Body Mass Index

Regular checkups help the doctor monitor your child’s growth and development. For years, doctors have used height and weight measurements as their primary tools for assessing a child’s physical growth in relation to other children of the same age.

Now they have another tool: body mass index (BMI). Why is this new measurement so helpful?

What Is BMI?

BMI is a calculation that uses a child’s height and weight to estimate how much body fat he or she has. Doctors use BMI to determine how appropriate a child’s weight is for a certain height and age.

Calculating BMI

The best way to determine your child’s BMI is to have your child’s doctor do it. That way, you’ll know the number is accurate and your child’s doctor can discuss the result with you. If you’re interested, you also can figure out your BMI by using this calculator:

Starting when your child is 2 years old, the doctor will probably determine his or her BMI at every routine checkup. The doctor will likely plot this measurement on a chart against those of other children who are the same age. Because what is normal changes with age, doctors must plot children’s BMI measurements on standard growth charts rather than using a universal normal range for BMI as is done with adults. They also use separate charts for boys and girls to account for differences in growth rates and amounts of body fat as the two genders mature.

That information is recorded in your child’s medical record, and over several visits, the pattern of measurements allows the doctor to track your child’s growth.

BMI is particularly helpful for identifying children and adolescents who are at risk for becoming significantly overweight as they get older. In older children and teens, there is a strong correlation between BMI and the amount of body fat. Therefore, those with high BMI readings – and probably high levels of fat – are most likely to have weight problems when they are older. If doctors can identify these at-risk children early on, they can monitor their body fat more carefully and potentially prevent adult obesity through changes in eating and exercise habits.

What Do These Figures Mean?

A child’s BMI percentile is a way of showing how his or her measurements compare to kids who are the same gender and age. For example, if a child has a BMI in the 60th percentile, 60% of kids of the same gender and age have a lower BMI.

BMI is not perfect. For example, it’s very common for kids to gain weight quickly – and see the BMI go up – during puberty. Your child’s doctor can help you figure out whether this weight gain is a normal part of development or whether it’s something to be concerned about. If you think your child may be gaining or losing weight too fast, talk to your child’s doctor. A child can also have a high BMI because he or she has a large frame or a lot of muscle, not excess fat. By the same token, a person with a small frame may have a normal BMI but might have too much body fat.

Although BMI is not a direct or perfect measure of body fat, a child above the 95th percentile is considered overweight because 95% of the population has a BMI less than he or she does. A child whose BMI is at the 50th percentile is close to the average of the population. A child below the 5th percentile is considered underweight because 95% of the population has a higher BMI.

Also, it’s important to look at the BMI numbers as a trend instead of focusing on individual numbers. Any one measurement, taken out of context, might give you the wrong impression of your child’s growth. The real value of BMI measurements lies in viewing them as a pattern over time. That allows both doctor and parents to watch the child’s growth and determine whether it’s normal compared with that of other children the same age. BMI is an important additional tool that can be used as an indicator that your child is growing and developing in a healthy way.

Reviewed by: Steven Dowshen, MD

Understanding Growth Charts
Instructions for using growth charts

Growth charts are an important way for pediatricians to monitor your child’s growth. With the availability of growth charts on the Internet, many parents have begun using them at home too.

Since the growth charts compact a lot of information into a small space, they can be a little confusing to use and I often get requests for help from parents who don’t understand how to plot their child on the charts.

This guide, and the picture below, should provide you with all of the information you need to use the growth charts to follow how well your child is growing.

The first step is to find the right growth chart. In our example, we are going to find the percentile for a 2 year old boy who weighs 30 pounds, so we will use the growth chart for Boys from Birth to 36 Months.

Next, (step A on the chart below) find your child’s age at the bottom of the chart and draw a vertical line (a straight line up and down) on the growth chart. In our example, we drew a line through 24 months or 2 years.

Now find your child’s weight on the right hand side of the chart, 30 pounds in our example, and draw a horizontal line (a straight line from side to side). This is step B in our example. Keep in mind that you don’t have to really physically draw a line on the growth charts. If you really do that each time, your growth chart will look very messy and will be hard to read. Instead, just imagine where the line should be or draw a light line with a pencil that you can later erase.

Step C involves finding the spot where these two lines intersect or cross each other. Find the curve that is closest to this spot and follow it up and to the right until you find the number that corresponds to your child’s percentile (step D).

In our example, you can see that a two year old boy who is 30 pounds is at the 75th percentile for his weight. What does that mean? It means that he weighs more than about 75% of boys his age. It also means that 25% of 2 year old boys weigh more than he does. Is that normal? Sure, if that is where he has always been on the growth charts.

Finding your child’s percentile is a little harder if a curve doesn’t actually pass through the spot where your child’s age and weight come together. For example, what would you do if the boy in our example actually weighed 31 pounds? You would use all of the same steps and would have to imagine a curve that is somewhere between the 75th and 90th percentiles and figure that he was at about the 80th-85th percentile.

If your child is above the 95th or below the 5th percentile, then you will also not be able to find an exact percentile, except to say that he is above or below the growth chart.

You can use the same steps to plot your child’s height and body mass index.

Here are some more examples (try them before looking at the answers below):

A. What is the percentile for a 2 year old boy who is 2 feet 10 1/2 inches (34 1/2 inches)? What is the percentile for a 13 year old girl who is 80 pounds?

