A Training Manual for Height and Weight Assessment
Contents
1.2. entry system Height and Weight Measurement Procedures STANDARDIZED MEASUREMENT PROCEDURE continued 3 Role of the Recorder The measurer will take the first height measurement and will call out the number to the recorder The recorder will call the number back to the measurer to confirm the correct reading Then the recorder will record that number on the data collection form or directly into the web entry system in the space indicated for 17 Height Next the measurer will position the child for the weight measurement and indicate to the recorder that the child is ready The recorder will then obtain the number for the weight measurement from the read out on the scale and record that number on the data collection form or directly into the web entry system in the space indicated for Weight The measurer will then re measure the child s height and the recorder will record the second height number in the space indicated for 217 Height using the same steps as used for the first height measurement NOTE The reading for the weight measurement is NOT called out by either the measurer or the recorder in order to ensure that the child and other staff_or children who may be standing nearby is not made aware of his her weight measurement Since the height measurement is more subject to error and is not generally considered to be sensitive data those measurement readings are called out by the measurer and recorder t
3. measurements are required in order to reduce error and therefore obtain a more accurate calculation of BMI If the difference between the two height measurements is greater than one inch then a second set of two height measurements should be taken to try to obtain values within one inch of each other NOTE If metric measures are used the difference between the two height measurements should be no greater than 2 centimeters The measurements of weight and height should be measured in rotational order as follows 1 height weight 2 height If the difference between the two height measurements is greater than one inch per above then the child must be re measured If after two trials a pair of height measurements within the one inch criteria cannot be achieved then the child s assessment is considered Unable to be Assessed When entering this child s data into the web entry system click on Unable to Assess Then click Could not get two measurements in range after two repeats and provide an explanation on the line s provided It is recommended that a team of two people perform the measurements together at each measurement station One person should be designated as the measurer and the other person should be designated as the recorder The measurer performs the weight and height measurements on the child and recorder either records the data on the assessment form or directly enters the child s information into the web
4. A Training Manual for Height and Weight Assessment Height and Weight Measurement Procedures ACKNOWLDEGEMENTS Training Manual Originally Developed by BMI Task Force November of 2003 BMI Task Force Included UAMS College of Medicine Department of Pediatrics and Arkansas Children s Nutrition Center e Judy L Weber PhD RD e Margaret Harris PhD Arkansas Center for Health Improvement e Joseph W Thompson MD MPH Kevin Ryan JD MA James Bost PhD Joy Rockenbach BSE Michelle B Justus MS Training Manual Revised December 2004 Arkansas Center for Health Improvement Michelle Justus MS Training Manual Revised June 2007 Arkansas Department of Education Joy Rockenbach BSE Paula Smith MNSc RNP Arkansas Department of Health Nancy Green BSN RN Stephanie Williams BSN RNP Cheryl Lindly BSN RN Tamara Baker BSN MPH RN Arkansas Center for Health Improvement Michelle Justus MS Training Manual Revised September 2010 Arkansas Department of Education Joy Rockenbach BSE Paula Smith MNSc RNP Arkansas Department of Health Nancy Green BSN RN Mary Wells MS RD CHES Cheryl Lindly BSN RN Mary Glasscock RN BSN MPH Emily Lyons RD LD Arkansas Center for Health Improvement Michelle Justus MS RD LD Table of Contents Eleng 1 EIEN ln Sinna Denisa eed h het eet dean reat EEE AER sista Mest goat aaiaas tine ers EAE TA ARA CRVEN 2 Recommended Equipment cccccccccescccceeeeeeeeeeeeeeeceeeeen
5. RCES continued For Kids and Parents Body and Mind http Awww bam gov Kidnetic http www kidnetic com Nemours Foundation Kids Health http Awww kidshealth org Smart Mouth Center for Science in the Public Interest http Awww smart mouth org Teen Growth http Awww teengrowth com Verb http Awww cdc gov youthcampaign For Physical Activity Active Living by Design University of North Carolina School of Public Health http www activelivingbydesign org America Walks http Awww americawalks org American Alliance for Health Physical Education Recreation and Dance http www aahperd org Human Kinetics http Awww humankinetics com Let s Move http www letsmove gov National Center for Bicycling and Walking http Awww bikewalk org Partnership for Walk able America Walk to School http www walktoschool org index cfm 18 Height and Weight Measurement Procedures RESOURCES continued For Nutrition BMI Calculator http www kidsnutrition org consumer nyc vol1_03 omi_calculator htm Food Pyramid Guide http fnic nal usda gov nal_display index php info_center 4 amp tax_level 1 Nutrition Counseling Education Services http Awww ncescatalog com Tools for Patients and Providers 2000 CDC Growth Charts http cdc gov growthcharts American Dietary Guidelines http Awww health gov dietaryguidelines Healthy People 2020 Toolkit http Awww healthypeople gov hp2020 19
