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Anthropometric Manual - Minnesota Department of Health

1. ny Possible incorrect Measurement Reason J v LK coef 40 Measuring lengthor height of children e All children lt 2 years of age must be measured in the recumbent position Ifthe child is lt 2 years old recumbent will be defaulted into the measurement position box e Children older than 3 years of age must be measured standing standing is defaulted into the measurement position box e Children between 2 and 3 years may be measured either standing or recumbent see page 10 for guidance on deciding the appropriate position Standing will be defaulted and this must be changed to recumbent if the child was measured in the recumbent position Step 3 Enter height length and weight into the Height and Weight tab in the clinic software Add Height Weight Measurement x Enter the value of the measured o length or height in inches and Measurement Date 77772010 v 1 3 inches Age at Measurement 1 Year s and 9 Months Height Weght Indicate if the measure was done Inches Eighths Pounds Ounces 4 j Me P in the recumbent or standing z m pay tas ek position Possible Incorrect Measurement Reason Enter the value of the weight in pounds and ounces Cancel Click the OK button to save This returns you to the Height Weight Subtab of the Ht Wt Blood tab Once back at the Ht Wt Blood tab the growth charts can be viewed by clicking on the Growth Grids button
2. The length standing height and weight is measured for all WIC applicants and participants during the assessment phase of the certification process The information gathered during the assessment is used to determine program eligibility and to determine what education and referrals should be provided to the participant parent caretaker Ifthe anthropometric measurements indicate a potential or overt problem WIC staff will address this by providing education nutritious foods and referrals at the time of the certification A plan for follow up to monitor progress with the issue will be created High quality measurements are essential to provide accurate information so that beneficial education and referrals canbe made If measurements are done poorly incorrect assessments may be made leading to incorrect education and counseling A parent may worry unnecessarily about poor growth or overweight when the child is actually growing appropriately or atrue growth problem may not be identified Multiple measurements done over time at WIC clinic visits will provide a more complete and more accurate picture of individual children s or women s growth and health Quality accurate measurementsare also important because individual WIC participants anthropometric measurements that are done in WIC clinics are combined to create reports These reports describe the WIC population for the WIC community and these reports are used by decision makers to inform futu
3. A number ona scale from 0 to 100 reflecting the relative position a measurement lies in a range of values Percentiles are commonly used to compare an individual s anthropometric measurements to a reference population For example if a child has a weight for height value that is plotted at the third percentile then 97 of the population of the same age gender and height weigh more than that child The distance from the crown of the head to the bottom of the heels when the subject is measured lying down The distance from the crown of the head to the bottom of the heels when the subject is measured standing upright also referred to as stature Charts developed by the Institute of Medicine used to assess weight gain during pregnancy Weight gainis assessed and monitored during pregnancy because better pregnancy outcomes are associated with differing weight gain amounts that vary based on the woman s weight status prior to pregnancy Women who were underweight prior to pregnancy are encouraged to gain more weight than women who were normal weight prior to becoming pregnant and overweight women are encouraged to gain less than normal weight women The number of weeks that have passed since the first day of the woman s last menstrual period the duration of the pregnancy thus far Part Anthropometric measurements done in WIC clinics and factors affecting health growth and pregnancy Anthropometric measurements done in WIC clinics
4. e The digits ina value were transposed 23 wasentered when the value was 32 e A field was not used correctly for example in the ounce field 6 was entered when the scale read 6 or six tenths pounds which should be converted to 11 ounces e The value for the weight measure was entered into the height field or vice versa e There isa note indicating that the child was very anxious and struggled significantly against the last measure If nothing can be found to explain the situation WIC staff will need to determine if it appears that the situation on the growth chart reflects the actual situation Hasthe child lost weight or not grown since the previous measure The clinic staff will need to evaluate other information to understand the situation to determine the correct actions Staff will need to consider any additional physical information e g hemoglobin measures physical aspects of the child that can be seen and ask the parents the nutrition and health assessment questions and probe all aspects to determine if a source of the problem can be found WIC staff will need to make recommendations and referrals that make sense to the situation 43 JV SELF ANTHROPOMETRIC CHECK ASSESSMENT 33 What do you need to mark on the height and weight screen when you use referral data A Enter the date the measurement was actually collected B Select a reason from the Possible Incorrect Measurement Position drop down list
5. hand plotting length or height and weight The instructions for entering length or height and weight data into the WIC clinic software are described below Procedures for plotting infants and children s height lengthand weight during certifications Using equipment and procedures described in Part II of this manual height or length and weight for infants and children will be measured and entered into the Height and Weight tab in the WIC clinic software Measurement data is enteredin the Height Weight subtab of the Ht Wt Blood tab in the clinic software File Participant Activities Benefit Management Document Imaging Help i gt s PIRS i HJATA CersScabon History Health informadon Nanaon Educabon Reterrals income Hestory Benefits Hes tory Apomurtments Demnographecs HTWT Blood Food Prescripton Rosk Factors VENA Hog Wet Measwrermert Date Age at Measwremert inches Eths Messuromernt Posbon Pounds Ounces Body Mass index 0 Months 3 Days X N A POW ioniy To enter height or length and weight data click on the Add button of the Height Weight Blood tab 39 Step 1 Enter date of collection The first step is to enter the date on which the measurements were taken Most often this will be the date of the certification 4 Add Height Weight Measurement Measurements Enter the date the data was collected gt gt Measurement Date 77772010 M If the data is collected on a date
6. Risk Code 114 At risk of Overweight Risk Code 113 Overweight Risk Code 115 High Weight for Length Risk Code 121 Short stature For the following questions look at the enlarged portion of a ruler below 29 11 30 20 08 The arrowis pointing at 5 8 3 8 4 16 6 8 16 12 The actual measurement is a 30 2 8 b 30 3 8 c 29 3 8 d 295 8 For the following questions look at the enlarged portion of a ruler below 30 31 13 The arrow is pointing at 6 8 6 16 Exactly between 6 8 and 7 8 7 8 200m 14 The measurement you record for the picture above is Hegre inches 2 Eighths 6 a Height b Inches 31 Eighths fo 4 Height inches 20 Eighths 5 4H 15 How should the following length values be recorded in the clinic software Height Inches Eighhs a 29 3 8 enter as Height Inches Eighths b 29 enter as Height inches Eighths c 29 enter as Now check your answers against the Answer Key at the end of this module Measuring weight for children younger than 24 months 2 years of age A Equipment Use either a medical grade digital or beam balance scale The scale must be capable of weighing up to 40 pounds and weigh in ounce or smaller increments The tray should be large enough to fully support the infant The scale should be easily zeroed Further it must have features that allow calibratio
7. The scale is marked in one half ounce increments allowing the measurement to be done to the one half ounce The infant weight is recorded in ounce measures and so the staff person must round the measure to the nearest ounce If the scale measures as exactly one half ounce the measure should be rounded down To what ounce is the arrow pointing to in the diagram below 0 oz 16 oz The arrow is pointing between 6 and 7 ounces but it is closer to six ounces therefore it should be read as 6 ounces 20 Reading measurements from Digital Scales Infant digital scales read in pounds ounces and one half or smaller increments of ounces We will record to the nearest ounce For example if the measurement result is 18 pounds 2 and a half ounces record 18 pounds and 3 ounces round to the next full ounce Infant digital scales have a read out panel that looks similar to this First two digits indicate pounds the next two digits indicate ounces and the last digit indicates fractions of ounces A reading of 1 up to 4 ounces must be recorded as the last full ounce round down and 5 to 9 ounces must be recorded as the next full ounce round up These weight measures should be recorded as 08 09 0 Rounddown 8 pounds 9 ounces 08 09 1 8 pounds 9 ounces 08 09 2 8 pounds 9 ounces 08 09 3 8 pounds 9 ounces 08 09 4 8 pounds 9 ounces 08 09 5 8 pounds 10 ounces 08 09 6 8 pounds 10 ounces 08 09 7 8 pounds 10 ounces 08 09
8. Weeks gestation from 0 to 40 are shown on a horizontal axis moving left to right Each grid line represents one week of gestation Pre pregnancy BMI 185 289 Weight gain chart Normal weight BMI gt 18 5 but lt 25 prior to pregnancy Weight gains 25 wo wn 6 Pre pregnancy weight zero n D c 5 amp paa D or Weight losses 5 10 15 20 25 Number of Weeks Pregnant Weight gainor loss from the pre pregnancy weight is depicted on the vertical axis along the left hand side of the chart The pre pregnancy weight is plotted at zero the starting point on the graph Weight gainis depicted by grid lines above zero and weight loss is shown by increments below zero Each grid line represents five pounds The chart displays a recommended range of weight gain for each week of gestation The actual weight change today s weight less the pre pregnancy weight is plotted against the weeks gestation Tracking 53 the weight gain or loss and comparing it to the recommended weight gain helps identify deviations from the expected rate of change This information along with accurate dietary and health information can help you assess a woman s healthand nutritional status In the example below the woman was assessed to be overweight prior to the pregnancy On the date of the measurement it was estimated that she was at twenty seven weeks gestatio
9. associated with childhood obesity as measured by BMI IOM W Cnutrition risk criteria a scientific assessment National Academy Press Washington D C 1996 Ifa woman s weight gain falls within the recommended range it is assumed that her weight gain is appropriate and healthy If the weight gainis greater than the recommended range she may be gaining too much weight or gaining too quickly If the weight gain is less than the recommended range she may not be gaining enough for the best pregnancy outcome A pregnant woman srate of weight gain reviewed together with information obtained from a diet and health assessment can help focus the nutrition education and counseling Itis very important to keep in mind that a single plot can be deceiving Staff should avoid drawing conclusions from a single weight measurement Serial measurements during pregnancy illustrate the pattern rate and amount of the weight gain Wherever on the grid the weight plots continued gradual weight gain should be encouraged For women who have gained more than the recommended amount the goal should be to slow the rate of gain but not to stop gaining For women who have gained less than the recommended amount a faster rate of weight gain is recommended NOTE Estimating Pre pregnancy weight Many pregnant women won t know what they weighed before they were pregnant so it is often only an estimate and prone to error If the estimate of pre pregnancy weight is
