Anthropometry

• Anthropometric measurements


  • Height/length
  • Weight
  • OFC
  • Mid arm circumference
  • Arm span
  • Upper and lower body segment
  • Limb length (real and apparent)
• Weight measurement


  Measured using a weighing scale, all clothing removed, remove shoes, measure to the nearest decimal
• Pictures


  • Height measurement
  • OFC
  • MUAC
• For age 6mo to 5yr, new tape for adults and pregnant women is now available
• Upper body segment/lower body segment ratio

  • 1.7 at birth, 1.3 at 3yrs, 1.0 at 7yrs
  • Increased ratio (US>LS) in ricket, achondroplasia, untreated hypothyroidism, turners syndrome, skeletal displasias
  • Reduced ratio (US<LS) in hypogonadism (Klinefelters syn), marfans, hurlers syndome, morquio l
• Arm span


  • In children 1cm less than height, in adolescence same as height, in adults 5cm more than height
  • Longer arm span seen in marfans, klinefelter synd
  • Shorter arm span seen in short limb dwafism, dysmorphisms
• Limb length discrepancy


  • Real length: measured with patient lying supine, from anterior superior iliac spine to medial malleolus
  • Apparent: measured from umbilicus to medial malleolus
  • Both limbs should be measured
• Causes of limb length discrepancies


  • Klippel trenaunay weber syndrome
  • Vascular malformations
  • Hemangiomatosis
  • Neurofibromatosis
  • Trauma
  • Skeletal displasias
• Evaluation of anthropometric measurements


  1. Compare values with expected values

  2. Discuss evaluation of this baby

  3. List 5 major group of conditions that may be responsible for the pattern of documented anthropometry
• Diarrhoea


  A symptom, and not a disease per se, of GIT illness which can occur as a result of a variety of pathologic or non-pathologic conditions
• When consuming typical western diet, infants pass about 10ml/kg/24hrs and adults up to 200g/24hrs of stool
• It is not easy to define a normal stool pattern in an individual because the frequency & consistency of stools can vary depending on the diet & other factors
• Frequency of stool in breast-fed infants can range from multiple stools daily to one bowel movements in a week and still be considered within normal range
• Operative definition of diarrhoea

  Passing of >3 liquid stools in a 24hr period
• Diarrhoea


  Passing of >10ml/kg/day or 299g/day for an older child
• The terms chronic, persistent and protracted diarrhoea are often times used interchangeably
• Chronic diarrhoea


  Passing four or more watery stools per day for a period of 2weeks or more
• Diarrhoeal diseases are the 2nd leading cause of mortality worldwide in children younger than 5 years of age (760,000 deaths/year) (WHO media news April 2013)
• In the US, <5yrs children have more than 20million episodes of diarrhea each year leading to 200,000 hospitalizations
• Water and solutes are absorbed in the intestine

  1. Na+ coupled solute transport

  2. Na+/H+ exchanges

  3. Paracellular transport
• In acute diarrhoea Na+/H+ exchangers and paracellular transport remains intact even with viral enteritis associated with epithelial damage
• Secretory functions of the small intestine

  Mainly dependent on chloride secretion
• The negatively charged Cl- in the intestinal lumen causes net passive transfer of Na+ and water to the lumen and hence increased fluid and ion loss
• Intestinal absorption occur @ the villi while secretion occur @ the crypts
• In the colon, net excretion of H+ and HCO3- and net absorption of Na+ occurs through HCO3- and Na+/H+ exchangers
• The journey of food from mouth to anus involves many complex steps, reflecting the integrated functions of different organs
• Any internal or external factor affecting the above mentioned organs and processes can alter stool consistency or frequency and cause diarrhoea
• Classification of Diarrhoea


  • Acute vs chronic according to duration
  • Secretory, osmotic, inflammatory and fatty diarrhoea
• Causes of Acute Diarrhoea


  • Infectious aetiologies: Viral, Bacterial, Parasites
  • Non-infectious causes: Drug induced, Food allergies, Extra-intestinal infections, Surgical conditions
• Acute diarrhoea


  • Usually benign, self limiting and resolves in a few days without any intervention
  • Can be watery or invasive (bloody) in nature
• Accompanying fever and vomiting increase the risk of dehydration
• Age (younger age) and pre-existing nutritional status are important determinants of severity and duration of diarrhoea
• During acute diarrhoea, young infants are at much greater risk of dehydration compared to older children
• Children with moderate to severe malnutrition are at higher risk of developing post enteritis syndrome due to malnutrition-induced immunodeficiency or altered intestinal permeability
• Stool Na+ can be as high as 90mmol/l in Cholera and 40 to 60mmol/l in Rotavirus diarrhoea
• WHO Oral Rehydration Solution (ORS) helps maintain hydration despite significant faecal loss of water and other solutes
• Stool should be sent for culture

  1. When there is a suspicion for Salmonella, Shigella, E. coli or Campylobacter

  2. For immunosuppressed children
• Stool should be checked for ova and parasites when there is a suspicion for parasitic infestation
• There is no evidence-based role for anti-motility agents in management of acute diarrhoea in children
• WHO guidelines for assessment of dehydration


  • None (<5%)
  • Some dehydration (5-10%)
  • Severe dehydration (> 10%)