The rates of weight gain and increase in body length of the child for each month. Optimal nutrition during these periods of a child's life. The growth and weight norms of children are approximate, deviations from the norm do not mean pathology, but this is a reason to observe the child and his health. The exact height and weight norms for boys and girls under one year old are presented in centile tables.
Table of average anthropometric data of children in the first year of life
| Age | Body weight in (g) | Weight gain per month (g) | Body length (cm) | Growth gain per month (cm) | Head circumference (cm) | Chest circumference (cm) |
| birth | 3100-3400 | - | 50-51 | - | 34-35 | 32-34 |
| 1 month | 3700-4100 | 600 | 54-55 | 3 | 36-37 | 35-36 |
| 2 month | 4500-4900 | 800 | 55-59 | 3 | 38-39 | 37-38 |
| 3 month | 5200-5600 | 800 | 60-62 | 2,5 | 40-41 | 39-40 |
| 4 month | 5900-6300 | 750 | 62-65 | 2,5 | 41-42 | 41-42 |
| 5 month | 6500-6800 | 700 | 64-68 | 2 | 42-43 | 43-44 |
| 6 month | 7100-7400 | 650 | 66-70 | 2 | 43-44 | 45-46 |
| 7 month | 7600-8100 | 600 | 68-72 | 2 | 43,5-44,5 | 45,5-46,5 |
| 8 month | 8100-8500 | 550 | 69-74 | 2 | 44-45 | 46-47 |
| 9 month | 8600-9000 | 500 | 70-75 | 1,5 | 44,5-45,5 | 46,5-47,5 |
| 10 month | 9100-9500 | 450 | 71-76 | 1,5 | 45-46 | 47-48 |
| 11 month | 9500-10000 | 400 | 72-78 | 1,5 | 45,5-46,5 | 47,5-48,5 |
| 12 month | 10000-10800 | 350 | 74-80 | 1,5 | 46-47 | 48-49 |
Detailed centile tables of the child's height and weight, which your pediatrician is guided by (click on the necessary link):
for boys >> for girls >>.
Guidelines for mom for the height and weight of the child
The first month of a newborn's life
Physical development. By the end of the month, weight gain is an average of 600 g; increase in height - by 3 cm, increase in head circumference - by 1-1.5 cm
Nutrition. Optimal is breast milk. 6 feedings every 3-3.5 hours. Night break - 6 hours. With artificial feeding - milk mixtures from 80 ml at the beginning to 100-120 ml per feeding.
The second month of a baby's life
Physical development. Weight gain - on average 800 g, increase in height - by 3 cm, head circumference - by 1.5 cm.
Nutrition. 6 feeds every 3.5
The third month of a child's life
Physical development. Weight gain by an average of 800 g, increase in height by 2.5 cm, head circumference by 1.5 cm.
Baby food. 6 feedings every 3.5 hours, 130-150 ml each
Possible problems. 1. Asks for food irregularly - more often, less often, in the middle of the night. In the first months, go to meet him, with breastfeeding, a healthy baby develops the necessary rhythm by this time. In case of artificial deviations from the schedule, it is permissible within 20-30 minutes.
2. Intestinal colic is disturbed. Prevention and assistance: laying on the stomach before meals, stroking the abdomen clockwise, warmth on the stomach (warmed diaper), special children's herbal teas with fennel, chamomile; position - upright in the arms of an adult after feeding.
The fourth month of a child's life
Physical development. The average weight gain is 750 g, an increase in height is 2.5 cm.Starting from this month, each subsequent increase in body weight usually decreases by 50 g.
Psychomotor development. She rejoices, seeing her mother, turns her head to the side, from where a voice is heard, the ringing of a rattle. With the gentle treatment of an adult, he perks up, laughs loudly, raises his hands, waves them.
Nutrition. 6 feedings every 3.5 hours, 150-170 ml each.
The fifth month of a child's life
Physical development. Weight gain - 700 g, increase in height - 2 cm. The total body weight doubles compared to the original.
Psychomotor development. He freely takes the toy from the hands of an adult, holds it, turns from his back to his stomach, stands straight with support under the armpits, hums melodiously, eats semi-liquid food from a spoon.
Nutrition. When feeding with mixtures as close as possible to breast milk, in addition, he is just beginning to try juices and fruit puree. The introduction of yolk and cottage cheese, according to the latest recommendations, is attributed to a later date. Breastfed - only mother's milk is recommended.
The sixth month of a child's life
Physical development. Weight gain - 650 g, increase in height - by 2 cm. Indicators of harmonious development: shoulder width is 1/4 of the body length. The circumference of the chest is greater than the circumference of the head.
Psychomotor development. Lying on his stomach, raises his head and shoulders high, turns from his stomach to his back, engages in a toy for a long time, transfers it from one hand to another, begins to pronounce the first syllables.