6. acy Log This form is required to verify the accuracy of each scale to be used for measurements on the day of the scheduled measurement at each school The scales should be placed in the exact location where measurements will take place and then verified in that location Once verified DO NOT MOVE the scales On the lines provided at the top of the scale accuracy log fill in the name of the school school district and county Fill in the date of the verification and the initials of the person performing the verification In the third column fill in the scale number and or model name number of the scale In the fourth column fill in the station number if more than one station will be used at a school on the same day In the last three columns fill in the weight readings obtained from the verification weights Three known weights of increasing heaviness are used however the use of one known weight is sufficient if time and or cost are an issue To minimize the misreporting of a child s BMI due to faulty equipment verification with at least one known weight is extremely important For each known weight used the verification steps are as follows a Turn the scale on to zero the scale b Place a known weight in the center of the scale If using more than one known weight place the smallest one on the scale first c Record the scale reading in the appropriate column i e if using a 5 lb known weight record the scale readout
7. ale should be no more than 0 2 kg higher or lower than the standard weight 5 Data Collection There are two methods for data collection They are e Direct data entry via web recommended e Onpaper forms to be entered on web site at a later time Height and Weight Measurement Procedures RECOMMENDED EQUIPMENT continued 6 Name Tags The use of nametags for the children who are being measured is recommended This helps to ensure that the correct data collection is completed for the corresponding child It is also recommended that nametags are used for all staff involved in the collection of these data This will identify the measurement team to the children and to the school staff 7 Adhesive Tape Duct tape or similar adhesive such as blue painter s tape is recommended to stabilize the wood board mounted stadiometers to the wall if the 84 yard stick or similar stadiometer is used 8 Office Supplies The following general office supplies are recommended when performing the height and weight measurements in schools Baskets for the children s personal items Black pens if not doing direct data entry Extra blank nametags Paper clips Contact Act 1220 Coordinator or State School Nurse Consultant at 501 683 3600 for purchasing information or other equipment options Height and Weight Measurement Procedures STANDARDIZED MEASUREMENT PROCEDURE It is recommended that multiple stations be used each consisting of one c
8. ansas Initiative http www arkansas gov ha 16 Height and Weight Measurement Procedures RESOURCES continued National Web Sites General Action for Healthy Kids http take actionforhealthykids org site Clubs club_id 1102 amp pg main Alliance for a Healthier Generation http healthiergeneration org American Obesity Association http www obesity org International Obesity Task Force http www Jo org National Association of School Nurses http Awww nasn org National Heart Lung and Blood Institute http www nhibi nih gov guidelines obesity ob_home htm Robert Wood Johnson Foundation Center to Prevent Childhood Obesity http www reversechildhoodobesity org The Weight Control Information Network National Institutes of Health NIH http www niddk nih gov health nutrit win htm Assessment Annie E Casey Foundation Kids Count http www aecf org kidscount National Center for Chronic Diseases Prevention Health Promotion Nutrition and Physical Activity http Awww cdc gov nccdphp dnpa index htm US Census American Fact Finder http factfinder census gov home saff main html _lang en Community CDC School Health Policies and Program Study http www cdc gov nccdphp dash shpps Institute for Economic Advancement Census State Data Center http Awww aiea ualr edu census default html School Health Index http Awww cdc gov Healthy Youth SHI T7 Height and Weight Measurement Procedures RESOU
