## Clinical Case of Children’s In Changes of body weight, height, mass

In the Clinical Case of Children’s, Assessment of body weight is of particular importance in pediatric practice since the weight has the fastest dynamics in the event of diseases and nutritional disorders of the child. Adequate nutrition is one of the criteria for a child’s health. The measurement of weight in healthy children must be carried out regularly and quite often since, in acute diseases and exacerbations of chronic diseases, it is important to assess weight loss to determine the severity of the condition and treat the child.

In case of diseases, the mass is measured once every 3-7 days, and in children, 1 year of age – every day, fixing the indicators in the form of a graph (“weight” curve). These curves are of great importance for monitoring the child’s treatment.

Chronic eating disorders are called **“dystrophy”** and can be of 2 types: **overnutrition** – **“obesity”, “paratrophy”** and malnutrition – **“malnutrition”, “exhaustion”. **The terms “hypotrophy” and “paratrophy” are practically used only for children of the first 1.5-2 years of life.

**Malnutrition**

Hypotrophy is a chronic underweight eating disorder. In the Anglo-American literature and the International Classification of Diseases, the term “protein-caloric deficiency” (PCN) or “energy” is used. Depending on the severity, hypotrophy of I, II, III degrees, and MCI of mild (weak), moderate and severe degrees, respectively, are distinguished.

You can roughly navigate the degree of malnutrition of a child by the percentage of weight by age (see the section “Assessing the degree of deviations in body weight”). However, nutritional status reflects more accurately the assessment of weight by height and the degree of weight deficit by height, and in children over 10 years old BMI – Quetelet-II (see the corresponding sections).

If the child’s weight indicator for height is “low”, that is, it is in the corridor from 3 to 10 centiles, but the weight deficit still does not exceed 10%, the child is included in the risk group and requires medical supervision. If the indicator of mass by height is in the corridor from 3 to 10 centiles or below 3 centiles, and the mass deficit is greater than 10%, then the indicator is considered pathologically low. Such children require an examination to find out the reasons for the delay in weight and, if necessary, treatment.

**The most common causes of malnutrition**

- Quantitative and/or qualitative underfeeding, starvation.
- Infections are intrauterine and postnatal, acute, and chronic.
- Malformations, especially of the digestive system, heart, brain, etc.
- Damage to the central nervous system (perinatal pathology, neuroses, etc.).
- Severe chronic somatic diseases (respiratory organs, cardiovascular system, urinary system, gastrointestinal tract, etc.).
- Syndrome of malabsorption.
- Hereditary metabolic abnormalities.
- Hyperthyroidism.
- Deficiency of zinc, iron, and other microelements, hypo-, and hypervitaminosis.
- Immunodeficiencies, especially the T-system.
- Psychosocial deprivation.

**Excess nutrition**

The main feature of childhood obesity is the risk of preserving the latter in adolescence and adulthood, which leads to negative consequences.

The degree of overnutrition is roughly estimated according to age-sex centile or sigma tables, but more accurately according to weight-growth tables with the calculation of the percentage of excess weight by height (see the corresponding section), and for children over 3 years old – according to the centile distributions of BMI Quetelet -II (see the last page of the Appendix).

If the indicator of mass by height is “high”, that is, it is in the corridor of 90-97 centiles, and the excess mass is from 10 to 15%, the child is included in the risk group and requires medical supervision. If the indicator of mass by height is “very high” (97 centiles and above), and the excess mass is more than 15-20%, the diagnosis is “obesity”. Such children require an examination to clarify the cause of excess weight, constant medical monitoring, nutritional correction, and, if necessary, treatment. Expressed (excess weight is more than 70-80%) and persistent obesity is formed in children with a constitutional predisposition and, as a rule, is of a family nature. Depending on the excess weight, the IV degree of obesity is distinguished (see Section “Assessment of the degree of deviations in body weight”).

## Clinical Case – 1. The boy was born on 09/10/1997, examined on 04/10/2009, has a height of 132 cm, weight 37 kg, head circumference 54 cm, chest circumference 75 cm

- Determine the age group.
- Assess anthropometric indicators and their totality according to centile type standards.
- Estimate anthropometric indicators and their totality using empirical formulas.
- Estimate the mass by height using centile tables.
- If you find pronounced deviations in growth and/or weight, estimate their degree in percent.

DECISION:

1. The age group is 12 years old; the child is 11 years old and 7 months old.

### 2. Evaluation by centile tables

Index | Measurement results | Centile interval | Indicator score |

Height, cm | 0-3 centiles (1st corridor) | very low | |

Weight, kg | 25-50 centiles (4th corridor) | middle | |

Head circumference, cm | 50-75 centiles (5th corridor) | middle | |

Chest circumference, cm | 75-90 centiles (6th corridor) | above average |

CONCLUSION. In this Clinical Case of Children, Physical development is very low because growth is very low. Additional analysis is required to assess harmony.

Assessment of body weight by height using centile tables.

Actual weight 37 kg (Corridor 8) – very high, i.e. there is an excess of mass for growth.