Nutrition. From the middle of the month - complementary foods with vegetable puree, gradually bring from a teaspoon to 180 g by 7 months. For a full serving, you can - 5 g of butter or vegetable oil. You can already juice (you can, but it is not necessary) - up to 50 ml in 2 doses, fruit puree - up to 50 g. Various juices and purees, start everything new with reduced portions.
From the end of the fifth - beginning of the sixth month, the transition to 5 meals a day after 4 hours. The total volume of food is no more than a liter.
Possible problems. Previously unnoticed neurological abnormalities may appear, the child lags behind in the development of movements, smiles little or does not at all, does not respond to affectionate speech, throws his head back sharply, rolls his eyes in fright so that the pupil is almost invisible. Neuropathologist consultation is required.
The fourth month is the typical time for rickets to appear. The most obvious symptom is increased sweating of the head, palms and feet. Necessary measures: to increase the stay in the fresh air, to carry out a course of treatment with vitamin D as prescribed by the doctor.
The seventh month of a child's life
Physical development. Weight gain - 600 g; increase in height - 2 cm.
Psychomotor development. For a long time he is engaged in toys, loves to knock them, swing them, throw them. It begins to crawl, by the end of the month it confidently moves on all fours.
Nutrition. 5 feedings after 4 hours. You can start gradually introducing a second complementary food - porridge (in the second morning feeding).
Eighth month of a child's life
Physical development. Weight gain - 550 g; increase in height - 2 cm.
Psychomotor development. He sits down and lies down, gets up, holding on to the barrier, stands, steps over. Fulfills requests: "make goodies", "give me a pen." Drinks from a cup held by an adult.
Nutrition. 5 feedings after 4 hours. In addition to the fourth feeding (at 6 pm), you can pound cottage cheese with milk or fruit puree, starting from one to 3 teaspoons. From the middle of the month, you can add hard-boiled yolk to the vegetable puree, starting with crumbs up to 1/4
The ninth month of a child's life
Physical development. Weight gain - 500 g; increase in height - 1.5 cm.
Psychomotor development. To the question "Where?" finds several familiar objects regardless of their location. Knows his name. Imitating an adult, repeats syllables after him, reproduces intonation.
Nutrition. 5 feedings after 4 hours. The main food is breast milk (or formula milk for a bottle-fed baby). Add mashed meat puree from lean pork, beef to vegetable puree (third feeding at 2 pm), starting from a teaspoon to 50 g (serving with vegetable puree - 220-250 g). Give the yolk with porridge.
Possible problems. Allergic reactions to any foods introduced into the diet: inflammation, redness of the skin of the cheeks, various rashes, itching, anxiety. Eliminate the most likely allergens - eggs, strawberries, carrots and other red and orange fruits and vegetables, chicken meat, cow's milk. Finding out what the child does not tolerate, keep a food diary, write down what he ate and what reactions have appeared, do not give two new foods in one day.
The tenth month of a child's life
Physical development. Weight gain - 450 g, increase in height - by 1.5 cm.
Psychomotor development. At the request of an adult, he acts in a variety of ways with objects: he closes and opens the box, puts the bowl one into the other, takes it out of the bowl or box, puts them back. Can take a small object with tweezers with two fingers - thumb and forefinger.
Nutrition. In the fourth feeding (at 6 pm), gradually replace milk or mixture with kefir plus 40 g of cottage cheese. The total amount of juice by this age can already be brought to 70 g (in two steps), fruit puree - 60 g.
The set of products remains the same. Porridge can be diversified by making an assortment of different cereals, adding fruits to them: an apple, a banana, berries, 5 g of butter is put in the porridge, 5 g of vegetable oil in mashed potatoes. With a tendency to constipation, plum and peach puree is useful.
Eleventh month of a child's life
Physical development. Weight gain - 400 g, increase in height - by 1.5 cm.
Psychomotor development. Stands alone, takes the first steps. On request, he finds a ball, a watch, a typewriter. Puts on the pyramid rings, takes them off. Knows how to place a cube on a cube. Pronounces the first designation words: "give", "na", "av", "ba".
Nutrition. When breastfeeding, one (preferably morning) feeding can be replaced with kefir, meat puree can be gradually replaced with a soft meatball, a steam cutlet. If there is no diathesis, by the end of the month, once a week, instead of meatball, give a fish meatball, mashed boiled fish.
The twelfth month of a child's life
Physical development. By the year the initial (at birth) weight of the child triples, the total increase in height is 25 cm,
Psychomotor development. Recognizes an adult acquaintance from a photograph. Carries out instructions - "bring", "find", "give". Easily repeats new syllables for adults, pronounces up to ten simplified words. Knows the word "no".