B. What is the percentile for a 16 year old girl who is 5 foot 4 inches (64 inches)?

C. What is the percentile for a 9 year old who has a body mass index of 18? ‘

D. What is the percentile for a 6 month old girl who is 14 pounds?

It is also important to understand that the growth charts are best used to follow your child’s growth over time or to find a pattern of his growth. Plotting your child’s weight and height at different ages and seeing if he follows a growth curve is more important than where he is at any one time. Even if your child is at the 5th percentile for his weight, which means that 95% of kids his age weigh more than he does, if he has always been at the 5th percentile, then he is likely growing normally. It would be concerning and it might mean there was a problem with his growth if he had previously been at the 50th or 75th percentile and had now fallen down to the 5th percentile.

Also remember that children between the ages of 6 and 18 months can normally move up or down on their percentiles, but older children should follow their growth curve fairly closely.
Answers to examples: A) 50th percentile, B) 10th percentile, C) 50th percentile, D) 75th percentile, E) about the 15th percentile

http://pediatrics.about.com/cs/growthcharts2/l/aa050802a.htm

Tabel Tinggi Badan – Berat Badan

DEFINISI

tabel tinggi badan – berat badan bisa digunakan untuk bayi, anak-anak, remaja dan dewasa.
tabel ini bisa digunakan untuk menentukan kisaran berat badan yang dianjurkan bagi tinggi badan tertentu (berat badan ideal).
kisaran tersebut berdasarkan kepada ukuran kerangka tubuh dan dibedakan antara pria dan wanita.taksiran ini merupakan angka perkiraan dan pada keadaan tertentu bisa bersifat tidak akurat (misalnya pada orang yang berotot atau pada wanita hamil).

fungsi dari tabel berat badan-tinggi badan adalah untuk membantu menentukan apakah berat badan seseorang masih dalam kisaran yang sesuai untuk tinggi badan dan ukuran kerangkanya.

penambahan atau penurunan berat badan digolongkan berdasarkan persentase kenaikan atau berkurangnya berat badan total (berat badan yang sesungguhnya, bukan berat badan ideal).
perhitungannya adalah sebagai berikut:
penambahan/penurunan berat badan ———————————– x 100
berat badan sebelumnya
contoh : penurunan berat badan sebesar 10 kg dari 70 kg menjadi 60 kg.
10/70 x 100 = 14% dari berat badan total.

obesitas digolongkan berdasarkan persentase atas berat badan ideal.
untuk menghitung persentase dari kelebihan berat badan, selisih antara berat badan sesungguhnya dengan berat badan ideal dibagi dengan berat badan ideal lalu dikalikan 100.
contoh : berat badan ideal adalah 60 kg, berat badan sesungguhnya adalah 75 kg. perhitungannya adalah sebagai berikut:
75-60 = 15
15/60 x 100 = 25% kelebihan berat badan.

menentukan berat badan yang diinginkan.

jika tabel tidak dapat digunakan, maka ada cara yang sederhana untuk menentukan berat badan yang diinginkan:

- wanita : berat badan 50 kg untuk tinggi badan 150 cm, setiap penambahan 2,5 cm maka berat badan bertambah sebanyak 2,5 kg.

- pria : berat badan 53 kg untuk tinggi badan 150 cm, setiap penambahan 2,5 cm maka berat badan bertambah sebanyak 3 kg.

- untuk ukuran kerangka besar ditambahkan 10% dan untuk ukuran kerangka kecil dikurangi 10%.

menentukan ukuran kerangka.

untuk menentukan ukuran kerangka tubuh, dilakukan pengukuran pergelangan tangan dengan pita meteran dan gunakan tabel berikut untuk menentukan apakah seseorang memiliki tulang yang kecil, sedang atau besar.

untuk mempertahankan berat badan yang diinginkan, gunakanlah perhitungan berikut untuk menentukan kebutuhan kalori perhari:

- untuk orang yang sangat aktif : 9 kalori/kg bb

- untuk orang dengan aktivitas yang normal : 7,5 kalori/kg bb

- untuk orang yang berusia > 55 tahun atau untuk orang dengan aktivitas yang ringan : 6,5 kalori/kg bb

- untuk orang dengan kelebihan berat badan atau orang yang tidak aktif : 5 kalori/kg bb.
dengan rumus diatas, kita bisa menentukan berat badan yang diinginkan.

panduan umum untuk berat badan anak-anak

Mengapa Anak Tidak Boleh Gemuk ?

Oleh Kompas Cyber Media

Ada banyak alasan medis kenapa anak tidak boleh gemuk.

Kebangkitan ekonomi, perubahan kultur, dan teknologi pangan melahirkan generasi anak gemuk. Padahal gemuk sejak kecil itu tidak sehat.

Mengapa banyak anak gemuk sekarang ?

Bukan saja di negara-negara maju, di negara sedang berkembang seperti Indonesia, di kota maupun di sebagian desa, semakin banyak ditemukan anak yang gemuk. Tidak selalu harus berasal dari keluarga kecukupan. Makan nasi melebihi porsi pun bisa saja bikin badan jadi luar biasa subur.

Gemuk sudah menjadi wabah di dunia. Dulu, negara-negara di Afrika banyak yang kelaparan. Sekarang, pusat-pusat pelangsingan tubuh sudah mulai banyak bermunculan di sana. Pola makan berlebih dan harga buah serta sayur-mayur lebih tinggi dari harga gorengan, gula, dan camilan, itulah yang menjadikan tubuh cenderung kelebihan kalori.

Gemuk juga untuk sebagian orang masih menyimpan lambang kemakmuran. Benar. Sebagian besar orang tua, ibu khususnya, menginginkan anaknya berbadan gemuk. Selain lucu, anak montok juga melambangkan keluarga yang makmur. Pesan keliru yang diwariskan sebagai mitos inilah yang perlu dikoreksi, oleh karena anak yang tidak gemuklah yang sebetulnya didambakan pemerintah di negara maju. Di mana-mana negara maju, lebih banyak manajer yang tidak gemuk dibanding yang gemuk.

