Height: measuring a child/young person 

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

It provides a sensitive guide to a child/young person’s: 
  • health
  • development
  • nutritional status
  • response to treatment
 
A healthy adequately nourished and emotionally secure child/young person grows at an optimal rate (Stanhope et al, 1994; Royal College of Nursing, (RCN) 2006).
 
Regular measurements of children and young people allow for early dictation of inadequate growth and ensuring appropriate health promotion and support is provided for families (Stoner and Walker, 2006). 
 
Many diseases do not cause obvious symptoms and poor growth may be the first or only indicator of a concern (Hall, 2000). Faltering growth could suggest a pathological disorder requiring diagnosis and possible treatment, e.g. malabsorption, an eating disorder, hypertension, psychosocial problems, craniopharyngioma (Skuse, 1989 Hopkins, Kyle and Paul, 2017).
 

Height measurement on admission or attendance at outpatients

On admission to Great Ormond Street Hospital (GOSH) all patients must have their height or length measured and appropriate documentation completed within 24hours. This includes all patients admitted for day care.
 
Patients over one year of age attending outpatient appointments must have their height measured and recorded.
 
To be useful it is essential that a child’s height or length is: (Rationale 1)
The technique used to obtain an accurate measurement of height or length is crucial (Voss, 2000; Voss et al, 1990; Stoner and Walker, 2006).
 
Measurements must be recorded in centimetres and documented in the following areas:
  • recorded in the child/young person’s health care/parent held record
  • recorded in the Patient Assessment Form (PAF) / Outpatient Assessment form (OSF)
  • recorded on the Nutrition Screening Flowchart 
  • recorded on the patients electronic records including  electronic prescribing system
  • recorded on the electronic growth charts on EDM
All paper documentation should have the date, time and the name of the measurer along with a signature and job role. The electronic growth chart will document the date and time the measurement was made and the name of the person who made the measurement (Voss, 2000; Nursing and Midwifery Council, 2015).
 

Frequency of height measurement

Patients over one year of age attending outpatient appointments must have their height measured and plotted on the electronic growth charts on EDM at least every 3 months or at each appointment if less frequent. 
 
It is mandatory for all patients to have their height/length recorded on the EGC
  • On admission 
  • Preterm infants - fortnightly 
  • 0-1 year olds - fortnightly 
  • 1 year onwards - once a month
  • On discharge – (not required for day case/overnight stays) 
Infants under the age of one must have their length measured and recorded every month. 
 
Heights measurements maybe required more frequently depending clinical assessment (Rationales 2 and 3)
 
A single measurement does not reflect the rate of growth (Martin and Collin, 2015) (Rationale 4).
 

Preparation

Child/young person and their family

Inform the family and child/young person if age appropriate, of the following: (Rationales 5, 6, 7, 13 and 14)
  • that a measurement of height or length is required
  • the reason for the measurement
  • what it entails
  • the likely length of the procedure
Prior to measuring a child/young person it is essential to consider their: (Rationale 8)
  • gender, culture and religious beliefs
  • dignity and privacy
The child/young person should normally have the following removed: (Voss, 2000) (Rationales 9, 10, 11 and 12)
  • their shoes
  • hair clips
  • braids, i.e. undo hair
  • orthopaedic braces
Professionals should also take consideration individual diversity of patients for example; head turbans worn by patients may add extra height giving an inaccurate measurement. Therefore, in this situation the professional should try a different approach when always remaining respectful of the patient and their family when explaining the process (Rationale 56)
 
An example, when carrying out a height measurement of a patient wearing a head turban you may ask the patient to face away from you (patient facing the equipment) this will ensure the highest part of the turban is at the back which will allow a more accurate measurement from the front of the head. However, staff must always remember to document if this process has been used.  
 
The child/young person’s health care records must indicate if any of these items are not removed. (Rationale 12)
 

Equipment

The technique used to measure the height or length of a child/young person is the same regardless of the equipment used.
 
