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Maternal and Child Health Bureau ~ 9

This is a photo of incorrect technique for arm span measurement. This child is not able to extend his arms fully, so an inaccurate measure would be taken. Therefore, arm span is not an appropriate measurement for this child.

Segmental lengths: Upper arm length and lower leg length For some children for whom stature measurements are impossible, segmental lengths (for example, upper arm length and lower leg length) can be used to monitor growth.

Upper arm length is not as affected by a high spinal lesion as stature. It is recommended for children with spina bifida who are bedridden or wheelchair bound (or for other children unable to stand or stretch out on the length board) (Cloud, 1997; Scott, 1997).

For children with cerebral palsy or other conditions that cause or result in contractures, lower leg length can be measured using either a steel or plastic tape measure or an anthropometer. This is a difficult measurement to take and, when taken, should be used with children ages 6-18 years (Cloud, 1997; Scott, 1997; Chumlea, Guo, Steimbaugh, 1994).

These measurements may be plotted on the CDC charts for stature-for-age or length-for-age. Even if measurements fall below the 5th percentile, they establish a growth pattern over time. Reference data exist for some segmental lengths (e.g., knee height), however they are old and do not include children with special health care needs or children who are non-ambulatory (and therefore may have different growth patterns) (Chumlea, et al, 1994)

Weight measures

Weight should be measured on beam-balance or digital scales. For children and adolescents with special needs who are unable to stand, chair scales, bucket scales and wheelchair scales should be used. In some facilities, bed scales may be available.

In clinical situations where equipment is limited to standing scales, it may be necessary to weigh someone (for example, a parent or caregiver) holding the child, weigh the parent or caregiver alone, and then subtract the weight of that person from the weight of the two together.

Sequential weights are important, and the child should always be wearing the same amount of clothing. Braces and special shoes should be removed in order to obtain an accurate weight. If the child wears braces, the braces may be weighed once, separately, and then subtracted from subsequent weight measurements.

Information about equipment, including sources for special scales is found in the module, Accurately Weighing & Measuring Infants, Children and Adolescents: Equipment.

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