Nutrition. For mashed potatoes with meat or fish, you can offer a little salad of grated or finely chopped vegetables or a vinaigrette. Give cottage cheese in the form of pudding, casserole. Since the child wakes up later, the whole mode is shifted 1-1.5 hours forward. The last breastfeeding can also be replaced with kefir, and if the child is sleeping peacefully by this time, cancel it altogether.
Possible problems with the child
1. The child does not chew, chokes in lumps; nervous children may develop habitual vomiting. More thorough grinding is not an option. The main measure: to stimulate the child's interest in food, his independence and activity, giving a spoon in his right hand, in his left hand - a piece of bread, carrots (if there is no diathesis), cauliflower, a slice of cucumber, a quarter of a peeled apple.
2. The child does not like to sit on the potty. Check if it's comfortable. Not being overly persistent can increase protest. To offer the procedure calmly, benevolently, at the moment of the greatest probability of success - after sleep, 15-20 minutes after eating. Do not blame for the lack of results. Wear diapers only for a walk.
According to the WHO recommendation, breastfeeding is recommended to be maintained for at least a year (at least 1 feeding during the day), and preferably up to 3 years and longer. But according to the recommendation of the Association of Gynecologists, breastfeeding for more than 1.5-2 years can lead to health problems for a nursing mother. Health to you and your children!
The main anthropometric data of children are body weight, height, head circumference, skinfold thickness, shoulder and hip circumference, body mass index.
Body mass
This is a very simple measurement and is often very poorly measured. Newborns should be weighed naked, and children should be weighed in the minimum amount of clothing [subject to shyness]. A wet disposable diaper can weigh up to 450 g, a child's indoor clothing, including sneakers and jeans, about 1.5 kg, while the annual increase at school age is 2-3 kg per year. All scales for measuring anthropometric data of children should be calibrated and checked regularly. A reluctant child can be weighed in the arms of the mother on an electronic scale - the mother is on the scale.
Body length and height
In children under 2 years of age and children with motor impairments, the measurement of body length is usually carried out in the supine position. The measurement is carried out by two people, more often the mother of the child and the auxologist (who assesses the anthropometric data of children). The head is fixed at the head board, the face is turned straight. Gently unbend the hips and knees and draw them to the footboard, pressing the feet at a 90 ° angle.
Standing height is measured using a stadiometer or other device. In this case, the child is stripped off, and the heels are pressed against the vertical plane of the stadiometer. The arms should be relaxed and freely positioned along the body, the face should be turned so that the outer corner of the palpebral fissure and the external auditory canal are at a horizontal level. The child is asked to take a deep breath, while exhaling, the auxologist gently pulls his head up behind the mastoid processes. It has been shown that a "traction technique" in which traction is applied slightly lengthens the spine is unnecessary and can lead to increased measurement errors.
The body length is measured almost at the very end of the exhalation. Repeated measurements to determine the growth rate are preferably carried out at the same time of day to avoid errors due to spinal compression: the average height measured in the morning is 8 mm greater than that measured in the afternoon. The standard error of a single measurement of height by an experienced auxologist is about 0.2 cm.
Sitting height
To assess the relative proportions of the body, the study of the length of the back and head is of great importance. The child's legs are bent at an angle of 90 °, the footboard is brought close to the buttocks. The study in older children is carried out using a special measuring instrument: the legs are on the crossbar, the hands are freely placed on the knees, the measurement is carried out according to the principles of easy traction, described above, which allows you to accurately determine the height while sitting. In a simpler definition, a rigid horizontal seat of a stationary stadiometer is used. To determine the length of the legs from the ischium, the sitting height is subtracted from the standing full height.
Head circumference
To determine the maximum occipital-frontal head circumference, the measurement should be taken with an inextensible paper or metal centimeter or lasso. For example, in the UK, Lasso from the UK Child Growth Foundation is used for these purposes. In children with irregular head shapes, it is sometimes impossible to accurately determine the circumference of the head.
Skinfold thickness
To measure skinfold thickness, a skin caliper with a known compression force and tip area is required. Typically four measurement sites are selected, the most common being above the triceps and in the subscapularis. The thickness of the skinfold above the triceps is measured on the left arm; the fold is trapped between the thumb and forefinger in the middle of the back of the shoulder. The calliper is installed and after stabilization (4-5 s) readings are taken. The thickness of the subscapularis skin fold is measured above the angle to the left scapula, with the arms freely lowered along the body. Measurement of the skin fold on the biceps is carried out in the same way as on the triceps, only on the front surface of the shoulder. The superior iliac crease is defined at the maximum height of the iliac crest. The thickness of the skinfold allows you to assess the amount of subcutaneous fat, its distribution; this information can be used in equations to calculate obesity rates.