Most of the anthropometric instruments (measuring equipment) used in clinical practice have digital counter displays. (Rationale 15)
 
Prior to using equipment the professional should ensure an appropriate calibration has been carried out and the equipment is clean, has been disinfected and is in good working order (Rationale 16).
 
The following equipment is recommended and can be ordered via E-Procurement:
The headboard of the Harpenden stadiometer must be weighted with a 500 gram wipeable beanbag (Rationale 20). This may also be used to calibrate weighing scales.
 
Equipment is available in the outpatient department for measuring a child/young person’s sitting height.
The outpatients department must be contacted in advance to arrange access to the equipment (Rationale 21).
 
All the measuring equipment must be checked: (Rationale 16)
  • with day-to-day cleaning for wear and tear
  • annually by the Biomedical Engineering department

In addition, Harpenden stadiometer must be checked prior to each use and after each session with the calibration rod (Voss, 2000) (Rationale 16)

If the equipment becomes faulty, the wooden parts need to be re-varnished or the professional has any concerns/questions contact the Biomedical Engineering Department (Rationale 22).

Measuring technique

Selecting position

A child/young person should be measured supine (lying face upward) until two years of age (Rationale 23).
 
Document method used in medical and nursing documentation.
 
A child/young person who is unable to stand, or who finds standing difficult, due to illness or physical disabilities should also be measured supine (Rationale 23).
 
A child/young person who has one leg shorter than the other should be measured standing on the longest leg. They should always be measured on the same leg and this leg documented in records for future use (Rationale 24).
 
In some forms of short stature, body proportions may also be clinically relevant, e.g. children with achondroplasia, or after spinal irradiation (Rationales 25 and 26).
 
The most useful body proportion is the relationship between trunk length and leg length.
 
This is obtained by measuring a sitting height & subtracting this from the total height.
 
Children and young people who need to be measured lying down should have their crown rump length measured, i.e. head to bottom. This measurement is then subtracted from the child’s total length.

Standing height

The positioning of the child/young person is crucial (Rationale 27).
 
Extreme care must be taken when measuring a child/young person who has: (Rationale 28)
  • rheumatoid disease
  • mucopolysaccharide (MPS) disease
  • Down’s syndrome
The person measuring the child/young person must first: (Rationale 29)
  • Ensure that standard precautions are applied for all patients
  • Check if in addition isolation precautions (including personal protective equipment) need to be applied 
  • Wear appropriate protective equipment  to prevent exposure to blood and body fluids 
Perform a social hand wash (see GOSH clinical guideline ‘Hand Hygiene’). The child/young person may require play and distraction techniques to be utilised whilst obtaining the measurement, if support is required for distraction contact the hospital play team (Rationale 30).
 
It is often easier if two people are involved in the measurement of a child/young person, one of who may be a parent or carer (Rationale 31).
 
The measurer must ensure they are eyeball to eyeball with the child/young person to be measured (Rationale 32).
 
The child/young person’s body must be positioned with their:
  • feet together
  • feet flat on the ground
  • heels touching the back plate of the measuring instrument
  • legs must be straight
  • buttocks against the backboard
  • scapula, wherever possible, against the backboard
  • arms loosely at their side
The child/young person’s head must be positioned with the lower margins of the orbit in the same horizontal plane as the external auditory meatus, i.e. the corner of the eyes horizontal to the middle of the ear (Martin and Collin 2015) ( Rationale 33) (See Appendix 1).
 
The headboard of the apparatus should be weighted with a 500gram wipeable beanbag and placed carefully on the child/young person’s head (Rationales 34 and 35).
 
Ensure the child/young person is in the correct position and hold their mastoid processes (Schling et al, 1997; Voss, 2000), the mastoid process is located at the posterior of the temporal bone.
 
Ask the child/young person to breathe in normally and as they inhale maintain the pressure on the mastoids (Schling et al, 1997; Voss, 2000, Martin and Collin 2015).
 
