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Nursing Diagnoses
Health-seeking behaviors (growth assessment) related to promotion of infant/child physical
growth Altered growth and development related to illness, stress, nutritional intake, and/or
parental knowledge deficit.
STEPS RATIONALE
Assessment
1. Determine presence of any physical anomalies. Certain physical anomalies may interfere with
accurate growth measurements. For example,
deformities that prevent full extension preclude
accurate measurement of height, or presence of a
cast does not allow accurate weight measurement.
Implementation
1. Prepare child.
By allaying anxiety and fear of unknown,
child is better able to cooperate.
a. For infants and some toddlers, distraction may be Special Considerations: If child is
necessary to keep them still during measurement. uncooperative and resistant, making
For cooperative toddlers and older children, age- accurate measurementimpossible, postpone
appropriate explanations of procedures, or omit measurement. Document reason.
equipment, and results are given.
b. Remove child's clothing. • Infants are completely Removal of clothing is required for accurate
undressed. • For children, all but minimal indoor weight determination. Removal of shoes and
clothing is removed: coats, shoes, caps, etc. headwear is necessary to measure length or
stature. Removal of headwear is also
essential for accurate measurement of head
circumference.
Special Considerations: Serial
measurements will provide a more accurate
picture if same approach is used each time
child is measured, such as if the infant is
always nude.
b. To obtain stature, have child stand with heels slightly Special Considerations: A child normally
apart, feet flat on floor, back straight, chin level, and eyes grows approximately 10 inches (25 cm) in
looking straight ahead; heels, buttocks, and shoulder first year of life, 5 inches (13 cm) in the
blades should touch measuring surface. Lower headboard second year, 3 to 4 inches (8 to 10 cm) in
to rest firmly on child's head. Read measurement to nearest the third year, and then 2 to 3 inches (5 to 8
1/4 inch (0.6 cm). cm) per year until pubertalgrowth spurt.
Birth length is normally doubled by 4 years
and tripled by 13 years. Greatest height
gain usually occurs in spring, and least
gain, in fall.
3. Obtain weight measurement. Place undressed child in Serial weight measurements provide a good
middle of weighing surface. Infants and young children are indicator of growth rate. Rapid or sudden
weighed while lying or sitting on pediatric scales; keep weight loss suggests serious, acute disease
hand close to but not touching child to prevent accidental or dehydration. Gradual weight loss
falls. Children over 2 to 3 years of age may be weighed suggests chronic disease or malnutrition.
standing on adult scales. Read digital display or adjust Underweight with normal growth rate may
beam weights on scale until horizontal beam is balanced at be caused by inadequate nutrition or may be
zero. Read weight to nearest ½ ounce (15 g) on pediatric related to genetic factors and normal for a
scales or ¼ pound (0.1 kg) on adult scales. specific child. Rapidweight gain usually
indicates overfeeding, but may be a sign of
fluid retention. Generalized overweight or
obesity is generally due to overeating and/or
underactivity but may be caused by
endocrine disorders.
5. Plot growth measurements on appropriate NCHS growth Accurate plotting on appropriate charts is
chart. Find child's age on horizontal scale and growth required for comparison with norms and
measurement on vertical scale; make dot or cross where interpretation. Special Considerations: For
two lines intersect. Repeat for each measurement obtained. premature infants,weeks of prematurity are
On weight-by-length or weight-by-stature graphs, find recorded on growth chart and then
length or stature on horizontal scale and weight on vertical subtracted from actual age before plotting
scale. Age is plotted to nearest month on birth to 36-month on growth charts. Adjustments are made
chart and to nearest quarter year on 2- to 18-year chart. until 18 months of age for FOC, 21 months
for weight, and 36 months for length or
stature.
6. Interpret measurements by comparison with percentiles If accurate measurements have been
on charts. In general, normal measurements for height, obtained, measurements falling about 95th
weight, and head circumference should fall between the percentile or below 5th percentile or serial
5th and 95th percentiles after making any indicated measurements showing marked change in
adjustment for prematurity. Serial measurements should percentile levels are suggestive of health or
follow the normal growth curve. nutrition problems. A change from one edge
of percentile zone to other edge of that zone
or shift across percentile zones away from
50th percentile is significant. The greater
the change in growth percentile since
previous measurements, the quicker the
change has occurred, and the younger the
age of child, the greater the reason for
concern. Special Considerations:
Additional techniquesfor assessment of
growth are available, such as skin fold
thickness measurements, water-resistance
measure for percent of body fat, ultrasound
methods, and incremental growth
measurements. These tools may be used for
more accurate assessment of children
falling outside of normal range on general
growth parameters.
Evaluation Outcomes Observational Guidelines
1. Accurate, appropriate growth measurements are Accuracy may be confirmed by repeating all
obtained. measurements 3 times. Weight is obtained
on all children. Recumbent length is
measured if child is under 24 months and
stature is measured if over 36 months;
between 24 and 36 months, either
measurement is acceptable. FOC is
measured if child is under 12 to 24 months
of age. BMI is calculated. Other
2. Growth measurements are correctly plotted on Confirm accuracy by rechecking plot points
appropriate NCHS growth chart. on chart. Recumbent length is graphed on
birth to 36-month chart; stature is plotted on
2- to 18year chart. Adjustments are made
for prematurity, if indicated.
3. Growth measurements falling outside range of normal Measurements above 95th percentile or
are identified. below 5th percentile, or serial measurements
showing significant change in percentile are
documentedand referrals are made as
appropriate.
Documentation
Child and Family Teaching
Date and actual numerical values of all measurements Results of physical growth assessment
should always be reviewed with the family
completed are recorded and plotted on appropriate NCHS
and child.
growth charts.
Growth charts are shared and the meaning
Any factors that may affect accuracy or interpretation
of plotted points is explained. For example,
of measurements, such as clothing, prosthesis, casts,
if child falls at 25th percentile on weight
prematurity, physical anomalies, or an uncooperative
for age, explain that if 100 children of the
child, are documented.
same age were compared, approximately 75
Nursing diagnoses and plan of care, including referrals, are
documented. would weigh more and 25 would weigh less
than this child. Normalcy is important to
family and child and can be reassuring.
This is particularly important to adolescents
for whom body image is a primary concern.
For those falling outside norms, sharing
growth charts can provide an opening for
developing intervention plans with family
and child, such as discussing nutrition in
more detail or referring family to
nutritionist.