Growth monitoring in child in manesar gurgaon

Growth denotes increase in physical size of the body and development denotes improvement in skills and function of an individual. Together they denote physical, intellectual, emotional and social well being of a person.

Growth monitoring in child in manesar gurgaon

Normal growth and development is observed only if there is proper nutrition, without any recurrent episodes of infections and if there is freedom from adverse and environmental influences.

Growth monitoring in child in manesar gurgaon

Determinants of growth and development

Growth monitoring in child in manesar gurgaon

• Genetic inheritance - especially height, weight, mental, social development and personality.
• Nutrition before and after birth - Retardation in an infant indicates malnutrition.
• Age - Growth rate is maximum during fetal life, first two years of life and during puberty.
• Sex - Men usually are larger in size than women. During puberty girls grow fast and earlier than boys, but boys grow more.
• Infections and infestations - Infection with TORCH during intrauterine life retards growth of fetus. Recurrent infections like diarrhea and measles especially in a malnourished child will adversely affect the growth.
• Growth monitoring in child in manesar gurgaon
• Physical surroundings - Sun shine, good housing, lighting ventilation have their effect on growth and development.
• Psychological factors - Love, tender care and proper child parent relationship are all found to influence growth in a child.
• Economic factors - Higher the family income better is the nutritional status of an infant.
• Growth monitoring in child in manesar gurgaon
• Other factors - Birth order, Birth spacing, Education of parents (higher the educational level better the growth).

Growth monitoring in child in manesar gurgaon

Assessment of nutritional status

2.1 Normal growth

• In children, parameters used to measure growth are weight in kilograms, height in meters and head and chest circumferences. Assessment can be longitudinal where serial measurement of the same child is recorded over different periods of time or cross-sectional where recorded measurement is compared to that of his peers.
• Growth monitoring in child in manesar gurgaon
• In India, we are using the new WHO child Growth Standards (2006) for children. However values differ substantially among adults of different ethnic groups. We have ICMR values as Indian standard.
• Growth monitoring in child in manesar gurgaon

2.2 Physical growth

2.2.1 Weight

Most widely used and simplest, reproducible anthropometric measurements for the evaluation of nutritional status.

Growth monitoring in child in manesar gurgaon

• It indicates body mass
• It is sensitive to even small changes in nutritional status due to childhood morbidity like diarrhea.
• Rapid loss of weight indicates a potential malnutrition
• Growth monitoring in child in manesar gurgaon
• Serial weight recording is more valuable for progressive growth of a child when age of a child is not known.

Technique for measurement

To measure weight beam or lever accentuated scales with an accuracy of 50-100 g are preferred. Portable Salter scale (CMS Weighing Equipment, Ltd. England): the child is suspended from the scale which is hung from a branch or a tripod. Special "pants" are used to weigh babies. Robust, cheap, and easy to carry, these scales should be replaced after one year because of stretching of the spring and inaccurate readings. The model with readings up to 25 kg (x 100 g) is recommended.

Growth monitoring in child in manesar gurgaon

Bathroom scales are not recommended as errors up to 1.5 kgs can occur with this.

Precautions to be taken while weighing

Growth monitoring in child in manesar gurgaon

• Zero error has to be adjusted.
• Minimal clothing should be worn and be without shoes.
• While recording the value do not lean against or hold anything.
• Preferably record under basal conditions in early morning.
• Most types of scales (especially beam scales) are sensitive to dust and mud.
• Growth monitoring in child in manesar gurgaon

Standards

Growth monitoring in child in manesar gurgaon

• On an average, a baby weighs double the birth weight by five months, trebles its birth weight by one year and quadruples its birth weight by two years.
• Growth monitoring in child in manesar gurgaon
• A baby should gain at least 500g per month in the first three months of life. If the growth is less than this it points to malnutrition. In different parts of India, the average birth weight is between 2.7 to 2.9 kgs.
• Weight for age is used to classify malnutrition.
• Growth monitoring in child in manesar gurgaon

2.2.2. Height

• Height of an individual is influenced by genetic as well as environmental factors.
• Maximum growth potential is decided by genetic factors.
• Nutrition and incidences of infection determine the extent of exploitation of that genetic potential.
• Growth monitoring in child in manesar gurgaon
• Inadequate dietary intake and/ or infections reduce nutrients available at the cellular level.This results in growth retardation. A prolonged period of severe deprivation leads to stunting.