10. s Manual for directions for calibrating the scale or consult with the scale s manufacturer A form that canbe used to document the accuracy checks is available in the Minnesota WIC Program Operations Manual MOM as an exhibit Local agencies may use their own form as long as the pertinent information is collected date scale tested weight tested and results of tests Local agencies may have a different combination of standard weights and in this case the procedure for testing the scale will be the same except that the available test weights will be used If you have questions you should contact the Nutrition Consultant assigned to your grantee B Technique Balance Beam scales 1 Confirm that the weights are set at zero and that the scale balances at zero 2 Have subject remove coats heavy clothing including sweatshirts and sweaters and shoes Have the subject set aside purses toys or any other items they may be holding 3 Have the subject stand in the middle of the platform with body upright and hands arms hanging naturally at their sides 4 Move the heaviest weight to the right until the scale tips indicating that too much test weight has been added return the weight to the highest position that indicates that more weight is needed Add smaller weights until the beams tips over indicating that too much weight has been added move to the highest position that indicates that more weight is needed Finally move the small
11. underweight BMI age gt and lt 10 at risk of underweight b 35 c 5 and 10 d 95 aT bT 63 41 42 43 44 D C al bT cF d F eF Her BMI 18 3 which falls in the lt 18 5 underweight category She should gain 28 to 40 pounds 64 Equipment checklists Infant Scale Checklist v High quality beam balance or electronic digital v Weighs to 40 Ib v Weighs in 1 2 oz or smaller increments v Tray large enough to support the infant v Can be easily zeroed and checked v Can be calibrated Infant Length board Checklist v Afirm inflexible flat horizontal surface with a measuring tape in 1 8 inch increments v Tape is stable and easily read v An immovable headboard at a right angle to the tape v Asmoothly moveable footboard perpendicular to the tape Child and Women Scale Checklist v High quality beam balance or electronic digital v Weighs in 1 4 lb or smaller increments vY Stable weighing platform v Can be easily zeroed v Can be calibrated v No stature device attached Child and Women Stadiometer Checklist v A vertical board with an attached metal tape or metal tape firmly mounted on a stable wall v An easily moveable horizontal headboard that can be brought into contact with the most superior part of the head If not attached the head board must be a right angle that is 6 wide A wide and stable platform or firm uncarpeted floor as the base Easily read stable
12. BMI Growth Chart is used to evaluate a child s BMI value In 2000 the Centers for Disease Control and Prevention developed BMI charts for children 2 to 20 years of age These charts represent a large reference population and show how a child s BMI compares to the BMI of other children the same gender and age The charts show the percentile distribution of BMI by age Weight classifications by BMI percentile for children lt 10 percentile underweight or at risk of underweight 11 to 84 NOrMal weight 85 to 94 at risk for overweight gt 95 percentile overweight An imaginary line used to correctly position anindividual s head for measuring both recumbent length and standing height Visualize a straight line along the side of the head from the opening in the ear to the lower bone of the eye socket For measuring in the recumbent position this line should be perpendicular i e ata right angle to the surface of the measuring board under the child s head For standing height this line should be parallel to the floor i e ata right angle to the surface of the measuring board behind the child s head A tool also referred toas a growth grid for comparing an individual child s growth with a reference population The chartsare specific for measurement position age and gender See BMI Growth Chart Percentiles Recumbent Length Standing Height Weight Gain Charts Weeks Gestation
13. C Enter an exception reason D AandB E All of the above 34 If a child is between two and three years what is the appropriate method of measuring A Always standing B Always recumbent C Depends on what parent prefers D None of the above 35 If a child is greater than three years old what is the appropriate method of measuring A Always standing B Always recumbent C Depends on if child is able to cooperate so that a good standing measure can be obtained otherwise should be done recumbent D None of the above 36 What are the first steps to take if it appears that a child s weight or height has changed drastically compared to previous plots on the growth charts A Make animmediate referralto the child s health care provider B Begin further assessment by asking the parent assessment questions e g does the parent think the child s weight or height status has changed VENA questions C Look at the measures entered in the recordto assure that the information was entered correctly e g entered 42 when should have been 24 or enteredthe decimal value when should have entered it s ounce equivalent e g entered 6 in the ounce field because the read out was 6 which should have been converted to 11 ounces D Re measure the child E First Cand if errors found D and if it appears that measures were correct thenB and if appropriate A 37 Which of the following statements are false
14. Reviewing the growth grids determine if the growth patterns of the two 2 children two 2 infants are normal or if the patterns indicate short stature underweight or overweight Evaluate a pregnant women s pre pregnancy weight status and make appropriate recommendations for weight gain during her pregnancy Using the pregnancy weight gain grids determine if the two pregnant women are gaining weight at an appropriate rate Explain appropriately and adequately to the parents caregivers of the four 4 children the results of their anthropometric assessment and tothe two pregnant women the results of their weight gain assessment Glossary Anthropometry BMI BMI Growth Chart Frankfort Plane Growth Charts Anthropometry is the science of weighing and measuring the body The anthropometric measurements used in WIC are standing height recumbent length and weight Body Mass Index BMI is a measure that adjusts bodyweight for height For children BMI is age and gender specific It is calculated as weight in kilograms divided by heightin meters squared The resulting value is compared to reference cut off points that designate weight status The weight classifications of BMIs for adults are lt 18 5 underweight gt 18 5to24 9 healthy weight gt 25to29 9 overweight gt 30 obese The cut off points for children s BMI vary by age so that a particular BMI value may fallin a different category at different ages The
15. Short Stature e Length for Age lt the 2 3 is criteria for Short Stature e Length for Age lt the 5 but above the 2 3 is criteria for At Risk of Short Stature NOTE because the 2006 CDC WHO charts area Standard not a reference narrower ranges are used to indicate possible concerns For example for children less than two years the risk code 121 Short Stature or At Risk of Short Stature is not assigned until the child s length age is lt 5 While for children older than two years measured standing is assigned when height age is lt 10 45 WHO 0 to 24 Weight for Age and Gender YMHTA p YMWilAp YMWINI w O26 WHO Loriga O26 WMO wT sige OMWHO WTA EB Blevege BMW ioe DEVIAS z i Oo ay 08 0012 1 Yew 19 Morte 60a 1 Vow 8 Morta 19 Dae 213 t Rex eteri 11 13 n E A P 1 Yos 8 Mote Tt Dee 1 Yew Morta M Ooy 7 Obd Feccertert Pek lt gt Om J cow J The 0 to 24 month weight for age charts represent the normal distribution of weight at specified ages for boys or girls in the WHO standard population These charts compare how heavy a child is compared to other children the same age and gender Weight for age is not used alone to classify infants and children as under or overweight However it is important in early infancy for monitoring weight and weight gain Further because weight for age is influenced by recent changesin health or nutritional status it can be helpful in explaining changes in weight for lengt
16. Weight Gain in Pregnancy Overweight Women pre pregnancy BMI is 2 25 and lt 30 This chart is used for women who were classified as overweight prior to pregnancy As with underweight and normal weight women by plotting the change in weight by weeks gestation it is possible to see if the current rate and amount of weight gain is on target to achieve the total recommended amount of weight gain For women who were overweight prior to the pregnancy the recommended range of weight gainis 15 to 25 pounds This chart is used for women whose pre pregnancy BMI is greater than or equal to 25 but less than 30 Pre gregnancy BMI 25 0 29 9 _ N D c 5 amp a r D 15 20 Number of Weeks Pregnant This woman s weight status was overweight prior to her pregnancy She is currently at 26 weeks gestation and has gained about 23 pounds This woman s total amount of weight gainis greater than recommended and the patternis slightly faster than recommended but in clinic you would need to consider her situation If there had been a concern that excess weight gain waslikely to be a problem for this woman this total and rate of gain may be an excellent clinical outcome Also keep in mind that the initial weight measurement was within approximately 5 pounds of the recommended range and the estimated pre pregnancy weight could easily be off by five pounds So even though the system will assign a risk code for
17. behavioral factors are most likely to cause differences in growth among children of similar age and gender On the positive side there is greater ability to influence these factors and thus improve health outcomes In Summary Itis important that WIC staff use good quality well maintained equipment and follow correct procedures when measuring weight length or height in WIC clinics because e Measurement of weight and length or height is a required component of WIC certifications e The anthropometric measurements are part of the information used to assess health and nutrition status of WIC participants e g identify participants who are or who may be at risk for overweight or underweight e The assessment process including evaluation of height length weight and growth provides a basis for nutrition education and counseling e Measurements done in WIC clinics are used to create reportsthat describe the WIC population for the WIC community e These reports are used in assessing the health status of WIC participants and in setting public health priorities WIC can impact the health growth and development of children and the health of women and their pregnancies through identifying health problems and factors that may contribute to diminished health This information can then be used to identify education counseling and referrals that will improve health and nutrition status SELF ANTHROPOMETRIC CHECK ASSESSMENT Questi
18. charts tell US cccccceccceeeeeeceeeeeeeeeeeeeeeseceeeneeseeeaeteneeeaeaenes 38 Using growth charts for assessing anthropometric MEaSUrEMENKS ccececeeeeeeeeees 39 Assessing Growth and Weight StatuS cccccecececeseeeeceeeeeeeeeeeeeeeeeseaeaeneeeenegegenes 45 Weight gain in pregnancy cceccccscecececeeeeeeceeeeeeeeeeeeenseseeeneeseseeeaeeeeeeaeaeneeaeaenensy 53 P rt IV Answer Key for Sell CHECKS oiriin een ea E E NEEE A E E AEE 62 Fap mMmENT E ACERS US iana E AEE E E AE E OS 65 Introduction Anthropometry refers to measurements of the body such as for example length or height weight and head circumference Lengthrefers to the measurement of infants and young children while lying down referred to as recumbent measurement Height refers to a standing measurement which is the method used for children over two years of age and women Height is sometimes referredto as stature In WIC weight and length for infants and children up to age two or standing height for children over two years and women are measuredat specific times depending on age and WIC type as part of the nutrition assessment process Children s measurements are compared to a comparison population using a growthchart Women s measurements are compared to weight standards and during pregnancy weight gain or loss is plotted on a pregnancy weight gain grid At specified intervals every six months for children a nutrition assessment is co