Kini, Amerika Serikat tengah bergulat menghadapi anak sekolah yang lebih separo populasinya tergolong gemuk. Sebagian besar membutuhkan konsultasi dokter. Berbagai upaya dilakukan, namun belum seluruhnya teratasi. Kita bisa memaklumi kalau anak Amerika cenderung kelebihan berat badan, mungkin sudah sejak usia bayi mula. Namun, kalau banyak pula anak-anak kita yang gemuk, tentu ada yang keliru dalam pola dan kebiasaan makan mereka. Junk food adalah salah satu penyebabnya.

Anak-anak di negara maju, pilihan menunya-lah yang cenderung membuat mereka jadi kelebihan berat badan. Kita memahami, menu junk food kaya lemak, boros gula, dan garam, serta sangat tinggi kalori. Lidah anak zaman sekarang sudah terkondisikan dengan cita rasa gurih, manis, asin, dan serba berbumbu. Itu pula yang menggiring mereka tidak lagi begitu menyukai menu meja makan ibu.

Demikian pula agaknya anak-anak kita di perkotaan. Mereka sudah terkondisikan pula oleh menu harian yang serba junk food di luar rumah, dan kehilangan selera makannya di meja makan ibu. Semakin dimanjakan anak oleh menu di luar rumah yang cenderung melebihi porsi kebutuhan tubuh, semakin besar potensi untuk menjadi gemuk, dan terus bertambah gemuk.

Anak dan bayi di pedesaan, yang bukan dari keluarga kecukupan pun, sudah tercemar oleh pilihan menu (jajanan) yang sekaliber junk food, kalau jenis jajanan pizza, burger, atau hot dog sudah masuk desa, selain penganan yang serba manis, dan berlemak tinggi.

Selain itu, rata-rata bayi di desa juga sudah lebih dini dan belum waktunya diperkenalkan jenis makanan padat, sehingga badannya rata-rata melebihi ukuran seusianya, mungkin lantaran ketidaktahuan.

Memberi nasi, pisang, bubur, sebelum bayi berumur 5 bulan, salah satu penyebab kenapa banyak bayi di pedesaan yang gembrot.

Kegemukan sejak bayi tidak boleh terjadi, oleh karena pola dan ukuran sel-sel lemak tubuhnya sudah telanjur terbentuk salah. Selain jumlah sel-sel lemaknya terbentuk lebih banyak dari anak normal, ukurannya pun lebih besar. Itu maka, sebaiknya anak tidak gemuk sejak usia bayi. Gemuk yang sudah telanjur terbentuk, sukar mengempiskannya lagi, kecuali menerimanya saja sebagai bakat yang dibawanya sampai usia dewasa.

Anak gemuk bolehkah berdiet, dan minum obat antilemak ?

Diet tanpa pengawasan dokter tidak dianjurkan bagi anak yang gemuk. Dalam masa pertumbuhan, tubuh anak tidak boleh sampai kekurangan zat gizi. Jika diet menguruskan badan tidak tepat, yang berkurang dalam menu bukan cuma kalorinya, melainkan juga semua zat gizi yang dibutuhkan tubuh anak untuk pertumbuhan. Bukan cuma lemak dan kalori yang berkurang dengan diet langsing bukan dari dokter, melainkan semua zat yang terkandung dalam menu harian akan ikut susut juga. Dan ini tidak boleh terjadi.

Obat antilemak seperti yang dikonsumsi orang dewasa yang lemak darahnya tinggi, tidak dianjurkan diberikan kepada anak. Diharapkan, dengan mengurangi porsi menu berlemak-berkolesterol, ditambah rutin latihan jasmani, lemak darahnya bisa turun menjadi normal.

Yang dapat dilakukan mungkin dengan cara akupunktur yang bisa menekan nafsu makan, sambil tetap mengatur kecukupan gizi agar pertumbuhan anak tetap tercukupi. Perilaku makan merupakan kesulitan terberat dalam upaya penurunan berat badan. “Lapar mata” adalah salah satu tantangannya.

Anak yang “lapar mata” terdorong untuk makan (apa saja) kendati tidak sedang lapar.Mestinya, tubuh dilatih hanya makan kalau sedang merasa lapar saja. Makan kapan saja melihat atau ditawarkan makanan (echo), akan mengondisikan tubuh senantiasa terdorong ingin makan kendati tidak merasa lapar.

Bagaimana supaya tidak telanjur menjadi gemuk ?

Bayi dan anak menjadi gemuk jika porsi yang dimakan melebihi kebutuhan tubuh. Kelebihan kalori disimpan menjadi lemak, dan gajih di bawah kulit. Sel-sel lemak tubuhnya menjadi besar-besar, selain jumlahnya lebih banyak dari anak normal.

Susu sapi harus dituding sebagai salah satu penyebab lainnnya. Kita tahu lemak dalam susu sapi lebih tinggi dari lemak ASI. Lemak susu sapi disiapkan untuk membangun tubuh anak sapi, bukan tubuh anak manusia. Maka masih tetap bijak jika ibu tetap hanya memilih ASI untuk bayi, daripada membiarkan menjadi gembrot oleh susu sapi nantinya.

Jika bayi diberikan makanan sesuai dengan umur dan tahapan perkembangan usianya, kecil kemungkinan anak bakal gemuk. Kita tahu, ada tahapan pemberian makanan bayi yang tidak boleh dilanggar.