Shoulder and waist circumference, hips
As an indicator of malnutrition, the shoulder circumference in the middle third can be measured using a flexible inextensible centimeter, and as an indicator of excessive nutrition - the circumference of the waist and hips (the ratios of the waist, hips are analyzed).
The shoulder circumference in the middle third is measured at a point midway between the elbow and shoulder joints. Waist circumference is measured between the lower ribs and the iliac crest at the level of the navel at the end of a normal expiration. The thigh circumference is determined at the level of both large tubercles of the femur.
Body mass index
Another commonly used measure of relative obesity is the body mass index (BMI), or Quetelet index, which can be calculated using the formula:
weight (kg) / height (m2).
BMI depends on gender and age, therefore its value must be compared with the relevant standards.
Other anthropometric data of children
In some cases, it is useful to evaluate other body sizes and their direct relationship; There are percentile curves for almost any parameter.
Measurement of the span of the arms, which is defined as the distance between the fingertips of horizontally spaced hands, can be of some value in endocrinological examination. The normal ratio of arm length to body length is calculated using the formula: arm length = height ± 3.5 cm.
When diagnosing conditions for which shortening of the limbs is characteristic, or if hemihypertrophy is suspected, direct measurement of limb segments is carried out with a specially designed anthropometer or a metal measuring tape.
Growth curves - percentiles
Modern standards for anthropometric data of children - for height, body weight, BMI and head circumference exist for many populations. Standards must be constantly updated to take into account the impact of acceleration. Ideally, comparisons of the results of measurements of the anthropometric data of children of different ethnic groups with the corresponding curves should be carried out, but this is not always possible. Less available, but published standards for sitting height, leg length, skinfold thickness, arm length.
The most commonly used child anthropometric curves are gender-specific; the parameter under study is indicated on the vertical axis, the age is indicated on the horizontal axis. Almost all scales of anthropometric data of children are linear. Only when displaying skinfold thickness standards on the vertical axis is a logarithmic scale used. In some cases, if it is necessary to display the data of children in the first months of life, a non-linear age scale can be used.
Many curves contain anthropometric percentiles of children, the intervals between which can vary, as determined by the design of the curve. Most often, the curves mark 0.4, 2, 25 and 50 centiles and the corresponding values above the average, which gives a total of 9 lines smoothed by the LMS statistical method. In a normal population, the indicators of only one child out of 250 children will be below 0.4 or above 99.6 centile, which allows the formation of normal indicators.
Pathological anthropometric data of children have long been grouped. Growth and weight curves have been published for many named syndromes; for skeletal dysplasias, there are curves for limb length, height and head circumference.
Measurement readings should be plotted as a simple dot, and other indicators, such as bone age, should be marked with a contrasting color or square symbol.
When analyzing the standard centile curves of any plot, you can quickly estimate the expected genetic potential of the patient by plotting the centile indicator of each parent on the right ordinate. Following this, you can plot the value of the average height of the parents. To calculate height, you can use the following formula:
Boy's target height (cm) = = (father's height + mother's height + 13) / 2
Girl's target height (cm) = = (father's height + mother's height - 13) / 2.
Non-metric units use height in inches and give an offset of 5 inches.
If acceleration is expected, for example, if the economic situation for children is much better than their parents' childhood, 4.5 cm must be added to the resulting target height.In 95% of cases, the child's final height is within ± 9 cm of the target height (so called target range). The centile projection of the target height can then be compared to the actual height of the child on the centile curve. This is the method used in the illustrations in this whole thing.
Since a child's growth is an ongoing process, its change over time is an even more important indicator than the absolute values of growth at a particular time. The final assessment of growth for any parameter is carried out by comparing subsequent measurements on the growth curve and visual assessment of any deviations up or down from the centile lines.
Growth rates can also be estimated by calculating the growth rate, which is compared with published curves of growth rate and body weight. The speed is calculated using the formula:
Growth rate = (height 2 - height 1) / interval (years in decimal units)
Due to the fact that the error in measuring the anthropometric data of children increases when two height values are used in the calculations (95% confidence interval for the growth rate obtained from two separate measurements with an interval of 1 year = ± xV2; for a three-month interval, the confidence interval is 4 times greater than this values), the accuracy of estimating the growth rate largely depends on the accuracy of the measurements and increases with increasing intervals between measurements. It is optimal to estimate the growth rate annually (in clinical practice, the minimum interval is 6 months).
For a more accurate quantitative assessment of any normal anthropometric data of children for whom there are standards, it is customary to use the standard deviation coefficient (SDS or Z-score), especially for values outside the normal centile values.
This method allows you to compare the anthropometric data of children of different ages and gender.