19. for Disease Control and Prevention website discussion of Growth Charts CDC Growth Charts and the document 2000 CDC Growth Charts for the United States Methods and Development page 25 General Growth Chart Principles Growth References and Standards What is a growth chart Growth charts consist of a series of percentile curves that illustrate the distribution of selected body measurements in children Growth charts are tools used to trackthe growth of infants and children that help to identify children who may be at risk for overweight underweight or short stature and those who fall within the average range of weight length or height for their age and gender Measurements of individual children are plotted on the growth charts This information along with accurate dietary health and hematological information can help you assess a child s health and nutritional status In developing the growth charts the WHO working groups defined a reference as a tool for providing a common basis for purposes of comparison and a standard as embodying a concept of a norm or target that is a value judgment Insimple terms a reference describes what is whereasa standard describes what should be In practice however reference values are often used as a standard Growth references are intended to be used to screen and monitor growthin individuals and populations They are not intended to be used as a sole diagnostic instrument Instead growth
20. high weight gainin pregnancy the focus would be on continued small gradual weight gains through the remainder of the pregnancy and not the risk code per se 58 Weight Gain in Pregnancy Obese Women pre pregnancy BMI is 2 30 This chart is used for women who were classified as obese prior to pregnancy As with overweight underweight and normal weight women by plotting the change in weight by weeks gestation it is possible to see if the current rate and amount of weight gain is on target to achieve the total recommended amount of weight gain For women who were obese prior to the pregnancy the recommended range of weight gainis 11 to 20 pounds This chart is used for women whose pre pregnancy BMI is greater than or equal to 30 Pre pregnancy BMI gt 30 a D C 5 amp s a 2 gt 15 20 25 Number of Weeks Pregnant This woman s weight status was obese prior to her pregnancy She is currently at 13 weeks gestation and has gained very little weight Her weight gain will be assessed by the system as being too low However counseling should not focus on this The current weight gain is very near to the recommended amount and the pre pregnancy weight is an estimate Further there is only one weight measurement and the pattern of weight gain throughout the pregnancy will be more important to monitor using consistent accurate scales Further especially for obese women advice about the amount and ra
21. stadiometer cannot be used it is recommended that a portable stadiometer be purchased A step stool or short stepladder for the staff to stand on to accurately read the height of an adult is necessary NOTE Do not use the movable measuring rod on platform scales for measuring height It isnot accurate because it is too narrow unsteady and the headpiece is easily bent Also they are difficult to read contributing to error when reading the measurement B Technique 1 Remove shoes hats and hair accessories Flatten interfering hairstyles if possible 2 The child or adult should stand tall and straight with heels close together shoulders level and relaxed hands at sides facing away from the measuring board Heels touch the base of the vertical board the buttocks and the participant s back at the shoulder blades should touch the measuring board If making all these points touch is impossible or uncomfortable have the participant stand with buttocks touching and heels touching or as close to the board as possible Ask the participant to inhale deeply and to stand fully erect without altering the position of the heels Make sure that the heels do not rise off the foot plate For measuring a younger child the assistant who could be a parent presses the knees and feet firmly so they are straight The person taking the measurement should be positioned in the best place to readthe measurement tape this is usually directl
22. tape readout in 1 8 inch increments NN Printed on recycled paper 65
23. weighed 100 prior to the pregnancy has a pre pregnancy BMI that falls in which range Select one underweight normal weight overweight or obese She should be encouraged to gain a total of to pounds Now check your answers against the Answer Key at the end of this module 61 Part IV Answer Key for Self Checks a a 9 po S 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Any of the following responses are correct Any of the following responses are correct e Measuring length height and weight is a required component of certifications in WIC e Results of the measures may identify possible or overt problems e g under or overweight e Results of the measures are used in determining planning education and counseling e Results of the measures are compiled to create reports that describe the WIC population e Results of the measures are compiled to create reportsthat are used by policy makers F T T Any of the following are correct many other responses would also be correct e Smoking e Drug or alcohol use e Good or poor dental hygiene e Active or sedentary lifestyle e Taking or not taking prenatal vitamins C T F a True b None of the risk codes will be assigned A D A A Height Inches 29 Eighths 3 a 29 3 8 enter as Height Inches 29 Eighths 6 Height Inches 29 Eighths 4 b29 enteras c 29 enter as F T 12 Ya 4 10 ounces B A D T
24. weight gain at this visit compared to their pre pregnancy weight b Ifawomanis gaining too slowly she should be encouraged to stop doing any exercise or activity that burns extra calories c Ifawoman is gaining too slowly the WIC CPA should assess why this might be the case For example does she have nausea or heartburnthat might inhibit her desire to eat what was her usual meal pattern before the pregnancy what is it now what does she usually eat is she eating a balanced diet 43 Markthe following statements T for True and F for False a Even obese women are encouraged to gain small amounts of weight each week with a goal of 11 to 20 total weight gain b Weight gains far above or far below the amount and rates suggested on the weight gain charts are associated with less favorable pregnancy outcomes c Awoman whois currently at 28 weeks gestation had a pre pregnancy BMI in the normal range and who has already gained 40 pounds should be encouraged to stop gaining weight and totry to stay at her current weight until the recommended weight gain range catches up with her current weight gain d The recommended weight gain depends on what the woman gainedin her last pregnancy If she gained 25 and the baby was healthy that is what she should gain with this pregnancy e Women almost always know their pre pregnancy weight within a couple of pounds 44 Fill in the blanks for the following statement A5 2 woman who
25. 62 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 a 145 pounds 11 ounces b 128 pounds 13 ounces c 116 pounds 0 ounces T o es M iiaa Possible answers any two of the following others also may be correct o shoes not removed hat not removed elaborate hairdo on crown of head knees bent Frankfort plane is not parallel to the floor feet legs not properly positioned i e feet not flat on floor body not properly positioned straight mid axillary line not achieved child lt 2 years measured standing child gt 3 years measured recumbent measurer did not crouch to read measure at eye level or did not use step stool when shorter than the person being measured Possible answers any two of the following others also may be correct o shoes not removed O O O O O OOOO o outer heavy clothing not removed o wetdiaper present o body not centered on scale o child jumping or moving around on scale o person is weighed while holding some object such as toy or purse o nutrition staff is distracted from recording a measurement immediately following procedure and records an incorrect measurement later o scale not balanced at zero setting before weighing the participant person being measured leaning on the wall or holding the stem of the scale o scale set to Kg A D none of the above depends on child s ability to stand correctly and cooperate A E B al bT cT dT eF a 5 BMI age lt 5
26. 79 180 ee did 113 118 1mo 154 155 167 185 186 er dig ns 191 192 e D 122 196i 197 69 MA 125 2021 203 70 i a 70 128 129 1731 174 188 2081 209 71 i32 133 178 9 3 2141 215 72 136 i 137 140 154 183 184 199 220 221 19 21 2491 25 27 2991 30 Under Normal Weight 1 Over Weight 1 Obese In establishing an estimated pre pregnancy weight the CPA must use professional judgment along with assessment and interviewing skills The CPA may begin by asking the woman what she estimates her pre pregnancy weight to have been Some women will know but many will not Many women will not have had access to a reliable medical quality scale The CPA must keep these things in mind when determining what weight to use as her pre pregnancy weight estimate The CPA may need to help the woman estimate the pre pregnancy weight by asking her if she thinks she has gained or lost weight consider asking her things such as if and how her clothes fit differently does she sense a physical change have there been measurements done at her clinic visits If for example she states that her pre pregnancy weight was 125 pounds she is currently at 8 weeks gestation and she states that her clothes mostly still fit with minor changes in the snugness of the waist band of her jeans and you measure her weight at the clinic as 135 pounds you may wish to change the estimate of pre pregnancy weight toa number closer to 135 pou
27. 8 8 pounds 10 ounces 08 09 9 Roundup 8 pounds 10 ounces Weight Pounds 8 Ounces 9 8 pounds 9 ounces Weight Pounds 8 Ounces 10 2 4 8 pounds 10 ounces If your scale measures in one half ounce increments the last digit will read Oor 5 Inthe case of a scale that reads in ounce increments record 0as the last full ounce and 5 as the next full ounce 21 Review the following examples Each of these examples pertain to scales that measure in 1 10 ounces 0 10 ounces Digital scale example 1 22 10 5 This is twenty two pounds and ten and one half ounces It should be recorded as 22 pounds 11 ounces round up for 5 to 9 ounces Digital scale example 2 24 11 7 This is twenty four pounds and eleven and seven tenths ounces It should be recorded as 24 pounds 12 ounces round up for 5 to 9 ounces D Recording weight measurementsin WIC clinic software Weights are measured in pounds and one half ounces and entered in the clinic software as pounds and ounces Weight Pounds Ounces mim To record the example above 24 pounds 11 and 7 10ths pounds Eleven and seven tenths ounces should be rounded to 12 ounces Weight Pounds 24 Ounces 2 22 CHECK ASSESSMENT SELF ANTHROPOMETRIC Questions Mark the following statements T for true and F for false 16 ____ Children younger than age 24 months may be weighed wearing a wet diaper 17 __ Weight of child
28. A Multiple vs single plots of weight height give a better picture of a child s growth B It doesn t matter if the length or height was measured recumbent or standing C Itis important to indicate the actual date measurements were taken so height and weight Git Now check your answers against the Answer Key at the end of this module plots will be based on the child s age at time of measurement 44 Assessing Growth and Weight Status The following charts are used by the Minnesota WIC Program to assess growth WHO 0 to 24 Length for Age and Gender Y26HT Age Y26WT Age Y2EWIMT BMI O24WHOLen Age O24WHOWT Age 9 O24WHOWTAen B Elen Age 8 6 WT Age BS WT Aen 8 8 n v c c v a 10 12 Age Months Ose hn Adpted Age Hegh Postion Peecerthe 08 10 2012 1 Yea 10 Morita 6 Oyi 1 You 8 Morita 19 Das In Recusbers 92 08 15 2012 1 Year 8 Morits 11 Oy 1 Yox Morta 24 Oys nS Recunbert 134 The WHO 0 24 month length for age charts represent the normal distribution of length at specified ages for boys or girls in the WHO Standard population These charts compare how long a child is to other children the same age and gender raised in an ideal environment Based on this chart the following risk code could be assigned WIC Risk Code 121 Short Stature or At Risk of Short Stature Length for Age lt the fifth percentile 5 is the criteria for assigning Risk Code 121 Short Stature or At Risk of