Ask the child/young person to breath out normally and exert upward pressure on their mastoid processes (Schling et al, 1997; Voss, 2000) (Rationales 36 and 37).
 
Ensure feet and heels do not rise up from the ground.
 
DO NOT lift or over extend the child/young person (Schling et al, 1997) (Rationale 38).
 
Once the child/young person has fully exhaled record the measurement to the last complete millimetre, read instrument at eye level (Schling et al, 1997; Voss, 2000) (Rationale 39 and 40).
 
DO NOT round the measurement up or down (Schling et al, 1997).
 
The professional should ensure that the patient is supervised at all times (Rationale 41).
 

Supine length

The positioning of the child/young person is crucial (Rationale 27).
 
The persons measuring the child/young person must first: (Rationale 29)
 
  • Ensure that standard precautions are applied for all patients
  • Check if in addition isolation precautions (including personal protective equipment) need to be applied 
  • Wear appropriate protective equipment  to prevent exposure to blood and body fluids 
  • Perform a social hand wash (see GOSH clinical guideline ‘Hand Hygiene’)  
Two people are required to measure a child/young person in the supine position (Rationale 42).
 
The child/young person may require play and distraction techniques to be utilised whilst obtaining the measurement.
 
Place the measuring board on a firm, flat surface (Rationale 43).
 
Lay the child/young person on the board (Rationale 44).
 
One person should ensure the head is supported in the correct position with the headboard.
 
They should then place the child/young person’s head with the lower margins of the orbit in the same horizontal plane as the external auditory meatus, i.e. the corner of the eyes horizontal to the middle of the ear (Rationale 32) (See Appendix 1).
 
The other person should position the child/young person with their: (Schling et al, 1997: Hopkins, Kyle and Paul 2017) (Rationales 32 and 45)
  • feet together
  • heels touching the back plate of the measuring instrument
  • legs straight and in alignment with the body
  • buttocks against the backboard
  • scapula, wherever possible, against the backboard
The patient’s ankles should be supported to ensure this position is maintained. Firm pressure may also need to be applied to keep their legs in position.
 
The child/young person must be completely aligned and flat against the board (Schling et al, 1997) (Rationale 46).
 
Record the measurement to the last complete millimetre (Martin and Collin, 2015).
 
DO NOT round the measurement up or down (Rationale 47).
 
The child/young person must not be left on their own at any point (Rationale 41).
 

Sitting height (Davies, 2004)

 
Some conditions cause asymmetry and disproportion to the skeleton (Martin and Collin, 2015)
 
It may therefore be necessary diagnostically to undertake sitting height or crown rump (CR) length measurements (Rationale 48).
 
The positioning of the child/young person is crucial (Rationale 27).
 
The person measuring the child/young person must first: (Rationale 29)
  • Ensure that standard precautions are applied for all patients
  • Check if in addition isolation precautions (including personal protective equipment) need to be applied 
  • wear appropriate protective equipment  to prevent exposure to blood and body fluids 
  • perform a social hand wash (see GOSH clinical guideline ‘Hand Hygiene’)  
The child/young person may require play and distraction techniques to be utilised whilst obtaining the measurement (Rationale 30).
 
It is often easier if two people are involved in the measurement of a child/young person, one of who may be a parent or carer (Rationale 31).
 
The measurer must ensure they are eyeball to eyeball with the child/young person to be measured (Rationale 32).
 
The child/young person’s body must be positioned on the sitting height table with their:
  • backs of the knees resting on the edge of the table
  • feet supported on adjustable step
  • thighs horizontal
  • back must be straight
  • buttocks against the backboard
  • scapula, wherever possible, against the backboard
  • hands on knees
The child/young person’s head must be positioned with the lower margins of the orbit in the same horizontal plane as the external auditory meatus, ie the corner of the eyes horizontal to the middle of the ear (Schling et al, 1997) (Rationale 33) (see Appendix 1).
 
