Michigan WIC Anthropometric Measurement Procedures

APPENDIX A: GLOSSARY OF TERMS

Accuracy	Degree to which a measurement of a person corresponds to his/her actual weight or height (length or stature).

Anthropometry	Body measurements consisting of length or stature, head or arm circumference, weight and skin fold.

BeamBalance Scale	A weighing device characterized by having a set of sliding weights to counterbalance the object being weighed.

Body Mass Index (BMI)	An anthropometric index of weight and stature that is defined as the weight in pounds divided by the stature in inches squared multiplied by 703. Like weight for length, BMI-for-age is a screening tool used to identify individuals who are underweight or overweight.

Health Professional	For the WIC Program, the term refers to a Competent Professional Authority (CPA).

Height	General term use to describe length or stature.

Length	Distance from the crown of the head to the bottom of the feet when the subject is measured supine.

Pattern of Growth	Progress of physical growth impacted by heredity and environment (health, food and socioeconomic factors). When a child is well, growth is sequential. During acute illness, growth rate will be depressed. The best interpretations of a child’s growth are made from several observations made over time rather than body measurements made at a single point in time. Measurements taken at different times permit calculations of growth over that defined time period. One time measurements give only size.

Precision	Degree to which successive measurements of the same child agree within specified limits.

Recumbent	Lying down, on either front or back of body.

Stature	Distance from the crown of the head to the bottom of the feet when the subject is measured standing.

Supine	Lying on the back.

Zeroed Scale	The condition of a scale being in balance when there is nothing being weighed and the sliding weights are directly over their respective zeroes or the display reads 0.0.

APPENDIX B: EQUIPMENT SOURCES AND SPECIFICATIONS

Head Circumference

Insertion tape readable to nearest 1/16 inch.

OR

Disposable paper tape readable to nearest 1/8 inch.

Several pharmaceutical companies print disposable paper measuring tapes as a service to health professionals. Mead Johnson Nutritional Division and Abbott Laboratories are possible sources.

Perspective Enterprises also has flexible plastic insertion tape for head circumference measurements available for purchase. These tapes are reusable and can be cleaned with alcohol.

Other sources are available online.

Weight

Beambalance scales (non-detachable weights with a zero adjustment weight, and WITHOUT builtin measuring rods).

Pediatric beambalance or digital scale that weighs in 0.01 kg (10 gm) or ONE (1) ounce increments.

Adult beambalance or digital scale in 1/4 pound ( or 0.2 pound) or 0.1 kg (100 gm) increments.

CDC checklist indicates the following Infant Scale checklist:

A scale for weighing infants should have a large enough tray to support the infant and weigh to 20 kg or 40 lb.

High quality beam balance or electronic digital

Weighs to 20 kg or 40 lb

Weighs in 0.01 kg (10 gm) or 1/2 oz increments (note: MI WIC allows 1 oz.)

Tray large enough to support the infant

Can be easily ‘zeroed’ and checked

Weight can be ‘locked’ in

Can easily be ‘tared’ to zero

Can be read at ‘eye level’ of measurer

Can be calibrated

Motion detector and stabilizer

No length device attached

Spring balance scales, such as bathroom scales, are not appropriate and should not be used. Over time, the spring counterbalance mechanism loses its accuracy.

Recommended scale models:

1. Pediatric Scales

2. Adult Scales

Since equipment changes frequently, specific models are no longer recommended. See the following for ‘Clinic quality’ equipment:

http://www.perspectiveent.com/

Perspective Enterprise

7829 Sprinkle Rd.

Portage, MI 49002

1-800-323-7452

Fax: 269-327-0837

For additional sources, please contact the state WIC Anthro consultant:

Joyce Bryant, MHSA, RD

Bryantj5@michigan.gov

517-335-8943

Scale Calibration

Testing the accuracy of clinic scales needs to occur at least once a year. This is done using standardized test weights with documentation of such recorded.

DIY- Standardized test weights can be purchased from various scale distributors, such as:

ZWeigh, Inc., 5321 Hill 23 Drive, Flint, MI 48507;

Pike William Co., 7741 Dix, Detroit, MI;

Perspective Enterprise, 7829 Sprinkle Road, Portage, Michigan 49002.

Scale service companies, such as Toledo Scales, can be used to calibrate agency scales.

Length or Stature

CDC recommended: Infant Recumbent Length Board Checklist:

Length boards for infants must be sturdy, easily cleaned and specific to the purpose and have:

A firm, inflexible, flat horizontal surface with a measuring tape in 1 mm (0.1 cm) or 1/8 inch increments.

Tape is stable and easy to read.

An immovable headboard at a right angle to the tape.

A smoothly moveable footboard, perpendicular to the tape.

A measuring device with hinges can lose screws and bend out of shape no longer maintaining a right angle to the ruler making it difficult to operate and obtain an accurate measurement.

Infant recumbent length boards are available from Perspective Enterprises, 7829 Sprinkle Road, Portage, MI 49002. Contact them at 1-800-323-7452, or Fax to (616) 3270837.

Stature

Steel tapeline readable to nearest 1/16 inch and at least 75 inches long.

Moveable headboard.

OR

Wall mounted stature measurement board with permanently attached headboard. The tape line should be readable to nearest 1/16 inch and at least 75 inches long.

Make certain the stature board and the foot board are mounted so that a small child can stand straight with heels and buttocks aligned vertically. Some stature boards may require a footboard and extension to measure small children.

Source for right angle headboard and a wall mounted stature measurement board is Perspective Enterprises, 7829 Sprinkle Road, Portage, MI 49002. Phone number: 1-800-323-7452. Replacement steel tapelines are available at hardware or department stores.

