Somatic Growth Height Weight And Head Circumference

Measurement of growth is one of the most important indicators of the health of children, and deviations from normal may provide an early indication of an underlying problem. To assess growth, it is important to compare a child's growth parameters with respect to

Table 17-5, pp. 750-759, shows several common abnormal growth patterns.

■ Normal values according to age and sex

■ Prior readings on the same child to assess trends

To be clinically meaningful, growth parameters should be measured carefully, using a consistent technique and, optimally, the same scales to measure height and weight.

The most important tools for assessing somatic growth are growth charts, which recently have been modified and published by the National Center for Health Statistics. These charts include height, weight, and head circumference for age, with one set for children up to 36 months and a second set for children ages 2 to 18 years. Charts plotting weight by length are also available. These growth charts have percentile lines indicating the percentage of normal children above and below the child's measurement by chronologic age. Table 17-4, Growth Charts, pp. 742-749, displays these growth charts.

Failure to thrive is inadequate weight gain for age. Common scenarios are:

■ Growth <5th percentile for age

■ Growth drop >2 percentiles in 6 months

■ Weight for height <5th percentile

Causes include environmental or psychosocial, and a variety of gastrointestinal, neurologic, cardiac, endocrine, renal, and other diseases.

Growth Patterns of Various Systems

Percent of 20-Year-Old Size

Growth Patterns of Various Systems

Percent of 20-Year-Old Size

Birth Age in Years

Height. For children older than age 2 years, measure standing height, optimally using wall-mounted stadiometers. Have the child stand with heels, back, and head against a wall or the back of the stadiometer. If using a wall with a marked ruler, make sure to place a flat board or surface against the top of the child's head and at right angles to the ruler. Stand-up weight scales with a height attachment are not very accurate.

Rule ofthumb on height: After age 2 years, children should grow at least 5 centimeters per year.

For children under the age of 2 years, measure body length by placing the child supine on a measuring board or in a measuring tray, as shown on the following page. Direct measurement of the infant using a tape measure is inaccurate unless an assistant holds the child still with hips and knees extended. Velocity growth curves, such as the one on the next page, are helpful in older children, especially those who are suspected of having endocrine disorders.

Weight. Weigh infants directly with an infant scale; this is more accurate than an indirect method based on weighing the parent and child together and subtracting the weight of the parent from the total weight. Infants should be clothed only in a diaper or weighed naked.

Children who can stand should be weighed in their underpants on a stand-up scale. While initially nervous, most young children can be coaxed onto such scales. School-age children and adolescents can wear gowns. This is particu-

Reduced growth in height may indicate endocrine disease, other causes of short stature, or, if weight is also low, other chronic diseases.

Short stature, defined as subnormal height for age, can be a normal variant or due to endocrine or other diseases. Normal variants include familial short stature and constitutional delay. Chronic diseases include growth hormone deficiency, other endocrine diseases, gastrointestinal disease (e.g., inflammatory bowel disease or celiac disease), renal or metabolic disease, and genetic syndromes.

Girls Physical Examination

larly important for adolescent girls being evaluated for underweight problems. Ideally, serial weights (and heights) should use the same scales.

Head Circumference. The head circumference of infants should be measured during the first 2 years of life, but measurement can be useful at any age to assess growth of the head. The head circumference in infants reflects the rate of growth of the cranium and the brain. In older children, head

A small head size may be due to premature closure of the sutures or to microcephaly. Microcephaly may be familial or due to a variety of chromosomal abnormalities, congenital infections, maternal metabolic disorders, and neurologic insults.

Velocity curves for length and height for boys and girls based on intervals of 1 year. (From Lowrey GH: Growth and development of children, ed 8, Chicago, 1986, Mosby.)

size is affected by genetic factors, and it may be useful to measure the head circumference of parents when children have abnormal head sizes.

To measure head circumference, place the measuring tape over the occipital, parietal, and frontal prominences to obtain the maximum circumference. During infancy this is done best with the patient supine. You may need to make several measurements and use the largest one. Measurements of chest and abdominal circumference are not clinically useful.

An abnormally large head size (>97th percentile or 2 standard deviations above the mean) is macrocephaly, which may be due to hydrocephalus, subdural hematoma, or rare causes like brain tumor or inherited syndromes. Familial megaloencephaly (large head) is a benign familial condition with normal brain growth.

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  • Arnor
    What is a somatic growth measurement?
    1 year ago

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