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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 2: Arm circumference


Trainees will be able to make and use a three-color arm circumference measuring tape to identify moderately and severely malnourished children. They will discuss the advantages and disadvantages of arm circumference as an indicator of growth and the use of the three-color tape as a screening tool in the community.

Time: 1/2 hour (1 hour if arm tapes are made during the session)


- Handout - ''Measuring Arm Circumference"

- Materials to make three-color arm circumference tapes(X-ray film; plastic or any other material that will not stretch; scissors; ruler; green, yellow and red marking pens or paint; pencils)

- Flipchart and marking pens


1. Distribute the Handout - "Measuring Arm Circumference" and explain that mid-upper arm circumference is a good indicator of malnutrition in children 1-5 years of age, because the size of the arm in a healthy child changes very little during this period. If the mid-upper arm becomes thin, this is a sign of malnutrition.

2. Distribute three-color arm tapes to the trainees and explain the reasons for the length of the colored areas on the tape. Or, help trainees make their own tapes following the instructions on the handout.

3. Demonstrate the correct method for measuring arm circumference using the tape. It is best to recruit a small cooperative child for the demonstration. Trainees should practice on a number of small children either during or after the session. Observe each trainee and correct any mistakes made using the tape.

4. Ask trainees to list the advantages of using arm circumference and the three-color tape in community nutrition action programs. These include:

- Simple, fast

- Easy for the community to understand and use

- Good where people cannot read or write

- Requires little training

5. Point out that the arm circumference tape:

- is an excellent tool for finding out about the present nutrition status of children 1-5 years;

- can only be used to detect malnutrition in children 1-5 years old;

- does not tell us about past malnutrition;

- while telling us which children are already malnourished, it is not a good tool for finding "high risk" children before they become malnourished.



Mid-upper arm circumference is a useful indicator of the nutritional status of children 1-5 years old

How to Make a Three-Color Arm Circumference Measuring Tape

1) You will need a strip of material that does not stretch (plastic is best).

2) Cut the strip about 20 cm long and 2 cm wide.

3) Mark the strip with fine vertical lines at 12.5 cm and 13.5 cm from one end of the strip.

4) Color the strip red from the end to 12.5 cm (use paint or felt pen that will not come off easily ) .

5) Color the strip yellow from the 12.5 cm mark to the 13.5 cm mark.

6) Color the strip green from the 13.5 cm mark to the other end.

Three-color arm tapes are available in some countries through UNICEF. They can also be ordered from the Voluntary Health Association of India, C-14 Community Center, SDA, Opp. IIT Main Gate, New Delhi 110 016, India. Insertion tapes marked in centimeters, instead of cut-off points, are also available.

Three-Color Arm Circumference Measuring Tape

How to Use the Three-Color Tape to Find "High Risk" Children

1) Only use the three-color strips with children 1-5 years old.

2) Place the strip around the middle part of the child's deft arm. Find the middle of the upper arm by using the top of the arm and the tip of the elbow as the end points.

3) Which color is touched by the red end of the strip? Green, Yellow or Red?

What Do the Colors Mean?

Green - The child is well nourished .

Yellow - The child is " in danger" of becoming severely malnourished.

Red - The child is severely malnourished and in need of immediate attention.

What to Do for "Yellow" and "Red" Children?

Children with yellow and red arm circumference should be fed extra food every day, and they should be treated for any existing illness.

Children with red arm circumference are in danger of death. They need more food in 5-6 small meals a day. In these children, treatment of illnesses that may be causing or complicating malnutrition is extremely important. Families of severely malnourished children may also need temporary assistance to care for and feed their sick children.

Following-Up Malnourished Children

Arm circumference slowly increases as a child's nutrition improves. Use the three-color strip to monitor and evaluate the progress of malnourished children by comparing their monthly arm circumference measures.

Who Can Use the Arm Circumference Tape to Find and Help Malnourished Children?

Health workers, community leaders and parents can be taught to use the tape for screening and monitoring the growth of children in the community.

The three-color arm circumference strip is easy to use and understand. Because it can be used with both literate and non-literate groups, it is a useful tool for involving parents and the community in the health and nutrition of their children.