Determining Gestational Age

MI-WIC calculates Expected Date of Delivery (EDD) when date of Last Menstrual Period (LMP) is entered on the Certification screen. MI-WIC will also accept entry of EDD provided by her health care professional. The American College of Nurse-Midwives produce Pregnancy Calculator wheels as a service to health professionals. EDD CALCUALTOR is available online. Gestational Wheel apps are also available The American College of Nurse-Midwives wheel describes gestational development according to month of pregnancy. Example is pictured in Appendix K. Follow the instructions on the bottom of the wheel for determining due date.

If for some reason the wrong EDD date is entered into MI-WIC and cannot be corrected, call 1-800-942-1636 , 1-1- for 3 Sigma to correct the EDD . The EDD is the number that determines the infant’s gestational age which drives the plot points of growth on the growth charts.

APPENDIX C: RECORDING MEASUREMENT VALUES

ACCURACY

The following 3 steps are necessary for obtaining accurate data about a client’s growth:

Taking the measurement:

The client needs to be in the best alignment. The top of the client’s head is parallel to the floor- in the correct position, the client is looking straight ahead when measuring their height, the heels are against the wall for children and adults. For infants, mimic the same alignment by having mom hold the head against the head board, straighten the knees and both heels are flat against the foot piece. If the measurement cannot be obtained using the procedure, mark the ‘?’ and enter a comment.

Recording the measurement:

Accurate measurements provide the best information on which to make accurate assessment of growth. To help ensure accuracy, it is recommended to say the measurement aloud and record measurements EXACTLY as seen on the measuring device on a recording form (sample at the end of this section).

Convert the measurement for MIWIC:

MIWIC calculates in whole numbers and16th’s. The measurement may be accurate but if the number is in a form other than 1/16’s, it must be converted into the form MIWIC recognizes in order to provide accurate plotting on growth charts. Use the guide below for the MI-WIC convention for measurements.

Measurement Read as* Read as* MIWIC Entry

1/16	1
(2/16)	1/8	2
3/16	3
(4/16)	1/4	4
5/16	5
(6/16)	3/8	6
7/16	7
(8/16)	1/2	8
9/16	9
(10/16)	5/8	10
11/16	11
(12/16)	3/4	12
13/16	13
(14/16)	7/8	14
15/16	15
16/16	0

*Measurements are ‘Read’ in the ‘reduced’ format commonly seen with height, length or head circumference

READING A STADIOMETER, RECUMBENT LENGTH BOARD OR HEAD CIRCUMFERENCE TAPE:

The picture of the head circumference tape shows 1/16th inch marks used on a head circumference tape. MIWIC entries are in inches and 1/16th (sixteenth’s) inches for length, height and head circumference but we may not read a measurement as a 16th. For example, we read 8/16th’s as ½. If a measurement reads as ½, we convert it to MIWIC convention- ½ is 8/16th’s so it is entered as ‘8’ under the ‘1/16th’ column in MIWIC. In the picture below, this measurement is 17 7/8th’s inches. MI-WIC data entry would be 17 in and 14/16’s.

The first mark after the whole inch mark is read as 1/16th.

The second mark is 2/16th’s and can also be read as 1/8th (remember elementary school math where a fraction is reduced to the smallest denominator).

The third mark is 3/16th’s.

The fourth mark is 4/16th’s and can also be read as 1/4th.

The fifth mark is 5/16th’s

The sixth mark is 6/16th’s and can also be read as 3/8th’s

The seventh mark is 7/16th’s

The eighth mark is 8/16th’s and can also be read as ½.

The ninth mark is 9/16th’s

The 10th mark is 10/16th’s and can also be read as 5/8th’s.

The 11th mark is 11/16’s.

The 12th mark is 12/16th’s and can also be read as 3/4th’s

The 13th mark is 13/16th’s.

The 14th mark is 14/16th’s and can also be read as 7/8th’s

The 15th mark is 15/16’s and read as 15/16th’s

The 16th mark is the next whole inch number.

The measurement above is 17 and 7/8th’s, translated for MIWIC as 17 and 14/16th’s.

There are 2 steps to accurate MI-WIC data entry- 1) accurate measurement and 2) converting the measurement to MI-WIC convention. Record the measurement exactly as seen on the measuring device, then convert the measurement to MI-WIC convention as we discuss below.

MIWIC data entry calls for measurements to be recorded in inches and sixteenths inches. In the picture below, there are only 8 marks between each inch line so this device measures to the 1/8th inch. If the ‘Read Here’ line fell between 2 marks, that reading would be a sixteenth of an inch.

If the ‘Read Here’ line were in the space between the 64 and the line above it, that measurement would be 64 and 1/16th, recorded as 64 1/16, read as 64 1/16 and entered into MIWIC as 64 1(16). Moving up to the first mark above 64, that mark is 1/8 so it would read as 64 and 1/8 but is entered into MIWIC as 64 and 2/16th’s. The measurement shown in the picture is 64 and ¼, read as 64 ¼ and entered into MIWIC as 64 and 4/16th’s.

Recording the measurement:

Length/Stature

Write measurement values in inches and fractions.

Example: Length of 24 2/16 inches - record on Recording Form as 24 2/16, MI-WIC data entry is 24 (inches) and 2 (16th)

Length of 30 2/8 inches - record on Recording Form as 30 2/8, MI-WIC data entry is 30 (inches) and 4 (16) * to make 2/8 into 16th’s, both the top and bottom number are multiplied by 2

Stature of 65 1/2 inches - record on Recording Form as 65 ½, convert to MI-WIC data entry format – 64 (inches) and 8 (16th’s)*to make ½ into 16’s, multiply both numbers by 8.

Stature of 46 inches - record on Recording Form as 46 0/16 and enter 46 (inches) and 0 (16th’s).

Head Circumference

Write measurement value in inches and fractions.

