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close this book Community Nutrition Action for Child Survival
close this folder Part I - Community nutrition problems and interventions
close this folder Unit 2: Measuring and monitoring growth in young children
View the document Session 1: Measuring growth
View the document Session 2: Arm circumference
View the document Session 3: The road to health chart
View the document Session 4: The thinness chart
View the document Session 6: Counseling, referral and follow-up of malnourished children

Session 1: Measuring growth


Trainees will review the measurements of growth in young children and their usefulness for identifying children at "high risk" of malnutrition.

Time: 1/2 hour


- Flipchart and marking pens

- Handout - "Measuring the Growth of Young Children"


1. Introduce this unit by reminding trainees that:

"Community managers must look for ways to benefit the greatest number of people with their often limited resources. One way we do this in nutrition activities is by clearly identifying and focusing our efforts on children at "high risk" of malnutrition and death. "

2. Ask trainees how they would define and identify "high risk" children.

Responses may include:

- Malnourished children

- Children from poor families

- Children whose mothers or fathers are absent

- Children who have physical signs of malnutrition

- Children who are sick

Summarize trainee responses by saying that there are many conditions and circumstances that may make children nutritionally "high risk." Growth failure is one of the most useful indicators we have for deciding whether children are at high or low risk of malnutrition.

Growth failure is the first sign of malnutrition

3. List and discuss common measurements of growth appropriate for community use. Use the Handout "Measuring the Growth of Young Children" to prepare and guide your presentation.

4. Explain why these measurements are compared with standard measurements for reference populations with normal and sub-normal nutrition status.

5. Explain the difference between single growth measurements and serial (repeated) measurements on the same child. Discuss the advantage of using serial measurements for early detection of growth failure.

6. Close the session by telling trainees that managers must choose which growth measurements and growth monitoring instruments are the best for use in their projects. A manager's choice often depends on the kinds of malnutrition common in an area, the workers' or volunteers' skills and the resources available for training and supervision.

In this module, three instruments for measuring and monitoring growth are presented:

- The three-color arm circumference measuring tape

- The Road to Health Chart

- The Thinness Chart

These instruments have been used successfully in communities worldwide to identify "high risk" children. Besides providing useful measures of growth, they also promote the active involvement of parents and community leaders in the identification of "high risk" children and the causes of malnutrition in their communities.



Measuring a child's growth is one way of detecting malnutrition before the visible signs and symptoms of severe PEM become apparent. Healthy children grow very rapidly, especially in the first few years of life. Failure to grow is the first sign of malnutrition. If we can find children in the community who are not growing normally, we can take action to improve nutrition and prevent serious illness and, in some cases, death.

Growth can be measured and compared in several different ways:

Weight is the most reliable indicator of growth in young children. Changes in the weight of a healthy child can be detected every month from 0-5 years of age. To measure growth, we can (1) compare a child's weight gain over time, (2) classify a child's weight for his age, and (3) compare this measurement to a standard weight for children of the same age.

Height increases more slowly than weight in young children, but comparisons of height-for-age and height-for-weight can be useful measures. Height-for-age tells us about the past nutrition status of a child. Children who are "stunted, " or shorter than normal children their age, have probably been chronically undernourished. Children who are too thin for their height when compared to normal children of the same height are "wasted" or currently malnourished.

Arm Circumference, or the distance around the middle of the upper arm, is another measurement of growth in children from 1-5 years old. In healthy children, arm circumference remains fairly constant between one and five years. When a child is malnourished, the arm circumference is reduced. By measuring arm circumference and comparing it to a standard for normal children, we can detect children who are currently malnourished, or "wasted."

In this module we focus attention on three growth assessment instruments that can be used by the community to identify children who are "in danger" of becoming malnourished and those who are currently malnourished and in need of immediate assistance. These are the:

- Three-color arm circumference tape

- Road to Health Chart

- Thinness Chart