29. Anthropometric Manual Minnesota WIC Program Minnesota Department of Health Revised October 2012 Division of Community and Family Health Supplemental Nutrition Programs 85 East Seventh Place P O Box 64882 Saint Paul MN 55164 0882 800 657 3942 TTY 651 201 5797 DEPARTMENT oF HEALTH RIMENT DEPARTMENT oF HEALTH HEALTH www health state mn us divs fh WIC Anthropometric Manual Minnesota WIC Program Minnesota Department of Health Revised October 2012 Division of Community and Family Health Supplemental Nutrition Programs 85 East Seventh Place P O Box 64882 Saint Paul MN 55164 0882 800 657 3942 TTY 651 201 5797 DEPARTMENT oF HEALTH RIMENT DEPARTMENT oF HEALTH HEALTH www health state mn us divs fh WIC Module Guidance a eal gi Read the knowledge and the performance objectives pages 4 5 of this module As you read the module STOP when you come to a Self Check section When you come to a Self Check section complete it right away Check your answer with the Self Checks against the ANSWER KEY at the end of the manual For any incorrect answers or for questions that you find difficult re read the appropriate section of text to clear up any confusion Then move to the next section If still confused consult your WIC Coordinator or designated trainer or if necessary your nutrition consultant Review any supplemental materials that are recommended After you have successful
30. Children Until age 2 children must be measured in the recumbent position After age 3 all children must be measured standing After age 2 years the CPA should make every effort to measure the child in the standing position If it isnot possible to obtain an accurate standing measure for children between 2 and 3 years the child may be measured in the recumbent position However no anthropometric risk codes willbe assigned for a child over two years measured in the recumbent position A Equipment Use a recumbent measuring board with a fixed headpiece and sliding foot piece that are both perpendicular upright form a 90 degree angle to the measurement surface Measurements should be readable to the nearest eighth of an inch Measuring board 11 Frankfort plane B Technique Two people the measurer and an assistant usually a parent are needed to measure recumbent length To measure recumbent length follow these steps 1 Put a cleancloth or paper on measuring board Remove shoes and hats and flatten interfering hairstyles if possible With the help of an assistant lay the child flat on his her back on the measuring board with their head located at the end with the fixed headpiece See illustration above Assistant should stand directly behind headboard and cup her hands over the child s ears while holding the child s head firmly against the headboard Child s eyes should be facing upward with the line of
31. RELAXES ARMS AT SICES LEGS STRAIGHT ANO KNEES TCGETHER FEET FLAT MEELS ALMOST TOGETHER SMCULSER SLAOES SUTTOCKXS MEASUREMCNY SURFACE Pictures From How to Weigh and Measure Children IrwinJ Shorr U N N Y 1986 25 NOTES 1 Itis helpful to have two people taking the height of a child one to hold the lower body i e knees and feet in position and one take the measurement This will not be necessary for adults or older children but be sure to check positioning before taking the measurement 2 If a child or adult has an elaborate hairstyle that affects measurement and cannot be altered note this in the record 3 With preschool age children the heels will likely touch the back of the board or wall For older or overweight children the heels will probably be away from the wall 4 Women must be measured Self reported height is NOT acceptable C Reading the measurements Reading the measurement for a standing height is very similar to reading the recumbent length see pages 13 14 You will read to the nearest 1 8 inch See if you know to which eighth of an inch the arrow is pointing on this enlarged view of an inch _ lt 39 If you said 2 8 you are correct 2 8 is equivalent to 1 4 Note when you are taking a standing height itis important that your eyes are at the same level as where you are reading the measurement Therefore you may have to crouch or bend down whe
32. This prompts the system to generate the appropriate growth chart so that the CPA can assess the child s growth When achild s measurements are plotted on the growth charts the results are displayed as percentiles For children over age two the data is plotted on the 2000 CDC growth charts and the percentiles represent the normal distribution of weight height weight for height or BMI for a nationally representative reference group of healthy children the same age and gender Percentiles are represented by curved lines on the growth chart 41 Interpreting growth charts On each chart the 5th 10th 25th 50th 75th 90th and 95th percentiles are indicated by lines On the BMI age chart the 85th percentile is also shown The 50th percentile is the mean the top percentile shown is the 95th and the lowest percentile displayed is the 5th percentile 2 a a Q Height Inches Age Years Children with measurements that are about average will plot near the mean or 50th percentile For children who are larger than average their measurements will be plotted above the mean and smaller children s measurements will be below the mean As a child s measurements deviate further above the mean the percentile representing that measure will be larger Asmeasurements deviate further below the mean the percentile will be smaller For example For a child whose weight plots on the 50th percentile of the we
33. ce These charts compare the combined weight and height to other same age and gender children BMI is used to classify children as underweight overweight or obese Based on this chart the following risk codes could be assigned WIC Risk Code 103 Underweight or At Risk of Becoming Underweight BMI for Age lt the tenth percentile 10 is the criteria for assigning Risk Code 103 Underweight or At Risk of Becoming Underweight e BMl for Age lt the fifth percentile 5 is used to screen for Underweight e BMl for Age lt the tenth 10 but above the fifth is used to screen for At Risk of Becoming Underweight WIC Risk Code 113 Obese Children 2 years and older BMI for Age 95th percentile is the criteria for assigning Risk Code 113 Obese WIC Risk Code 114 Overweight Children 2 years and older BMI for Age 85th percentile up tothe 95th percentile is the criteria for assigning Risk Code 114 49 Note In 2000 the CDC introduced BMI charts for children The BMI for age charts are used to evaluate weight status compared to height and age BMI for age charts is superior for evaluating weight status and BMI for age is the measure WIC staff should use to assess weight status The CDC has created a BMI age training module that all staff should review e Onthe BMI for age chart the child s age is included in the assessment of the child s weight status Including age in the assessment is important because children s adiposity var
34. charts are tools that contribute to forming an overall clinical impression for the child being measured The American Academy of Pediatrics AAP National Institutes of Health NIH and CDC recommend that the WHO 2006 charts be used for children under age twoyears and the 2000 CDC charts for children over age two years USDA has accepted these recommendations for the WIC program In WIC clinics the CDC 2000 growth charts for children 2 to 18 years are used as part of the nutrition assessment process for children over twoyears of age These charts illustrate how a child s growthin weight and height compare with that of other children of the same age and gender in the United States The 2000 CDC charts area reference meaning they compare growth of individual children to the growth of children in a reference population For children over age twoand measured standing the clinic software will create the appropriate growth charts and height for age weight for age and BMI for age will be displayed The plots on the CDC 2000 growth charts for children 2 to 18 years are used to assign anthropometric risk codes for children over age two years measured in the standing position For children older than two years measured in the recumbent position anthropometric risk codes do not apply Children over age two measured in the recumbent position will not have risk codes related to lengthor weight For children over age two years but measured in the recumben
35. e result A form that canbe used to document the accuracy checks is available in the Minnesota WIC Program Operations Manual MOM as an exhibit Local agencies may use their own form as long as the pertinent information is collected date scale tested weight tested and results of tests 18 The scale should weigh the test weights within ounce For example if the test weight is 15 it is acceptable if the scale measures anything between 14 pounds 15 ounces up to 15 pounds and ounce If the scale measures the test weight differently than the test weight s value plus or minus the allowed tolerance in this case ounce the scale must be calibrated Check the scale s User s Manual for directions for calibrating the scale or consult with the scale s manufacturer Local agencies may have a different combination of standard weights and in this case the procedure for testing the scale will be the same except that the available test weights will be used If you have questions you should contact the Nutrition Consultant assigned to your grantee B Technique Balance the scales at zero If a paper drape or pad is used zero the scale with the drape or pad on the tray Check the instructions manual for how to do this Prior to weighing check that the scale balance indicator is centered assuring that the scale is balanced at zero For most digitalscales place drape on scale before turning the scale on check the i
36. e weighing techniques for women infants and children Describe appropriate techniques for measuring length and height Describe or find reference that describes features of equipment that may be used in WIC Describe how to designate that a measurement was done on a date different than the certification date List two common errors made when measuring length and height List two common errors made when measuring weight Identify at what agesit is appropriate to measure children s length in a recumbent position vs height in a standing position Identify how to record height length and weight Describe what the various WHO and CDC growth grids tell us Describe what the pregnancy weight gain grids tell us List WIC criteria used to define normal versus abnormal growth patterns of children Performance Objectives The CPA will be able to i 10 Observe other staff members weigh and measure four 4 children and two 2 pregnant women Explain the purpose and procedure for measuring weight and length height of infants children of different ages Explain the purpose and procedures for measuring women Measure weight and length height of two 2 children two 2 infants and two 2 women using appropriate procedures Record weight and length height measures in the data processing system Designate in the data processing system that a measurement was done as recumbent and the actual date of collection of referral data
37. erpendicular at aright angle to the surface of the measuring board under the child s back see diagram on previous page e Ensure that the child was straight and centered on the board from head to feet e Extend both legs and ensure that the toes were pointing up e Slide the foot piece firmly against the child s heels e Carefully read and record the measure i I I I I I i I I I f I i I I I I I I I I I I I i I I i I i I I L C Reading the measurements Proper technique is essential when measuring the recumbent length of a child Equally important is a correct reading of the measurement This can be difficult since the increments on the measuring board tape are quite small Itis important for you to understand fractions of an inch to accurately read the measurement Below is an enlarged portion of a tape 29 30 lirdi VV VVVVVV I Se soy g g If you look between the longer lines that mark each inch example above shows 29 to 30 inches you see there are smaller lines between them Beginning at 29 move to the right to the next smaller line counting each of the spaces between the lines There are seven lines between the inch marks and eight spaces Each space lying between two of the small lines represents one eighth 1 8 of an inch Remember that the total number of spaces betweeninch 29 and inch 30 pictured above is eight 13 When measuring an infant s or a child s recumbent lengt