Example: Head circumference of 13 12/16 inches- record on Recording Form as 13 12/16

Head circumference of 15 5/8 inches - record on Recording Form as 15 5/8

Convert the measurement for MIWIC:

Length/Stature

Write measurement value in inches and fractions

MI-WIC units are in sixteenths

Convert fractions to sixteenths**

Example:	Length of 24 2/16 inches-enter in MI-WIC as 24 inches-2

Length of 30 2/8 inches-enter in MI-WIC as 30 inches-4

Stature of 5 feet 5 1/2 inches-enter in MI-WIC as 65 inches-8

Stature of 46 inches-enter in MI-WIC as 46 inches- 0

**If measurement values are in eighths, quarters or halves, it is necessary to convert values to sixteenths.

Measurement* May be Read as May be Read as MIWIC Entry

1/16	1
(2/16)	1/8	2
3/16	3
(4/16)	1/4	4
5/16	5
(6/16)	3/8	6
7/16	7
(8/16)	1/2	8
9/16	9
(10/16)	5/8	10
11/16	11
(12/16)	3/4	12
13/16	13
(14/16)	7/8	14
15/16	15
16/16	0

*Measurements are ‘Read’ in the ‘reduced’ format commonly seen with height, length or head circumference

Head Circumference

Enter inches and fraction

Convert the fraction to sixteenths if not in sixteenths

Example:	Head circumference of 13 12/16 inches-enter on MI-WIC as 13 inches-12

Head circumference of 15 5/8 inches-enter on MI-WIC as 15 inches-10

Measurement* May be Read as May be Read as MIWIC Entry

1/16	1
(2/16)	1/8	2
3/16	3
(4/16)	1/4	4
5/16	5
(6/16)	3/8	6
7/16	7
(8/16)	1/2	8
9/16	9
(10/16)	5/8	10
11/16	11
(12/16)	3/4	12
13/16	13
(14/16)	7/8	14
15/16	15
16/16	0

*Measurements are ‘Read’ in the ‘reduced’ format commonly seen with height, length or head circumference

INFANT SCALES:

Infant scales have a sensitivity to 1 ounce

Recording the measurement:

Write measurement values in pounds, ounces and fractions* (on some Infant scales).

Example: Weight of 6 pounds, 4.8 ounces - record on Recording Form as 20-4.8

Weight of 28 pounds, 12 3/4 ounces - record on form as 28-12 3/4

Rounding the weight measurement: For Infants and C-1 only

If an ounce measurement is GREATER than .5 or ½, round UP

If an ounce measurement is LESS than .5 or ½, round DOWN

In the above picture, the measurement reads 6 lbs 4.8oz. so MI-WIC data entry is 6lbs 5oz

Convert the measurement for MIWIC:

All of MIWIC’s weight measurements data are in pounds and ounces (oz)

Weight - Pediatric Scale- Infant- C1

Enter actual pounds, ounces and round ounce fraction to nearest ounce

Example:

so enter the display reading is as follows:

Digital- Display of 30 lbs 6.4oz, enter 30 pounds 6oz (last decimal less than .5 so round 6 down to 6) Don’t use TAB

Digital- Display of 6 lbs 4.8oz, enter 6 pounds 5 ounces (last decimal more than .5 so round 4oz up to 5) Don’t use TAB

Beam Balance scales: Weight of 20 pounds 5 3/8 ounces-enter in MI-WIC as

20 pounds-5oz (3/8 is less than ½ so round 5 down to just 5)

Beam-Weight of 28 pounds 12 6/8 ounces-enter in MI-WIC as 28 pounds-13 ounces (6/8 is more than ½ so round 12oz up to 13)

ADULT SCALES

Adult scales have a sensitivity to .2 pounds (3.2 oz) if digital or 1/4lb (4oz) if beam balance. The adult scale is not sensitive enough to pick up a one or two ounce weight gain or loss of an infant or C-1 child if the child is uncooperative and held by an adult and then the weight is tared (to ‘tare’, weigh the adult with the child, then weigh the adult alone and subtract the adult’s weight to obtain the weight of the child).

Weight - Adult Scale

Record actual pounds plus ounces*

Convert measurement value into MI-WIC units

Example:

Beam-Weight of 52 3/4 pounds-enter in MI-WIC as 52 pounds - 12 ounces

Beam-Weight of 155 1/4 pounds-enter in MI-WIC as 155 pounds-4 ounces

Digital- Weight 45.2, hit ‘Tab’ and weight populates as 45 pounds 3 ounces**

Digital- Weight 37.8, hit ‘Tab’ and weight populates as 37 pounds, 13 ounces**

*It is necessary to change the pound fraction to ounces:

