Weight, measuring a child

Assessment and measurement of weight is vital and must be done with precision and accuracy to be meaningful (Voss, 2000).

It provides a sensitive guide to a child’s:

• health

• development

• nutritional status

• response to treatment

(Hall, 2000; Voss, 2000; Freeman, 1990; Gibson, 1990)(Rationales 1 and 2).

It is also used for the accurate calculation of drug doses, intravenous and oral fluid replacement and oral parenteral feeds (RCN, 2010).

A healthy adequately nourished and emotionally secure child grows at an optimal rate (Paton, 1962; Stanhope, 1994). It provides the opportunity for all healthcare professionals to observe the child's general health and be alert to any safeguarding concerns (RCN, 2010).

A slow rate of growth could suggest a pathological disorder requiring diagnosis and possible treatment, eg malabsorption, an eating disorder, hypertension, psychosocial problems (Sherwood, 1986; Skuse, 1989). Regular measurement of children can allow early diagnosis of these problems (Stern, 1985).

Many diseases do not cause obvious symptoms and poor growth may be the first or only indicator of a problem (Hall, 2000; Smith, 1989). 

On admission to Great Ormond Street Hospital for Children, all children, including day cases, must be weighed within 24 hours.

This measurement must be:

• recorded in the child’s health care/parent held record

• recorded in the Patient Assessment Form (PAF)

• recorded on the Nutrition Screening Record

• recorded on the Electronic Prescribing system

• plotted on a centile chart

The date, time and the name of the measurer must also be recorded (Voss, 2000).

Unless specifically asked to do it more frequently, a child who attends the outpatient department should normally be weighed at least once a month.

To be useful, it is essential that a child’s weight is:

• accurately measured using good equipment

• recorded with the date in the child’s health care records

• plotted accurately on a centile chart

A single measurement does not reflect the rate of growth. 

Daily measurements should only be used to indicate fluctuations in fluid status.

All children in hospital must be weighed weekly (RCN, 2006).

Some patients may require more frequent measurements, for example:

• infants under one year of age

• children who are nutritionally unstable and who are receiving active nutrition intervention

• children receiving large amounts of intravenous fluids for example parenteral nutrition

• those with fluid balance problems, for example renal, cardiac, oncology and bone marrow transplant patients

The weight of a child in hospital must be plotted:

• on a weight chart

• on their centile chart every three months

• the BMI should be calculated for all children aged over two years

Refer to the medical team if BMI > 90th centile (90 – 95th centile = overweight, >95th centile = obese).

Preparation

Child and family

Inform the family, and child if age appropriate, of the following:

• that a measurement of weight is required

• the reason for the measurement

• what it entails

• the likely length of the procedure

Prior to measuring a child it is essential to consider their:

• gender, culture and religious beliefs

• dignity and privacy 

A child under the age of two years should be weighed naked.

A child over the age of two years should be weighed in minimal clothing or light underwear (vest and pants).

The following must always be removed:

• nappies

• shoes or slippers

• pocket contents (including coins/mobile phones)

If for any reason clothing has not been removed or a child is weighed with additional equipment (eg splint, cast, medical equipment or dressing) this must be recorded in the child’s health care records.

It is important to use visual observation and good communication skills when obtaining a child's weight.It is also important to note the views/reactions of the child/family when the weight is obtained as part of a holistic assessment (RCN, 2010).

The child may require preparation from a play specialist or healthcare professional prior to being weighed.

Equipment

The technique used to weigh a child is the same regardless of the equipment to be used.

Standard equipment for weighing children of all ages and for weighing the very sick child must be available on all wards.

The following equipment is recommended and can be ordered via E-Procurement (refer to Biomedical website for Trust standard):

• 0-2 years (up to 14 kg) ‑ baby scales

• > 2 years (over 14 kg) ‑ sitting or stand on scales

• complex needs children will require an age-appropriate sling/hoist

If the child is very sick or unable to sit unaided, the child should be measured with a carer on sitting scales (ensure sitting scales brakes are on prior to starting). The weight of the carer with child should be measured, then the carer’s weight subtracted.