The headboard of the apparatus should be weighted with a 500gram wipeable beanbag and placed carefully on the child/young person’s head (Rationale 34 and 35).
 
Ensure the child/young person is in the correct position and hold their mastoid processes (Schling et al, 1997; Voss, 2000).
 
Ask the child/young person to breathe in normally and as they inhale maintain the pressure on the mastoids (Schling et al, 1997; Voss, 2000).
 
Ask the child/young person to breathe out normally and exert upward pressure on their mastoid processes (Schling et al, 1997; Voss, 2000) (Rationales 36 and 37).
 
DO NOT lift or over extend the child/young person (Schling et al, 1997) (Rationale 38).
 
Once the child/young person has fully exhaled record the measurement to the last complete millimetre, read instrument at eye level (Voss, 2000; Schling et al, 1997) (Rationales 49 and 40).
 
DO NOT round the measurement up or down (Schling et al, 1997).
 
The child/young person must not be left on their own at any point with the headboard in contact with their head (Rationale 41).

Crown rump (CR) length

The persons measuring the child/young person must first: (Rationale 29)
  • Ensure that standard precautions are applied for all patients
  • Check if in addition isolation precautions (including personal protective equipment) need to be applied 
  • Wear appropriate protective equipment  to prevent exposure to blood and body fluids 
  • Perform a social hand wash (see GOSH clinical guideline ‘Hand Hygiene’)  
Two people are required to measure a child/young person in the supine position (Rationale 42).
 
The child/young person may require play & distraction techniques to be utilised whilst obtaining the measurement (Rationale 30).
 
Place the measuring board on a firm, flat surface (Rationale 43).
 
Lay the child/young person on the board (Rationale 44).
 
One person should ensure the head is held in contact with the headboard (Rationale 32).
 
They should then place the child/young person’s head with the lower margins of the orbit in the same horizontal plane as the external auditory meatus, i.e. the corner of the eyes horizontal to the middle of the ear (see Appendix 1) (Rationale 33).
 
The other person should position the child/young person and: (Schling et al, 1997) (Rationale 32 and 45)
  • grasp infant by ankles aiming to straighten legs
  • buttocks touching baseplate of the measuring instrument
  • thighs vertical
  • scapula, wherever possible, against the backboard
The ankles of the patient should be supported and this position maintained to ensure accurate measurements. 
 
The child/young person must be completely aligned & flat against the board (Schling et al, 1997) (Rationale 50).
 
Record the measurement to the last complete millimetre (Schling et al, 1997).
 
DO NOT round the measurement up or down (Rationale 47).
 
The professional should ensure that the patient is supervised at all times. (Rationale 41).

Completing the procedure

The child/young person should be redressed and left comfortable (Rationale 51).
 
After use the measuring equipment including the bean bag should be thoroughly cleaned and disinfected using a sanitising wipe (e.g. Clinell®) and allowing it to dry (Rationale 29).
 
If the equipment is contaminated with blood or body fluids, it should be cleaned and disinfected using a spill kit (e.g. Clinell® Spill wipe). Protective clothing must be worn (Rationales 52).
 
If a Rollametre becomes damaged it must be discarded (Rationale 54).
 
Those involved in measuring the child/young person must perform a social hand wash following the procedure (Rationale 29).

Documentation

Any member of staff who has had the appropriate training and experience can record height on the appropriate documentation including the electronic growth chart.
 
The child/young person’s height or length must be: (Rationale 12)
  • recorded in the child/young person’s health care/parent held record
  • recorded in the Patient Assessment Form (PAF)
  • written on Nutrition Screening Flowchart
  • written on the Electronic prescribing system
  • plotted on the electronic growth charts within EDM.  User guides are available on the Trust website .
All paper documentation should be recorded with the date, time and the name of the measurer along with a signature and job role. The electronic growth chart will document the date and time the measurement was made and the name of the person who made the measurement.

