Health Supervision

Physical Examination: Assessment of Physical Growth

Body Measurements

Body measurements of infants and children help to identify significant conditions, including growth retardation, malnutrition, obesity, and developmental abnormalities. Plot all measurements of head circumference, length/height, and weight on age- and gender-specific CDC Growth Charts.

Head Circumference (Infants and Toddlers)

  • Use non-stretchable measuring tape.
  • Extend the tape around the most prominent part of the occiput to the mid-forehead, tightening the tape to compress the hair.
  • Plot the measurement on the appropriate CDC Growth Charts.

Height (or Length)

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  • Measure height or length at each visit for all ages and plot it on the appropriate CDC Growth Charts.
  • For children less than 2 years old (and those ages 2-3 who cannot stand unassisted), use a measuring board to measure length while they are in a lying-down position.
  • For children older than 2 years, obtain a standing height. The child should stand barefoot or in socks with their head, shoulder blades, buttocks, and heels touching the wall

Weight

  • Measure weight at each visit for all ages and plot it on the appropriate CDC Growth Charts.
  • For infants and small children, use a balance-beam or electronic scale and ensure the child is unclothed or in a dry diaper.
  • For older children, use a floor model beam scale while the child is unclothed and draped in a light gown.

Weight-for-Length (Birth to 24 Months)

  • After measuring weight and length, plot the measurement on the weight-for-length growth chart.
  • This measurement corresponds to the body-mass-index-for-age used in older children.

Recording and Interpreting Measurements

  • Plot measurements on the correct age- and gender-specific CDC Growth Charts.
  • Interpret measurements in the context of the child’s family and growth history.
  • Recognize that large or sustained deviations from a growth curve may signal a potential problem.
  • If measurements are between the 5th and 10th percentiles or between the 90th and 95th percentiles, assess past growth patterns to determine if follow-up is needed.
  • If measurements are less than the 5th percentile or greater than the 95th percentile, recheck the measurements; if confirmed, consider a detailed medical evaluation.

Body Mass Index (BMI) (Ages 2-20)

  • Calculate BMI using the CDC's BMI calculator and plot it on the appropriate BMI-for-age growth chart for the child's gender and age.
  • Use the BMI percentile to assess for weight status:
    • Underweight: Below the 5th percentile
    • Healthy Weight: 5th percentile to less than the 85th percentile
    • Overweight: 85th to less than the 95th percentile
    • Obesity: 95th percentile or above

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