Selain agar tubuh anak tidak dirugikan oleh menu yang tidak tepat, kemungkinan anak menjadi kelebihan berat badan pun tidak perlu sampai terjadi. Buat anak di atas setahun, tentu pilihan susunya hanya susu sapi. Jika anak sudah gemuk, pilihlah susu nonfat, yang sudah dibuang lemak susunya. Anak hanya membutuhkan kandungan protein susunya.

Biasakan anak banyak gerak. Latihan jasmani bukan sekadar permainan, melainkan harus dimanfaatkan juga untuk membantu membangun tulang dan otot, selain membakar kelebihan kalori yang diperoleh dari makanan yang mungkin berlebih. Semakin kurang bergerak, berolahraga, dan latihan jasmani, semakin besar kemungkinan menjadi gemuk, dan badan anak pun tidak bugar. Kurikulum olahraga di sekolah kita sangat kurang memadai. Semboyan hidup anak sekolah di negara maju, tiada hari tanpa olahraga.

Selera makan anak yang sudah telanjur gemuk umumnya jadi meningkat luar biasa. Itu maka, anak yang sudah telanjur gemuk dengan mudah bertambah berat badannya kalau dorongan untuk terus makannya tidak ditahan, atau terkendali.

Bayi normal akan bertambah berat 2 kali lipat pada usia 5 bulan, dan menjadi 3 kali lipat ketika berumur setahun. Selanjutnya berat badan ideal anak sampai usia 11 tahun bisa dihitung dengan rumus 8 + (2 X umur) kg. Anak yang berumur 5 tahun, idealnya memiliki berat badan 8 + (2 X 5) kg atau 18 kg. Lebih dari itu waspada.

Namun, lebih tepat untuk usia di atas setahun dipakai formula Indeks Masa Tubuh (Body Mass Index), yang dihitung dengan cara membagi angka berat badan dengan tinggi badan (dalam meter). Nilai 23 – 25 tergolong ideal, dan lebih dari 25 berarti sudah kelebihan berat.

Gemuk juga bisa berarti penyakit

Anak yang gemuk bukan cuma sebab kesalahan memberi makan berlebihan, melainkan bisa juga sebagai sebuah kasus penyakit. Ada beberapa jenis penyakit (kelainan hormon dan gen) yang membuat tubuh anak gemuk abnormal, dan gemuknya kelihatan tidak sehat.

Dalam hal gemuk penyakit, tidak mudah mengoreksinya, karena memang ada yang salah dalam sistem hormonal atau gennya. Gemuk yang tak terkendali dengan diet, dan upaya membuang kalori ini, tergolong gemuk yang harus diterima apa adanya, dengan segenap risiko yang dibawanya.

Bagaimana mengatasi anak gemuk ?

Ini masalah baru yang dihadapi Amerika sekarang. Baru-baru ini, sekolah di AS membuat �kartu rapor berat badan�. Anak yang dinyatakan kelebihan berat badan memerlukan konsultasi dokter untuk diet khusus, dan latihan jasmani ekstra agar berat badan ideal bisa tercapai.

Di sekolah-sekolah Singapura, misalnya, anak yang kelebihan berat badan diberi porsi olahraga yang lebih banyak dibanding anak yang tidak gemuk, agar berat badannya menyusut menjadi tidak gemuk lagi.

Kegemukan diantisipasi medis bisa membawa banyak penyakit, sehingga sumber daya manusia menjadi kurang berkualitas.

Dengan �kartu rapor berat badan�, anak dipantau terus oleh sekolah sampai batas tidak gemuknya tercapai. Setelah itu, berat badan yang tercapai ideal dipertahankan dengan cara makan tidak rakus, dan pilihan menunya tepat, sambil tetap berolahraga sehingga gemuknya tidak kambuh.

Anak gemuk apakah berarti profil lemak dalam darahnya juga tinggi ?

Ya, hal itulah yang paling kita takuti. Kebanyakan remaja Amerika yang pola makan dan pilihan menunya serba junk food itu, rata-rata sudah kelebihan kadar lemak dalam darahnya.

Walau tidak selalu harus lemak dalam darahnya tinggi, namun kebanyakan remaja di negara maju, kolesterol dan trigliseride-nya sudah di atas normal. Itu berarti, risiko muncul malapetaka akibat tingginya profil lemak tubuhnya, sudah dimulai sejak usia pubertas mula. Dan itu yang menerangkan, mengapa dewasa ini banyak serangan jantung atau stroke muncul pada usia yang lebih dini. Semakin banyak stroke dan serangan jantung koroner prematur (kurang dari usia 40 tahun) muncul sekarang ini.

Lemak dalam darah yang berlebih kini diyakini juga mencetuskan bangkitnya kanker di organ tubuh mana saja, kanker rahim, ginjal, dan payudara khususnya. Risiko perlemakan hati, kencing manis, juga didongkrak oleh dibiarkan semakin tingginya lemak dalam darah. (Tabloid Nova)

IDENTIFYING POOR GROWTH IN CHILD & ADOLESCENT

Source : http://depts.washington.edu/growth/poorgrowth/text/page1a.htm

1. Anthropometrics: Weight, length, and weight-for-length

The three measures of body size shown on the growth charts for infants (birth to 36 months of age) are length, weight, and weight relative to length. The latter is an indicator of how the child’s weight matches his or her length. Weight-for-length corresponds to body-mass-index-for-age in older children.

In children less than 2 years old, recumbent length is measured; in children over 3 years old, stature (height) is measured. For children between 2 and 3 years old, there is a choice. Either length or stature can be measured. To continue to use the set of charts for birth to 36 months, measure length; to use the charts for 2 to 20 years, including the BMI-for-age chart, measure stature.