1/4 pound - enter as 04 ounces

2/4 pound - enter as 08 ounces

3/4 pound - enter as 12 ounces

** Tenths of a pound ounce equivalents

.2 pound – equivalent to 3 ounces

.4 pound - equivalent to 6 ounces

.6 pound – equivalent to 10 ounces

.8 pound – equivalent to 13 ounces

APPENDIX C: RECORDING MEASUREMENT VALUES - continued

SUMMARY TABLE

Measurement	Recording Form	DATA ENTRY
Weight: Infant Scale	Record actual values in 1/8, ¼ or decimal intervals. Write values in pounds, ounces and fractions or decimals. EXAMPLE: weight of 20 pounds and 13 5/8 ounces record as 20-13 5/8 weight of 20lb 5.4oz, write as 20lb 5.4 __________	Enter actual pounds, ounces, and round ounce fraction to nearest ounce (less than ½ round DOWN, greater than ½ round UP). BEAM EXAMPLE: actual weight of 20 lbs and 13 5/8 ounces, enter as 20 pounds-14 ounces (round UP). DIGITAL EXAMPLE: actual weight of 20 lbs and 5.4 ounces, enter as 20 lbs-5 ounces (round DOWN) DO NOT ‘TAB’ FOR INFANT DIGITAL WEIGHTS
Weight: Adult Scale	Record actual values as displayed pounds and fractions or decimal intervals. Write values in pounds and fractions. EXAMPLE: weight of 52 and 3/4 pounds record as 52 3/4.	Enter actual pounds and ounces. BEAM EXAMPLE: actual weight of 52 and 3/4 pounds, enter as 52 pounds-12 ounces. DIGITAL EXAMPLE: actual weight of 50.2 lbs, hit ‘Tab’ and MI-WIC converts to 50 lbs 3 ounces MAY ‘TAB’ FOR C-2 – ADULT DIGITAL WEIGHTS
Measurement	Recording Form	DATA ENTRY
Length/Stature	Record actual values in 1/16 inch intervals. Write values in inches and fractions. EXAMPLE: 24 and 4/16 inches record as 24 4/16.	Enter actual inches and fraction. EXAMPLE: actual length of 24 and 4/16 inches, enter as 24-4.
Head Circumference	Record actual value in 1/16 or 1/8 inch intervals. Write values in inches and fraction. EXAMPLE: 13 and 13/16 inches record as 13 13/16.	Enter actual inches and fraction in sixteenths. EXAMPLE: actual head circumference of 13 and 13/16 inches, enter as 13-13.

Anthro Recording Form

Anthropometric measurements for a WIC Family No______________________

HEIGHT (Length or stature)
Name	R/S	First height	Second height	Confirming Height	MI-WIC Entry
in	Units*	in	Units*	in	Units*	in	1/16

WEIGHT
Name	First Weight	Second Weight	Confirming Weight	MI-WIC Entry
lbs	Units*	lbs	Units*	lbs	Units*	lbs	oz

HEAD CIRCUMFERENCE
Name	First HC	Second HC	Confirming HC	MI-WIC Entry
in	Units*	in	Units*	in	Units*	in	1/16

* Specify Units of Measure.

APPENDIX D: ONE INCH MEASUREMENT LINES ON A RULER OR TAPE

Sample below is a mockup of an inch increment of a ruler showing 1/16, 1/8 and 1/4 subdivisions.

APPENDIX E: MEASUREMENT FRACTIONS AND EQUIVALENTS

Ounces and their equivalents

1 oz. = 1/16 lb.

2 oz. = 2/16 lb. = 1/8 lb.

3 oz. = 3/16 lb.

4 oz. = 4/16 lb. = 2/8 lb. = 1/4 lb.

5 oz. = 5/16 lb.

6 oz. = 6/16 lb. = 3/8 lb.

7 oz. = 7/16 lb.

8 oz. = 8/16 lb. = 4/8 lb. = 2/4 lb. = 1/2 lb.

9 oz. = 9/16 lb.

10 oz = 10/16 lb. = 5/8 lb.

11 oz. = 11/16 lb.

12 oz. = 12/16 lb. = 6/8 lb. = 3/4 lb.

13 oz. = 13/16 lb.

14 oz. = 14/16 lb. = 7/8 lb.

15 oz. = 15/16 lb.

16 oz. = 16/16 lb. = 1 lb.

Fractional Ounces and their equivalents (Beam Balance Scales)

1/8 ounce

2/8 ounce = 1/4 oz.

3/8 ounce

4/8 ounce = 1/2 oz.

5/8 ounce

6/8 ounce = 3/4 oz.

7/8 ounce

8/8 ounce = 1 oz.

Fractional inches and their equivalents

1/16"	= 1/16"

2/16"	= = 1/8"

3/16"	= 3/16"

4/16"	= = 2/8" = 1/4"

5/16"	= 5/16"

6/16"	= = 3/8"

7/16"	= 7/16"

8/16"	= = 4/8" = 2/4" = 1/2"

9/16"	= 9/16"

10/16" = = 5/8"

11/16" = 11/16"

12/16" = = 6/8" = 3/4"

13/16" = 13/16"

14/16" = = 7/8"

15/16" = 15/16"

16/16" = = 8/8" = 4/4" = 1 in.

APPENDIX F: CONVERTING FRACTIONS TO DECIMALS

When converting a fraction to a decimal, start by remembering any number divided by itself is 1. The number one is also the same as 4 over 4 or 4/4 or any number divided by itself. This symbol “/” means divided by so 4/4 is 4 divided by 4 which equals 1 (one). When you want to find the decimal of, let’s say ¾, divide 3 by 4. That is .75. So when you read ¾ on a measuring tape, that is short for saying that measurement reached 3 out of 4 of the marks to make one inch or if you read ½, you are saying that measurement only reached 2 of 4 marks to make an inch.

Fractions and their decimal equivalents

1/16 = .0625

2/16 = 1/8 = .125

3/16 = .1875

4/16 = 2/8 = 1/4 = .25

5/16 = .3125

6/16 = 3/8 = .325

7/16 = .4375

8/16 = 4/8 = 2/4 = ½ = .5

9/16 = .5625

10/16 = 5/8 = .625

11/16 = .6875

12/16 = 6/8 = 3/4 = .75

13/16 = .8125

14/16 = 7/8 = .875

15/16 = .9375

16/16 = 1

Decimals and their ounce equivalents

Remember there are 16 ounces in one pound. Most of the scales we use round to .2 (two tenths) of a pound (lb.). Two tenths of a pound is .2times 16. [.2 x 16 = 3.2]

.2 lb. (.2 x 16) = 3.2 ounces

.4 lb. (.4 x 16) = 5.6 ounces

.6 lb. (.6 x 16) = 9.6 ounces

.8 lb. (.8 x 16) = 12.8 ounces

1 lb. = 16 ounces

APPENDIX G : EXHIBITS OF GROWTH CHARTS

Purpose: To plot physical growth measurements.

Form Design: Single sheet, front and back, 8 1/2 x 11; available 250 forms/pkg.