9. cluded in assessing BMI provided by the parent or guardian Weight A measurement in pounds or kilograms Height and Weight Measurement Procedures RECOMMENDED EQUIPMENT The equipment listed below is what is recommended for the accurate measurement of height and weight in Arkansas public and charter schools equipment was tested in pilot schools across Arkansas and was shown to be accurate and reliable The equipment recommended is listed below 1 permanently affixed to a wall Stadiometers a 84 Yard Stick on Wood Board Stadiometers and Scales Height will be measured using a stadiometer Stadiometers can be either portable or In general it is recommended that portable stadiometers are used so that schools can share equipment and to avoid problems relating to proper installation of wall mounted models It is also recommended that digital scales be used over other models due to better precision of the measurements and ease of reading the digital read out Recommended Stadiometers and Scales Originally the Department of Corrections mounted an 84 metal yard stick onto an 86 wood board To build your own stadiometer to the Department of Education s specifications see Appendix A Taping the wood board to the wall with some type of strong adhesive tape i e duct tape is suggested for stability of the stadiometer A carpenters triangle is used for the headpiece This arrangement allows that unit to be portab
10. dy be in the web entry system If the information is already in the system check the information for accuracy This will help eliminate errors in the generation of the student health report Finally the child s weight and both height measurements should be entered into the web entry system where indicated If the child is not able to be assessed click the box for the appropriate reason why These reasons include Absent Child Refused Parent Refused Pregnancy Physically Disabled Wrong School No 2 Measurements within 1 Inch Weight Exceeded Scale Other NOTE For full compliance all Unable to be Assessed information must be entered into the web entry system One of the changes resulting from Act 201 of 2007 allows parents the option to refuse weight and height measurements If the parent wishes for their child not to participate they must provide a written refusal to the school a Height and Weight Measurement Procedures SUMMARY OF MEASUREMENT PROCEDURE e Setup measurement stations with the appropriate equipment o Computer with Internet access if available Digital scale Stadiometer stabilized against the wall Step stool Basket and general office supplies 0 0 OFO e Verify accuracy of the scales e Prepare the child for measurements o Name tag o Remove outer wear shoes glasses jewelry o Empty pockets e Measure 1 height weight 2 height o Measurer positions the child and performs the mea
11. eeeeeesaaaeeeseeaaaaeeesnseaeeesnseaeeeseenenaees 4 Stadiometer ee 4 SISP SOO AAEE EE beaten E tue cacie es hei ells 5 Battere Sro teat eects E tute ia es a aE 5 Standard Weights for Checking Accuracy c cccceceeeeeeeeeeeeeeeeeeaaeeeeceeeeseaaeeeceaaeesecaeeeeseaeeesinaeeeeeaes 5 Data Collection EE dee A ee aia dean ata avn been Sieh Ae 5 Name tags EE 6 Adhesive Taponen sinatra ee a ee ie 6 E Mere TEE EEN 6 Standardized Measurement Procedure c cccecceeeeeeeeceeeeeeeeeeeeeeeee scenes seeeeeseeeeseeeesneeenaas 7 Preparation of the Cid DEE E 7 Meet tetentt Wett g et Seege EES SE eet Seege AC H Role of Me Recordo eeithir enai E Eeh EE EEEE AREE EFE NE EA E e RERE TEE 8 Weight Measurement o gortaet isea AyrA AA EA A E AA E A SEEE IAEE AA EE EO ERAN 9 aala e e EE 9 Recording the Data EE 10 AGHI Scale Accuracy Logoi EE E 10 Measurement Station Information Form 11 Height and Weight Data ENG ER 11 Summary of Measurement Procedure AAA 13 Summary of Ee ue EE 14 Summary of Height Measurements ccs ccieeninceisieteectenneies we REENEN EEN 15 geess eege 16 Arkansas Specific Websites eccccceceseeeeeeceeeeeeeeeeeeeeeeeeaaaeeeeaeeeeeeaaeeeceaaessaaeeseeeaaeeecaaeseneneeeeenaaeees 16 National EE EE 17 EEN 17 ASSOSSIMOMM EE 17 COMMUNI EE 17 For Kids and Parents neadi NEE EE EEN Ae fad ate PES Goes deed ten eas eva E ad AN eae ea tented ee 18 For Physical e EE E EE 18 Schei le EE 19 Tools for Patients And Pr
12. in the 5 lb column for the known weight used If using more than one weight repeat the steps until all of the known weights have been used If the recorded scale reading is more than half a pound English measure higher or lower than the known weight the measurement should be repeated and re recorded on the next line of the form If the scale reading remains more than half a pound different from the known weight then that scale should not be used for measurements that day NOTE If scales are used that measure in metric units then the verification should be no more than 0 2 kg higher or lower than the known weight RECORDING THE DATA continued 10 Height and Weight Measurement Procedures 2 Measurement Station Information Form The Measurement Station Information Form was designed to document what stadiometers and scales are used at each station at each school especially when more than one model is used at the same school This is important because the type model of equipment used determines the appropriate unit of measurement e g centimeters or 1 8inch fractions of pounds or whole pounds only etc After ensuring that the stations have been verified for accuracy fill out the station information section in the web entry system A station form is required for each station used These details must be entered before any student data is entered At the top of the form enter the station number as well as scale and stadiometer de