In a population with a normal distribution, the average SDS will be 0, and SD 1. SDS in the range from -1 to +1 includes 68.26%, and from -2 to +2 - 95.44% of the population. Only 0.13% of the population will have SDS greater than or less than 3. In this book, the diagrams show the mean ± 1 and 2 SD.
The article was prepared and edited by: surgeonAnthropometry methods are, first of all, a set of measuring measures aimed at determining the compliance of a person's physical development with the norms, provided that a healthy lifestyle is maintained, and there is sufficient physical activity. Anthropometric techniques are based mainly on the consideration of morphological external and quantitative indicators. However, there is also a number of studies aimed at determining the parameters of internal organs and indicators of body systems.
Why is anthropometry required?
Assessing those around us, we ask ourselves why people are so different from each other in a number of external parameters. The reason for the presence of characteristic differences lies not only in genetic inclinations, but also in perception of the world, peculiarities of thinking and character.
Human existence presupposes the course of successive processes of maturation, maturity and aging. Development and growth are interdependent, closely related processes.
The anthropometry method is an effective tool for determining the compliance of certain development parameters with the norms characteristic of a particular age period of a person. Based on this, the main purpose of the method lies in identifying the developmental characteristics of both a child and an adult sexually mature person.
Anthropometric Research Factors
The continuous course of metabolic processes in the body, energy conversion becomes a determining factor, which is reflected in the characteristics of development. As the method of anthropometry shows, the rate of change in circumferences, mass and other body parameters in separate periods of human formation are not identical. However, this can be judged visually, without resorting to scientific research. It is enough to remember yourself in preschool, adolescence and adulthood.
Indicators of body weight, height, an increase in the volume of certain parts of the body, proportions are part of the program laid down in each of us from birth. In the presence of optimal conditions for the development of the body, all these indicators change in a certain sequence. However, there are many factors that can affect not only the violation of the development sequence, but also lead to the appearance of irreversible negative changes. It should be highlighted here:
- External factors - social conditions of existence, improper lack of rational nutrition, non-observance of the work and rest regime, the presence of bad habits,
- Internal factors - the presence of serious diseases, negative heredity.
Fundamentals of Anthropometric Research
The fundamentals of the anthropometry method are a set of scientific studies on measuring the parameters of the human body, which originated in the middle of the last century, when scientists became interested in the patterns of variability of individual anthropometric indicators.
Considering the data of anthropometry, for example, the length of the body and limbs, growth characteristics, changes in mass, transformation of the circumference of body parts, it becomes possible to visually assess the norm of a person's physical development.
Conducting anthropometry allows you to draw up general ideas regarding Get such ideas in the process of performing several basic measurements:
- body length;
- body weight;
- chest girth.
Conditions for conducting anthropometry
Anthropometric methods are measurements based on the use of adjusted, proven measuring mechanisms. Scales, height meters, dynamometers, etc. are most often used here.
Anthropometric examinations are usually performed on an empty stomach in the morning. In this case, the subjects should be dressed in light shoes and clothing. For the anthropometric assessment to be as close to reality as possible, careful observance of the measurement rules is required.
Analysis of the correspondence of the necessary indicators of physical development to specific standards are the most important elements on which anthropometry is based. The research template allows you to identify risk factors, signs of abnormal development and the presence of certain diseases. Therefore, a correct assessment of the results of anthropometry can contribute to the establishment of a direction towards a healthy lifestyle and healthy development.
Below is a template for anthropometry in kindergarten:
Surname, name of the child | Health group | Growth | ||||
Autumn | Spring | Autumn | Spring |
|||
The template is filled with data for each pupil of a certain group of kindergarten. Here are the columns with the child's FI, information about the data on height and weight for individual seasons.
Body length measurement
The most common procedure is child anthropometry. It is carried out subject to the availability of a whole complex of measuring instruments. Standing growth measurements are taken. For this, specialized height meters are used. The examinee is placed on the platform of the device, leaning his back against the measuring stand in a natural vertical position. A horizontal sliding bar is applied to the child's head without excessive pressure, the position of which corresponds to a certain gradation on the measuring scale.
It is extremely important that children's anthropometry is carried out in the first half of the day, because in the late afternoon, a person's height decreases on average by about 1-2 centimeters. At the root of the phenomenon lies the presence of natural fatigue, a decrease in the tone of the muscular apparatus, compaction of cartilaginous vertebrae, as well as flattening of the foot as a result of stress during walking.
A number of genetic factors, age and sex differences, and health conditions are reflected in the indicators of a person's body length. Growth can either correspond to a person's age or differ significantly from the acceptable norm. So, insufficient body length in accordance with a certain age range is called nanism, and a noticeable excess of growth is called gigantism.
Measuring mass
Anthropometry of children and adults when measuring weight is carried out using special floor scales. When measuring weight, a deviation from real indicators is considered to be a permissible error of no more than 50 g.