Technique for measurement

• Children below two years are measured by using an infantometer.
• Baby is made to lie on the scale and crown heel length is measured.
• For children above two years and adults a vertical measuring rod anthropometer- is used and maximum height is measured.
• Measuring scale should be capable of measuring to an accuracy of 0.1 cm.
• Growth monitoring in child in manesar gurgaon

Standards

• Length of the baby at birth is 50 cm.
• By first year it increases by 50% to 75cm.
• By third year end it increases by 12cm.
• During puberty, growth spurt, boys add 20cm to their height and girls gain about 16 cm.
• Indian girls reach 98% of their final height by 16.5 yrs. and boys reach the same stage by 17.75 yrs.
• Growth monitoring in child in manesar gurgaon
• Low height for age indicates nutritional stunting or dwarfing. It reflects past or chronic stunting. Cut off point for diagnosis of stunting is 90% NCHS values.
• Growth monitoring in child in manesar gurgaon

2.2.3. Mid upper arm circumference

• Mid upper arm circumference and calf circumference indicate the status of muscle development. Mid calf and mid upper arm are heavily muscled and is approximately circular.
• Mid upper arm circumference is simple, easily accessible in any age and sex and practical to measure.
• Growth monitoring in child in manesar gurgaon
• Well-nourished children have a nearly constant arm circumference (about 16 cm) between 1 and 5 years. Undernourished children have a thinner upper arm and a smaller AC.
• Children can be classified as malnourished if their AC falls below an arbitrarily specified level. If ages are not known, AC can be related to height (arm circumference or height).
• Growth monitoring in child in manesar gurgaon
• As poor musculature and wasting are cardinal features of PEM in early childhood, MUAC helps in identifying malnutrition and in determining mortality risk in children. It correlates well with weight, weight for height and clinical signs.( QUAC stick).

Technique

• Usually left arm is measured. Arm is flexed at the elbow.
• The circumference is measured on the left upper arm half way between the end of the shoulder (acromion and the tip of the elbow (olecranon). To locate this point, the arm is flexed at a right angle. Then the arm is allowed to hang freely and a tape-measure (preferably of fibreglass) put firmly round it. Do not pull too tight.
• Growth monitoring in child in manesar gurgaon
• Tapes or strips can be made locally from thin cardboard or X-ray films which are marked in centimeters. Special plastic tapes (insertion tapes) have been manufactured.
• Fibre glass tape is preferred to tailors cloth tape as it is seen to lose accuracy.

2.2.4 Body Fat

• Subcutaneous fat constitutes body's main store of energy reserves. Muscle and fat constitute the soft tissues that vary most with a deficiency of protein and calories.
• Many accurate and near accurate methods like densitometry and DEXA but physical anthropometry using skin-fold calipers are practicable in field circumstances to determine the nutritional status of a person.
• For this a standard skin fold caliper has to be used. The skin fold measured consists of a double layer of skin and subcutaneous fat.
• For adults multiple sites are selected like triceps, the abdomen and the sub scapular and subcostal sites. By using different formulae we can derive at the amount of total body fat.
• Growth monitoring in child in manesar gurgaonIn young children, the triceps skin-fold is used. The site is exactly at the mid upper arm as determined by the method used for mid arm circumference.
• The technique needs prolonged supervised practice and repetition to obtain reliable and reproducible results.
• Values differ in different communities thus necessitating local standards for comparisons.Hence it is used mostly by researchers and academics in the field.

Growth monitoring in child in manesar gurgaon

Growth monitoring in child in manesar gurgaon

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