ANTHROPOMETRIC MEASUREMENT TRAINING Michigan WIC 201920 - - PDF document
7/17/2020 ANTHROPOMETRIC MEASUREMENT TRAINING Michigan WIC 201920 Anthropometric PRINT PRINT Measurement Training ATTACHMENTS Worksheet 1 Worksheet 2 Worksheet 3 LINKS LINKS Worksheet 4 Worksheet 5 Agenda PowerPoint Pgs. 1 36
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LINKS LINKS
Agenda PowerPoint
Manual
PRINT PRINT
Worksheet 1 Worksheet 2 Worksheet 3 Worksheet 4 Worksheet 5
ATTACHMENTS
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Use measuring equipment correctly, read measurement values accurately, observe client privacy Evaluate plotting values on age and sex Specific growth charts To record measurements and round accurately for data entry in MI‐WIC Develop consistency in measuring techniques and data entry methods Provide basic measuring equipment care
Training will be able to
Training Overview WHO/CDC Growth Charts Recording Values Preterm Infants MI‐WIC Data Entry Prenatal Weight Gain Measurement Procedures Risk Codes Evaluations
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This Photo by Unknown Author is licensed under CC BY‐NC‐ND
POLICY 1.02 STATE OF MICHIGAN WIC MISSION AND VISION
Evaluate Values
Chart Record Measurement Values Measure Physical Growth
Infants Children Women Record Form MI‐WIC Gain Grid NCHS/CDC Growth Charts (B < 24 Months
Prenatal Weight
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Why do we need Anthropometric training?
Person Off Street 15 Minutes!
Weight Head Circumference Height
Stature (Standing Height) Length (lying down)
Required for a WIC Nutrition Assessment
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1 2 3 4 5
CLUES Health and Nutritional Well‐being GROWTH Normal or Delayed WEIGHT Normal, Overweight or Underweight PREGNANCY/POSTPARTUM Weight Gain or Loss DETERMINATION OF RISK FACTORS For Care Plan Development
Measurements 1 2
OVERMEASUREMENT Impression of excessive leanness of fatness UNDER MEASUREMENT Impression of shortness or thinness
Measurements
A half (1/2) inch measurement error can change a child’s ranking from the 10th percentile to below the 5th percentile length‐for‐age.
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Key Point #1
The major focus of Anthropometric Training is to learn procedures and techniques that will result in…
Consistent Measurement Techniques Improved Accuracy Reduced Errors Over Time
*Use Recumbent (lying down) Length Board Cont…
Infants (Birth to 12 Months)* Children (12 to 24 Months)* Length, Weight and Head Circumference at certification and mid‐cert evaluation (I‐Eval) Length, weight and head circumference at Certification, mid‐cert evaluation (C‐Eval) and recertification
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Use Stadiometer (Standing) If child must be measured recumbently (laying down), record measurement, check “?” box, make entry in ‘Comments’. Measurement will plot as red asterisk but risk code will not be assigned
Children: 2 to 5 Years Women Stature and weight at certification, mid‐ cert evaluation (C‐Eval) and recertification Stature and weight at certification and recertification
Boys (Birth <24 Months of Age): WHO GROWTH CHART Form DCH ‐ 0313a Boys (2 to 5 Years of Age): CDC GROWTH CHART Form DCH ‐ 0313b Girls (Birth < 24 Months of Age): WHO GROWTH CHART Form DCH ‐ 0313c Girls (2 to 5 Years of Age): CDC GROWTH CHART Form DCH ‐ 0313c
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Key Point #2
Check ‘UNK’ if a measurement is not known and enter a comment Check ‘?’ if measurement could not be taken according to procedure and enter a comment For example, if a child is uncooperative and must be measured recumbently (laying down), record the measurement, check “?” box, make entry in ‘Comments’. Measurement will plot as red asterisk but risk code will not be assigned
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Before saving Anthropometric Measurement for the Cert visit, enter Weeks Gestation. Agencies must have consistent method of determining weeks gestation (Anthropometric Measurement Procedures Manual). Weeks Gestation must be recorded in weeks of completed gestation
(ie, 39 weeks, 6 days recorded as 39 weeks gestation).
Accurate Weeks Gestation is essential – determines way growth percentiles are calculated. Cannot be changed in MI‐WIC after day of entry!
Key Point #3
Weeks of Gestation must be entered accurately in order for growth chart percentiles to be correctly calculated in MI‐WIC. WIC Policy: Clinics must have consistent procedure for determining Gestation Age.