Compared to body length, weight indicators are quite unstable and can change due to a wide range of factors. For example, the average person's weight fluctuation per day is about 1-1.5 kg.
Anthropometric determination of the human somatotype
There are separate somatotypes, which are determined by anthropometry. Templates for kindergarten, primary and higher educational institutions, as well as for adults, allow you to distinguish mesosomatic, microscopic and macroscopic somatotypes. The assignment of an individual to one of the indicated somatotypes is performed based on the sum of the scale values when measuring weight, body length and chest circumference.
The somatotype is most often determined by anthropometry in kindergarten. It is at the initial stages of development that the most reliable results can be obtained that correspond to the characteristics of a particular type of body structure. So, with a total of up to 10 points, according to the above parameters, the structure of the child's body is referred to the microscopic type. The amount from 11 to 15 points indicates a mesosomatic structure. Accordingly, a high score from 16 to 21 indicates a macrosomatic type of the child's body structure.
Determination of the degree of harmonious development
It is possible to declare the harmonious development of the child's body structure based on the results of anthropometric studies only if the difference in weight, chest circumference and body length does not exceed one. If the average statistical difference between these indicators is two or more, then the development of the child's body is considered disharmonious.
Technique for performing anthropometric studies
Currently, a fairly simple technique is used with which anthropometry is performed. The kindergarten and elementary school templates allow you to quickly complete research to produce results with low margin of error.
Usually, anthropometric studies of a child's structure are carried out by nurses. However, as in the case of other scientific methods, anthropometry requires compliance with certain conditions, the presence of which, along with special skills, ensures the accuracy and correctness of the results.
The main conditions for technically correct anthropometry are:
- conducting research according to a unified methodology for all subjects;
- performing measurement activities by one specialist using the same technical base;
- conducting research at the same time for all subjects, for example, in the morning on an empty stomach;
- the subject should have a minimum of clothing (usually light underpants or cotton clothes are allowed).
Eventually
Anthropometric studies are of particular importance, in particular when examining children, as they allow timely identification of the patterns of a child's development in accordance with certain age and physical requirements. Moreover, the results of anthropometric studies give an idea not only of the rate of development of body parameters, but can also tell about the beginnings of certain diseases.
In the course of anthropometric studies, it is important not to forget about the universality of the values of body parameters. Until recently, the assessment of a child's health was often carried out based on the compliance of height and body weight with the tabular requirements. However, this approach is fundamentally wrong. In particular, a whole group of factors, such as heredity, etc., is reflected in a sharp change in body weight. That is why it is not worth making decisive conclusions about the state of health based on anthropometry, because only special tests aimed at identifying a specific disease can confirm the existing assumptions.
To assess physical development, they mainly use the data of anthropometric measurements (height, weight, dimensions of individual parts of the body, etc.).
Measuring the growth of children in the first year of life . The measurement is carried out with a special stadiometer in the form of a wide board 80 cm long and 40 cm wide.On one side of the board, there are divisions in centimeters. At its beginning there is a fixed transverse bar. At the end of the scale there is a movable cross bar that can be easily moved along the centimeter scale.
The legs should be straightened by light pressure with the left hand on the knees; with the right hand, bring the movable bar of the stadiometer tightly to the soles of the straightened legs.
The distance between the movable and fixed slats corresponds to the height of the child. The accuracy of such measurements is ± 0.5 cm.
Measuring the growth of older children. The measurement is made with a stadiometer, which is a wooden board 2 m 10 cm long, 8-10 cm wide and 50x75 cm thick.On the vertical board there are 2 graduation scales (in cm): one (on the right) for standing height, the other (on the left) for measuring the length of the body while sitting. A 20 cm long bar slides along it. At the level of 40 cm from the floor, a folding bench is attached to the vertical board for measuring sitting height.
Weigh the children from the moment of birth to 2-3 years old on a pan scale with a maximum permissible load of up to 20 kg (Fig. 23.3). The scale consists of a tray and a balance beam with two scale divisions: the lower one - in kilograms, the upper one - in hundredths of a kilogram. The balance beam has a counterweight. If the scales are not balanced, you should carefully turn the washer (microscrew) on the counterweight towards you or away from you, focusing on the balance indicators.
Weighing technique: Weigh the diaper first. The child is placed on the wide part of the tray with his head and shoulder girdle, the legs - on the narrow part of the tray. If the child can be seated, then he is seated with his buttocks on the wide part of the tray, his legs - on the narrow part. Putting the child on and off the scales can only be done with the balance arms closed, facing the scale. The weights are read from the side of the weight where there are notches or notches. After recording the weight, the weights are set to zero, and the balance beam is set to the safety catch. To determine the weight of the child, subtract the weight of the diaper from the scale readings. Weighing accuracy ± 10 mg.