Please note:

Non-registered staff (Bands 2 -4) employed by GOSH must be supervised at all times when undertaking height measurements and these must be verified by a registered nurse or competent professional. Non-registered staff must complete appropriate training and be assessed as competent within their care certificate. Once assessed as competent they can undertake this task unsupervised.
 
Pre-registration student nurses must have all measurements verified by a Registered Nurse (RCN, 2013).
 

Growth Charts

There are a number of Growth charts available for use within the electronic growth chart system. This includes the childhood and puberty close monitoring (CPCM) chart and also trisomy 21 growth charts, however for routine practice the early years ‘WHO 0-4 years chart is the centile chart that is recommended from birth to 4 years of age. For children 2- 18 years the ‘WHO 2-18 years chart’ is recommended (Rationale 55)
 
Training for how to add weights and heights to the electronic growth charts is available on the intranet.
 
All patients reviewed as both in and out patients must have their anthropometry recorded on the electronic charts.
 
A normal growth curve is one that runs roughly on or parallel to one of the printed centile lines.
 
If the child was born before 37 weeks gestation, (any child born before 37 weeks is considered premature) the number of weeks of prematurity needs to be added at the time of data entry to the electronic growth chart at the first measurement (Rationale 12).

Endocrine growth disorder chart

For patients under the care of the endocrine team the ‘Four in One Decimal’ growth chart should be used. These charts record the child/young person’s age in decimal years, i.e. 10 months in a year and must be plotted as described below:
 
The height should be plotted on the relevant grid of the growth chart with a well-defined dot and not a cross. The dot must not be circled. It should also be recorded in the recording box (Schling et al, 1997).
 
  • The measurement needs to be plotted in for decimal age. The decimal age is obtained by: (Child Growth Foundation 1996) (Rationale 58)
  • Identifying the year of birth. 
  • Looking on the table to cross-reference the month of birth against the date of birth.
  • This gives the decimal date of birth. 
  • Repeating the formula for the measurement date.
  • Subtract one from the other & round off the last figure to give the decimal age. 
  • Measurements of growth need 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 (Rationale 12).
  • 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

Care should be taken in:
  • choosing the interval between height measurements (Rationale 59)
  • interpreting growth rates measured over less than a year
  • choosing the time of day, i.e. wherever possible measurements should be made at the same time of day (Rationale 60)
Any abnormality or deviation from the expected centile must be reported to the child/young person's doctor (Rationale 63)
 
When a child/young person’s growth pattern is abnormal, a brief history should be taken and recorded in the child/young person’s health care records. Relevant information may include: 
  • the child/young person’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 63).
 
A child/young person should also be referred if they or their parent is worried about the measurement irrespective of the centile (Rationale 64).

Potential height calculation:

The potential height for a child is calculated by obtaining the mid-parental height (MPH) (Schling et al, 1997). The electronic growth charts will calculate the MPH.
 
This calculation is only valid if both natural parents are of normal stature.
 
If you are required to calculate this manually please follow these steps:
 
To calculate the MPH for a boy: (Schling et al, 1997)
  • add together the father’s height and the mother’s height
  • divide this by two
  • add 7cm to the total
  • this gives the mid parental centile
The height would still be normal for him if it deviates by 10cm either way.
 
To calculate the MPH for a girl: (Schling et al, 1997)
  • add together the father’s height and the mother’s height
  • divide this by two
  • subtract 7cm from the total
  • this gives the mid parental centile
The height would still be normal for her if it deviates by 8.5cm either way.
 

Standard deviation score

A child/young person’s height is expressed as a standard deviation score (SDS). It is another way of expressing the child/young person’s height relative to their peer group (Child Growth Foundation 1996) (Rationale 61).
 