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* Longitudinal study * Hypothesis ‐ breastfed infants grow differently than formula‐fed infants * Studied Breastfed infants in 6 countries throughout the world * Families followed study protocol for the duration of the study * Data collected provided the information needed to construct new growth grids * Breastfed infants and children do grow differently than formula‐fed infants.
Graphs For Plotting Data Sheet Included On Charts
Length‐for‐age Weight‐for‐age Head circumference‐for‐age Weight‐for‐length
Birth < 24 Months (Boys & Girls)
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2‐5 Years (Boys & Girls) Data sheet included on charts Data sheet included on charts Graphs for plotting: Graphs for plotting:
Stature‐for‐age Stature‐for‐age Weight‐for‐age Weight‐for‐age BMI‐for‐age BMI‐for‐age
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Infants that were born < 1500 grams (VLBW) may also be assessed for growth using the IHDP VLBW charts in addition to the CDC growth charts. The VLBW charts are now optional for educational purposes.
Gestation‐Adjusted Age (GAA) is bottom axis on 3 charts plotted for age. Chart may be printed Data Sheet Included on Charts Same Plot Graphs as Birth < 24 Months: Length‐for‐age Weight‐for‐age Head Circumference‐for‐age Weight‐for‐length
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If an infant is born at 32 weeks, subtract that number from 40
40 weeks – 32 = 8 Weeks
Gestational –adjusted age is 4 months when the chronological age is 6 months
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Growth will not begin plotting on WHO Growth Charts until infant reaches 40 weeks gestation adjusted age. Percentiles are shown in pink in MI‐WIC if adjusted for prematurity. VLBW charts will plot growth for infants up to 2 months preterm
Note: Adjustments for gestational age are Not used when using the 2‐5 years charts
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Key Point #4
The measurements of infants born less than or equal to 1500 grams (3
chart in MI‐WIC. This chart uses metric values only. The VLBW chart does not assign risks but does give parents an idea
relation to other VLBW babies
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Key Point #5
Adjustments for Preterm are made in MI‐WIC through 23 months of age The WHO Birth <24 Month and VLBW charts (if < 1500 grams) are the default growth charts. Measurements in MI‐WIC are not adjusted for preterm after 24 months of age. Measurements of any child over the chronological age of 2 are plotted on the 2‐5 year old chart.
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BMI means Body Mass Index Simple formula that combines weight and height The formula is: the weight divided by the square of the height x 703
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Bottom Axis: Age (heavy 1 yr., faint ½ yr., 3 mo. Hatch mark – nearest month) Side Axis: BMI (Faint lines = 0.2 – nearest 0.1 BMI)
Date Age Weight Height BMI Comment
Mother’s Height _______ Father’s Height________ Gestational Age__________ Weeks
4/4/20 3 yrs 7 mos 37 lb 4 oz 41.5 in 15.2
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Sam’s BMI‐for‐age is at the 29th %tile so it falls within the normal range.
Boys: 2 to 20 years
BMI BMI BMI BMI
This chart shows that Sam is heavier for his height than 29 % of other boys his
heavier for their height than Sam. Interpretation
BMI is automatically calculated in MI‐WIC if stature measurement is used (C2‐C5). BMI‐for‐age charts are the default option when the 2‐5 yr. charts are
for‐length charts by selecting the “Prev. Graph”
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BMI: “It is used to judge whether an individual is appropriate for their height.” CDC “Background Information on United States Growth Charts”‐ CDC Website The larger the BMI number, the heavier the individual is in proportion to their
then the person with the higher BMI will also weigh more.
Navigate
to lab
Enter
Height and Weight on grid, save
Select
“Height/Weight” Tab
Display
Prenatal Weight Gain Chart by selecting “Prenatal Chart” button at bottom of screen.