CDC recommends using the BMI-for-age charts beginning at age 2 years because BMI-for-age can be used to track overweight into adulthood. On the other hand, for children between 2 and 3 years, the charts for birth to 36 month charts offer continuity with their earlier data and show data in a more expanded display that is easier to interpret.

In this module we use the charts of infants and children from birth to 36 months. These charts include weight-for-age, length-for-age, head-circumference-for-age, and weight-for-length. (The use of head circumference-for-age is reviewed in the module, Interpreting Growth in Head Circumference.)

With all these measures, monitoring a child’s measurements over time provides the best information. Growth faltering, or slowed growth velocity, often indicates a problem. Cutoff values are also used to classify children’s growth as normal or questionable. See Overview of Growth Charts for more information about guidelines for growth assessment.

Several guidelines have been established to identify poor growth. The most common cutoff point for concern is the fifth percentile, though other cutoffs are also used. The table below summarizes recommendations of several agencies and organizations. Criteria refer not only to weight but also to length and weight-for-length.

The Institute of Medicine made recommendations for the identification of children needing special nutrition services through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). WIC, with its preventive emphasis, recommends the tenth percentile weight-for-length as a point for intervention. The fifth percentile of weight-for-age is commonly used in medical settings. The World Health Organization (WHO) takes a worldwide perspective and emphasizes the needs of developing countries. The WHO cutoff, 2 standard deviations below the mean, is slightly lower than the 5th percentile used in the US.

Surveys of the prevalence of poor growth (how common it is in a population) use measures of children’s growth at the time of the survey. They use attained growth in length, weight, weight-for-length, or combinations of those measures.

For an individual child, it is important to consider growth faltering or slowed growth velocity. A commonly used criterion for growth faltering is that the child has dropped across two major percentile lines on the chart (for example, from the 75th to the 25th percentile) over the course of a few or several months. Another criterion for growth faltering is that the rate of the child’s growth, or growth velocity, is below the velocity in the reference data. Guo, et al (1991) report reference data on gains in weight and length during the first two years of life, based on the sample for the 1977 growth charts. Both these criteria are used in clinical practice. However, no standard definitions of these criteria have been established.

The fact that a child meets criteria for poor growth does not necessarily imply that something is wrong. Many children meeting these criteria are growing normally. However, others have nutritional or feeding problems or medical conditions or illnesses that impair growth. If a child meets criteria for poor growth, further evaluation is needed.

2. Identifying poor growth – examples

You will now be presented with four growth charts to interpret.

Example 1, Part 1. This child’s growth appears to be poor because she is below the 5th percentile.

However, assessing growth is more than identifying the child’s growth indices as below the 5th percentile. It is important to look at the trend over time. The child may be following her own track.

Example 1, Part 2. This is a look at the growth over time of the child in Example 1.

This child’s parents are both small, and it is likely that she is genetically predisposed to being short. After an evaluation was done, concern about this girl’s growth pattern was lessened. Other factors that can affect growth potential include being born small for getational age.

Example 2. This child, whose weight-for-age, length-for-age, and weight-for-length are also below the 5th percentile at age 15 months, does present concerns. Her weight-for-age, length-for-age, and weight-for-length have decreased over time.

Now one should be more concerned because the child is more likely to have a nutritional or medical problem. The child is growing poorly. In this case, all 3 growth measures–length-for-age, weight-for-age, and weight-for-length–dropped together. That is not always the case.

3. Describing growth in quantitative terms

In order to tell whether an individual child is overweight or underweight, the simplest method is to plot his or her growth measurements on a growth chart and interpret the changes in percentiles from the chart.

If you’d like to calculate percentiles exactly, you can use computer programs. One is Epi Info 2000, a program that allows you to enter and analyze data. The anthropometric component of Epi Info 2000, Nut-Stat, can be used to calculate percentiles exactly. The program can be downloaded at no cost from www.cdc.gov/epiinfo.

For Statistical Analysis System (SAS) users, CDC has written a code that calculates percentiles (www.cdc.gov/growthcharts). Instructions for using the CDC growth chart data to calculate z-scores, as well as the data files, can be found on-line.

When a child’s growth is far from the norm, percentiles carry less meaning. In these situations, it is convenient to use the special charts that show the 3rd and 97th percentiles. Another approach is to quantify “less than the 5th percentile.” It’s hard to interpret, for example, the fact that a child’s growth has gone from the 1.5 percentile to the 2.0 percentile. Then it may be best to describe growth in terms of standard deviations or z-scores. For example, a very underweight child might be described as being 2.5 standard deviations below the mean (z = -2.5). For more information about standard deviation scores, see chapter 2 in Kessler and Dawson, 1999.

4. Evaluation of reasons for poor growth

Children who appear to be growing poorly may be quite normal, or they may have medical or nutritional problems. There are many possibilities.

Children whose growth appears poor on charts may require services from clinicians or professionals in more than one field: nutrition, medicine, child development, and others. Results of an evaluation may range from normal to the discovery of serious problems.

Evaluation is especially important if the child is young (for example, in the first few months of life, rather than age 2 years), if the growth deviation is severe, or if there are symptoms of illness, clues to problems in feeding or family relationships, or unusual feeding practices. Evaluation is accomplished most effectively by a multidisciplinary team, but referrals to registered dietitians, feeding specialists, medical providers, and mental health professionals can also accomplish the work.

5. References

Guo S, Roche AF, Fomon SJ, et al. Reference data on gains in weight and length during the first two years of life. Journal of Pediatrics. 1991; 119:355-362.

Institute of Medicine. WIC Nutrition Risk Criteria: A Scientific Assessment. Washington, DC: National Academy Press, 1996.