Thus, a child in terms of height (1st corridor) and weight (8th corridor) belongs to the group of high risk for pathology. High-risk assessment group for pathology, an in-depth examination is necessary.

### 3. Estimation by empirical formulas.

Index | Measurement results | Calculation by formula | Deviation from the average | Deviation assessment | Indicator score |

Height, cm | 130 + 5 × (12-8) = 150 | -eighteen | Over 3 ages intervals | Pathological | |

Weight, kg | 12 × 5-20 = 40 | -3 | Within 1 age interval | Middle. | |

Head circumference, cm | 50 + 0.6 × (12-5) = 54.2 | -0.2 | Within 1 age interval | Middle. | |

Chest circumference, cm | 63 + 3 × (12-10) = 69 | +6 | 1 to 2 ages intervals | Above average. |

CONCLUSION. In this Clinical Case of Children’s, Physical development is pathologically low since the growth is pathologically low, disharmonious since the indicators of growth and weight are in different evaluative categories. Assessment of physical development requires clarification with more objective methods. High-risk assessment group for pathology.

### 4. Assessment of deviations in height and weight.

Calculation of the growth deficit by age.

The average height (50th centile) is 149 cm. There is a growing deficit of 17 cm.

149 cm – 100%

17 cm – X X = (17 × 100): 149 = 11.5%.

Conclusion: In this Clinical Case of Children’s, there is moderate growth retardation.

Calculation of the percentage of weight by height.

Average weight in height (50 centile) – 28 kg. An excess of 9 kg is noted.

28 kg – 100%

9 kg – X X = (9 × 100): 28 = 32%.

### 5. Conclusion: the excess weight is 32% – obesity of the II degree.

FINAL CONCLUSION. In this Clinical Case of Children’s, The child has a moderate delay in physical development, possibly due to pathological reasons, and excess body weight (obesity II degree). High-risk assessment group for pathology. An in-depth examination is required to determine the causes of deviations in physical development.

Assessment of the physical development of children in the first year of life.

## Clinical Case – 2. The girl was born weighing 3500 g, 50 cm long, 35 cm head circumference, 34 cm chest circumference. She is currently 5 months old. 1 week Examined by a pediatrician, weight 6800 g, length 64 cm, head circumference 42 cm, chest circumference 42 cm.

- Determine the age group.
- Assess anthropometric indicators at the birth of a child. Calculate the mass-growth index of the Tour.
- Assess anthropometric indicators and their totality according to centile type standards.
- Evaluate the anthropometric indicators and their totality using empirical formulas.
- Calculate the Tour index (the ratio between the circumferences of the head and chest).

DECISION

1. The age group is 5 months. child 5 months 1 week.

### 2. Assessment of anthropometric indicators at birth.

Length 50 cm (25-50 centiles, corridor 4) – medium.

Weight 3500 g (50-75 centiles, corridor 5) – average.

Head circumference 35 cm (75-90 centiles, corridor 6) – above average.

Chest circumference 34 cm (50-75 centiles, corridor 5) – medium.

Thus, anthropometric indicators at birth correspond to the average age.

The mass-growth index of Tour at birth is 3500: 50 = 70, which corresponds to the normal indicator (60-80).

### 3. Evaluation by centile tables.

Index | Measurement results | Centile interval | Indicator score |

Body length, cm | 50-75 centiles (5th corridor) | middle | |

Weight, g | 50-75 centiles (5th corridor) | middle | |

Head circumference, cm | 50-75 centiles (5th corridor) | middle | |

Chest circumference, cm | 25-50 centiles (4th corridor) | middle |

CONCLUSION. In this Clinical Case of Children’s, Physical development is average because of average body length; harmonious because the difference between the length and mass corridors does not exceed 1, i.e. bodyweight corresponds to the length.

Evaluation group basic, variant of the norm.

### 4. Evaluation by empirical formulas.

Index | Measurement results | Calculation by formula | Deviation from the average | Deviation assessment | Indicator score |

Body length, cm | 50 + 3 × 3 + 2.5 × 2 = 64 | Within 1 age interval | Middle. | ||

Weight, g | 3500 + 800 × 5 = 7500 | -700 | Within 1 age interval | Middle. | |

Head circumference, cm | 35 + 2 × 3 + 1 × 2 = 43 | -1 | Within 1 age interval | Middle. | |

Chest circumference, cm | 45-2 × (6-5) = 43 | -1 | Within 1 age interval | Middle. |

CONCLUSION. In this Clinical Case of Children’s, Physical development is average, harmonious since the length and weight of the body is in the same assessment category. Evaluation group basic, variant of the norm.

- Tour index: 42 cm – 42 cm = 0, which corresponds to the age norm.

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## Clinical Case – 3. The girl was born with a bodyweight of 2700 g, a length of 48 cm, a head circumference of 34 cm, a chest circumference of 33 cm. She is now 6 months old. 3 weeks Examined by a pediatrician, bodyweight 6450 g, length 64.5 cm, head circumference 42 cm, chest circumference 43 cm.

