Nutrition Interventions for Children with Special Health Care Needs

Chapter 2 - Anthropometricss
Mild malnutrition has been defined as 80-89% of expected weight for stature (15).
This roughly corresponds with the 5-10th percentile on the weight for stature charts.
Moderate malnutrition has been defined as 70-79% of expected weight for stature,
and severe malnutrition as less than 70 percent. Both of the criteria correspond to
less than the 5th percentile on the weight for stature charts.
Secondary Measures
Triceps Skinfold and Mid-Upper Arm Circumference (2,3)
Together, triceps skinfold thickness and mid-upper arm circumference are used
to calculate arm muscle circumference, arm muscle area, and arm fat area,
which are indicators of body fat and muscle stores when compared to population
percentiles (3,7). For typically developing children, the calculations of arm muscle
circumference, arm muscle area, and arm fat area provide a better estimate of body
composition than triceps skinfold alone.
Accurate measurements of triceps skinfold thickness and mid-upper arm
circumference are difficult to obtain by an inexperienced or untrained measurer.
Measurement error is likely to be higher when measuring young children because it
is difficult to maintain the child in the proper position while the measurement is being
performed. It is also difficult to separate fat from muscle tissue (7). These secondary
measurements are useful only if obtained with precise and accurate technique that
is developed with training and practice. In the course of training, the measurements
must be validated by a person experienced with skinfold thickness techniques. Only
calibrated calipers should be used for measuring skinfold thickness; plastic calipers
are not accurate. For further information on these measurements see Frisancho (16),
Guiney (17) Tanner (18), and Cameron (19).
Recommended guidelines for interpretation have been published, and an individual’s
measurements can be compared to population reference data (16). These
interpretations, however are based on assumptions of the bone diameter and the
distribution of muscle and fat around the bone of typically developing persons; these
assumptions may be inaccurate for persons with physical abnormalities. The best use
of these measurements for children with special health care needs is for assessing
changes over time (e.g., increases in fat and muscle stores in the undernourished
child and decreases in fat stores in the overweight child). Skinfold measurements are
not appropriate for children with subcutaneous edema.
26 Nutrition Interventions for Children With Special Health Care Needs