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ANTHROPOMETRIC MEASUREMENT AND GROWTH
MONITORING IN NORMAL CHILDREN
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Anthropometric Measurement
A part of well baby clinics
To detect growth faltering
To measure the prevalence of under nutritionand over nutrition
To identify groups with increased nutritionaland health need.
Growth chart application CDC Growth charts
WHO growth charts, 2005
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Is my child growing well ?
Is my child growing well ?
Is my child short ?
What should be done to make my childtaller ?
Is children growth in different manner
If the parents are short, will all mychildren became short ?
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Evaluation of growth
Anthropometry: reliability
training
equipment Plotting
Absolute height
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Evaluation of growth
Height velocity
Measurement at 6 mos interval
Deceleration / crossing centiles age 3-12 yrs: indicates
pathologic until proven otherwise Normal velocity indicates normal growth
Weight / height relationship
W/H ratio: suggestive endocrine causes
W/H ratio: suggestive systemic disease
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Growth Phase
Infants
Deceleration
50% during 1styear
25% of 1styear growthduring 2ndyear
Childhood
Constant 5-7 cm / year
Puberty
Acceleration
Deceleration
Halt
Interaction between GH andsex steroids
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Growth monitoring
Effective growth monitoring needs
Precise measurement
Accurate plotting on a chart Correct interpretation
Plan of investigation
School entry measurement best
opportunity to detect growth disorder
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Periodic assessment of child growth
Maintain or improve growth and health
Growth monitoring should not be a stand aloneactivity, but part of broader community basedprogramme to improve primary health care,education and sanitation.
Growth monitoring
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NORMAL GROWTH :
When weight and height/length track along similarpercentiles or growth channels
Canadian Pediatric Society, Dietitians of Canada and Health Canada. Nutritional for healthyinfants, Minister of Public Works and Government Services, 1998
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Hal-hal yang perlu dipantau dalam
pertumbuhan seorang anak
2 tahun pertama kehidupan:
Tinggi badan (TB/U), Berat badan (BB/U), BB/PB,body mass index (BMI/U), dan lingkar kepala(LK/U)
Usia 2-10 tahun:
TB/U, BB/U, dan BMI/U
Usia > 10 tahun: Hal-hal diatas (2-10 th)
Penilaian perkembangan status pubertas anak
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Measuring Body Weight
Electronic digital scales, calibratedin metric units are recommended.Chair scales are available for thosewho are not capable of standing.
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Weight Measurement
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Weight Measurement
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Measuring Growth in Length and
Stature Recumbent lengthis measured from birth until a
child is able to stand
Measured from the vertex (highest point on skull) to the
soles of the feet
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Length Measurement
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Height Measurement
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Measuring height
Measuring height is subject to error as aresult of
poor technique,
variations between instruments and observers,
diurnal variation
plotting mistakes
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Single height measurement
Will identify only stature
Very short/tall child
Will not identify process of growth
Children growing slowly (CHD)
Turner syndrome
Acquired disorder : hypothyroidism, coeliac disease
Children growth crossing centiles
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How many times height should be
measured ?
Consensus
Routinely up to 2 years 0.5, 1, 2, 4, 6, 9, 12, 18, 24 mos
Every 6 month up to 6 years
Every year up to 18 years
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Additional parameter for
evaluation of growth
Target height Boy = Fh+(Mh+13)
2
Girl= (Fh-13)+Mh
2
Mid parental height
Genetic height potential
Prediction of final height
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5 Directory of Growth
1. Catch-up growth
2. Normal growth
3. Growth faltering4. Flat growth
5. Loss of growth
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Algorithm of Growth Monitoring
Weighing
Plotting
Make curve
Interpretation
Increase
Not Increase
Identification of the problem
Solution
Evaluation
Not Increase
Catch-up Growth
Normal Growth
Growth Faltering
Flat GrowthLoss of Growth
Increase
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Indices derived from growth
measurement Constructed from two or more raw
anthropometric measurement and are simplenumerical ratio
Weight / Height 2 (BMI)
W for A : H for A : W for H
Essential part of the interpretation ofanthropometric measurement
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CDC GROWTH CHARTS
CDC G th Ch t
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CDC Growth Charts
Based on American population 1977
White
Hispanic
Black
Asian
First growth chartswithout BMI charts,
then in 2002 BMI is included
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WHO growth charts
Based on 18 cities in the world
First part2005
Only for 1
5 years boys and girls
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Nutricia workshop, 16 sept 2006 Malang
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IMT WHO dan CDC
Nutritional
Status
IMT WHO
2006
(0-5 th)
IMT WHO 2007
(5-19 th)
IMT CDC
2000
(2-20 th)
Obesitas > +3 > +2 SD > P 95Overweight +2 SD s/d +3
SD> +1 SD P 85 p 95
Normal -2 SD s/d +2
SD
-2 SD s/d +2 SD P 3 - < p 85
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Rekomendasi Klasifikasi Status Gizi
Status Gizi BB/TB
(% median)
BB/TB
WHO 2006
IMT CDC
2000
Obesitas > +3 > P 95
Overweight > +2 SD hingga +3 SD > P 85 P 95
Normal >90% -2SD hingga +2 SD
Gizi Kurang 70-90% -2 SD hingga -3 SD
Gizi buruk < 70% < - 3SD
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Indikator Pertumbuhan
Z-score TB/PB menurut
usia
BB menurut
usia
BB/PB atau BB/TB BMI menurut usia
>3
>2
>1
0 (median)
Di bawah
-1
Di bawah
-2
Di bawah
-3
Pendek(stunted)
Sangat pendek
(severely
stunted)
BB kurang(underweight)
BB sangat
kurang
(severely
underweight)
Sangat gemuk
(obese)
Gemuk
(overweight)
Kemungkinan
risiko overweight
Kurus (wasted)Sangat Kurus
(severely wasted)
Sangat gemuk
(obese)
Gemuk
(overweight)
Kemungkinan
risiko overweight
Kurus (wasted)Sangat Kurus
(severely wasted)
Interpretasi Indikator Pertumbuhan WHO
Child Growth Standards
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2014 03 01
2013 02 01
1 01
usia kronologis
01
Usia 1 th / 12 bln
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