This SDS can be calculated by following the formula:
 
SDS=(x - x-)/SD
 
x = the child/young person’s height in cm 
 
x- = the mean of stature in cm for the child/young person’s age
 
Examples of this in practice are: (Rationale 62)
  • a child/young person of average height will have an SDS of 0 
  • a child/young person near the 98th centile would have a SDS of about +2 
  • a child/young person near the 2nd centile would have a SDS of -2
Children/young people should be referred to their doctor if their height: (Rationales 63 and 64)
  • falls below the 0.4th centile
  • above the 99.6th centile
  • outside of their target centile range
Also refer: (Rationale 64)
  • a pre-school child veering up or down over 12-18 months by one centile band 
  • a school age child who veers up or down by two thirds of a band
A height measurement should be repeated in six months if: (Rationale 64)
  • the child is aged less than five years and the curve veers by only two thirds of a band
  • the child is aged over five years and the curve veers by only half a band

Rationale

Rationale 1: To monitor growth. 

Rationale 2: Hospitalised children/young person are at nutritional risk. 

Rationale 3: Chronic illness compromises growth. 

Rationale 4: Serial measurements allow for a more accurate assessment of a child’s growth rate. 

Rationale 5: To obtain “consent”.

Rationale 6: To reduce anxiety. 

Rationale 7: To aid compliance. 

Rationale 8: This will affect: who will measure them; who will be present whilst they are measured. 

Rationale 9: To avoid inconsistencies of measurements. 

Rationale 10: To enable visualisation of the child’s feet flat on floor and the heels against wall. 

Rationale 11: To enable an accurate measurement to be taken (buttocks, heels and scapulae against wall). 

Rationale 12: To maintain an accurate record. 

Rationale 13: To minimise fright from the equipment. 

Rationale 14: To help to psychologically prepare the child. 

Rationale 15: The digital counters greatly reduce observer error but they make it impossible to take a direct reading of the measurement. 

Rationale 16: To ensure accuracy of medical device. 

Rationale 17: To obtain an accurate length. 

Rationale 18: To obtain an accurate standing height

Rationale 19: To obtain an accurate length on a child who cannot stand. 

Rationale 20: To ensure contact between the head and the headboard. 

Rationale 21: To enable effective planning. 

Rationale 22: To facilitate repair. 

Rationale 23: To obtain an accurate measurement. 

Rationale 24: To ensure accuracy of the measurement (same leg used each time). 

Rationale 25: To determine body proportions. 

Rationale 26: To identify skeletal dysplasia. 

Rationale 27: Poor positioning results in inaccurate measurements. 

Rationale 28: To reduce the risk of dislocating the child's cervical vertebrae. If this dislocation does occur, the child's head must be supported and urgent medical help sought. 

Rationale 29: To minimise the risk of cross infection. 

Rationale 30: To minimise discomfort and distress. 

Rationale 31: To help maintain a correct position, e.g. ensuring contact of feet to the floor. 

Rationale 32: To ensure accuracy of measurement (Brook 1982)

Rationale 33: This position is referred to as the Frankfurt plane. 

Rationale 34: To compress their hair. 

Rationale 35: To ensure good contact with between the head and the headboard. 

Rationale 36: To relax the muscles down the spine. 

Rationale 37: To allow the spine to be straightened. 

Rationale 38: To counteract the effects of gravity. 

Rationale 39: To obtain height of child. 

Rationale 40: To enable an accurate reading (Voss 2000)

Rationale 41: To maintain the child/young person’s safety. 

Rationale 42: One to ensure contact of the feet and other contact of the head with the measuring board. 

Rationale 43: To ensure stability of the measuring device. 

Rationale 44: To obtain measurement. 

Rationale 45: To ensure the head and body are in complete alignment. 

Rationale 46: To obtain their true length. 

Rationale 47: It will lead to future measurement errors. 

Rationale 48: To calculate sub-ischial length (height minus sitting height = leg length). 

Rationale 49: To obtain sitting height of child/young person. 