38. es a child may be difficult to measure However make every effort to obtain as accurate a measurement as possible by asking for assistance and using toys or mobiles to distract the child If necessary achild may be weighed in an adult s arms First the adult is weighed alone and that weight is recorded Next the adult is weighed with the child and this second weight is recorded The adult s 19 weight is then subtracted from the second reading adult and child together Staff should record weight obtained in adult s arms in the participant record NOTE Most digital electronic scales have a tare feature which allows you to zerothe scale while the adult is on it before handing the infant or child to the adult With this feature only the weight of the infant will appear in the scale display after the adult s weight is tared Check the instruction manual Staff should document that the weight was obtained in an adult s arms C Reading the Measurements Using proper techniques when measuring the weight of an infant child is very important and equally criticalis properly reading the measurement Pediatric scales are readto the nearest ounce and there are sixteen ounces in one pound Reading Measurements from Balance Beam Scales Below is an enlarged portion of the fractional beam balance on a baby scale 0 oz 16 oz bitititeditutibidititibibititinsd This is an enlarged view of the ounce portion of the infant balance beam scale
39. es based on how the child s measures plot on the 2006 WHO charts What do the growth charts tell us Growthcharts show you how each child s measurements compare with children of the same gender and age Eachchart has smoothed curves or lines that represent growth percentiles For children over age two years the curves percentiles serve as a reference for comparison The height or weight of a child will be plotted on the grid and then compared to these percentiles Deviation from the curves for a child over age two signal that further investigation should be done but because the curves represent a reference not a standard WIC staff must be cautious in how the charts are interpreted For children under age two years the 2006 WHO charts can be used as a standard to assess a child s growth Deviations from the curves for children under age two should be given serious consideration when evaluating the child s nutrition status Regardless of which chart is used for the assessment the charts cannot be used in isolation Additional information about the child and the situation e g hematology dietary home environment and health information must be part of the evaluation Likewise single measurements of height and weight in isolation only begin to provide clues about a child s growth Measurements from two or more WIC visits begin to show the child s growth pattern This pattern can then be compared to the expected pattern of growth In o
40. est weight until the scale balances within pound four ounces 5 Immediately record the result 6 Returnthe weights to the zero position Digital scales 1 Turn on scale and confirm that zero is indicated 2 Have subject remove coats heavy clothing including sweatshirts and sweaters and shoes Have the subject set aside purses toys or any other items they may be holding 3 Havethe subject stand in the middle of the platform with body upright and hands arms hanging naturally at their sides 4 Immediately record the reading 30 C Reading rounding the measurement Correctly reading rounding and recording the weight measurements is important Ifthe value is incorrectly read rounded or recorded incorrect assessments may be made leading to inappropriate nutrition education Additionally incorrect risk codes might be assigned or risk codes might not be assigned Beam Balance Scale Balance beam scales usually measure to pound and thus adults and children weighed on these scales will have results that must be converted to ounces Readthe result to the nearest quarter pound if the result is exactly between two quarter pound increments round down to the last full quarter pound Then convert to ounces Record quarter pounds as the following ounce values Record pound as 4 ounces Record pound as 8 ounces Record pound as 12 ounces Digital Scale The digital scale reads the weight result quickly The value will be d
41. gh risk and an INCP will need tobe written NOTE There will be no anthropometric risk codes assigned to children greater than two years measured in the recumbent position 47 Two to six year Height for Age and Gender Y2SHT Age Y2SWT Age Y26WT HT BMI B26 Len Age B 36WT Age B 36 WT Len m lt O c ee lt D cx 48 Age Months The height for age charts represent a normal distribution of heights at specified ages for boys or girls in the nationally representative reference These charts compare how talla child is to the height of other children the same sex and age These charts can be an indicator of short stature or growth faltering Based on this chart the following risk codes could be assigned WIC Risk Code 121 Short Stature or At Risk of Short Stature Height for Age lt the tenth percentile 10 is the criteria for assigning e Height for Age lt the fifth percentile 5 is used to screen for Short Stature e Height for Age lt the tenth 10 but above the fifth is used to screen for At Risk of Short Stature 48 Body Mass Index BMI for Age and Gender Y26HT Age Y26WT Age Y26WT HT BMI B 36 Len Age B3EWT Age B 36 WT Len 48 Age Months 022009 10 09 2008 2 Years 2 Months 19 Days 19 80 97 89 The BMI for age charts represent a normal distribution of weight and height together and compare BMI for boys and girls of the same age in the nationally representative referen
42. h you need to measure to the nearest eighth 1 8 of an inch You will need to count the number of lines or eighths that are to the right of the whole inch mark Looking at where the arrow is pointing in the example below you would count three lines from the 29 inch mark which would make it 29 and three eighths inches 29 3 8 29 30 lirila I 3 8 Some measuring tapes have additional lines between eighthinch 1 8 marks These are sixteenth inch 1 16 marks See example below Do not let this confuse you Ignore the smaller sixteenth lines and read tothe nearest eighth mark Looking at where the arrow is pointing in the example below you would count three of the more prominent lines from the 29 inch mark which would make it 29 and three eighth inches 29 3 8 D Rounding the measurements Many recumbent length and height measurements will not fall directly on an eighth inch 1 8 increment Therefore you will need to round your reading Round as follows e If the measurement lies closer to one of the eighth 1 8 marks round to the nearest eighth mark In the example below the measurement lies closer to 33 1 8 than to 33 inches therefore round to 33 1 8 inches 33 34 Liila m o 33 1 8 inches e f the measurement falls exactly between two eighth marks round down tothe lower eighth mark 14 E Recording the measurements Length and height measurements are recorded in the clinic software in Inches and Eig
43. h or BMI for age 46 WHO 0 to 24 Weight for length and Gender V264HT Moe NEVIS YMWIAT OM O2 WHO Lege 3 O00 Wi WT Ape OM WHO WTA PRlevkge 3 BW oe PEYIA s S SxS 3 2 7 50 DO A nP 1 Yew 10 Mote amp Dues Yew Moda 19 0a Jt Die ron Dam wtert lt 2 LAY NLN 1 Yew Mybs 11 Dues 1 Vou Motua 24 Oa 21 Ot Sa Dam wierd The WHO O to 24 month weight for length charts represent a normal distribution of weight compared to length for boys or girls in the age range from birth to 24 months These chartscompare the weight measures of all same gender children of a given length Compared to other children the same gender how does the child s weight compare to other children this length These charts can be an indicator of overweight or underweight Based on this chart the following risk codes could be assigned WIC Risk Code 103 Underweight or At Risk of Becoming Underweight Weight for Length lt the fifth percentile 5 is the criteria for assigning WIC Risk Code 103 e Weight for length lt the 2 3 percentile 2 3 is criteria for Underweight e Weight for length lt the fifth percentile 5 but above the 2 3percentile is the criteria for At Risk of Becoming Underweight WIC Risk Code 115 High weight for length Weight for length 97 7 for infants and children less than two years old is the criteria for assigning WIC Risk Code 115 Children 12 months and older with this risk code are considered hi
44. hths of inches In the example above 33 1 8 inches will be recorded in the clinic software as 33 1 8 Add Height Weignt Measurement Messuremerts Meesuremert Oste 7 Age at Measurement ths Height Weight inches 33 Gighths j 4 Pounds Ounces Messuremert Postion CR ag Body Mass index Possible incorrect Measurement Reason z o o All fractions for height measures are recorded as eighths of inches Fraction Recordas 1 8 inch 1 8 1 4 inch 2 8 3 8 inch 3 8 1 2 inch 4 8 5 8 inch 5 8 3 4 inch 6 8 7 8 inch 7 8 15 SELF ANTHROPOMETRIC CHECK ASSESSMENT Questions Fill in the blank with the correct letter 7 Until what age at aminimum should a child be measured lying down recumbent a 6 months b 1 year c 2 years Mark the following true T or false F 8 10 ped It is very difficult for one person alone to obtain an accurate recumbent length measurement of a child Recumbent length measures for children should be readto the nearest For the following situation in clinic select the correct answer for eachstatement that follows Situation in Clinic Even though several attempts have been made it is not possible to obtain a standing measure for a 25 month old child True or False it is acceptable to measure this child in the recumbent position Which of the following risk codes will be assigned Risk Code 103 Underweight
45. ies by their stage of development which is reflected by the child s age e BMI can be used to evaluate weight status through adolescence and into adulthood This allows for tracking a child s weight over time BMI for age is the appropriate method for evaluating children s weight status Weight for height should not be used to assess weight status in WIC clinics Two to six year Weight for Age and gender Y26HT Age Y26WT Age Y26WT HT BMI B 36 Len Age B 3EWT Age 8 36 WT Len ia wo S Qe D VN 3 c 5 a ev D S wo 48 Age Months 07 02 2009 44 3 ibs 1009 2008 2 Years 2 Months 190 37 5 ibs Standing 99 00 2 Years 11 Months 12 The two to six year weight for age charts represent a normal distribution of weights at specified ages for boys or girls in the nationally representative reference These charts compare how heavy a child is to the weight of other children the same sex and age Weight for Age alone is not used to classify children as over or underweight but it often reflects recent changesin health or nutritional status and can be important in assessing changes in BMI status 50 Please do the WHO Growth Chart Training Case Examples following the links below Case Example 1 Low Weight for Length Case Example 2 Inadequate Growth or Just Small Case Example 3 Excess Weight Gain Case Example 4 Transitioning from the WHO Weight for Length Chart to the CDC BMI for Age Cha