Kessler, DP, Dawson, P. Failure to Thrive and Pediatric Undernutrition: A Transdisciplinary Approach. Baltimore: Paul H. Brookes Publishing Company. 1999. Available at www.brookespublishing.com.

Mei Z, Grummer-Strawn LM, Pietrobelli A, Goulding A, Goran MI, Dietz WH. Three screening indices for body composition: which is the best indicator of overweight and underweight in children and adolescents? American Journal of Clinical Nutrition. Forthcoming.

Needlman, R.D. Assessment of growth. In Behrman, R.E., Kleigman, R.M., and Jenson, H.B. (eds.), Nelson Textbook of Pediatrics. 2000. Philadelphia: W.B. Saunders.

U.S. Department of Agriculture, Food and Nutrition Service. WIC Policy Memorandum, 98-9, Nutrition Risk Criteria. Available from state WIC agencies.

World Health Organization. Physical status: The use and interpretation of anthropometry. WHO Technical Report Series 854. Geneva. 1995.

Food pyramid: The shape of a healthy diet

Original Article:
http://www.mayoclinic.com/invoke.cfm?id=NU00190

Perhaps you’ve noticed that the days of the four basic food groups — dairy, meat, vegetables and fruit — are long gone. Today, healthy eating plans encompass a far wider range of options: legumes, whole grains, seeds and nuts, fish, and even plant oils, such as olive oil. Add in ethnic, religious, cultural and personal preferences, and you have more options than ever when planning healthy meals and snacks.

A healthy eating plan can be illustrated many ways, but they’re most often found in the shape of a pyramid. These pyramids outline various food groups and food choices that, if eaten in the right quantities, form the foundation of a healthy diet.

Is there an ideal eating plan?

Many people yearn for — and spend a lot of time and money seeking — the perfect eating plan. An ideal diet would assure excellent health, provide energy and strength, and promote resistance to some diseases. It would delay aging and keep you at your ideal weight.

Does such an eating plan exist? Probably not. Your nutritional needs differ at different stages of life, and they may change if you have a chronic disease. Everyone has unique genetic tendencies toward certain diseases, so food components such as salt or fats pose different risks for different people. Food intolerances and allergies also affect what kind of food you eat. In addition, such factors as your culture, family background, religious and moral beliefs, and the cost and the availability of food can all affect your food choices. People like different foods and prepare similar foods in different ways.

The pyramid plan

Although there really isn’t one perfect diet for everyone, some general principles for choosing foods apply to most people. These principles are often represented in a food pyramid.

The triangular shape of the pyramid shows you where to focus when selecting foods. Foods that you should eat the most of create the large base of the pyramid, and those foods you should eat sparingly form the smaller tip.

Probably the most familiar food pyramid is the Food Guide Pyramid, established by the Department of Agriculture and the Department of Health and Human Services. But many others now exist, including the Asian, Latin American and Mediterranean Diet Pyramids, the Mayo Clinic Healthy Weight Pyramid, and the Vegetarian Diet Pyramid, just to name a few.

These food pyramids have much in common, and you can use any of them as a basis for healthy eating. They follow the same premise of variety, portion control and moderation in eating. Most follow these basic principles:

• Eat more fruits, vegetables and whole grains.
• Reduce saturated fat and cholesterol.
• Limit sugar and salt.
• Drink alcoholic beverages in moderation, if at all.
• Eat moderate-sized portions.
• Include physical activity in your daily routine.

Focus on food groups

Your body requires certain nutrients, such as protein, carbohydrates and fiber, to function properly. Since no single food provides all of the nutrients that your body needs, eating a wide variety of foods ensures that you get the necessary nutrients and other substances that promote good health.

In general, food pyramids present these types of food:

• Fruits. From apricots to oranges, fruits are great sources of vitamins and minerals and soluble fiber. Except for a few varieties — such as coconuts — they’re low in fat and calories.

• Vegetables. Like fruits, vegetables are great sources of vitamins, minerals and fiber. If you don’t smother them in cream sauces, butter or dips, vegetables are low in fat and calories.

• Grains. Breads, pasta, rice, noodles, couscous, polenta, bulgur and other grains are your main sources of carbohydrates. Most are low in fat. Choose whole grains as much as possible for more fiber and a wider variety of nutrients.

• Dairy products. Milk, cheese, eggs, yogurt and other dairy products are good sources of calcium, protein and other vitamins and minerals. However, these foods can be high in cholesterol, fat and calories, so choose low-fat versions.

• Meat and beans. Meat, poultry and fish provide protein and are good sources of B vitamins, iron and zinc. However, some types of meat may be high in cholesterol, fat and calories. Legumes — such as soybeans, black beans, split peas and lentils — are good substitutes for meat because they provide protein and also have added fiber, without the extra cholesterol, fat and calories.

• Fats, oils and sweets. These types of foods — which include salad dressings, sour cream, and margarine along with cakes, cookies, ice cream and pastries — are high in fat and calories.

So what’s the difference?

Although all food pyramids reflect the same general principles of healthy eating, they demonstrate different food choices. These differences reflect personal preferences, dietary patterns, food availability and cultural eating patterns. For example, some pyramids, such as the Latin American Diet Pyramid, might include tortillas and cornmeal within the grains food group, whereas another, such as the Asian Diet Pyramid, might emphasize noodles and rice.

Another difference is in the food groups themselves. For example, some pyramids group plant-based proteins — soybeans, beans and nuts — separately from animal proteins found in meat, poultry, eggs and dairy products. This is because animal proteins are often higher in fat and cholesterol, and some diets limit animal proteins, placing them toward the top of the pyramid.

