11/13/24, 7\:07 PM Guide | Paediatric growth assessment

Paediatric growth assessment

Table of contents

Background

Assessing growth is a key component of the paediatric exam. The measurement of height, length, weight and head
circumference appears deceptively simple but requires accuracy, adaptability of method and patience to ensure it is done
correctly.
With all children, don’t expect to follow a pre-de
involving parents, siblings and the toys available to you.

Introduction

Introduce yourself to the parents and the child, including your name and role.
Con
Explain what the growth assessment will involve and explain why the measurement is required\:
c h i l d' s h e i g h t ( o r l e n g t h ) , w e i g h t a n d h e a d c i r c u m f e r e n c e , w h i c h w i l l i n v o l v e t h e u s e o f s c a l e s , b o a r d - a s a p p r o p r i a t e ) a n d a t a p e m e a s u r e .
"
" T o d a y I’ d l i k e t o m e a s u r e y o u r
a s t a n d i n g r u l e r ( o r m e a s u r i n g
Gain consent from the parents/carers and/or child before proceeding\: “ A r e y o u h a p p y f o r m e t o c a r r y o u t t h e a s s e s s m e n t ?”
Wash your hands.

Length/height measurement

Children less than 2 years old should be measured supine (lying down, facing upwards).
Children unable to stand, or who
If the child is known to have one leg shorter than the other, they should be measured standing on the longest leg. They should
always be measured on the same leg.
The following should be removed\:
Shoes
Hair clips and braids (undo braids)
Orthopaedic braces

Supine length

Preparation
Two people are generally required to measure a child when supine.
Play and distraction techniques may be useful to keep the child comfortable and entertained during what can be a distressing
moment of measurement.
An appropriate measuring board/rollameter should be placed on a
Measurement of supine length
1. Lay the child on the board.
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2. One person should ensure the head is supported (in contact with the headboard) and is in the correct position (the corner
of the eyes horizontal to the middle of the ear – looking straight up at the ceiling). This is a great job for the parent/carer,
helping to also minimise distress for the child being held in this position.
3. The other person should position the child\:
Feet together
Heels touching the backplate of the measuring instrument
Legs straight and in alignment with the body
Buttocks against the backboard
Scapula against the backboard if possible
The ankles should be supported, and this position maintained
4. Record the measurement to the last complete millimetre. Don’t round up or down.

Standing height

Preparation
The positioning of the child/young person is crucial for the accurate measurement of height.
It is often helpful to involve the parent/carer in the measurement of the child to aid in positioning.
An appropriate stadiometer (standing ruler) should be used, with an accompanying 500-gram beanbag to weight the
headboard.
Measuring standing height
1. The measurer should be performed at a level that is eye to eye with the child.
2. The child should be positioned with\:
Their feet together and
Heels touching the backplate of the measuring instrument
Legs straight
Buttocks and scapula against the backboard
Arms loosely by their side
3. The child’s head should be positioned with the corners of their eyes horizontal to the middle of the ear, looking straight
ahead.
4. The weighted headboard should be placed carefully on the child’s head.
5. Hold the child’s mastoid processes to ensure they are in the correct position.
6. Ask the child to take a ‘ b i g b r e a t h i n’ and maintain pressure on the mastoids.
7. Ask the child to ‘ b r e a t h o u t n o r m a l l y’ and exert upward pressure on their mastoid processes. Ensure their feet and heels
remain on the ground. Don’t lift or overextend the child.
8. Once the child has fully exhaled, record the measurement to the last complete millimetre. Read at eye level. Don’t round
up or down.
N B . S i t t i n g h e i g h t o r C r o w n-r u m p l e n gt h m a y a l s o b e r e q u i r e d i n s o m e c h i l d r e n . a p p r o p r i a t e m e a s u r e m e n t g u i d e s .
S e e t h e ‘ F u r t h e r r e a d i n g’ s e c t i o n b e l o w f o r
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Measuring standing height using a stadiometer. (2)

Weight assessment

Preparation

A child is weighed naked up to 2 years old. Appropriate baby scales should be used (ensure the nappy is removed).
After 2 years of age, light clothes only should be worn. Shoes or slippers should be removed and pockets emptied of their
contents.
Appropriate sitting or stand on scales should be used.
If the child is weighed with additional equipment (i.e. splint/cast, medical equipment or dressing), this should be
documented.

Measurement

As with height/length, it is often easier if two people are involved in the process of weighing a child. This may include the
parent/carer if they are willing to assist.
Again, play and distraction techniques may be useful throughout the measurement of weight.
If appropriate, ask the parent/carer to place the child on suitable scales. The child must be placed completely on the scales
and their weight fully borne.
For a d i s t r e s s e d c h i l d , the carer can be asked to stand on the standing scales, the scales then zeroed with the carer still
standing on them, and the child handed to the parent. The scale should then show the child’s weight.
Alternatively, the child can be measured with the carer on sitting scales. The weight of the carer with the child should be
measured, then the carer’s weight subtracted.
Record the
children or if >4kg. Do not round the measurement up or down.
The child should then be redressed and left comfortable.
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Weighing infant on baby scales. (3)

Head circumference measurement

A Lasso-o™ is the recommended equipment used to measure head circumference as per RCPCH guidelines.
The child’s hairstyle should allow for accurate measurement (i.e. remove plaits or braids and remove any hair adornments). If
these are not removed – this must be documented.

Measurement

Preparation
Again, play and distraction techniques may be useful throughout the measurement process.
Before using the measuring tape\:
Consider the general clinical condition (e.g. is the child irritable or vomiting).
Observe the state of the fontanelle (open, closed, full, tense, soft or dipped).
Note the shape of the child’s head (i.e. craniosynostosis, or a low hairline, e.g. S a e t h r e-C h o t z e n s y n d r o m e ).
Measurement of head circumference
1. Loop the Lasso-o™ and place over the child’s head.
2. The tape should be placed above the ears and midway between the eyebrows and the hairline, to the occipital
prominence at the back of the head (the aim is to measure the largest circumference possible).
3. Pull the Lasso-o™ or measuring tape taut so that any hair is compressed.
4. Read the measurement from the appropriately marked place. This should be taken to the nearest millimetre.
5. Repeat the procedure above to ensure the accuracy of the measurement.
If the child does have an abnormally shaped head, the tape should be placed over the largest measurable circumference. This
should be documented against the recorded measurement.
A separate head circumference chart is available for children with achondroplasia and trisomy 21.
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Measuring head circumference. (4)

To complete the assessment...

Explain to the child and parents that the assessment is now
Ensure the child is re-dressed after the examination.
Thank the child and parents for their time.
Explain your
Ask if the parents and child (if appropriate) have any questions.
Wash your hands.
Report/record Growth Chart Documentation
guide for further instructions on appropriate documentation).

Reviewer

Dr Sunil Bhopal
Senior Paediatric Registrar

References

Text references

Southern, L (2017). Height\: measuring a child/young person. C l i n i c a l G u i d e l i n e s - G r e a t O r m o n d S t r e e t H o s p i t a l f o r C h i l d r e n
N H S F o u n d a t i o n T r u s t . Accessed 28 March 2019. [LINK]
Southern, L (2017). Weight\: measuring a child/young person. C l i n i c a l G u i d e l i n e s - G r e a t O r m o n d S t r e e t H o s p i t a l f o r C h i l d r e n
N H SF o u n d a t i o nT r u s t Accessed 28 March 2019 [LINK]
Source\: geekymedics.com
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