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Six Steps to Accurate Measures
Measure Correctly Carefully Confirm Measurement Say Measurement Out Loud Record Exactly as
Convert Correctly For MI‐WIC Enter Correctly In MI‐WIC
Stature, Recumbent Length & Head Circumference
Write values in inches and fractions on recording Form exactly as indicated by measuring device Determine Confirming Measurement
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2 Consecutive Measurements within the following parameters: Recumbent Length 2/16th or 1/8th inch or less Stature 2/16th or 1/8th inch or less Infant Weight 1 ounce or less Child or Adult Weight ¼ pound or 2 tenths (.2) pound less
Key Point #6
Measurement values must be recorded in the units of the measurement device
Do not transpose or round numbers before recording them as they are read from the instrument EXACTLY
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Convert for data entry Enter inches and fractions in sixteenths
MI WIC thinks/calculates all measurements in 16ths
Length, height, and head circumference
measurements are calculated by the 1/16th inch
1 pound equals 16 ounces
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Into MI‐WIC Units If height (or length or head circumference) measurement is a value
For example, ½ inch is how many 16ths? Do the MI‐WIC conversion and enter the recording form
1/16 1 (2/16) 1/8 2 3/16 3 (4/16) 2/8 1/4 4 5/16 5 (6/16) 3/8 6 7/16 7 (8/16) 4/8 1/2 8 9/16 9 (10/16) 5/8 10 11/16 11 (12/16) 6/8 3/4 12 13/16 13 (14/16) 7/8 14 15/16 15 16/16
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Record the actual measurement value on recording form Write in pounds,
fractions or decimal on recording form exactly as read
Enter actual pound, ounce and ounce fraction or tenth of an
Round ounce fraction to nearest ounce in MI‐WIC Some scales are more sensitive and display to the nearest tenth ounce, e.g., 19lbs 2.8 oz Some scales round to the nearest ounce for you If your scale reads to the tenth ounce, you must do the rounding
The sensitivity of infant scales is to the nearest ounce
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If the last digit is less than ½ fractional or .5 digital, round down If the last digit is greater than ½ fractional or .5 digital, round up 14 lbs 2 1/4 oz 27 lbs 7 5/8 oz 7 lbs 7.6 oz 6 lbs 9.2 oz
It is necessary to change the pound fraction to ounces: 1/4 Pound enter as 04 ounces 1/2 Pound enter as 08 ounces 3/4 Pound enter as 12 ounces
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.2 Pound equivalent to 03 ounces .4 Pound equivalent to 06 ounces .6 Pound equivalent to 10 ounces .8 Pound equivalent to 13 ounces
Enter pounds with decimal, click ‘Tab’ and MI‐WIC will convert decimal to ounces
DO NOT USE ‘TAB’ With infant C1 that measure fraction of an ounce
This Photo by Unknown Author is licensed under CC BY‐NC‐ND
If your weight measurement device measures in decimals for fraction of pounds how do you enter in MI‐WIC?
Use the special decimal feature! Enter pounds, then decimal to two digits, click tab and MI‐WIC converts the decimal to ounces! (C2 through adult)
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Record the actual measurement value on recording form Write in pounds,
fractions or decimal on recording form exactly as read
Enter actual pound, ounce and ounce fraction or tenth of an
Convert into MI‐WIC Units
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Practice recording and converting exercises
Enter Confirming Measure in third column Enter Confirming Measure in third column Convert into MI‐WIC units and enter in fourth column Convert into MI‐WIC units and enter in fourth column
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Weight of 27 pounds 15‐3/4 ounces: Record as 27 15‐3/4 on Measurement Sheet & 28 lbs 0 oz. in MI‐WIC. Weight of 52 ‐3/4 pounds: Record as 52 ‐3/4 on Measurement Sheet & 52 lbs 12 oz. in MI‐WIC. Weight of 18.6 pounds: Record as 18.6 on Measurement Sheet & 18.6 lbs in MI‐WIC, then TAB. Stature of 4 feet 7‐5/8 inches: Record as 55‐5/8 on Measurement Sheet & 55 inches 10 (1/16) in MI‐WIC. Length of 36‐2/8 inches: Record as 36‐2/8 on Measurement Sheet & 36 inches 4 (1/16) in MI‐WIC.
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And maybe some things you didn’t want to know!