46. ight for age chart we expect that half 50 of all healthy children of the same gender and age weigh less than the measured child and half weigh more e For a child whose height plots on the 25th percentile of the height for age chart we expect that 25 of all healthy children of the same age are shorter thanthe child and 75 are taller For a child whose BMI plots on atthe 95th percentile on the BMI for age chart we expect that 95 or most healthy children of the same height age and gender will weigh less and only 5 or not very many will weigh more than this child Whenever a measurement doesn t make sense or seems incorrect the staff must investigate the situation often the first step will be to re measure the child For example if a child is shorter weighs less than previous measures or it appears that very little growth or weight gain has occurred clinic staff should re measure the child to determine if the measurement done today is correct 42 If the second measure matches the day s earlier measure staff should begin to assess the situation to determine the source of this unexpected situation For example was the participant measured incorrectly the last time measurements were done Is it possible that the measurement at the previous clinic visit was enteredincorrectly This might happen when e Two children from the same family are measured and the values are entered into the incorrect child s file
47. imes per year Clinics with high volumes should test scales more often To test adult older children s scales Zerothe scale Add standardized 5 and 10 weights Record the result Remove the weights Add standardized 5 10 20 and 25 weights on the scale Record the result Remove the weights Have a staff person step on the scale and note the weight Have them step off of the scale allow the scale to zero and return to the scale while holding a standardized 20 or 25 weight Record the result 29 Compare the scale s reading with the value of the combined weights that were measured Electronic scales measure the fractional pounds in one tenths 0 1 or two tenths 02 of a pound Thus the scale must measure within 1 10 or 2 10 pound of the value of the standardized weight For example if the staff person weighed 135 8 pounds plus the 25 weight test weight a measurement of 160 7 up to 160 9 it is acceptable if using a scale that measures in one tenth increments if the scale measured in 2 10 pound increments 160 6 up to 161 0 is acceptable The results should measure within pound 4 ounces for balance beam scales So the scale must measure within pound of the value of the standardized weight In this example the staff person weighed 135 pounds and held a 25 weight The scale must read between 160 up to 161 pounds If the scale measures outside of this range the scale must be calibrated Check the scale s User
48. in this case a 100 pounds from the lower arm plus 25 pounds from the upper arm the arrowis pointing closest to 4 for a total weight of 125 pounds 32 Record in the clinic software as 125 pounds 4 KS Height Inches 65 Eighths 3 125 H Measurement Position Recumbent Standing Body Mass Index 20 6 Example 2 A woman is measured on a digital scale that reads 125 5 One hundred twenty five and five tenths The same woman is measured on a balance scale and it reads V 1 3 v2 7 4 Va v2 100 on the lower arm and the upper arm looks like this 24 25 26 100 lower arm 25 upper arm 125 pounds These values would be entered into the clinic software as 125 8 ounces digital scale 5 converts to 8 ounces see chart on page 31 and on the balance scale converts to 8 ounces see chart on page 31 Height Weight Inches 65 Eighths 3 i Pounds 125 Ounces 8 EE Measurement Position P CR Tr G Stand Body Mass Index 20 7 33 SELF ANTHROPOMETRIC CHECK ASSESSMENT Questions 25 What value should be entered into the clinic software for the following weight values a 145 7 Pounds Ounces b 128 8 Pounds Ounces c 116 0 Pounds Ounces Mark eachas True or False 26 The scale should be balanced at zero prior to each weighing 27 Children can wear their boots and coats while being weighed because the digital scale can tare for these items 28 Itis importan
49. incorrect the chart used to plot her weight change during the pregnancy might be inappropriate and assessed weight gained or lost could be incorrect Staff must always remember when using the charts that they may have incomplete information However even though the information is not perfect it is important to assess weight change during pregnancy Excessive weight gains and serious weight losses should be evaluated first to verify that the weight change is accurate i e that no measurement errors occurred Whenever large deviations from the expected rate of change are identified it is essential to determine whether it reflects measurement error or actual weight changes If the weight changes seem to be accurate the CPA should explore possible explanations for the weight gain or loss The CPA should review recent dietary intake exercise habits as well as other aspects of the woman s health and home situation Significant unexplained weight shifts may signal a problem with the pregnancy and the woman should consult with her doctor 60 SELF ANTHROPOMETRIC CHECK ASSESSMENT 41 Obese women should be encouraged to Lose weight earlyin the pregnancy to avoid excess total amount of weight gain Gain approximately 8 to15 pounds during the entire pregnancy all of the above none of the above 200 42 Which of the following is true a Itis easy to assess women s weight gain at their first visit because you can compare her
50. isplayed as pounds and 1 10th pounds For example 125 and 2 tenths of pounds will readlike this 125 2 In Minnesota WIC tenths of pounds will be converted to ounces according to the following chart Recording ounces from digital scales Digitalread out Record as Ounces Ounces Ounces Ounces Ounces Ounces 10 Ounces 11 Ounces 13 Ounces 14 Ounces Local Agencies should post a copy of this chart on the digital scales so staff won t need to think about the conversion from 1 10 pounds to ounces 31 D Recording the measurement in the WICclinic software balance and digital scales Weight measurements for women and children are recorded in the WIC clinic software in the ht wt tab Weight is recorded in pounds and ounces m E Inches 65 Eighths 3 Pounds 129 Ounces 13 Measurement Position Example 1 a woman is measured on a digital scale that reads 125 2 One hundred twenty five and two tenths pounds Recordin the clinic software 125 in the pounds field and convert 2 10 pounds to ounces using the table on page 31 This converts to 3 ounces and will be entered into the software as 125 3 Ounces m me Inches 65 Eighths 3 i Pounds 125 Ounces 3 Measurement Position OR Standing Body Mass Index 20 6 Example 1 Continued The same woman is measured on a balance beam scale balance beam scale reads 100 pounds and On the balance beam scale read to the hittin bd nearest pound
51. ly completed a section arrange with your agency WIC Coordinator or designated trainer to observe experienced staff demonstrating the procedure and then demonstrate the knowledge and skills you have learned After successfully demonstrating the skills move on to the next section Good Luck Table of Contents Module GUNG AICS San von eos vanes uc E uci vor E E storie Uva ease Ene aS 1 PTE TOC UIC Gl Ol Nani ars Vans aw cio cio ee ca E an wre oe ole ce ae ese acre veactatine san eae same E 3 ODIE CUIV ES tiaras oo a2 Sas aha ta i Gr oeran oacaee nee ntenea ava saenmeaedee nec eacccenan EA 4 GIOSSALY sacs oan nc cas E A ue Ghawen concen can wanaue uence nis E 6 Part Anthropometric measurements and factors affecting growth and pregnancy 686 8 ParcllProceatresand SOUND ICI bss aadascec cad evscudiaaiinenwcieah aoainesacuteesawt ned ova innaeebeaaesaesmeauausiets 11 Measuring recumbent lengt Miss siravcssseteiveeteleacedcakencataanendeataiesetelaetacdaeshsauanentuanwndes 11 Measuring weight children less than two yearS ccccceeceseeceeceeteseeceneeeteaeesensetenes 18 Measuring standing height adults and older cChildren ccccecceeeceeeeeeeeeeeceeeeeenes 24 Measuring weight adults and children over twO yearS ssssosesesssreresessrersererrssrrers 29 Part Ill Using and interpreting growth charts and pregnancy weight gain charts 00008 37 Wiat is a STOWLM CMalt recor Sa E E E O E 37 What do the growth
52. n The balance scale should have a non detachable balance weight a zero adjustment weight and free sliding weights non detachable on both main and fractional beams The scale should be clearly marked in increments of at least one half ounce All scales must be placed on a hard level flat surface Scales should not be placed ona rug Digitaland balance beam scales can usually be read in either pounds or kilograms Make sure the digital scale is set to measure pounds and that the weights on the balance beam scale are properly placed so that they settle into the pound increment slots Testing scales for accuracy Digitaland balance beam scales must be checked for accuracy using standard weights at least two times per year approximately every six months Clinics withhigh volumes should test scales more often Recommend testing quarterly for scales used in locations with monthly caseloads of 1 000 participants Zerothe scale Test three different amounts of weight beginning with a small standard weight then testing weight at a midrange and then near capacity of the scale Zerothe scale and then add standard weights for example e Place astandardized 5 weight on the scale read and record the result e Remove the 5 weight and allow to zero Then place the 10 and the 5 weight on the scale at the same time Read and record the result e Remove these weights and then place a combination of weights to test at 30 to 35 Read and record th
53. n and she had gained approximately 23 pounds Weight gain chart overweight BMI gt 25 but lt 30 Pre pregnancy BMI 250 299 prior to pregnancy Plot showing weight gain 23 at 27 weeks gestation Pre pregnancy weight zero Weight Gain pounds 15 20 Number of Weeks Pregnant Zero weeks 40 weeks gestation gestation The pregnancy weight gain charts used in the Minnesota WIC Program were developed based on the recommendations from the Institute of Medicine Nutrition During Pregnancy Institute of Medicine National Academy of Sciences National Academy Press 2009 1OM published recommended amounts of weight gain based on pre pregnancy weight status underweight normal weight overweight and obese reflecting the different recommended amounts of weight gain based on pre pregnancy weight status A woman s pre pregnancy weight status is assessed using Body Mass Index BMI and determined to be either underweight normal weight overweight or obese 54 Procedures for determining recommended weight gain Step 1 Determine the woman s pre pregnancy BMI You can use the system calculated BMI a BMI chart or a calculator BMI Chart 88 1 89 9 100 1181 119 129 1431 144 911 92 1231 124 1481 149 in inches 58 Ree Sji 95 1531134 aa 97 os 100 111 131 133 m 158 15 62 00 o 163 164 es if 105 10 118 10 aaa 152 169 170 it aos no 12 i4 me i 1m4 175 6s o o 1
54. n measuring achild or use a step stool when measuring adults Rounding the measurement If the measure appears to be exactly between two of the eighth marks round down to the last full 1 8 measure otherwise round to the closest mark 26 D Recording the measurement Height measurements are recorded in the WIC clinic software as inches and eighth inches In the example below the child s height should be entered as 41 and 3 8 inches E 42 C z7 41 Height Weight Inches 41 Eighths 3 Pounds Ounces Measurement Position s CR e gt Body Mass Index Standing must be indicated in the Measurement Position field All measures are recorded in inches For adults height in feet will need to be converted to inches For example the measure for a woman who was measured at 5 7 will be recorded as 67 inches and 6 eighth inches Convert five feet to 60 inches and add the 7 inches to get 67 inches then convert inch into 6 8 inch always recordin eighth inches Self reported height is NOT ACCEPTABLE women s height must be measured For women 2 20 years of age height must be measured at the first certification and at subsequent certifications the previous measure may be used For women who are less than twenty height should be measured at each certification 27 SELF ANTHROPOMETRIC CHECK ASSESSMENT Questions Select the correct answer 21 Height should be taken a with shoes on b with