Head circumference measured with a centimeter tape, which is carried out from behind through the most prominent point of the occipital protuberance, and from the front along the brow ridges (Figure 23.5).
The size of the large fontanelle in infants is determined by measuring the distance from the middle of one of its four sides to the other, opposite, but not diagonally (from corner to corner).
To measure the height of the head, an anthropometer or a special compass is used, one end of which is installed on the crown of the head, and the other on the most prominent part of the chin.
To characterize the physical development of a child, it is of great importance to assess the characteristics of his chest and abdomen, as well as the ratio of the circumferences.
Chest circumference measured at rest (Figure 23.6). The tape is applied at the back at the angles of the shoulder blades, and in front - along the areola. In girls of puberty, the tape is drawn from the front along the fourth rib. Measurement in children of the first year of life is carried out in the supine position, and in older children - standing (hands down, breathing is calm).
Measurement of the chest is carried out at the height of inspiration, with full exhalation and with calm breathing.
In order to measure the anteroposterior and transverse diameters of the chest, use a special compass. When measuring the anteroposterior diameter, one leg of the compass is placed at the lower end of the sternum body, and the other at the same level at the spinous process of the spine. To determine the transverse diameter of the leg of the compass, set along the mid-axillary line at the level of the lower edge of the sternum.
Abdominal circumference measured at the level of the navel. If the abdomen is significantly enlarged, a measuring tape is passed in the area of its greatest protrusion. The abdominal circumference of a healthy child should be measured before meals (measurement of the abdomen is not of great importance for assessing the state of the child's physical development). In a sick child, such a repeated measurement is necessary in the presence of diseases in which changes occur in the volume of the abdomen (ascites, tumors, flatulence, etc.)
Torso length determined by the distance from the spinous process of the seventh cervical vertebra to the tip of the coccygeal bone. In small children, the torso is measured in a lying position on its side, in older children - in a standing position: when measuring, the measuring tape should be tightly attached to the surface of the back.
Limb measurement... The length of the limbs is measured with Martin's anthropometer, and in its absence - with a conventional measuring tape.
Arm length measured from acromion to the end of the third toe; shoulder length - from acromion to the apex of the elbow joint; the length of the forearm - from the elbow joint to the middle of the wrist.
Shoulder circumference determined by the area of greatest development of the biceps muscle (upper third of the shoulder). The measurement is carried out twice: first with a freely lowered arm and relaxed muscles and then with a tense state of the muscles. The child is asked to raise his arm to shoulder level, and, bending it at the elbow, as much as possible to strain the muscles.
Leg length measured from the greater trochanter of the thigh to the level of the sole; the length of the thigh - from the greater trochanter to the knee joint; the length of the lower leg - from the knee joint to the ankle. Thigh circumference is measured approximately at the level of the crotch at the widest part of the thigh; a measuring tape is passed horizontally directly under the gluteal fold.
Shin circumference determined on the calf muscles, at the level of their greatest volume.
23.2. Assessment of the physical development of children of different ages.
The World Health Organization (WHO) defines the physical development of a child as a summary indicator of the health status of an individual child and the population, and indicators of the physical development of young children as a criterion for assessing the socio-economic development of a particular region or country. Monitoring of the physical development of young children is considered by WHO to be one of the most effective measures taken by health workers to reduce the mortality and morbidity rate in young children. Assessment of the physical development of a child under 3 years old is carried out on the basis of the "Growth Standards", which were developed by WHO in 2006 and are recommended as an international standard for the physical development of a child in all countries, regardless of ethnicity, socio-economic status and type of nutrition. These norms (standards) of physical development of young children should be used:
For medical workers: as an effective tool for screening assessment of the physical development of young children for the timely detection of deviations from the norm and diseases, counseling parents, prescribing the necessary examination and treatment if necessary;
For healthcare organizers: as a tool to substantiate the need to develop state and regional programs aimed at realizing the child's right to normal physical development, supporting breastfeeding, ensuring rational nutrition, increasing the availability and quality of medical care for children and mothers;
Parents: as a tool that allows the family, together with medical workers, to more effectively monitor the physical development of the child, understand the importance and necessity of following recommendations on feeding and nutrition, and seek medical help in a timely manner.
The assessment of physical development is carried out at each mandatory medical preventive examination of the child. Anthropometric measurements (weighing, length / height and head circumference) are performed by the nurse. The data obtained are plotted on the corresponding graphs of physical development, which are filled in separately for boys and girls. This makes it possible to see the tendency of a child's physical development over a certain period of time and to identify problems of physical development. It is also necessary to pay attention to the dynamics of indicators for the period of observation of the child.