13. kwards onto the scale and stand still over the center of the scale with body weight evenly distributed between both feet In order to ensure confidentiality and to prevent the child from seeing his her weight it is required that the child step on the scale backward facing away from the readout The child s arms should be hanging freely by the sides of the body with palms facing the thighs The child should hold his her head up and face forward Weight is recorded to the nearest 0 2 pound using the recommended scale with a digital readout Depending on the type of scale used record to the nearest fraction of a pound whole pound pounds and ounces kilograms or grams 5 Height Measurement For the measurement of standing height the child will be asked to stand with his her back against the board The back scapulae and buttocks are in contact with the vertical board if possible or whichever part of the body touches the board first The weight of the child should be evenly distributed on both feet The child will be asked to place the legs together bringing the ankles or knees together whichever comes together first often they will come together simultaneously If the child has knock knees the feet are separated so that the medial borders of the knees are in contact but not overlapping The child is instructed to stand erect stand up straight and look straight ahead The child s position should be verified from both the FRONT and fr
14. le as recommended As a result of testing numerous plastic stadiometers in a similar price range it was found that most of those models were not durable especially the thin plastic headpieces Therefore in order to keep costs in a reasonable range the board mounted metal yard stick with a hard plastic carpenter s triangle headpiece was tested and found to work quite well Shorr Board The Shorr Measuring Board Stadiometer is top of the line Gold Standard equipment commonly used in research settings It offers accurate measurement due to the wide wooden head piece used for measuring height thereby reducing the chances for measurement error commonly caused when a narrower head piece is used The Shorr Board is sturdy and durable as it is handcrafted out of solid wood It is also collapsible which allows it to be stowed away or transported easily The recommended Height and Weight Measurement Procedures RECOMMENDED EQUIPMENT continued Scales a Tanita HD 314 Scale The Tanita HD 314 scale is a portable scale originally designed for home use but capable of withstanding heavy duty use It measures up to 330lbs is lightweight for good portability and has a digital read out b Tanita HD 351 Scale The Tanita HD 351 scale is a portable scale originally designed for home use but capable of withstanding heavy EW duty use It measures up to 440lbs is lightweight for good portability and has a digital read out If using
15. o increase the overall accuracy of height measurements The recorder is responsible for checking the two sets of height measurements to determine if there is more than a one inch difference between the two heights If directly entering into the web entry system a message note will appear notifying the recorder if there is a more than a one inch difference If there is more than a one inch difference then the child must be re measured as discussed in the Standardized Measurement Order section If a re measurement needs to be made the recorder should place a single line through the entries for the first set of measurements and initial the line if using the assessment form Then the second set of two measurements is recorded on the lines provided for 3 Height and Af Height If using the web entry system simply fill in the 3 Height and 4 Height in the indicated places Whether or not the one inch criteria are achieved with the second set of two measurements no additional height measurements will be taken Remember if after two trials a pair of height measurements within the one inch gt 2cm criteria cannot be achieved then mark the Unable to Assess box and the Could not get two measurements in range after two repeats box Height and Weight Measurement Procedures STANDARDIZED MEASUREMENT PROCEDURE continued 4 Weight Measurement For the measurement of weight the child will be asked to step up bac
16. ogether bringing knees or ankles together e Child stands erect head is up and facing straight ahead e Verify body position front and left e Position head in Frankfort Horizontal Plane e Child inhales deeply holding his her breath WITHOUT moving head or body e Bring headpiece down onto the upper most point on the head compress the hair e Child is told to let breath out e Height is recorded to the nearest 1 8 inch or appropriate unit for the stadiomenter e Repeat after obtaining weight 15 Height and Weight Measurement Procedures RESOURCES Arkansas Specific Web Sites Arkansas 217 Century Network http www yale edu 21c arkansas Arkansas Center for Health Improvement http www acht net Arkansas Child Health Advisory Committee http www healthy arkansas gov programsServices familyHealth ChildAndAdolescentHe alth CoordinatedSchoolHealth Pages CHAC aspx Arkansas Coordinated School Health http Awww arkansascsh org Arkansas Department of Education http ArkansasEd org Arkansas Department of Health htto www healthyarkansas com Arkansas Government Act 1220 of 2003 http www arkleg state ar us assembly 2003 R Acts Act1220 pdf Arkansas Government Act 29 of 2003 http www arkleg state ar us assembly 2003 S2 Acts Act29 pdf Arkansas Government Act 201 of 2007 http www arkleg state ar us assembly 2007 R Acts Act201 pdf Arkansas Governor s Council on Fitness http www arkansasfitness com Healthy Ark
