Weighing and measuring of babies, children and young people

The assessment and measurement of growth in babies, children and young people is an important aspect of both child health surveillance and acute paediatric care. It must be done with precision and accuracy to be meaningful. It allows assessment of health, development, nutritional status and response to treatment.

This policy applies to all staff working across NHS Borders who undertake these procedures and are responsible for the care of babies, children and young people e.g. hospital and community nursing, medical, dietetic staff. It has been developed using the evidence based practice identified by the Royal College of Paediatrics and Child Health (RCPCH) and the World Health Organisation.

The policy aims to encourage good practice for the weighing and measuring of babies/children and to ensure that all staff working with babies, children and young people have the appropriate training, knowledge and skills to carry out these procedures.

The following guidance is a key resource and is a key reference supporting this
policy:
‘Using the New UK – World Health Organisation 0-4 years Growth Charts’
(Department of Health, 2009)

Click here to access the World Health Organisation website for 5-19-years charts
Royal College of Paediatrics and Child Health growth charts for school-age (2-18 years) are currently in use. Click here to access these charts.

UK-WHO growth charts:

• Measuring and plotting
• Growth charts for 0-4; 2-18; neonatal and infant close monitoring; down syndrome 0-18; childhood and puberty close monitoring, etc.
• Fact sheet for parents: understanding growth charts
• Royal College of Nursing (2017) Standards for the weighing of infants,
  children and young people in the acute health care setting

New-born babies should be weighed and measured (i.e. weight, length and head circumference) at birth and in the first week.

Length or height should be measured whenever there are any worries about a child’s weight gain, growth or general health. Head circumference should be measured at birth, at the 6-8 week check and at any time after that if there are any worries about the child’s head growth or development.

If parents wish, or if there is professional concern, babies can be weighed in line with the Universal Health Visiting Pathway Scotland at:

• 6-8 weeks
• 12 weeks
• 16 weeks
• 12-13 months
• 27 months
• P1 school-age children, 5 to 6 years

If there is concern, weigh more often; however, weights too closely together are often misleading, so babies should be weighed no more than:

• once a month from 2 weeks to 6 months of age
• once every 2 months from 6 to 12 months of age
• once every 3 months over the age of 1 year

However, most children do not need to be weighed this often; families should be reassured that they can seek advice without having their baby weighed.

There may be clinical indications where babies and children need more frequent weighing and measuring.

4.1 Equipment

Weighing and measuring equipment must be fit for purpose and must take account of the need to weigh and measure all children including neonates and those with restricted mobility. A contract should be in place for the annual servicing of all measuring and weighing equipment.

4.2 How to weigh and measure length, height and head circumference

1. Weighing children
   all babies and children up to 2 years should be weighed without any clothes or nappy.
   Children older than 2-years can be weighed removing outer bulky clothing, shoes and socks.
   Only Class III clinical electronic scales in metric settings should be used
2. Measuring head circumferences
   Head circumference should be measured using a narrow plastic or disposable paper tape measure and should be taken where the head circumference is widest.
3. Measuring supine length – until the age of 2 years
   Use a length board or mat; the procedure requires 2 people. Length should be measured without nappy or footwear.
4. Measuring height
   Always measure with shoes removed (and socks if thick).
   Height should be measured from aged 2-years using a rigid rule with T pieces, or stadiometer (height measuring device).
   Feet should be together and flat on the ground, with heels back and legs straight. The buttocks and shoulders (scapula) should be against the back board. The head should be positioned with the lower margins of the eye (corner of eyes) in line with the external auditory meati and horizontal to the middle of the ear.
   The patient should be encouraged not to stretch up.
   Ask the patient to take a deep breath and measure on expiration, supporting the head in the correct position.

4.3 Training

All staff involved in the weighing and measuring of children and the interpretation of data should be trained in the process.
Staff should also have the knowledge of normal growth rates, which will help alert staff to possible inaccurate weights or abnormal weight loss or gain. Staff should also be aware of abnormal patterns of growth (relating to height) which may require
referral or further investigation.

