LENGTH AND HEAD CIRCUMFERENCE MEASUREMENT

DOCUMENT TYPE: PROCEDURE

PurposeProcedure and responsibly of weekly infant measurements for the inpatient areas of the Neonatal Program.

ApplicabilityThe inpatient areas of the Neonatal Program.

Policy Statement This excludes admission measurements and critically ill infants as their measurements should be done in consultation with the core care team.

The determinant of length and head circumference is a routine component of care used on growth charts to compare and monitor an infant's measurements. Careful and precise measurements are essential to establish the size relative to gestational age of every infant. These measures are used, in addition to other parameters, to assess clinical and nutritional status of infants, and to both improve and optimize medical and nutritional interventions.

Equipment & SuppliesTape Measure

Infant Stadiometer (Length Board) For infants up to 50cm use the Stadiometer marked “Preemie” For infants 35cm or greater, use the Stadiometer marked “Newborn”

Procedure

Measured Weekly: Length and head circumference measurements are performed weekly by the family with help from the point of care nurse or by the point of care nurse each week on day “0”, the day the infant reaches a new week of gestational age (example: 35+0/7 weeks).

Measurement of length is a two person procedure: one person to hold the infant’s head, and the other to hold the infant’s legs.

Measurement of head circumference should be performed 3 times to obtain the occipito-frontal circumferences (OFC) and document the largest number collected. Antenatal head compression can result in overlapping sutures or molding which can impact the initial OFC. Document all relevant physical findings i.e. caput succedaneum, cephalohematoma, and other external signs of trauma (vacuum extraction or forceps marks)

Head Circumference:

STEPS RATIONALE1. Perform Hand Hygiene.

2. Performed during care of the infant. If infant is wearing a hat, the hat will need to be removed. A RRT may be needed to support measurement with ventilation equipment.

To cluster care. To ensure accuracy of the measurement and maintain ventilation support throughout.

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LENGTH AND HEAD CIRCUMFERENCE MEASUREMENT

DOCUMENT TYPE: PROCEDURE

3. Ensure the tape measure crosses the frontal bone and the parietal bones on each side, on top the occipital bone at the back of the skull.

To ensure accuracy of the measurement.

4. Place infant on a flat surface. If a flat surface is contraindicated due to clinical status, place the infant on the inclined bed.

5. Lift head and slip the tape measure underneath the head with the centimeter markings on the outside.6. Position around the fullest part of the head, above the ears, from the middle of the forehead to the midline of the back of the skull and ensure the start of the measurement “0” is at the front of the infant’s head.

For most accurate and ease of visualization of the measurement obtained.

7. Bring the tape measure up around the infant’s skull tautly, overlap the tape measurer and carefully slide the front of the tape measure down slightly to visualize the centimeter measurement seen at the overlap.

8. Repeat steps 3-7 twice for a total of 3 measures. The largest measure will be documented.

9. Remove the measuring tape and replace hat for thermoregulation or respiratory support as needed.

10. Perform Hand Hygiene.

11. Document the largest of the three measures appropriately.

Length:

STEPS RATIONALE1. This is a two person procedure at minimum. Additional assistance may be required dependent on the infant’s condition and equipment supports.

Infant comfort and patient safety.

2. Perform Hand Hygiene.3. Gather appropriate Stadiometer board For measurement accuracy. Less than 50cm in

length: preterm board. Greater than 35cm in length: newborn (term) board.

4. Clean Stadiometer board with appropriate cleansing wipe.

Infection precaution.

5. Perform Hand Hygiene.

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LENGTH AND HEAD CIRCUMFERENCE MEASUREMENT

DOCUMENT TYPE: PROCEDURE

6. Performed during care of the infant. If infant is wearing a hat this will need to be removed. A RRT may be needed to support measurement with ventilation equipment.

To cluster care. To ensure accuracy of the measurement and maintain ventilation support throughout.

7. Position the Stadiometer on a safe flat surface such as incubator or crib mattress. If a flat surface is contraindicated due to clinical status, place the infant on the inclined bed.

Patient safety.

8. Position the infant on the Stadiometer, with a blanket or sheet between the board and the infant, with the head against the fixed headpiece.

Thermoregulation and infection prevention.

9. One care provider (parent or staff) positions the infant’s head so it is touching the fixed headpiece, and the infant’s upper body is straight.

Infant comfort and measurement accuracy.

10. An additional care provider (parent or staff) gently straightens the infant’s legs, so that the knees are flat and the feet are at 90 degrees while sliding the foot piece towards the infant until contact is made with the soles of both feet.

Infant comfort, patient safety. Addition personal may be required for line and ventilator equipment management.

*Image only depicts single foot for visualization only. Please measure with both feet against the foot piece.

11. Note measurement obtained for further documentation and remove board and resettle the infant.

Infant comfort.

12. Perform hand hygiene. Infection prevention.

13. Clean with appropriate cleanser and return Stadiometer board.

Infection prevention.

14. Document appropriately.

C-06-12-60125 Published Date: 26-Mar-2019Page 3 of 4 Review Date: 26-Mar-2022

This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.

LENGTH AND HEAD CIRCUMFERENCE MEASUREMENT

DOCUMENT TYPE: PROCEDURE

DocumentationGrowth ChartsMeasures of length and head circumference are recorded on the gestational age-appropriate growth chart, including the date and gestational age at time of the measure.

For infants less than 40 weeks gestational age, use the Fenton Preterm Growth Chart For infants 40 weeks gestational age or greater, use the WHO Growth Charts for Canada

Patient & Family Engagement/EducationHead and length measurements provide both the opportunity for parental involvement and education. Engage the family to participate in the taking of the measurements and educate on the importance of measurement taking and the reflection of the infant’s nutritional status.

ReferencesCorkins, M.R., Balint, J., Bobo, E., Plogsted, S., Yaworski, J.A. (Eds.). (2015). The A.S.P.E.N. Pediatric Nutrition Support

Core Curriculum, 2nd Edition, Silver Spring, Md: American Society of Parenteral and Enteral Nutrition

Centers for Disease Control (2016) Anthropometry Procedures Manual, National Health and Nutrition Examination Survey (NHANES) Retrieved from https://www.cdc.gov/nchs/data/nhanes/nhanes_07_08/manual_an.pdf

AppendicesGrowth charts

Preterm infant: ePOPS 00.00 (BC Women’s) Fenton Preterm Growth Chart WHO Growth Charts for Canada (female) WHO Growth Charts for Canada (male)

Growth charts can be found in the Communication Center, and can be sent to the unit by the “Back Unit Clerk”

Version HistoryDATE DOCUMENT NUMBER and TITLE ACTION TAKEN24-Oct-2018 C-06-12-60125 Measuring Length And Head

CircumferenceApproved at: Neonatal Leadership Committee

DisclaimerThis document is intended for use within BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document.  This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA. 

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This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.