For a distressed small child the parent can be asked to stand on standing scales. The scales are then set to zero and the child handed to the parent. The scales will then show the child's weight (Davies, 2004).

All weighing equipment must have be checked, calibrated and and clean prior to use.

It should be re-calibrated using 500 gram wipeable bean bag. This may also be used to calibrate the stadiometer.

All the measuring equipment must be checked:

• prior to each use and after each session (Voss, 2000)

• annually by the Biomedical Engineering department

If the equipment becomes faulty contact Biomedical Engineering department.

Measuring technique

The person weighing the child must first:

assess the need for standard precautions
wear appropriate protective clothing to meet any identified risk
perform a social handwash and thoroughly dry their hands (Your 5 Moments for Hand Hygiene) (PDF, 185 KB)

Ensure appropriate clothing has been removed.

If for any reason clothing has not been removed or a child is weighed with additional equipment (splint, cast, medical equipment or dressing) this must be recorded in the child’s health care records.

The child may require play and distraction techniques to be utilised whilst obtaining the measurement.

It is often easier if two people are involved in the measurement of a child.

The child must be completely on the scales and their weight fully borne.

Record the figure shown on the scales to the last complete gram for neonates or children < 4kg and to the last 100g (00.00kg) for older children or children > 4kg.

Do not round up the measurement.

The child must not be left on their own at any point.

Completing procedure

General

The child should be redressed and left comfortable. 

After use the measuring equipment should be cleaned with detergent and hot water followed by an alcohol impregnated wipe.

If the equipment is contaminated with blood, it should be cleaned with detergent and hot water followed by the hypochlorite solution. Protective clothing must be worn.

Those involved in measuring the child must perform a social handwash following the procedure.

Documentation

The child’s weight must be:

• recorded in the child’s health care/parent held record

• recorded in the Patient Assessment Form (PAF)

• recorded on the Nutrition Screening Record

• recorded on the Electronic Prescribing system

• plotted on a centile chart

The date and time the measurement was made and the name of the person who made the measurement, must also be included.

NB All 3-year course pre-registration student nurses must have all measurements verified by a qualified member of the nursing staff.

The UK-WHO Growth Chart 0-4 years and Neonatal and Infant Close Monitoring Charts are recommended for children under four years of age.

The Trust has been using UK-90 for children > 4 years olds since May 2010. These charts record the child’s age in years and calendar months, ie 12 months in a year.

'Four in One Duodecimal Growth Chart' is the centile chart that is recommended for general use in children over four years of age (Cole, 1994; Fry, 1994).

The weight should be plotted on the relevant grid of the growth chart with a well-defined dot & not a cross. The dot must not be circled. It should also be recorded in the recording box.

The growth curve should be traced with a clear track of dots.

A normal growth curve is one that runs roughly on or parallel to one of the printed centile lines.

For endocrine growth disorder children the ‘Four in One Decimal’ growth chart is used. These charts record the child’s age in decimal years, ie 10 months in a year and must be plotted as described below:

• identifying the year of birth, eg 1998

• looking on the table to cross reference the month of birth against the date of birth, eg Sep 15=704

• this gives the decimal date of birth, for example 15 September 1998 is 98.704

• repeating the formula for the measurement date, for example 12 December 1999 is 99.945

• subtract one from the other and round off the last figure to give the decimal age, for example 1.24

Growth needs to be adjusted for prematurity if a child is born before 37 weeks gestation. The adjustment should continue to be made until the child is one year old.

For example, for a child who was born 20 weeks ago at 28 weeks gestation, draw a vertical line on the growth chart at 28 weeks and count 20 weeks across the grids. The measurement should therefore be plotted at eight weeks which is the age adjusted for gestation.

A child born at or after 40 weeks gestation does not need any adjustments to be made and measurements should be plotted from the expected date of delivery.