Rationale 50: To obtain sitting height of child/young person. 

Rationale 51: To maintain safety and comfort of child/young person. 

Rationale 52: To minimise the risk of cross infection 

Rationale 54: It is an infection risk. 

Rationale 55: It is based on the latest growth data. 

Rationale 56: Culture can affect height. 

Rationale 58: The chart is divided into 10 not 12. 

Rationale 59: During times of acute illness the growth of a child/young person may fluctuate seasonally and/or monthly (Marshall 1975)

Rationale 60: To minimise diurnal variations i.e. there is less variation in height in the afternoon when the rate of height loss slows down (Voss 2000)

Rationale 61: It enables simple statistical comparison between groups. 

Rationale 62: To determine if medical referral is required. 

Rationale 63: To facilitate appropriate management. 

Rationale 64: To meet the guidelines of the British Society of Paediatric Endocrinology & Diabetes (BSPED) (Schling et al 1997)

Rationale 65: To identify organic and non-organic causes of abnormal growth. 

Rationale 66: To identify measurement error. 

Rationale 67: To enable effective follow-up. 

References

Brook CGB (1982) Growth assessment in childhood and adolescence. Blackwell Scientific. Oxford

Child Growth Foundation (1996) Four-in-one growth charts. London. Child Growth Foundation.

Davies K (2004) Assessment of Growth Failure in Children. UK, Mims for Nurses Pocket Guide

Doull IJ, McCaughey ES, Bailey BJ, Betts PR (1995) Reliability of infant length measurement. Archives of disease in childhood. 72 (6): 520-1.

Freeman JV, Cole TJ, Chinn S, Jones PR, White EM, Preece MA (1995) Cross sectional stature and weight reference curves for the UK, 1990 . Archives of disease in childhood 73 (1): 17-24.

Gibson RS (1990) Principles of nutritional assessment. Oxford. Oxford University Press

Hall DM (2000) Growth monitoring . Archives of disease in childhood. 82 (1): 10-5.

Hopkins, D., Kyle, A. and Paul SP,. (2017) How to carry out growth assessment in infants and children under two years old, Nursing Standard. 31 (25): 40-45. 

Marshall WA (1975) The relationship of variations in children's growth rates to seasonal climatic variations . Annals of Human Biology. 2 (3): 243-50.

Martin, L. and Collin, J. (2015) An introduction to growth and atypical growth in childhood and adolescence, Nursing Children And Young People. 27 (6):  29-37. 

Nursing and Midwifery Council (2015) The Code. Professional standards of practice and behaviour for nurses and midwives. London: NMC.

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

Schling S, Hulse T (1997) Growth monitoring and assessment in the community. A guide to good practice. London, Child Growth Foundation.

Skuse DH. (1989) ABC of child abuse. Emotional abuse and delay in growth . BMJ 299 (6691): 113-5.
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.

Stoner A, Walker J (2006) Growth assessment: how do we measure up? Paediatric Nursing 18 (7): 26-29.  
Voss LD (2000) Growth Monitoring. Archives of Disease in Childhood. 82: 14-15.

Voss LD, Bailey BJ, Cumming K, Wilkin TJ, Betts PR (1990) The reliability of height measurement (the Wessex Growth Study) . Archives of disease in childhood. 65 (12): 1340-4.

Appendices

Appendix 1: Frankfurt plane (PDF) 

Document control information

Lead Author(s)

Liam Southern, Practice Educator

Additional Author(s)

Victor Mead, Auxologist, Endocrinology
Catherine Peters, Consultant, Endocrinology
Philippa Wright, Head of Dietetics

Document owner(s)

Catie Stuart, Matron

Approved by

Guideline Approval Group

Reviewing and Versioning

First introduced: 
01 September 2002
Date approved: 
25 September 2017
Review schedule: 
Three years
Next review: 
25 September 2020
Document version: 
7.0
Previous version: 
6.0