These six pyramids also differ in how they address servings. The Food Guide Pyramid recommends a daily number of servings from each food group. And it specifically defines serving sizes, for example, a serving of rice is 1/2 cup and a serving of milk is 1 cup.

But other food pyramids offer more general guidelines, such as eating particular foods at every meal, or on a weekly or monthly basis. For example, the Latin American Diet Pyramid recommends that you eat whole grains, vegetables and fruits at every meal but eat red meat, sweets and eggs once a week or less.

No matter which pyramid diet you follow, remember to select a variety of foods from each food group and focus on those groups toward the bottom of the pyramid.

How to use a food pyramid

To see how your diet matches up to any of these pyramids, keep a food diary for several days. Then compare how much of your diet comes from the bottom of the pyramid and how much comes from the top. If you’re top-heavy, work your way toward the bottom by making small, gradual changes, such as eating more vegetables, fruits and whole grains and limiting fats and sweets.

Here are other tips for using a food pyramid:

• Choose a variety of foods from each major food group. This ensures that you get all of the calories, protein, vitamins, minerals and fiber you need. Choosing a wide range of foods also helps make your meals and snacks more interesting.

• Adapt a pyramid to your specific tastes and preferences. For example, a serving of grains doesn’t only mean a slice of wheat bread. It can be long-grain or wild rice, grits, cornmeal muffins, or even popcorn.

• Combine foods from each major group in a pyramid however you like. For example, you might make a meal of tortillas from the grain group and beans from the meat and beans group. Or you could top your fish with fruit salsa or serve steamed vegetables over pasta. The possibilities are endless.

• Select your meals and snacks wisely if you need to avoid all foods from one or more food groups. For example, if you don’t consume dairy products because of lactose intolerance or for another reason, choose other foods that are good sources of calcium.

• Create a daily menu following the pyramid guidelines. Emphasize foods at the bottom of the pyramid and limit those at the top. These sample menus show how the pyramid can help you plan your meals and snacks.

By Mayo Clinic staff

CARA BACA GROWTH CHART YG TEPAT

Grafik pertumbuhan dan persentil

Apakah yg dimaksud dg Persentil ?

Ketika kita membuka grafik pertumbuhan, maka kita akan melihat 7 kurva dengan pola yg sama. Tiap kurva tsb mewakili persentil yg berbeda : 5th, 10th, 25th, 50th, 75th, 90th, dan 95th. Persentil 50^th menunjukkan rata-rata nilai pada umur tsb.

Selain itu ada juga grafik dengan tambahan persentil 10th, 25th, 50th, 75th, 90th, dan 97^th

Biasanya dokter menggunakan grafik ini jika angka yang di-plot berada di luar dari kurva yg standar. Pertumbuhan seorang anak akan di-plot pada persentil2 tsb.

Untuk mempelajari lebih jauh tentang bagaimana membaca atau menginterpretasikan grafik tsb, perhatikan contoh berikut.

Seorang bayi yg memiliki lingkar kepala persentil 90th akan di-plot disebelah kanan dari kurva kedua dari atas pada grafik pertumbuhan. Jadi termasuk kurva persentil 90^th. Artinya lingkar kepala bayi tsb termasuk >= 90% dari total populasi anak seusianya yang ada di negara tsb. Sedangkan 10% dari populasi anak memiliki ukuran lebih dari itu.

Jika berat badan seorg anak berumur 4 tahun berada pada persentil 20^th, berarti ia berada pada kurva di antara 10th dan 25th. Ini artinya juga 80% dari anak-anak sebayanya memiliki berat di atas anak tsb, dan 20% lainnya memiliki berat di bawah anak tsb.

Kesimpulannya, besar atau rendahnya persentil tidak berarti menunjukkan adanya masalah. Seorang bayi dengan lingkar kepala di persentil 90th dapat memiliki berat badan & tinggi badan di persentil 90th. Ini artinya dia termasuk anak normal yang berperawakan besar. Bisa jadi ia anak dari seorang atlet.

Sebaliknya, anak yg memiliki berat badan di persentil 20^th bisa jadi memiliki orang tua yang tinggi & beratnya juga di bawah rata-rata. Jadi sangat normal jika sang anak berada pada persentil 20th.

Namun demikian, ada juga pola grafik yang naik tajam atau turun drastis atau grafik berada pada kurva paling ekstrim (di luar dari semua kurva). Sebagai contoh, seorang anak memiliki berat badan (BB) di bawah persentil 5th, maka ia dimasukkan dalam kategori underweight (BB kurang). Sedangkan anak dg BB di persentil 85th akan dimasukkan dalam kategori overweight (beresiko obesitas) dan mereka yg memiliki BB di persentil di atas 95th digolongkan dalam obesitas.

Terkadang ada juga grafik dengan kurva melebihi persentil 95^th atau saling silang antar kurva persentil. Misalkan, awalnya ia berada di kurva persentil 40th kemudian langsung loncat ke persentil 75th. Artinya tanpa melewati persentil 50th dan 75th. Jika hal tsb terjadi, maka perlu diperhatikan penyebab terjadinya kondisi tsb.

Di lain pihak, dapat juga terjadi pengukuran atau pola grafik jatuh di bawah persentil 5th atau saling silang antar kurva persentil. Misalkan, turun drastis dari persentil 50th ke 20th. Jika hal itu terjadi, maka dokter akan mengevaluasi kemungkinan adanya gangguan kesehatan yg mempengaruhi pertumbuhan sang anak.

Apa yang dapat growth chart jelaskan tentang pertumbuhan anak kita ?

Meskipun grafik pertumbuhan (growth chart) adalah alat ukur yg sangat berharga, alangkah baiknya dokter ataupun orang tua tidak terfokus pada angka-angka atau kurva yg terdapat dalam grafik.