17. om the LEFT side of the body Next the child s head is positioned in the Frankfort Horizontal Plane In this position an imaginary line can be drawn from the bottom of the eye socket orbital margin to the external opening of the ear external auditory canal The child will be asked to inhale deeply and hold his her breath WHILE MAINTAINING the head and body in the same position Sometimes a child will either lift his her head or pull up onto the toes when taking the deep breath If this happens the measurer will need to re position the body and head before taking the measurement The moveable headpiece is brought onto the upper most superior point on the head with sufficient pressure to compress the hair After the measurement is obtained the child should be told they no longer need to hold his her breath The measurement is recorded to the nearest 1 8 of an inch or nearest 0 1cm nearest 1 16 inch or nearest mm depending on the stadiometer used Height and Weight Measurement Procedures RECORDING THE DATA Whether using the paper assessment forms inputting the data directly into the web entry system the information needed is the same There are three forms needed to be maintained by the assessors 1 The ACHI Scale Accuracy Log formerly called the ACHI Scale Calibration Log 2 The ACHI Measurement Station Information Form and 3 The ACHI Height and Weight Data Collection Form or direct web entry 1 ACHI Scale Accur
18. omplete set of data collection equipment 1 stadiometer stabilized against the wall with duct tape if necessary 1 scale tested for accuracy 1 step stool data collection forms or computer basket for the child s personal items and general office supplies In order for an individual school to utilize multiple stations several schools will need to share equipment and rotate that equipment from one school to the next For the most accurate measurements it is highly recommended that assessments be conducted on hard surface floors i e gym floor tile floors and avoid floors that are carpeted 1 Preparation of the Child The child should be asked to remove as much outerwear as possible Regardless of the clothing worn the child should be asked to remove his her shoes and will be measured either barefoot or wearing socks Additionally the child will be asked to empty his her pockets and remove all jewelry or other objects The child will be asked to remove eyeglasses hair barrettes and ties or rubber bands if possible so that accurate height and weight measurements can be obtained A small box or basket should be provided at each measurement station for the child to place their personal items in until their measurements are complete Measurement Order One measurement of weight and two measurements of height should be taken and entered on each child Because the measurement of height requires greater skill to perform correctly two
19. on the Centers for Disease Control and Prevention s CDC BMI for age growth charts for boys and girls Carpenter s square An instrument for ensuring a level reading of height Certificate of completion Document provided upon completion of BMI assessment training protocol Confidential Information marked or intended for a specific person or persons Digital Scale An instrument for measuring weight External Auditory Canal Passageway that leads from the outside of the head to the tympanic membrane or eardrum membrane of each ear Frankfort Horizontal Plan Imaginary line passing through the external ear canal and across the top of the lower bone of the eye socket immediately under the eye Height A standing measurement in inches or meters Medial Border Relating to the middle or center Orbital Margin The top of the lower bone of the eye socket Private Not openly or in public Recorder Person who writes down student heights and weights or enters measurements into database Height and Weight Measurement Procedures DEFINITIONS continued Scapulae Two large flat triangular bones forming the back part of the shoulder also called shoulder blade Stadiometer Instrument for measuring standing height Student Health Report A written notice to parents with student s health screening information Written Refusal A document to school district requesting a child not be in
