A New Approach to Comprehensive Growth and Nutrition Assessment in Children

Bilateral asymmetry in arm anthropometric measurements according to laterality and nutritional status in children and adolescents from 6 to 12 years old

OBJECTIVE

To compare and correlate anthropometric measurements of the left arm versus the right arm and to establish their relation to laterality, sex, and nutritional status in children and adolescents from 6 to 12 years of age.

METHODS

A cross-sectional study included 605 children and adolescents (285 males; 320 females), with a middle socioeconomic status, that attended an urban elementary school. Anthropometric measurements were taken in both arms, along with height and weight, to assess nutritional status. Self-reported hand preference was recorded.

RESULTS

A total of 49.3% were females and 93% of the subjects were right-handed (n = 563). The mean comparison of right arm and left arm measurements and areas, according to laterality, showed differences in arm fat measurements, with higher values in the right arm. However, the mean difference in triceps skinfold and upper arm measurements between the right arm and left arm was smaller than the technical error of measurement. Significant differences were observed between arm measurements and areas. Upper arm and total upper arm areas of both arms had the highest regression coefficients, with an adjusted R² of .98, whereas the arm fat index had the lowest (adjusted R² of .88). Adjusting the previous differences between the right arm and left arm by age, sex, BMI, and laterality produced similar results.

CONCLUSIONS

Statistical but not clinically significant differences were found between some measurements and areas of both arms, discretely modified in models adjusted for age and BMI, so the measurements can be made on either arm.

Growth Measurement Practices from a National Survey of Neonatal Nurses

PURPOSE

To describe neonatal nurses' growth measurement practices, attitudes, knowledge, bases of practice knowledge, and barriers and facilitators for changing practice; and to identify differences in practices and knowledge by nursing organization, unit type, education, and experience.

DESIGN AND METHODS

A cross-sectional online survey of U.S. neonatal nurses was distributed through two neonatal nursing organizations.

RESULTS

The survey was completed by 301 nurses. Some evidence-based practices (EBPs) were infrequently reported including recording frontal-occipital head circumference (FOC) and length using 0.1 cm increments (17.9% and 17.6%, respectively); measuring FOC, weight, and length more than once before recording (61.9%, 27.2%, and 39.6%, respectively); and for length, using a length board instead of tape measure (19.4%), with a second person assisting (25.1%), with Frankfort plane head positioning (3.3%), and measuring from crown to heels of both feet (19.1%). Most nurses perceived their measurements as accurate or highly accurate (96.7% for FOC, 99.3% for weight, and 87.1% for length). The mean percentage correct on knowledge items was 68.1%. NICU nurses scored slightly better than well-newborn nurses (mean 69.3% correct vs. 65.1% correct, p = .04). Most based measurement practices on clinical practice guidelines (86.6%) and unit policies and procedures (85.9%). Team culture (33.3%) and insufficient resources (32.6%) were the most common barriers to EBP. The support of nurse managers (70.0%) and unit educators (68.5%) were common facilitators.

CONCLUSIONS AND IMPLICATIONS

Knowledge gaps and practice improvement areas were identified. Results can inform interventions to improve the accuracy and reliability of neonatal growth measurement practices.