Measuring Physical Parameters of Growth

Key Points

• Measure height and weight at all well-child visits.

• Measure head circumference in children up to 24 months of age and blood pressure in children 3 years and older.

• Plot measurements on NCHS growth charts to demonstrate normal growth.

• Investigate significant deviations if the child's growth crosses multiple percentile lines on the growth chart.

Weight, length, and head circumference are the most useful routine measurements in infants. Total body length in children up to age 2 is obtained most accurately by placing them in the recumbent position and measuring from crown to heel. The child's head is placed perpendicular to the surface touching a fixed plate, the hips and knees are fully extended, and the soles of the feet are placed against a sliding board. Older children should have their shoeless standing height measured with a stadiometer with their heels and back touching the wall. Regardless of age, the head should be positioned so that the outer canthus of the eye is aligned with the external auditory canal and perpendicular to the measuring surface (Halac and Zimmerman, 2004). Children should ideally be weighed on the same scale at each visit. Infants should preferably be weighed nude; older children may wear light clothing but not shoes. Height and weight are then plotted on age- and gender-appropriate growth charts developed by the National Center for Health Statistics (NCHS) (see eFig. 23-1, A-H, and Web Resources).

Body mass index (BMI) is a reliable indicator of body fatness for most children and teenagers that is age and gender specific. A BMI less than the 5th percentile for age is underweight, from the 5th to 85th percentile is healthy weight, from the 85th up to 95th percentile is overweight, and the 95th percentile or greater is considered obese (CDC, 2009). BMI charts are also available from the same website.

Head circumference reflects the growth of the cranium and its contents. It should be determined and recorded at all routine physical examinations during the first 2 years of life. This also may be done as part of the initial examination at any age. A nonstretchable measuring tape (usually paper or flexible plastic) is used to obtain the greatest circumference encompassing the occipital, parietal, and frontal prominences. A small head circumference (microcephaly) may be familial; caused by craniosynostosis, congenital viral infections, fetal drug syndromes, or underlying structural abnormalities; or secondary to trauma, infection, or dysmorphic syndromes. A large head circumference (macrocephaly) most often is caused by hydrocephalus, but it may be familial, caused by intracranial bleeding or masses or thickening of the skull, or associated with fragile X syndrome and other conditions (Green, 1986).

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