Boys (Birth to 24 Months of Age):	Form DCH0313a

Boys (2 to 5 Years of Age):	Form DCH0313b

Girls (Birth to 24 Months of Age):	Form DCH0313c

Girls (2 to 5 Years of Age):	Form DCH0313d

Note: Only the 2-5 chart is illustrated.

APPENDIX G : EXHIBITS OF GROWTH CHARTS - continued

VLBW Boys - IHDP Growth Charts, Ross Pediatrics

VLBW Girls - IHDP Growth Charts, Ross Pediatrics

See illustrated chart on the following page. Note: Only the girls chart is illustrated.

APPENDIX H: SUMMARY OF PLOTTING UNIT INTERVALS FOR CDCBASED GROWTH CHARTS

GROWTH CHARTS AGE	LENGTH/ STATURE-FOR-AGE	WEIGHT-FOR-AGE	HEAD CIRCUM.	WEIGHT-FOR-LENGTH/ BMI-FOR-AGE
Birth < 24 Months	1/2 inch	1 pound	1/2 inch	Length: 1 inch Weight: 1 pound
2 to 5 Years	1/4 inch	1 pounds	----------	Age: 1/2 year BMI: .2 BMI unit

WHO GROWTH CHARTS FOR BIRTH < 24 MONTHS

CHART	VERTICAL LINE	HORIZONTAL LINE
Length-for-age	Age: 1 month intervals	Length: 1/2 inch intervals
Weight-for-age	Age: 1 month intervals	Weight: 1 pound intervals
Head Circumference-for-age	Age: 1 month intervals	Head Circumference: 1/2 inch intervals
Weight-for-length	Length: 1 inch intervals	Weight: 1 pound intervals

CDC GROWTH CHARTS FOR BOYS/GIRLS (2 TO 5 YEARS OF AGE)

CHART	VERTICAL LINE	HORIZONTAL LINE
Stature-for-age	Age: 2 month intervals	Stature: 1/4 inch intervals
Weight-for-age	Age: 2 month intervals	Weight: 1 pound intervals
BMI-for-age	BMI: .2 BMI unit	Age: 1/2 year intervals

VLBW GROWTH CHARTS (BIRTH < 24 MONTHS-for Education Purposes)

CHART	VERTICAL LINE	HORIZONTAL LINE
Length-for-age	Age: 1 month intervals	Length: 2 cm intervals
Weight-for-age	Age: 1 month intervals	Weight: 1/2 kg. intervals
Head Circumference-for-age	Age: 1 month intervals	Head Circumference: 1 cm intervals
Weight-for-length	Length: 2 cm intervals	Weight: 1/2 kg. intervals

APPENDIX I: GUIDE FOR PLOTTING AGE ON GROWTH CHARTS

Each set of growth charts has the age line divided into different intervals.

Birth < 24 Months of Age Growth Chart has the age lines divided into one month intervals.

2 to 5 Years of Age Growth Chart has the age lines divided into two month intervals and hatch marks at one month intervals.

Guide for Rounding Off Age to Plot Age or Growth Chart

After calculating the age of the person, locate the age line on the appropriate growth charts. To facilitate the plotting of age, age can be rounded. For the 2 to 5 Chart, round to the nearest year and month by rounding down for days 1-15 and rounding up for days 16 and above. For the Birth < 24 Month Charts, round to the nearest one half month. To round off age to the nearest one half month, follow these rules:

ROUNDING TO THE NEAREST HALF MONTH FOR BABIES 0-24 MONTHS

0-7 Days	Round DOWN to previous month
8-21 Days	Round to half month
22-31 Days	Round UP to next month

EXAMPLE: Child's age is 2 months, 15 days

Plotting age is 2 1/2 months.

EXAMPLE: Child's age is 2 months, 23 days

Plotting age is 3 months.

EXAMPLE: Child's age is 4 months, 6 days

Plotting age is 4 months.

EXAMPLE: Child's age is 1 year, 6 months, 28 days

Plotting age is 19 months (1 year, 7 months).

EXAMPLE: Child's age is 4 years, 6 months, 29 days

Plotting age is 4 years, 7 months.

Birth to 24 Months of Age Growth Chart

The location of the age line on this growth chart can either represent the rounded age and use the

chart's printed age line which is divided into one month intervals, or the position of actual age is

estimated.

2 to 5 Years of Age Growth Chart

Since the age lines are divided into 6 month intervals, the child's calculated age is rounded to

year and nearest month. To locate the position of age on the growth chart, find the child's age in

years and estimate position of approximate age in months. The approximate age in months

reflects the combination of months plus days rounded to the nearest month.

APPENDIX J: PRENATAL WEIGHT GAIN GRIDS DETERMINED BY PRE-PG BMI

APPENDIX K: ESTIMATION OF DUE DATE

https://www.acog.org/About-ACOG/News-Room/News-Releases/2016/ACOG-Reinvents-the-Pregnancy-Wheel?IsMobileSet=false

ACOG supports the use of the EDD Calculator and will transition away from the physical plastic wheel in favor of this modern reinvention.
Katherine Chen, MD, MPH, Professor and Vice Chair of Ob-Gyn at the Icahn School of Medicine at Mount Sinai says: "The ACOG EDD Calculator is an accurate app that received high marks for comprehensiveness, function and design, resulting in an APPLICATIONS© score of 13 out of 16. That's the highest score among all of the other pregnancy wheel apps that my colleagues and I previously evaluated in our study published in Obstetrics and Gynecology in June 2015. In addition, it is the only pregnancy wheel app on the market that has a special feature that allows redating based on ultrasonography."

The new EDD Calculator is part of the primary ACOG app.
To Download the ACOG App for free:

For Apple: Visit the App Store

For Android: Visit Google Play

Current users of the ACOG app need to update their copy from Google Play or App Store. Running the in-app updates do not install the EDD Calculator applet. For more information, visit www.acog.org/acogapp.