What’s under the hood! Everything you ever wanted to know about Anthro in MI‐WIC Enter Data and View Charts For:
(Worksheet #4 – Salmon) Alice Peter Mary Tom
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Michigan WIC
Five‐Year‐Plan Increase 1st trimester entry into WIC from 29.4% to 32.9% Increase ideal PG weight gain from 29.8% to 31% Reduce Low Birth Weight births From 10.2% to 9.0% Increase BF Initiation 67.7% to 70.5%, 6 month duration from 20.5% to 23.0%
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Michigan WIC
Five‐Year‐Plan Decrease early childhood
from 13.5% to 12.7% Decrease low Hgb from 19% to 15% in children
Top Risks
OVERWEIGHT PREPG 7491/16420
OVERWEIGHT PP 10634/42562
LOW MATERNAL WT GAIN 4128/16420
EARLY TERM 19825/85380
SHORT INTRVAL PG 9263/42562
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Top Risks
HI MAT WT GAIN 7159/40874
2020 LOW HGB 8346/42562
PG 5.1% C1 10.9%
2019 LOW HGB 31106/164845
PG 12.6% C 10.4%
H/O PRETERM BIRTH 2885/40874
MAT SMOKING 5117/42562
PG C BF PP I 2019 7.7 2020 7.2 2019 57.3 2020 58.4 2019 40.3 2020 42.9 2019 59.7 2020 56,1 2019 22.8 2020 22,4
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131 LOW MTRNL WT GAIN 2930/15262 19.2% 142 PRETERM BIRTH 8682/85520 10.2% 141 LBW 8402/85520 9.8% 113 OBESE CHILDREN 2‐5 5351/85651 6.2% 310 H/O PRETERM BIRTH 1088/15262 7.1%
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most common Risk Codes associated with Michigan WIC clients are Anthro Risk codes.
are associated with increased infant mortality
This Photo by Unknown Author is licensed under CC BY‐SA‐NCSCALES, INFANTOMETERS, STADIOMETERS, INSETRTION TAPES
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Children from birth to 24 months of age must have their head circumference measured This procedure is used as a screening measurement for non‐nutrition related abnormalities (micro‐ and macrocephaly).
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Continued
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Length is the height measurement taken of infants from birth < 24 months of age. Length refers to the distance from the crown (top) of the head to the bottom
infant is lying on his/her back. Equipment Infant recumbent length board Disposable sheet to place on board
(Continued)
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Key Point #7
Infant Scale must be zero‐balanced with a paper sheet and dry diaper (medium size for balance‐beam scales). Note: a balance beam scale can be zero‐balanced with a sheet and diaper once daily. A digital scale MUST BE ZERO‐BALANCED for every weight taken, unless scale has re‐weigh function
Stature is the height measurement taken for people 2 years of age and older Stature is defined as the distance from the crown (top) of the head to the bottom of the feet when the person is in the standing position.
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Key Point #8
When using a digital scale, a zero balance must be done every time you weigh. For infants, put the sheet and dry diaper on the scale, zero balance, then remove the dry diaper to weigh the child.
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Proper Stature Posture
Continued
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Key Point #9
Align client according to procedures for the client’s category and measurement Infants and C‐1: Recumbent Infants and C‐1: Head Circumference C‐2 Through Adult: Stature
Key Point #10
Confirming measurements are necessary for accuracy Numerous errors, such as, transposing numbers, equipment failures or improper techniques can be caught by confirming measurements.
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Inspected Annually Inspected Annually Pediatric sensitivity = 1 oz. Pediatric sensitivity = 1 oz. Secure before moving scales Secure before moving scales Accurate at 10 and 100 lbs. Accurate at 10 and 100 lbs. Adult Sensitivity = 1/4 lbs or 3.2 oz. Adult Sensitivity = 1/4 lbs or 3.2 oz. Cleaned regularly with cleansing solution If child soils equipment, should be disinfected with antiseptic immediately
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Use of improper equipment Incorrect use of equipment Inadequate maintenance Use of wrong Growth Chart Poor Technique Failure to do Confirming measurements Incorrect age calculated Transposing Of measurement values
Impact of Improper Measurement Errors
Inaccurate information about child’s growth Misrepresentation of the nutritional status
being screened Example of stature board attached to wall 1 ½ inch too high – all children measured shorter than they are
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Key Point #11
To help prevent errors, say every measurement
Key Point #12
All measurement devices should be validated with an independent measurement. For example, the stature tape or stature board should be confirmed with a good quality carpenter’s measuring tape or calibration rod.
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be to the nearest ounce up to 2 years of age
nearest 1/16th but can be to the nearest 1/8th inch
circumference should be measured no more than 60 days prior to certification or Nutrition/Health evaluation
should not be more than 60days and reflect their current certification type, e.g., if being certified as PG, the weight should have been taken while PG
This Photo by Unknown Author is licensed under CC BY‐NC‐ND 7/17/2020 58
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Anthropometrics Training
Thank you for your attention Thank you for your attention Please complete evaluations Add this training to your Staff Training in MI‐WIC Please complete evaluations Add this training to your Staff Training in MI‐WIC Have a great day! Have a great day!