55. nds 55 Step 2 Determine the woman s recommended weight gain amount and pattern The following table lists pre pregnancy BMI values and the corresponding weight gain recommendations The clinic software will display the appropriate chart based on information entered into the health information and height weight blood tabs BMI prior to Pre pregnancy Recommended total Weight Gain Chart used to plot pregnancy weight status weight gain weight in pregnancy Underweight 28 to 40 pounds Underweight chart 18 5 to 24 9 Normal weight 25 to 35 pounds Normal weight chart 25t029 9 Overweight 15to 25 pounds 11 to 20 pounds Weight Gain in Pregnancy Underweight Women pre pregnancy BMI is less than 18 5 This chart is used for women who were underweight prior to the pregnancy The total amount of recommended weight gain is greater for women who began their pregnancy underweight In order to achieve a greater total weight gain the weight gain pattern will be slightly different By plotting the changes in her weight by the week s gestation it is possible to see if her current rate and amount of weight gain is on target to achieve the total recommended amount of weight gain For women who were underweight prior to the pregnancy the recommended range of weight gain is 28 to 40 pounds Prepregnancy BMI lt 18 5 Weight Gain pounds 15 20 25 Number of Weeks Pregnant This woman was underweight prior to pregnancy She is c
56. nducted as part of the certification process for all WIC participants Much canbe learned about the nutritional status and general health of WIC applicants and participants when these measurements are used along with hematologic data and diet and healthinformation that are gathered during the certification process The certification process determines eligibility to participate in the WIC program and thus each aspect of the nutrition assessment must be done during the certification The nutrition assessment is at the heart of WIC it is through the assessment that staff identifies any health issues that should be addressed through education referrals or the food package You have an important role in helping parents and caregivers determine whether their children are growing normally Information you are expected to know is listed on the next page entitled Objectives of the Anthropometric Assessment Module The skills that you will need to appropriately demonstrate and document are listed on the page entitled Performance Objectives Objectives of the anthropometric assessment module Knowledge Objectives The CPA will be able to 1 2 3 4 5 6 7 10 11 12 13 14 List four reasons for assessing the weight and length height of WIC applicants participants List three factors that influence the growth of infants and children List three factors that influence weight gain patterns during pregnancy Describe appropriat
57. nstructions manual for information specific to that model scale Turn digital scales on Have the parent caregiver undress the child removing the child s outer clothing undressing the child to a single layer undergarment and dry diaper A wet diaper can weigh as much as 2 pounds NOTE if it is cold in the clinic light clothing may be worn but document this in the participant record Lay the very young child infant in the center of the scale Older toddlers may sit in the center of the scale For the digital scale simply read the result For a balance beam scale move the weight on the main beam away from the zero position until the indicator drops below center showing that a little too much weight has been added Then move the weight back towards the zero position until the indicator rises slightly showing that just a little too much weight has been removed Move the weight on the fractional beam away from its zero position until the indicator is at center indicating that the child and the weights are in balance with each other You may have to go back and forth with the fractional weight a few times to reach the balance point Return the weights to zero when finished NOTE the scale should be placed on a firm stable and level surface and care should be taken to protect the child from accidents throughout the procedure An adult should be able to reach the infant at all times Children who do not wantto be weighed Sometim
58. ons Mark the following statements either true T or false F or answer the question 1 List a reason for measuring length height and weight as part of the WIC certification process 2 List a second reason for measuring length height and weight as part of the WIC certification process 3 True or False Ifthe height and weight measures at previous certifications indicated good growth repeat measurements may be skipped at the next WIC re certification 4 True or False An individual s growth or pattern of weight gain is influenced by a combination of genetic hormonal environmental and behavioral factors 5 Trueor False Environmental factors are more likely to influence the growth of preschool age children compared to genetic factors 6 Name one behavioral factor that can influence the health of a pregnancy Now check your answers against the Answer Key at the end of this module 10 Part Il Procedures and equipment for weighing measuring and recording anthropometric data In order to accurately reflect health status measurements must be taken carefully using standardized techniques The results must be recorded accurately and compared with the appropriate references Measurements do not need to be done twice if the one measurement is done correctly using proper equipment and technique If there is any doubt about the accuracy of a measurement it should be repeated Measuring Recumbent Length of Infants and Young
59. ort plane not at 90 degree angle to measuring board I Knees bent Only measured one leg Feet not flat against footboard i Did not use recumbent board Or EL ir en ae Height Incorrect age for instrument child less than two years measured standing Hat or elaborate hairstyle not removed I Knees bent Frankfort plane not at 90 degree angle to measuring board f Feet not flat standing on tip toes Body and head not aligned correctly Stool not used when person being measured is taller than the measurer i Headboard not parallelto the floor Oy OY a ee Weight 1 Child measured in wet diaper 2 Scale not at zero before weighing l 3 Equipment out of calibration 4 Scale set to measure or sliding weights placed in metric units i SELF ANTHROPOMETRIC CHECK ASSESSMENT Questions 31 State twocommon sources of errors in height measurements 32 State twocommon sources of errors in weight measurements Now check your answers against the Answer Key at the end of this module Locate the anthropometric equipment used in your clinic Does it meet the criteria noted in this section Is it in good working condition Take notice of the increments on each measuring and weighing tool Also see page 65 Equipment Checklists for detailed lists of required features of equipment 36 Part Ill Using and interpreting growth charts and Pregnancy weight gain charts The following background was taken from the Centers
60. other koaha Ya than the current date as happens with at Height referraldata the actualdate of Eel Ens e o collection must be entered a Body Mass Index eccwnsccnscsnessoncccersesd KY cancel Child s age at time of data collection calculated by clinic software The clinic software will calculate the child s age based on the indicated date of collection and displays this on the Height and Weight screen The system defaults in today s date because most often height and weight are measured during the certification appointment However WIC may use anthropometric measures collected by other medical providers at an earlier date Ifsuch information is used the actual date of the measurements must be entered so that the data will be plotted based on the child s actual age at the time of measurement See Minnesota Operations Manual chapter five for specific information regarding requirements for using referral data Step 2 Indicate whether the child was measured standing or recumbent Itis essential to correctly indicate whether the child was measured standing or recumbent The child s length or height is assessed using the gridthat matches the child s measurement position Add Height Weight Measurement Heart e Wegt inches Eighths tt Pounds Ounces Indicate if the infant or child s Messuremert Postion measurement was done in the standing Recumbert C Sanding SO or recumbent position
61. out shoes c doesn t matter 22 Which of the following are correct statements about measuring children and women s height select as many as apply a Ideally the participant s heels buttocks and shoulder blades will touch the vertical board of the stature board b The back of the participant s head will always touch the vertical board c Usually only one person is needed to measure young children 23 The Frankfort plane is check one a A747 airplane that takes you to Frankfurt Germany b A position for weighing a child 2 years and older and adults c AGerman type of hotdog eaten with sauerkraut d An imaginary line drawn from the opening of the ear canalto the bottom of the eye socket that is used to determine the proper head position to measure height or length 24 True or False When measuring height of children and adults the WIC staff person should look for the participant s Frankfort plan Now check your answers against the Answer Key at the end of this module 28 Measuring weight of children and adults A Equipment Medical quality balance beam or digital scales are used in WIC clinics The balance beam scale must have non detachable free sliding weights Both types of scales must measure in or less increments and must be capable of being zeroed Testing scales for accuracy Digitaland balance beam scales must be checked for accuracy using standard weights at least two t
62. re policy and priorities Factors affecting growth development and pregnancy outcomes Children s health growth and development and the health of women and their pregnancies including weight status and weight gain during pregnancy are influenced by several interacting factors including Environmental factors for example o quality of dietary intake excess juice or sugary beverages inadequate protein o quantity of dietary intake excess or inadequate calories presence of disease frequent colds amp or frequent use of antibiotics may cause diminished appetite or poor absorption secondary to diarrhea exposure to environmental toxins lead second hand smoke and other pollution Behavioral factors for example o activevs sedentary lifestyle imbalance of calories o smoking appetite suppression organ damage and poor oxygen circulation o drug and or alcohol use appetite suppression direct effects of the drugs and diminished ability to care for themselves and their children o timing of weaning dental damage appetite suppression and excess calories dental hygiene dental damage and impact on ability and desire to eat and chew o taking or not taking prenatal vitamins O Genetic factors i e inherited family characteristics Hormonal factors e g hormonal changes that are partly responsible for the morning sickness that many women experience early in pregnancy Among preschoolers environmental and
63. ren younger than 24 months should be read to the nearest one half ounce Use the enlarged portion of the beam balance of the baby scale pictured below to answer question 18 Circle the correct answer 0 oz 16 oz f 18 What measurement in ounces is the arrow pointing to 12 4 10 11 6 19 What fraction of a pound is four ounces 1 4 3 4 6 8 15 8 11 16 What fraction of a pound is 12 ounces 1 4 3 4 7 8 1 20 Assuming you are using ascale that measures to 1 10th ounce increments how should 10 4 ounces be recorded in the clinic software 11 ounces 10 ounces 10 4 ounces Now check your answers against the Answer Key at the end of this module 23 Measuring standing height of children and adults A Equipment A measuring board with a moveable headboard called a stadiometer is the preferred equipment The board should be marked in eighth inch 1 8 increments The headboard should be wide enough to measure the participant s crown top of head and create a right angle to the measurement surface The stadiometer may be mounted ona wall ina fixed position or it may be portable A measuring rule made of a flat metal material that can be attached to a wall or any vertical flat surface may be used The rule must be marked in eighth inch increments A headboard or right angle block at least 6 inches wide must be used with this technique This is the least preferred approachto measuring standing height Ifa manufactured