APPENDIX L: ANTHROPOMETRIC MEASUREMENT PROCEDURE CHECKLIST

Note: when measuring infants, wash your hands before and after measuring them.

WEIGHTS

Infants and children less than two years of age (Wash hands before and measuring infants):

___ 1.	Have the mom or authorized person remove all clothing, except a dry diaper and light clothing such as one thin undershirt while you are zero balancing the scale.

___ 2.	Zero balance the scale -place a disposable sheet and medium dry diaper onto the scale. Press ‘Zero’ to zero balance the scale if digital for each client. If Beam Balance scale, check the scale in the morning before clinic begins to see if the indicator is centered in middle of the opening. If not, adjust the thumb screw until the indicator is centered.

___ 3.	Remove the dry diaper. Place the infant in the middle of the scale's pan on the sheet. Do not touch the child. Do not allow the child to hold onto the part of the scale that would interfere with the accurate weight.

___ 4.	Press ‘WEIGH’. If Beam Balance scale-Adjust the main beam weight until the indicator goes all the way down, then move it back one notch. Move the fractional beam weight until the indicator is centered.

___ 5.	State the measurement out loud.

___ 6.	Record the weight in pounds and ounces to the nearest tenth of an ounce if digital or 1/8 ounce, 1/4 ounce if beam balance on the form.

___ 7.	Get a confirming measurement according to the type of scale being used- one with a reweigh function or beam balance scale, keep the infant on the scale, hit ‘Reweigh’ or for Beam Balance scale return the main beam and fractional beam to the zero position and follow 4-6 looking for a measurement that is within 1 ounce of previous measurement – the confirming measurement, state the measurement out loud and record. For a digital scale without the ‘Reweigh’ function, remove the infant or child, zero balance the scale again with the dry diaper, place the infant or child back on the scale looking for a weight within 1 ounce of the previous measurement- the confirming measurement – state the measurement out loud and record.

___ 8. If the two weights you have recorded are not within one ounce, repeat steps 3 through 7 until you have two (2) weights within agreement record the final accepted (confirming) weight on the form.

___ 9. Convert to MI-WIC data format

___10. Enter in MI-WIC.

ADULT/CHILD > C2

___ 1.	Have the client remove shoes and heavy outerwear and extra clothing of persons two years old or older.

___ 2.	Place a paper towel on the scale platform.

____3. Zero balance the scale. Digital- hit ‘Zero’ before weighing each client. If Beam Balance scale, zero balance the scale before the clinic begins by moving the main beam and fractional weights to zero and see if indicator is reading zero. If not, adjust the thumb screw.

___ 3.	Ask the client to step onto the middle of the scale platform covered with a paper towel.

___ 4.	Press ‘Weigh’ or adjust main beam weight one notch too heavy, then move it back (left) one notch. Adjust fractional beam weight to balance.

____5. State the measurement out loud.

___ 6.	Record the weight reading.

___ 7.	Confirm the measurement. Press the ‘Reweigh’ function if scale has one or have the person step off the scale, zero the scale or return weights to zero, ask the client to step back on the scale and weigh for a confirming weight looking for a weight that is within .2 lb on a digital scale or ¼ lb on a beam balance scale. State the measurement out loud.

___ 8.	Compare the first and second weights. If they are not within .2 or 1/4 pound of each other, repeat steps 3 through 6 until you have two weights within agreement.

___ 9. Convert to MI-WIC data format

___10. Enter in MI-WIC.

LINEAR MEASUREMENTS

Infants and Children less than 2 years of age. Note: when measuring infants, wash your hands before and after measuring them.

LENGTH

___ 1.	Check the equipment for ease of operation, e.g., the foot piece slides easily.

___ 2.	Spread disposable sheet on the recumbent length board.

___ 3.	Have the mom remove shoes with feet bare or thin socks.

___ 4.	Place the infant flat on his or her back in the middle of the board and position the crown of the head against fixed headboard, looking upward. Ask the mom or authorized person to keep the child’s head touching the headboard and demonstrate how to hold head.

___ 5.	Hold knees together and feet on footboard and firmly press downward to fully extend the infant with both heels touching and feet are flat against board.

___ 7.	State the measurement out loud and record the measurement on the form.

___ 8.	Keep the child in the middle of the board and slide the foot board away from the feet.

___ 9.	Confirm the measurement-repeat steps 5 through 7. Record the second reading.

___ 10.	Compare the first and second readings. If the second reading is within 2/16 or 1/8 inch of the first, record it as the confirming measurement. If the two readings are not within 2/16 or 1/8 inch of each other, repeat steps 4 through 7 until two readings are within 2/16 inch or 1/8 inch of each other.

___ 11.	Record the final accepted (confirming) reading.

HEAD CIRCUMFERENCE

___ 1.	Thread the flexible insertion tape so that all words on the wide end of the tape show.

___ 2.	Have the mom hold the child in a sitting position and explain what you are going to measure the child’s head for a head circumference.

___ 3.	Position the tape on the infant's head covering the fullest circumference of the head: above the eyebrows, above the ears, over the fullest part of the head back.

___ 4.	Position the tape so you are reading it at the side of the head or middle of the forehead.

___ 5.	Pull the tape snug and recheck placement.

___ 6.	Take the reading at the top line (inch marking) and to the nearest 1/16 inch at the arrow indication. State the measurement out loud.

___ 7.	Record the reading to the nearest 1/16 inch on the form immediately.

___ 8.	Remove the tape from the baby's head without unthreading.

___ 9.	Repeat the steps from 3 through 7. Record the second reading.

___ 10.	Compare the first and second readings. If they are not within 2/16, repeat steps 3 through 8 until there is an agreement between 2 consecutive readings.

