Best practice measurement

Best practice growth assessment requires accuracy in measuring and plotting. MCH nurses should consider using Key Ages and Stages consultations for assessment of growth.

Accuracy in measuring and plotting

Small errors, particularly in measuring or recording growth parameters in young children can have a large impact on the growth assessment. For example, an error of 0.5 kg can result in a child being assessed as being on the 10th to less than the 5th centile.

Measurements are compared to a given reference chart to allow the practitioner to assess whether the child's growth is adequate, below or above that expected for his/her age.

Accurate weighing and measuring needs standardised techniques and equipment calibrated and serviced according to manufacturer's advice. See: Equipment for Weighing and Measuring Children (pdf - 103.56kb)

Child weight, length, height, head circumference and BMI are monitored in MCH practice as per Maternal and Child Health Service: Practice Guidelines 2009 (pdf - 791.74kb)

Measurement guidelines

Head circumference

Measurement of head circumference is important in infants as it allows detection of abnormalities of head growth, which are usually due to non-nutritional factors.

For more information, see: Maternal and Child Health Service: Practice Guidelines 2009 (pdf - 791.74kb)

Equipment

  • Head circumference should be measured using a flexible, non-stretchable measuring tape or disposable paper tape.
  • Ensure the tape is clean after each use.
  • Replace the plastic tape at least yearly, or more often if needed.
  • 0.5 - 1.0 cm width and 0.1 cm increments.

Preparation

Sit the child on the carer's lap facing you. Very young infants may be measured lying down.

Procedure

  • Place the tape around the head at points just above the eyebrows, above the ears and around the occipital prominence at the back of the head.
  • Pull the tape gently to compress the hair.

Recording

  • Record head circumference to the nearest 0.1 cm.
  • Plot on the WHO Head circumference growth chart.
Weight

Weighing children less than two years

Equipment

  • Use a levelled pan scale.
  • Either high quality electronic digital or beam balance.
  • Portable or 'fixed' options are suitable.
  • Scale should weigh up to 20 kg, in 0.01 kg (10 gm) increments.
  • Tray needs to be large enough to support children up to two years of age.
  • Motion detector and stabilizer.
  • No length or stature device should be attached because they do not have a stable platform.
  • Clean the scales regularly.

Service the scale (including calibration) according to manufacturers' guidelines. This is usually annually or more frequently if the scales are moved regularly; or there are concerns about accuracy

Preparation

  • Place a sheet/paper towel on the scale.
  • Child is undressed with nappy removed.

Procedure

  • Turn on scale and 'tare' to zero.
  • Ask the parent to place the baby in the centre of the scale and ensure that weight is evenly distributed.
  • Weigh with parent/carer on a platform scale if unable to weigh alone. This can be done either using a scale which can be 'zeroed' after the parent/carer stands on them (a 'taring' scale) or by subtraction as follows:
  • For example: 60 kg parent/carer and 6.5 kg child.

    1. Weigh parent/carer and record weight = 60kg.
    2. Weigh parent/carer with child = 66.5 kg.
    3. Difference is the weight of the child. e.g. 66.5 - 60 = 6.5 kg.

Recording

  • Wait until the scales settle at a reading.
  • Record weight to the nearest 10 grams.
  • Make a note if the child is in plaster, harness or any other item unable to be removed.
  • Plot on the WHO weight for age growth chart.

Children less than two who can stand without assistance may be weighed on either infant or platform scale.

Weighing children two years and over

Equipment

  • Scales for weighing children can be either high quality beam balance with movable weights, or high quality electronic (link to equipment handout resource).
  • Weighs in 0.1 kg (100 gm) increments and can be 'locked' in.
  • The scale can be easily 'zeroed'.
  • Weight is read at 'eye level' of measurer.
  • Stable weighing platform which is large enough to support the child.
  • No length or stature device should be attached because they do not have a stable platform.

Service the scale (including calibration) according to manufacturers' guidelines. This is usually annually, or more frequently if the scales are moved regularly, or there are concerns about accuracy.

Preparation

  • Place the scale on a firm surface (not carpet).
  • Explain to the child that you are measuring their weight.
  • Make sure that any outer heavy clothing such as a coat, jacket or jumper is removed. Light clothing can be worn.
  • Remove hats, hair ties and items in pockets such as toys or stones.
  • Help the child to remove their shoes.

Procedure

  • Turn the scales on and wait until they zero.
  • Ask the child to stand on the middle of the scales, looking straight ahead.
  • You may need to move them into the right position.
  • Check the child is not holding onto a wall or table; and arms are at their side.
  • Ask the child to look straight ahead and stand still.
  • Wait until the scales settle at a reading.