20. oviders 19 Height and Weight Measurement Procedures OBJECTIVES The goal of this protocol for Body Mass Index BMI assessment for age is to certify participants in the measurement techniques described in this manual At the completion of this training the participant will be able to 1 2 Ot gt 8 9 Set up measurement stations with all of the appropriate equipment Check accuracy of the scales Prepare student for measurement Measure height and weight following proper procedure Perform the steps of the weight measurement correctly Perform the steps of the height measurement correctly Apply the one inch rule for height Record enter data into the electronic data entry system www achi net Maintain students privacy and confidentiality 10 Print and distribute student health reports in a confidential manner Height and Weight Measurement Procedures DEFINITIONS BMI Body Mass Index Weight in Pounds BMI Height in Inches x Height in Inches x 703 Weight in Kilograms BMI Height in Meters x Height in Meters BMI for age assessment protocols A detailed plan designed to describe appropriate procedure for assessment BMI for age assessment Calculating the height and weight as in the definition for BMI and applying the CDC growth charts for age and gender BMI Percentile for Age An indicator to assess the size and growth patterns of individual children based
21. surements in rotational order o Recorder verifies data entry either paper record or web entry then checks height measurements for one inch 2cm criteria e Apply the one inch 2cm criteria for height re measure height if necessary sare Height and Weight Measurement Procedures SUMMARY OF WEIGHT MEASUREMENT e Turn on the scale to zero the scale e Place standard weight on the scale to ensure accuracy of the scale e If the readout is more than one half pound off the standard weight change the batteries Then place the standard weight on the scale again If it is still off by more than a half a pound do not use this scale e If scale is accurate begin assessments e Ask the child to remove extra layers of clothing jewelry and any items in his her pockets e Ask the child to step on the scale backwards for confidentiality e Ensure that the body weight is evenly distributed between both feet e Arms hang freely by the sides of the body palms toward thighs e Head is up and facing straight ahead e Weight is recorded to nearest 0 2 pounds or appropriate unit for the scale 14 Height and Weight Measurement Procedures SUMMARY OF HEIGHT MEASUREMENT e Child stands with back against the board or whatever part of the body touches the board first may be more than one body part e Body weight is evenly distributed on both feet e Arms hang freely by the sides of the body palms facing the thighs e Legs are placed t
22. tails Click Save to update the information If any required information is not correct the system will not save the information but rather post a go back message for the form to be corrected The completion of this form will assist personnel in interpreting the data and therefore calculating accurate BMI values when units of measurement may be in question This process should also assist school personnel in determining the correct unit of measurement for the equipment they are using thereby increasing their comfort level with the measurement process 3 Height and Weight Data Entry Two methods of recording height and weight are acceptable The same information is needed regardless of the method chosen The two methods are 1 Record height and weight on the ACHI Height and Weight Data Collection form and then enter the information into the web entry system 2 Directly enter the height and weight into the web entry system at the time of the assessment The following student information is needed to calculate the BMI and to create the student health report sent home to parent guardian Student s full name Social Security Number SSN or School ID number Guardian name Student address Student grade Student gender Assessment date Date of birth 11 Height and Weight Measurement Procedures RECORDING THE DATA continued H a student has been previously assessed for BMI then the student information may alrea
23. this scale it is recommended that a piece of colored taped be placed over the previous weight readout for confidentiality purposes 2 Step Stool It is recommended that each school purchase a two height step stool for use with the height measurements The accurate measurement of height requires that the measurer is able to read the measurement line at eye level Additionally some measurers will not be tall enough to do this without standing on a step stool even for elementary school children 3 Batteries Many scales require batteries Usually AA batteries or lithium batteries are required but you will need to check the type and number of batteries required for the scales used at your school 4 Standard Weights for Checking Accuracy At the beginning of each measurement day at the school accuracy of the scales will be required A known standardized weight must be placed on each scale This weight reading on the scale should be logged on the calibration log with the corresponding date and time noted If the recorded weight is more than half a pound higher or lower than the standard weight the measurement should be repeated and re recorded If the recorded weight is more than half a pound different from the calibration weight then you should change the batteries If that does not correct the problem then this scale should not be used for assessments NOTE If you are using scales that measure in metric units then the weight on the sc
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