- Determine the age group.
- Assess anthropometric indicators and their totality according to centile type standards.
- Estimate weight by length. Is there a mass deficit? If so, rate its degree.
- Evaluate the anthropometric indicators and their totality using empirical formulas.

DECISION

1.Age group for 7 months, because of age 6 months 3 weeks.

### 2. Evaluation by centile tables.

Index | Measurement results | Centile interval | Indicator score |

Body length, cm | 64.5 | 10-25 centiles (3rd corridor) | below the average |

Weight, g | 3-10 centiles (2nd corridor) | low | |

Head circumference, cm | 25-50 centiles (4th corridor) | middle | |

Chest circumference, cm | 10-25 centiles (3rd corridor) | below the average |

CONCLUSION. In this Clinical Case of Children’s, Physical development is below average because length is below average, harmonious. After all, the difference between the corridors of mass and length does not exceed 1, but since the boundary mass index to clarify the correspondence of the mass to the length, an estimate of the mass along the length is required.

### 3. Estimation of body weight by length according to centile tables.

Actual weight 6450 g – 25-50 centiles, corridor 4 – average weight.

Calculation of the percentage of weight by body length.

Average weight along the length (50th centile) 6600 g.

6600 – 100%

6450 – X, X = (6450 × 100): 6600 = 97.7%

The mass deficit is 2.3%, which is within the permissible deviation.

Thus, the conclusion: In this Clinical Case of Children’s, physical development is below average, harmonious. The evaluation group is basic, however, bodyweight control is required.

### 4. Evaluation by empirical formulas.

Index | Measurement results | Calculation by formula | Deviation from the average | Deviation assessment | Indicator score |

Body length, cm | 48 + 3 × 3 + 2.5 × 3 + 1.5 = 66 | -2 | 1 to 2 ages intervals | Below the average | |

Weight, g | 2700 + 800 × 6 + 400 = 7900 | -1450 | Over 3 ages intervals | Pathological | |

Head circumference, cm | 34 + 2 × 3 + 1 × 3 + 0.5 = 43.5 | -1.5 | 2 to 3 ages intervals | Low | |

Chest circumference, cm | 45 + 0.5 × (7-6) = 45.5 | -2.5 | Over 3 ages intervals | Pathological |

CONCLUSION. Physical development is below average since body length is below average; disharmonious since body length and weight are in different evaluative categories. Assessment of anthropometric indicators requires clarification by more objective methods.

## Clinical Case – 4. The boy was born with a bodyweight of 3000 g, a length of 50 cm. He is currently 2 months old. 3 weeks Examined by a pediatrician, bodyweight 4400 g, length 59 cm, head circumference 41 cm, chest circumference 36.6 cm.

- Determine the age group.
- Assess anthropometric indicators and their totality according to centile type standards.
- Estimate anthropometric indicators and their totality using empirical formulas.
- Estimate weight by length. Is there a mass deficit? If so, calculate the extent of the deficit.

### DECISION

- The age group is 3 months. age 2 months 3 weeks.

### 2. Evaluation by centile tables.

Index | Measurement results | Centile interval | Indicator score |

Body length, cm | 25-50 centiles (4th corridor) | average | |

Weight, g | 0-3 centiles (1st corridor) | very low | |

Head circumference, cm | 50-75 centiles (5th corridor) | average | |

Chest circumference, cm | 36.6 | 3-10 centiles (2nd corridor) | low |

Conclusion. In this Clinical Case of Children’s, Physical development is average, because of average body length; disharmonious, because the difference between the corridors of mass and length exceeds 1, i.e. weight does not correspond to body length. Evaluation group of high risk for pathology, the examination is required to find out the cause of the lag in weight and control of body weight.

### 3. Estimation by empirical formulas.

Index | Measurement results | Calculation by formula | Deviation from the average | Deviation assessment | Indicator score |

Body length, cm | 50 + 3 × 3 = 59 | Within 1 age interval | Middle | ||

Weight, g | 3000 + 800 × 3 = 5400 | -1000 | 1 to 2 ages intervals | Below the average | |

Head circumference, cm | 43-1.5 × (6-3) = 38.5 | +2.5 | 1 to 2 ages intervals | Below the average | |

Chest circumference, cm | 36.6 | 45-2 × (6-3) = 39 | -2.4 | 1 to 2 ages intervals | Below the average |

CONCLUSION. In this Clinical Case of Children, Physical development is average because the body length is average, harmonious since the indicators of weight and height are in the adjacent evaluation categories.

### 4. Estimation of body weight by length.

The actual weight of 4400 g (3-10 centiles) is low, which confirms the discrepancy between weight and length.

### Calculation of the percentage of weight by length and weight deficit

Average weight in length (50 centiles) 5400 g.

5400 – 100%

4400 – X X = (4400 × 100): 5400 = 81.5%

The mass deficit is 18.5%, which makes it possible to diagnose degree I hypotrophy.

FINAL CONCLUSION. In this Clinical Case of Children, Physical development is average, disharmonious, as there is a mass deficit of the 1st degree. In a high-risk assessment group for pathology, a more in-depth examination is required to clarify the cause of hypotrophy and control of body weight.