Recording

  • Bend down if necessary to read the scale at eye level.
  • Record weight to the nearest 100 grams.
  • Plot weight on the CDC weight for age growth chart.
Length and height/stature

Length measurement for children less than two years

Equipment

  • Length is measured in the recumbent position using an infantometer (infant length board) designed for the purpose.
  • The board should have a firm, flat horizontal surface with a measuring tape in 1 mm (0.1 cm) increments.
  • The tape or measurements should be fixed, and easily read.
  • The device has a fixed head-board at right angle to the tape.
  • And a smoothly-moving foot-board perpendicular to the tape.

Preparation

  • Remove the child's shoes and socks if applicable.

Procedure

  • Ask the parent/carer to place the child on the lengthboard.
  • The child should be facing vertically upwards with the crown of the head firmly on the headboard.
  • Ensure the child's body and pelvis are straight along the measuring device.
  • Parent holds the child's head against the immovable headboard.
  • A second person straightens both of the child's legs, holds the feet with toes pointing directly up and moves the foot-board into position against the child's feet.

Recording

  • Record length to the nearest 0.1 cm.
  • Complete the measurement quickly.
  • Plot length on the WHO length chart.
  • Record whether length or height/stature has been measured because length is greater than height/stature by up to 2 cm.

Height/stature measurement for children 2 years and older

Equipment

  • Height is measured in the standing position using a stadiometer (height measurer) or a correctly installed 'pull down' measure which are designed for the purpose.
  • A stadiometer consists of a vertical board with an attached metric ruler with an easily moveable horizontal headboard that can be brought into contact with the most superior part of the head; ideally spring loaded.
  • The equipment has a wide and stable platform, or firm uncarpeted floor as the base.
  • Equipment should be accurately and firmly mounted on a wall.
  • Ensure that fixed position devices have been installed correctly, and re-check after moving or re-location.
  • Should have an easy to read, stable tape or digital readout in 0.1 cm increments.

Preparation

  • Show the child the stadiometer / height measurer and explain you are going to see how tall they are growing.
  • It can be helpful to measure the parent first if the child is hesitant.
  • Take the child over to the height measurer and make sure they face away from the equipment.
  • Assist the child to remove their shoes.

Procedure

  • Ask or help the child to stand facing away from the stadiometer or wall:
    • with bare feet close together
    • legs straight
    • arms at sides and shoulders relaxed.
  • Ask the child to look straight ahead 'like a soldier', and take a big breath in and out to relax, but do not extend the mastoid process.
  • Check that their arms are by their sides, and shoulders relaxed.
  • Double check their position, making sure their knees are straight, heels on the floor and head, shoulder blades, bottom and heels are in contact with the stadiometer or the wall.
  • Bring the measuring device down to rest on the child's head.
  • Crouch down so your eye is level with the height.

Recording

  • Record height to the nearest 0.1 cm
  • Plot height on the CDC height for age growth chart
  • Record whether length or height / stature has been measured because length is greater than height/stature by up to 2 cm.

Length versus height/stature measurement for the 2 year old child

  • In Maternal and Child Health practice, a child's height / stature is measured at two years and over
  • If height / stature cannot be measured, the child can have length measured (in recumbent position).
  • Record whether length or height / stature has been measured because length is greater than height/stature by up to 2 cm.
  • Use the appropriate growth chart to plot growth. WHO chart for length and the CDC chart for height/stature.

Using the Key Ages and Stages consultations (MCH nurses) for assessment of growth

Assessment of the growth and the physical health of children is an important component of the Maternal and Child Health (MCH) Service. The MCH Key Ages and Stages consultations provide an opportunity for the MCH nurse to review growth, provide information relating to growth and refer to appropriate agencies as needed.

In the 2010-2011 MCH Annual Report, counselling sessions about child growth accounted for 18 per cent of all counselling sessions with families about child health and wellbeing and six per cent of all child health and wellbeing referrals.

Anticipatory Guidance underpins the MCH Key Ages and Stages framework. It is intended to be complimented by opportunistic activity by MCH nurses, on the basis of their clinical judgement, in response to other parental concerns and nurse observation.

Discussion with parents

Discussions with parents about their child's growth are just as important as correctly measuring children.

Maternal and Child Health Nurses are well regarded by parents and the broader community for their expertise in growth monitoring of children from birth to school entry.

Sensitivity in discussions about child feeding and growth are used, irrespective of the growth chart used.

Best practice growth monitoring requires:

  • accurate measurements
  • high quality, calibrated equipment
  • accurate plotting
  • a working understanding of the chart used
  • correct interpretation of a child's pattern of growth
  • sensitivity in discussions about child's growth with the parent/carer and agreeing on actions
  • referral for medical assessment if concerns arise
  • ongoing monitoring and follow-up as required.