Sebaliknya, angka-angka tsb seharusnya dilihat sbg sebuah trend. Grafik pertumbuhan dapat juga memberikan kesan yg salah tentang kondisi pertumbuhan anak kita. Contohnya, seorang anak memiliki tinggi badan (TB) di persentil 5th. Bukan berarti ia memiliki masalah kesehatan. Apalagi jika pola grafik atau trend kurvanya menunjukkan bahwa ia memang selalu berada di kurva persentil 5th (sejak bayi hingga kini, sang anak selalu berada dalam kurva persentil 5th). Analisanya, bisa jadi sang anak mendapatkan gen ”pendek” dari sang orang tua yg juga pendek. Jika dokter atau orangtua terpaku pada angka di grafik pertumbuhan (bukan trend grafik pertumbuhan), maka bisa jadi kita akan salah menilai pertumbuhan anak kita. Khawatir terhadap hal yg salah.

Ketika grafik pertumbuhan dibaca & dianalisa berulang kali, maka grafik tsb akan mengungkapkan suatu pola pertumbuhan. Pola tersebut akan memberitahukan kita bagaimana pertumbuhan anak kita dibandingkan dengan anak-anak sebayanya. Selain itu, pola tsb juga menunjukkan kepada kita bagaimana progress sang anak dari pengukuran sebelumnya. Grafik pertumbuhan akan sangat bermanfaat jika dilihat sbg pola pertumbuhan anak dibandingkan dengan melihat angka per angka.

Updated and reviewed by: Steve Dowshen, MD

Date reviewed: March 2002
(Translatted by Lulu – Alyssa’s mom)

http://www.growtall.com/growth-charts2.htm

HOW TO DETERMINE YOUR GROWTH PERCENTILE CORRECTLY

Height And Growth Charts For Your Growth Percentile

What Do the Percentiles Mean?
When you look at a growth chart, you will see seven curves that follow the same pattern. Each one represents a different percentile: 5th, 10th, 25th, 50th, 75th, 90th, and 95th. The 50th percentile line represents the average value for age. (There are also charts that show 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles. Doctors sometimes use these when they plot measurements that fall to the very outer edges of one or more growth curves). Your child’s growth measurements will be plotted among these percentile curves. To better understand how to interpret those readings, consider these examples.

An infant whose head circumference falls in the 90th percentile will be plotted right on the second curve from the top of the chart (the 90th percentile curve). Being in the 90th percentile means the child’s head measurement is greater than or equal to the measurements of 90% of children that age in the country. The remaining 10% of infants that age have head measurements that exceed that child’s.

If a 4-year-old’s weight at a checkup falls in the 20th percentile, that reading will be plotted between the curves for the 10th and 25th percentiles. That means 80% of children that age weigh more and 20% weigh less than that child.

Now, you shouldn’t assume that a high or low reading means there’s a problem. A baby whose head circumference is in the 90th percentile might also fall in the 90th percentile for weight and length – he’s just a normal kid who’s large overall. (He could be the son of a 6-foot, 8-inch former linebacker!)

The child whose weight falls in the 20th percentile may have parents who are a bit below average for height and weight. For him, being in the 20th percentile is an entirely normal reading.

Sometimes, however, a child’s measurement increases or falls sharply, or is at one extreme of the growth chart. For example, children who fall below the 5th percentile on the weight for stature (height) chart are considered underweight; children at or above the 85th percentile on this chart are considered overweight (and at risk for obesity); and those at or above the 95th percentile are considered to be obese.

Generally, if a measurement exceeds the 95th percentile or crosses two percentile curves (such as climbing from the 40th percentile to the 75th percentile, thereby crossing the 50th and 75th percentile curves), there may be some cause for concern. On the other hand, if a measurement falls below the 5th percentile or crosses two percentile curves (dropping from the 50th to the 20th percentile, for instance), the doctor will also consider the possibility of a health problem affecting the child’s growth. What Can the Charts Tell Me About My Child’s Growth?
Although growth charts are valuable tools, both doctors and parents must be careful not to focus too much on any one reading. Instead, the numbers should be viewed as a trend. Any measurement, taken out of context of the others, might give you the wrong impression of your child’s growth. For example, a child’s height measurement might place him at the 5th percentile, but this usually doesn’t indicate a growth problem if his subsequent measurements continue to track along that percentile curve (as might be the case for a child who has inherited “short genes” from his parents). If the doctor and parents fixate on that one measurement, however, they might wrongly worry about the child’s growth.

When growth chart readings are examined over time, they reveal a pattern of development. That pattern lets you know how your child is growing in relation to other children his age and also shows you how he has progressed from previous measurements. This information is a much more useful indicator of whether a child is growing normally than any single measurement.

Updated and reviewed by: Steve Dowshen, MD
Date reviewed: March 2002

http://www.growtall.com/growth-charts2.htm

BOBOT BAYIKU TURUN, Normalkah?

“Dok, bayi saya kok bobotnya turun ya? Waktu lahir beratnya 3,5 kg sekarang jadi 3,3 kg, apa dia sakit?” tanya Nita saat membawa kontrol bayinya yang baru berusia 2 minggu. Apakah Anda memiliki kasus yang kurang lebih sama dengan Nita? Berikut penjelasan Dr. Attila Dewanti, Sp.A dari Klinik Khusus Tumbuh Kembang, RSAB Harapan Kita, Jakarta kepada Hilman Hilmansyah.

BERAT DAN TINGGI BADAN RATA-RATA
(Umur 0-5 Tahun, jenis kelamin tidak dibedakan)