Assessment of the physical development of older children It is also carried out on the basis of the results of anthropometric studies, by comparing the individual indicators of the child with the normative ones. To do this, use the method of approximate calculations by empirical formulas and the method of anthropometric standards. The method of approximate calculations using empirical formulas is based on knowledge of the basic patterns of increase in weight and height, head and chest circumference. It should be noted that this method gives only an approximate picture of the physical development of the child and is rarely used by pediatricians.
The method of anthropometric standards is accurate, since individual anthropometric values are compared with the normative ones, according to the age and sex of the child. There are two types of regional tables of standards: sigma (parametric) and centile (nonparametric).
Sigma standards method... The essence of this method consists in comparing the obtained indicators for each characteristic with the average (standard) data developed on the basis of conducting mass anthropometric examinations of children of different ages. The results of comparing anthropometric data with standard data allow us to evaluate each feature separately.
A significant disadvantage of this method is that each feature is assessed separately, without interrelation with other indicators.
Centile standards method... The essence of the method is as follows: all measurement results of one feature are arranged in an ascending gradation in the form of an ordered series. This ordered series, covering the entire range of fluctuations of the feature, is divided into 100 intervals. Hits in them have equal probabilities, but the ranges of such centile intervals in absolute units are not the same. The central tendency of the ordered series is the fiftieth centile - the median. Usually, to characterize the distribution, not all 100 are given, but only 7 fixed centiles: 3rd, 10th, 25th, 50th, 75th, 90th, 97th.
The intervals between centile probabilities are called centile intervals (corridors). This method is not mathematical and therefore better characterizes the series of variations in biology and, in particular, in medicine. It is quite easy to use, does not require calculations, fully allows you to assess the relationship between various anthropometric indicators and therefore is widely used in the world. In the overwhelming majority of cases, deviations from the standard growth rates of body weight and length / height indicate health problems and require a careful analysis of the situation with the application of appropriate measures.
Control questions
1. Anthropometric measurements and features of their implementation in children of different ages.
2. Features of assessing the physical development of children of different ages.
Center tables for boys
Centile tables of physical development of children
When you bring your son to a pediatrician's appointment, who will weigh him and measure his height, chest and head circumference, you hear an assessment of these indicators: a four, or another figure from one to eight. What are these points? This centile corridor, in which the indicators of your boy are located according to the table. Centile tables are shown below.
physical development of the child
An example of assessing the physical development of a newborn boy
Height-length - 50 cm, corresponds to the "average" indicators. Weight - 3800 g, corresponds to the assessment "above average". Chest circumference - 37 cm, corresponds to the assessment of "wide". Head circumference - 36cm, corresponds to "average" values. Correspondence of mass to the child's body length - a moderate excess of mass relative to length, "above average".
Bringing your baby to an appointment with a pediatrician, who will weigh her and measure her height, chest and head girth, you hear an assessment of these indicators: a four, or another number from one to eight. What are these points? This centile corridor, in which the indicators of your girl are located according to the table.
Using the tables, you can find out if the height and weight of your child is normal at a given age (from birth to 17 years). Centile tables are shown below.
Dental tables for assessing the physical development of a child represent a kind of "mathematical photograph" of the distribution of a large number of children in terms of increasing indicators of growth, weight, chest and head circumference. The practical use of these tables is extremely simple and convenient, combined with a good logical understanding of the assessment results.
Columns of centile tables show the quantitative boundaries of the trait for a certain proportion (percentage, centile) of children of a given age and gender. In this case, the mean or strictly normal values are taken as values characteristic of half of healthy children of a given sex and age, which corresponds to the interval of 25-50-75%. In our tables, this interval is shaded. The intervals that are close to the average are assessed as below and above the average (10-25% and 75-90%, respectively). These indicators to parents can also be regarded as normal. If the indicator falls into the 3-10 or 90-97% zone, you should be on your guard and tell your doctor about it. This is an area of attention that requires additional consultations and examination. If the child's indicator goes beyond 3 or 97%, it is very likely that the child has some kind of pathology that is reflected in the indicators of his physical development.
distribution of children around the head circumference
To understand what a dental scale is, for example, growth, you can use the following example. Imagine 100 children of the same age and gender, lined up in height from the smallest to the tallest. The height of the first three children is assessed as very low, from 3rd to 10th - low, 10-25th - below average, 25-75th - average, 75-90th - above average, 90-97 - tall and the last three guys are very tall.
The indicator of height, weight, etc. of a particular child can be placed in its own "corridor" of the centile scale of the corresponding table. Depending on which "corridors" the child's anthropometric data fell into, a value judgment is formulated and an appropriate tactical medical decision is made.
The same principle is used to assess the correspondence of body weight to the length-height of the child, while the distribution is constructed using the weight indicators of children with the same height.
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