64. rt at Age 2 years Case Example 5 Early Lactation Difficulties Complete the quizzes as you work through the examples Complete the following self check using the information gleaned from this document and the case studies You may wish to print the certificate of completion at the end of the case examples 51 SELF ANTHROPOMETRIC CHECK ASSESSMENT 38 Choose T for True or F for False for each of the following statements a The pattern of growth reveals more about a child s nutritional status than a measurement at one point in time b Height or weight plotted at a certain age tells you how a child compares in size with other children of the same age and gender c Percentiles are curved lines on the growth chart that are used to show how a child s measurements compare with other children d Short stature low length or height for age might indicate a growth problem but it may simply reflect normal growth for that child e Tosee if a3 year old child has an appropriate weight for his height plot the measurement on the weight for height chart 39 Fill in the blanks with the appropriate percentiles a BMI for ageless than or equal to lt the percentile may indicate underweight b BMI for age greater than or equal to the _ percentile may indicate overweight c BMI for age greater gt thanthe percentile and less thanor equalto s the __ percentile may indicate the child is at risk of under
65. sight and Frankfort Plane perpendicular to the measuring surface The top of her his head should be touching the headboard See glossary in introduction for complete description of Frankfort Plane While the assistant holds the infant s head in the proper position the measurer aligns the infant s trunk and legs and extends both legs placing one hand on the infant s knees to maintain full extension Bring the footpiece firmly against the infant s heels The infant s toes should point upward Infants often bend or curl their toes and push them against the movable footpiece which may result in an inaccurate value Try gently massaging the infant s feet to relax their toes Itis important that both legs be fully extended for an accurate measurement If only one leg is extended the measurement will likely be inaccurate Correctly positioning the infant for alength measurement requires two people Read the measured length to the nearest eighth of an inch Recording the length immediately 12 Checklist for Recumbent Length Did you e Have the parent or assistant help by holding the child s head cupping her hands over the child s ears in the correct position according to the Frankfort Plane NOTE To determine the Frankfort Plane look at the side of the child s head and draw an imaginary line from the bottom of the eye socket to the hole in the child s ear beginning of the auditory canal This line should be p
66. t position the CDC 2000 growth charts for birth to 36 months length for age weight for age and weight for length charts will be created and the plots displayed WIC staff will use the information in these charts along with the hematologic health 37 and dietary information to assess the child s growth But no anthropometric risk codes will be assigned based on these charts WIC staff is encouraged to obtain measures for children older than two years in the standing position The WHO World Health Organization 2006 Growth Charts for children 0 to 59 months are used in WIC as part of the nutrition assessment process for all children less than two years old The WHO Charts represent a Standard for growth in young children meaning they compare an individual s growth to the growth of children the same age and gender raised in ideal environments Ideal environments were characterized by e fully or mainly breastfeeding for the child s first six months e continued breastfeeding for the first full year e introduction of appropriate solid foods at six months e non smoking households e receipt of appropriate routine medical care e adequate resources to assure proper growth The 2006 WHO charts illustrate how an individual infant or child is supposed to grow The clinic software will create the 2006 WHO charts and the individual infant or child s weight and length measures will be displayed The system software will assign risk cod
67. t that a child stand on both feet on the scale s platform to get an accurate weight 29 ___ Weight of children over age two is recorded to the nearest ounce Choose the correct answer a b c or d below 30 1 pound _ ounces Y pound _____ ounces 2ounces pound 12 4 and 16 4 and 8 2and 8 16 4 and 1 8 a b C d Now check your answers against the Answer Key at the end of this module 34 COMMON MEASUREMENT ERRORS The accuracy of anthropometric data is dependent upon having accurate equipment that is working correctly and carefully following the appropriate procedures Itis also necessary to correctly read the results and to correctly record the information The goalisto minimize the number of errors that can occur The lists below identify some of the more common errors that staff should take care to avoid All Measurements I 1 Inadequate equipment e g bathroom scales stretchable tapes I i 2 Shoes and or heavy clothes not removed l 3 Poorly maintained equipment e g worn broken loose sliding headboards I 4 Scale not zeroed I 5 Reading result incorrectly e g 3 8 inch readas inch staff not wearing reading i glasses so can t see detail I 6 Recording result incorrectly e g inch recorded as 3 8ths when should be 6 8 inch 7 Active struggling child Recumbent length 1 Headnot aligned with body Top of head not against the head board Body arched Frankf
68. te of weight gain should be from her doctor What do the Weight Gain in Pregnancy Charts Tell Us The weight gain in pregnancy chart allows comparison of a woman s weight gainto a recommended range of weight gain based on the pre pregnancy weight status The recommended standards provide a range of weight gain for given pre pregnancy weight status The standards are developed by an expert panel for the Institute of Medicine IOM and are based on the best available scientific evidence 59 Low maternal weight gain is associated with an increased risk of small for gestational age SGA infants especially in underweight and normal weight women IOM Weight gain during pregnancy reexamining the guidelines National Academy Press Washington D C 2009 Likewise women with excessive gestational weight gains are at increased risk for cesarean delivery and delivering large for gestational age infants This can secondarily lead to complications during labor and delivery There is a strong association between higher maternal weight gain and both postpartum weight retention and subsequent maternal obesity High maternal weight gain may be associated with glucose abnormalities and gestational hypertension disorders but the evidence is inconclusive Obesity is one of the most important long term child outcomes related to high maternal weight gain A small number of relatively large and recent epidemiologic studies show that higher maternal weight gain is
69. ther words you can evaluate whether the child is growing at a rate similar to that of their peers and unexpected increases or decreases in height for age or weight for age weight for length or BMI should be assessed Growth charts are valuable tools that are part of the nutrition assessment process For example if a 26 month old girl is below the 5th percentile weight for age less than 5 of girls her age weigh less However the only context for this child s weight is her age other factors such as her 38 height must be considered If she is also on the low end of the stature continuum her weight might be appropriate for her Growth charts can be used to identify children who potentially have growth issues but they are only part of the overall assessment Using growth charts for assessing infants and children s anthropometric measurements As you assess children s length height or weight as part of a certification for the Minnesota WIC program you will use the automated growth charts that are part of the clinic software Basedon the information entered into the height weight tab the software generates the relevant growth charts For children over age two the 2000 CDC growth charts are generated and the child s measurements are plotted on these charts For infants and children less than 2 years the 2006 CDC WHO charts are generated and the measurements are plotted on these charts The automated system eliminates the need for
70. urrently at 8 weeks gestation and has gained five and a half pounds It is recommended that she gain is at least 28 pounds but less than 40 pounds Strictly speaking her current weight gain is high it falls above the range but your counseling would not 56 focus on the slight discrepancy between her current weight gainand the range More important will be weight changes going forward measured on reliable consistent scales Weight Gain in Pregnancy Normal Weight Women pre pregnancy BMI is 2 18 5 and lt 25 This chart is used for women who were classified as normal weight prior to pregnancy i e the BMI was between 18 5 and 24 9 As with underweight women by plotting the changes in weight by weeks gestation it is possible to see if the current rate and amount of weight gainis on target to achieve the total recommended amount of weight gain For women who were normal weight prior to the pregnancy the recommended range of weight gainis 25 to 35 pounds Pre pregnancy BMI 18 5 24 9 A D c 5 amp e D 15 20 Number of Weeks Pregnant This woman s weight status was normal prior to her pregnancy She is currently at 20 weeks gestation and has gained about eleven pounds Her current weight gain assuming the pre pregnancy weight estimate is correct is within the recommended range of weight gainand she is on track to gainan appropriate amount of weight during the pregnancy 57
71. weight d BMI for agegreaterthanor equal to gt the _ percentile may indicate the child is obese 40 Choose T for True or F for False for each of the following statements a Weight and length or height should be measured at every certification for all children b The growth chart should be reviewed at every certification for all children Now check your answers against the Answer Key at the end of this module 52 Weight Gain in Pregnancy Appropriate weight gain is important to achieving a healthy pregnancy WIC can have a critical role in facilitating appropriate weight gain among WIC participants by accurately assessing the rate of weight gain and by providing appropriate advice regarding the individual s unique situation Weight gain recommendations are based on a woman s pre pregnancy weight status i e underweight normal overweight or obese For example women who were underweight prior to the pregnancy should gain more weight than normal or over weight women By monitoring a woman s weight gain over the course of the pregnancy WIC can provide individualized nutrition information and support to improve the likelihood that she will gaina healthy amount of weight Whatis a pregnancy weight gain chart The pregnancy weight gain chart is a tool used to plot a woman s weight gain or loss over the course of her pregnancy to monitor the amount and rate of weight gain throughout the pregnancy
72. y to the side of the child or adult 24 HEADPIECE FIRMLY ON HEAD LEFT HAND ON KNEES KNEES TOGETHER AGAINST BOARD Y RIGHT HAND ON fians HEELS n BACK AND BASE OF BO RD A _ ON KNEES gure ON KNEE yd 5 Determine the position of the head by locating the Frankfort plane which is the imaginary line drawn from the hole in the ear to the bottom of the orbit of the eye the eye socket The Frankfort Plane should be perpendicular to the measuring board that is located behind the child s head The participant may appear to be looking slightly downward but do not be concerned about this as this will ensure that the crown of the participant s head is in the proper position to measure standing height Older children s and many adults heads will not touch the vertical board See diagram on next page for illustration of Frankfort plane 6 Lower the headboard until it firmly touches the crown of the head and createsa right angle with the measurement surface Ensure that the body stays in position by having the assistant firmly pressing their hands on the child s k nees and ankles 7 Readthe stature to the nearest eighth of an inch Q9 Record the measure immediately 9 Use a step stool whenever the person being measured is taller than the person doing the measuring Hi thiini l sles or ae ji LP j ih hsa l LOOKING STRAIGHT AHEAD AHEAD SHOULS IRS

Anthropometric Manual - Minnesota Department of Health

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