___ 11. Record the final confirming reading on the form.

Equipment Requirements:

___ 1.	Tape line is metal and readable to nearest 1/16 inch.

___ 2.	Tape line is attached firmly to a flat surface with clear strapping tape in a straight line, on a wall without extending baseboard.

___ 3.	Tape line is attached above an uncarpeted floor or one with indoor/outdoor hard surface.

___ 4.	Tape line is attached with "0" at the heel position (at floor), extending upward 84 inches.

___ 5.	Right angle headboard and recording form are available.

STATURE

Positioning:

__ 1. Person is two years of age or older.

___ 2.	Have person remove shoes and heavy coat, etc.

___ 3.	Cover area where client steps with a papertowel. Place person against the wall with heels, buttocks and shoulders touching wall.

___ 4.	The client should look straight ahead;

knees are not bent

arms are straight at sides

legs are straight

heels flat on floor against the wall

- not leaning on tape line

___ 5.	Move the right angle headboard until it firmly touches the crown of the head. State the measurement out loud. Read measurement to the nearest 1/16 inch and record immediately on the form.

___ 6.	Recheck that the person has not bent knees or lifted heels off the floor.

___ 7.	Read measurement to the nearest 1/16 inch and record immediately on the form.

___ 8.	Repeat steps 3 though7.

___9. Compare the first and second readings. If the second reading agrees within 2/16 of the first reading, record it as the confirming reading. If the two readings are not within 2/16 of each other, repeat steps 3 through 7 until you have two consecutive readings within agreement.

___ 10. Record the final confirming measurement.

.

Minimal Expected Weight Gain

Table #1

0	0.1	0.2	0.3	1.0	1.1	1.2	1.3	2.0	2.1	2.2	2.3	3.0	3.1	3.2	3.3	4.0	4.1	4.2	4.3	5.0	5.1	5.2	5.3	6.0
1.0	19
1.1	25	19
1.2	31	26	21
1.3	37	32	27	23
2.0	46	40	36	31	27
2.1	50	45	40	36	31	23
2.2	55	49	45	40	36	27	21
2.3	59	54	49	45	40	32	26	19
3.0	65	59	55	50	46	37	31	25	19
3.1	69	63	59	54	50	41	35	29	23	17
3.2	73	67	63	58	54	45	39	33	27	21	17
3.3	77	71	67	62	58	49	43	37	31	25	21	16
4.0	82	76	72	67	63	54	48	42	36	30	26	21	17
4.1	85	80	75	71	66	58	52	45	39	34	29	25	20	15
4.2	89	83	79	74	70	61	55	49	43	37	33	28	24	19	15
4.3	92	87	82	78	73	65	59	52	46	41	36	32	27	22	18	14
5.0	97	91	87	82	78	69	63	57	51	45	41	36	32	27	23	19	15
5.1	100	94	90	85	81	72	66	60	54	48	44	39	35	30	26	22	18	13
5.2	103	97	93	88	84	75	69	63	57	51	47	42	38	33	29	25	21	16	13
5.3	106	100	96	91	87	78	72	66	60	54	50	45	41	36	32	28	24	19	16	12
6.0	110	104	100	95	91	82	76	70	64	58	54	49	45
6.1	112	106	102	97	93	85	78	72	66	60	56	51	47	42
6.2	114	109	104	100	95	87	81	74	68	63	58	54	49	44	40
6.3	116	111	106	102	97	89	83	77	70	65	60	56	51	46	42	38
7.0	119	114	109	105	100	92	86	79	73	68	63	59	54	49	45	41	37

Age at first weight is along the top of the table. Age at current weight is along the left side of the table.

(Month. Week) First number is the months. The number of weeks follows the decimal.

Minimal Expected Weight Gain

Table #2

0.1	0.2	0.3	1.0	1.1	1.2	1.3	2.0	2.1	2.2	2.3	3.0	3.1	3.2	3.3	4.0	4.1	4.2	4.3	5.0	5.1	5.2	5.3	6.0
7.0	114	109	105	100	82	86	79	73	68	63	59	54	49	45	41	37
7.1	116	111	107	102	94	88	82	75	70	65	61	56	51	47	43	39	35
7.2	114	109	105	96	90	84	78	72	68	63	59	54	50	46	42	37	34
7.3	111	107	99	92	86	80	74	70	65	61	56	52	48	44	39	36	32
8.0	110	101	95	89	83	77	73	68	64	59	55	51	47	42	39	35	32
8.1	104	97	91	85	79	75	70	66	61	57	53	49	44	41	37	34	30
8.2	100	93	87	82	77	73	68	63	59	55	51	47	43	40	36	32	29
8.3	96	89	84	79	75	70	65	61	57	53	49	45	42	38	34	31	28
9.0	92	87	82	78	73	68	64	60	56	52	48	45	41	37	34	31	28

Table #3

2.0	2.1	2.2	2.3	3.0	3.1	3.2	3.3	4.0	4.1	4.2	4.3	5.0	5.1	5.2	5.3	6.0	6.1	6.2	6.3	7.0	7.1	7.2	7.3	8.0
9.0	92	87	82	78	73	68	64	60	56	52	48	45	41	37	34	31	28
9.1	89	84	80	75	70	66	62	58	54	50	47	43	39	36	33	30	28
9.2	87	82	78	73	69	65	61	56	53	49	46	42	39	36	33	30	28
9.3	84	80	75	71	67	63	58	55	51	48	44	41	38	35	32	30	28
10.0	83	78	74	70	66	61	58	54	51	47	44	41	38	35	33	30	28
10.1	80	76	72	68	63	60	56	53	49	46	43	40	37	35	33	30	28
10.2	78	74	70	66	62	59	55	51	48	45	42	39	37	35	33	30	28
10.3	76	72	68	64	61	57	53	50	47	44	42	39	37	35	32	30	28
11.0	75	71	67	64	60	56	53	50	47	44	42	40	38	35	33	30	28

Age at first weight is along the top of the table. Age at current weight is along the left side of the table.