Babies born more than 28 days premature will be scheduled for the 6-8 week assessment by gestational age. The baby should be weighed naked on a modern, electronic, self-zeroing scale, properly maintained and placed on a firm surface. A separate low birth weight chart is available for infants of less than 32 weeks’ gestation and any other hospitalised neonate or infant requiring detailed assessment. Weighing of neonates in Special Care Baby Unit is generally done twice weekly unless their condition determines otherwise.
Please click here for link to ‘UK-WHO Growth Charts – Fact Sheet 5’ – Plotting Preterm Infants

Specialised equipment is available for weighing and measuring children with impaired mobility. A length mat for older children and wheelchair scales are available within Ambulatory Care, Ward 15, Borders General Hospital.

All babies/children requiring enteral feeding will be reviewed on a 6-monthly basis at the Children’s Home Enteral Feeding (CHEF) Clinic. This is a multi disciplinary team involving Community Children’s Nurses, Paediatric Dieticians and Speech and Language Therapists

Where practical, all babies, children and young people should be weighed and measured at out-patient appointments.
When children are seen in Outpatient Clinics, weight and measurements taken should be included in the clinic letter / communication with parents and other professionals.

All babies, children and young people admitted to hospital must be weighed, measured and the results plotted on a UK-WHO growth chart. Consideration should be given to calculating Body Mass Index (see Section 10). The child’s weight should also be recorded in the medication chart and admission documentation.

It is good practice for the information / measurement to be shared with the child’s health visitor or school nurse to enable documentation within all child health records. Where possible this information should also be recorded in the child’s ‘Red Book’.

Weight must be recorded in kilograms.
Height, length and head circumference must be recorded in centimetres. The date and name of measurer should be recorded.

The UK-World Health Organization (WHO) 0-4 growth charts have been introduced for all new births from January 2010. Click here to access.

RCPCH growth charts for school-age (2-18 years) should be used for the recording of weight, length / height and head circumference data.
Click here to access.

Information must be recorded in the baby/child’s ‘Red Book’ and Child Health Record (public health nursing record) and Borders General Hospital medical and / or nursing records

Body Mass Index (BMI) indicates how heavy a child is relative to their height and is the simplest measure of thinness and fatness from the age of 2 years, when height can be measured fairly accurately.

In a child over 2 years of age, the BMI centile is a better indicator of overweight or underweight than the weight centile. A child whose weight is average for their height will have a BMI between 25th and 75th centile whatever their height centile. A BMI above the 91st centile suggests that the child is overweight. A child above the 98th
centile is very overweight (clinically obese). A BMI below the 2nd centile is unusual and may reflect undernutrition.

Calculating BMI

BMI = weight in kg divided by (height in m x height in m i.e. height in m2)

BMI should be plotted on the UK 1990s (Child Growth Foundation) BMI charts. These charts can be used from birth to 20yrs age and feature the standard BMI centile range (0.4th - 99.6th centile).

BMI centile can also be worked out and recorded using the UK – World Health Organisation 0-4 years Growth Charts.

Traditionally, concern has been shown for children below the third centile, but a fall across centiles, crossing a centile upwards, reaching a plateau or fluctuating weight or height are more worrying and require further assessment.

Patterns of faltering growth:

• Falling centiles – a downward deviation in weight or height across two or more major centile lines.
• Crossing of the centiles upwards across two or more centiles, or an upward trend towards the 91st centile or above.
• Poor Parallel centiles – when growth falters, a child’s centile position initially falls, and growth for height and weight follows a lower parallel centile line.
• Height and weight centiles markedly discrepant – where there is a marked discrepancy between height and weight centiles and between the individual child and other family members, further investigation should be considered. The child’s
  expected growth pattern is based on mid parental height.
• Discrepant family patterns – children whose growth falters frequently or shows marked discrepancies from the parents attained height centiles. Parental height is influenced by a number of factors including whether the parents failed to thrive as children or have underlying conditions that may
  influence growth.
• Retrospective rise – improvement in the child’s centile position (in height and weight) may occur if nutrition is improved, or the underlying condition is diagnosed and treated, demonstrating catch up growth. This may also include an improvement in social circumstances.
• Saw-tooth pattern – this is also referred to as ‘dipping’, whereby a child’s weight fluctuates, crossing and re-crossing centile positions. Dips in weight may be related to episodes of intercurrent illness but may reflect other problems such as family stress around life events.

If there are concerns about an infant/child’s growth then discussion should take place with the General Practitioner about further assessment and management. Further advice can be sought from a Consultant Paediatrician. NICE guidance on Faltering Growth - Recognition and Management of Faltering Growth in Children is expected to be published in October 2017.