowly lower headboard

until it touches the crown of the head firmly.

7. Check the child’s position. Measurer’s eyes are parallel with the headpiece.

8. Measure height to the nearest 1/8”.9. On CHDP PM 160,

record measurement to nearest 1/4”.

Equipment needed:

Beam balance or electronic scale At least 35 lb capacity Weigh in 10 g or ½ oz increments Large tray to fully support infant Can be easily “zeroed” and calibrated

Weighing Infants & Toddlers

• Up to 36 months if unable to stand without assistance

Weighing Infants & Toddlers

Weighing Infants & Toddlers1. Weigh infant wearing only light underclothing

or a clean, dry diaper.2. Place infant in the center of the scale tray.3. If using a beam scale, move lower weight from

the zero until marker drops below the center point.

4. Weigh infant to nearest 10 grams or ½ oz. 5. Record weight right away.6. If using beam balance, return upper and lower

weights to zero.

1. Weigh parent and child together= Total Weight

2. Weigh parent alone

3. Total Weight minus Parent’s Weight= Child’s Weight

Alternate Weighing Method

Weighing Children & AdolescentsEquipment Needed:

Beam or electronic scale Weigh in 100 g or ¼ lb increments Large platform to support the child No length device attached No remote display with attachment cord

Weighing Children & Adolescents

Weigh in: Undergarments Gown

Lightweight clothing Socks/bare feet

Weighing Children & Adolescents1. Remove bulky outer clothing (jackets and

sweaters) and shoes. Empty pockets of contents. Use clean dry diaper.

2. Balance and zero the scale.

3. Have the child stand in the center of the scale, feet slightly apart.

4. Read the measurement to nearest 100 gram or ¼ lb.

5. Record the measurement right away.

http://depts.washington.edu/growth/

U.S. Department of Health and Human Services

Health Resources and Services Administration (HRSA)

Maternal and Child Health Bureau

AdditionalGrowth Chart Training Modules

Essential clinical tools in training packet Resource handout lists sources for:• Online tutorials• Online resources• Growth charts• Plotting aids• BMI calculators and wheels

CDC BMI Percentile Calculator for Child and TeenCHOP Body Mass Index and Z-score Calculation in ChildrenShape Up America! Childhood Obesity Assessment Calculator

• Software applications

Growth Assessment Resources

PedNSS data: http://www.dhcs.ca.gov/services/chdp/Pages/CountySurveillanceData.aspx

Health Resources and Services Administration (HRSA) is part of the U.S. Department of Health and Human Services and helps provide health resources for medically underserved populations. http://www.hrsa.gov/index.html

Health Assessment Guidelines: http://www.dhcs.ca.gov/services/chdp/Pages/Pub156.aspx

Photos with permission. Ventura County CHDP Program and Mandalay Bay

Women and Children's Medical Group, August 19, 2011. Ventura County Health Care Agency. http://www.vchca.org/

References

Photo Credit

Practice Time