(Month.Week) First number is the months. The number of weeks follows the decimal.

4.0	4.1	4.2	4.3	5.0	5.1	5.2	5.3	6.0	6.1	6.2	6.3	7.0	7.1	7.2	7.3	8.0	8.1	8.2	8.3	9.0	9.1	9.2	9.3	10.
11.0	75	71	67	64	60	56	53	50	47	44	42	40	38	35	33	30	28
11.1	73	69	66	62	58	55	52	49	47	44	42	40	37	35	33	30	28
11.2	72	68	65	61	58	55	52	49	47	44	42	39	37	35	33	30	28
11.3	70	67	63	60	57	54	51	49	47	44	42	39	37	35	33	30	28
12.0	71	67	64	61	58	54	52	49	47	44	42	40	38	35	33	30	28
12.1	67	64	61	58	54	52	50	48	45	43	40	38	35	33	31	29	26
12.2	65	62	59	55	53	50	48	45	43	41	39	36	34	31	29	26	24
12.3	62	59	56	53	51	49	46	44	42	39	37	34	32	30	27	25	23
13.0	60	56	54	52	50	47	45	42	40	37	35	33	31	28	26	23	21

Table #5

6.0	6.1	6.2	6.3	7.0	7.1	7.2	7.3	8.0	8.1	8.2	8.3	9.0	9.1	9.2	9.3	10.0	10.1	10.2	10.3	11.0	11.1	11.2	11.3	12.0
13.0	60	56	54	52	50	47	45	42	40	37	35	33	31	28	26	23	21
13.1	57	55	53	50	48	45	43	41	38	36	34	31	29	26	24	22	19
13.2	55	53	51	48	46	44	41	39	36	34	32	29	27	25	22	20	17
13.3	54	52	49	47	44	42	39	37	35	33	30	28	25	23	20	18	16
14.0	52	50	47	45	43	40	38	36	33	31	28	26	24	21	19	17	14
14.1	50	48	46	44	41	39	36	34	31	29	27	25	22	20	17	15	12
14.2	49	46	44	41	39	37	35	32	30	27	25	22	20	18	16	13	11
14.3	47	45	42	40	37	35	32	30	28	26	23	21	18	16	13	11	9
15.0	46	43	41	38	36	33	31	29	27	24	22	19	17	14	12	10	8

Age at first weight is along the top of the table. Age at current weight is along the left side of the table. (Month.Week) First number is the months. The number of weeks follows the decimal.

Minimal Expected Weight Gain

Table #6

8.0	8.1	8.2	8.3	9.0	9.1	9.2	9.3	10.0	10.1	10.2	10.3	11.0	11.1	11.2	11.3	12.0	12.1	12.2	12.3	13.0	13.1	13.2	13.3	14.0
15.0	46	43	41	38	36	33	31	29	27	24	22	19	17	14	12	10	8
15.1	43	41	39	37	34	32	29	27	24	22	20	18	15	13	10	8	7
15.2	42	40	37	35	32	30	28	25	23	21	18	16	13	11	9	8	7
15.3	40	38	35	33	31	28	26	23	21	19	16	14	12	9	9	8	7
16.0	39	36	34	32	29	27	24	22	20	17	15	13	10	9	9	8	8
16.1	37	34	32	30	27	25	23	20	18	15	13	11	10	9	9	8	7
16.2	35	33	31	28	26	23	21	18	16	14	12	11	10	9	9	8	7
16.3	33	31	28	26	24	22	19	17	14	12	11	11	10	9	9	8	7
17.0	32	29	27	25	23	20	18	15	13	12	12	11	10	9	9	8	8

Table #7

10.0	10.1	10.2	10.3	11.0	11.1	11.2	11.3	12.0	12.1	12.2	12.3	13.0	13.1	13.2	13.3	14.0	14.1	14.2	14.3	15.0	15.1	15.2	15.3	16.0
17.0	32	29	27	25	23	20	18	15	13	12	12	11	10	9	9	8	8
17.1	30	28	25	23	20	18	16	14	13	12	12	11	10	9	9	8	7
17.2	28	26	24	21	19	16	14	13	13	12	12	11	10	9	9	8	7
17.3	27	24	22	19	17	15	14	13	13	12	11	11	10	9	9	8	7
18.0	25	22	20	18	16	15	14	14	13	12	12	11	10	9	9	8	8
18.1	23	21	18	16	15	15	14	14	13	12	12	11	10	9	9	8	7
18.2	21	19	17	16	15	15	14	13	13	12	12	11	10	9	9	8	7
18.3	20	17	17	16	15	15	14	13	13	12	11	11	10	9	9	8	7
19.0	18	18	17	16	16	15	14	14	13	12	12	11	10	9	9	8	8

Age at first weight is along the top of the table. Age at current weight is along the left side of the table.

(Month.Week) First number is the months. The number of weeks follows the decimal.

Table 8

Use this table for children whose current age is greater than 19 months of age. The first column is the amount of time between weights, and the second column is the "minimal expected weight gain" for that time period. The period of time between weights may not be more than 7 months or less than 3 months.

(Months.Weeks) First number is month. Second number after the decimal is number of weeks.

3.0	½ pound
3.1	½ pound
3.2	½ pound
3.3	½ pound
4.0	½ pound
4.1	½ pound
4.2	½ pound
4.3	½ pound
5.0	¾ pound
5.1	¾ pound
5.2	¾ pound
5.3	¾ pound
6.0	1 pound
6.1	1 pound
6.2	1 pound
6.3	1 pound
7.0	1 pound