Interpretation

Any abnormality or deviation from the expected centile must be reported to the child’s doctor (Walters, 1998).

When a child’s growth pattern is abnormal a brief history should be taken and recorded in the child’s health care records. Relevant information may include:

• the child’s energy and school performance

• school attendance records

• behavioural and emotional concerns

• chronic or recurrent illness

• eating patterns

• decreased or increased patterns of buying clothes & shoes

• previous data recorded in parent held record

All concerns about deviations in weight should be reported to the appropriate multidisciplinary team member.

Rationale

References

Reference 1:
Child Growth Foundation (1996) Four-in-one growth charts. London, Child Growth Foundation

Reference 2:
Cole TJ (1994) Do growth chart centiles need a face lift? BMJ 308 (6929): 641-2.

Reference 3:
Cooney M (1999) Practice still imperfect. Nurs Times 95 (48): 64-5.

Reference 4:
Davies K (2004) Assessment of Growth Failure in Children. London, MIMS for Nurses Pocket Guide

Reference 5:
Freeman JV, Cole TJ, Chinn S, Jones PR, White EM, Preece MA (1990) Cross sectional and weight reference curves for the UK. Archives of Diseases in Childhood 73: 17-24.

Reference 6:
Fry T (1994) Introducing the new Child Growth Standards. Prof Care Mother Child 4 (8): 231-3.

Reference 7:
Gibson RS (1990) Principles of nutritional assessment. Oxford, Oxford University Press

Reference 8:
Hall D (2000) Growth Monitoring. Archives of Diseases in Childhood 82(1): 10-14.

Reference 9:
Paton RG, Gardner LI (1962) Influence of family environment on growth. Pediatrics 30: 957-962.

Reference 10:
Scottish InterCollegiate Guidelines Network (April 2003) No 69: Management of obesity in children and young people: A national clinical guideline. www.sign.ac.uk. Viewed on: 29/05/2007

Reference 11:
Sherwood MC, Stanhope R, Preece MA, Grant DB (1986) Diabetes insipidus and occult intracranial tumours. Arch Dis Child 61 (12): 1222-4.

Reference 12:
Skuse D (1989) ABC of child abuse. Emotional abuse and delay in growth. British Medical Journal 299: 113-5.

Reference 13:
Smith DE, Booth IW (1989) Nutritional assessment in children: Guidelines on collecting and interpreting anthropometric data. Journal of Human Nutrition and Dietetics 2: 217-244.

Reference 14:
Stanhope R, Wilks Z, Hamill G (1994) Failure to grow: lack of food or lack of love? Prof Care Mother Child 4 (8): 234-7.

Reference 15:
Stern M, Zaiken H (1985) Assessing the child with short stature. Paediatric Nursing 11: 106-10.

Reference 16:
Voss LD (2000) Standardised technique for height measurement. Archives of Diseases in Childhood 82: 14-15.

Reference 17:
Walters E (1998) Know how nutritional assessment. Nurs Times 94 (8): 68-9.

Reference 18:
Royal College of Nursing (RCN) (2010) Standards for the weighing of infants, children and young people in the acute healthcare setting. London, RCN

Reference 19:
Royal College of Nursing (RCN) (2006) Malnutrition. What nurses working with children and young people need to know and do. London, RCN

Reference 20:
Child Growth Foundation (2009) Growth assessment recommendations. www.childgrowthfoundation.org/pdf_files/measuring_guidelines_dec_2009.pdf. Viewed on: 26/10/2011

Document control information

Zoe Wilks, Head of Nursing, Outpatients

Additional authors
Sinéad Bryan, Research Nurse, Endocrinology
Victor Mead, Auxologist, Endocrinology

Document owner
Zoe Wilks, Head of Nursing, Outpatients

Approved by
Clinical Practice Committee 

First introduced: 1 September 2000 
Date approved: 26 October 2011
Review schedule: Two years
Next review: 28 October 2013
Document version: 3.0
Replaces version: 2.0