Children's nutritional status: identify how to measure up to the results of the assessment

The nutritional status of children is one of the benchmarks for assessing the fulfillment of daily nutritional needs and the use of these nutrients by the body. If children's nutritional intake is always fulfilled and used optimally, of course their growth and development will be optimal. However, if the opposite is true, the nutritional status of your little one could be problematic so that it affects his development into adulthood. Well, here is a complete explanation about how to calculate a child's nutritional status.

Is the method of calculating the nutritional status of children and adults the same?

The growth process in childhood and adulthood is different.

In the age range of children from 0-18 years old, including at the age of 6-9 years of development, the body will continue to experience growth and development.

Meanwhile, after reaching adulthood, this growth will usually stop gradually.

The age of children is an important period in which the body grows very rapidly.

Starting from the ideal body weight of children 6-9 years, height, to the overall body size will continue to change.

Children's cognitive development, children's social development, children's emotional development, especially children's physical development are influenced by their nutritional status.

This aims to prepare the body before entering real adulthood where the child's body is expected to have developed maturely.

Well, because the body at the age of children will continue to experience development, then how to calculate the nutritional status of children is different from adults.

Measuring body mass index (BMI), which is often used as a measure of the nutritional status of adults, cannot be used in children.

Body mass index (BMI) is an assessment of nutritional status for adults by comparing body weight in kilograms to height in meters squared.

The calculation of BMI is considered inaccurate in measuring the nutritional status of children.

Again, this is because weight and height in children tend to change very quickly.

Quoting from Nutrition Teaching Materials: Statuz Nutrition Assessment, the nutritional status of children can be measured by several specific indicators, namely:

1. Gender

The assessment of the nutritional status of boys is certainly not the same as that of girls.

This is because their growth and development are different, usually girls will grow much faster than boys.

That is why, in calculating the nutritional status of children on the nutritional status of children, it is important to pay attention to gender.

This is because the growth pattern of boys is different from that of girls.

2. Age

The age factor is very important to determine and see whether the child's nutritional status, including nutrition for school children, is good or not.

This actually makes it easier for you to know whether the baby is experiencing normal growth when compared to other children his age.

Although indeed every child will experience different growth and development even though they have the same age range.

3. Weight

Body weight is one of the most frequently used indicators of assessing the nutritional status of children.

Yes, body weight is considered to provide an overview of the adequacy of the amount of macro and micro nutrients in the body.

Unlike height, which changes over time, weight can change very quickly.

Changes in body weight can indicate changes in nutritional status in children.

That is why body weight is often used to describe the current nutritional status of children, also known as tissue mass growth.

4. Height or body length

In contrast to body weight which can change very quickly, height is actually linear.

The linear meaning here is that the change in height is not so fast and is influenced by many things from the past, not just now.

It's easy like this, if your little one eats too much, he might gain weight even though only 500 grams or one kilogram in a few days.

However, this does not apply to height.

Height growth is closely related and depends on the quality of food you give your child from childhood, even from birth.

Exclusive breastfeeding or not during infancy until the quality of complementary foods you give your little one affects their growth.

Therefore, height tends to be used as an indicator to determine chronic nutritional problems in children, aka nutritional problems that have been going on for a long time.

In the past, when children were 0-2 years old, body length was measured using wooden planks (length board).

Meanwhile, for children older than 2 years, height measurement uses a tool called a microtoise that is propped against the wall.

5. Head circumference

In addition to the indicators previously mentioned, head circumference is one of the things that is usually measured to determine the nutritional status of your little one.

Although it does not describe directly, the baby's head circumference should always be measured every month until the child turns 2 years of age.

The reason is, the head circumference can provide an idea of how the size and development of a child's brain at that time.

Measurements are usually carried out at the doctor, midwife, or posyandu, using a measuring tape that is looped around the baby's head.

Once measured, the child's head circumference will be classified into normal, small (microcephaly), or large (macrocephalus) categories.

A head circumference that is too small or large is a sign that there is a problem with a child's brain development.

How do you calculate the nutritional status of a child?

As previously explained, the assessment and how to calculate the nutritional status of children and adults are not the same.

Indicators of age, weight, and height are interrelated to determine the nutritional status of children.

The three indicators will later be included in the child growth chart (GPA) which is also differentiated according to gender.

Well, this graph will show whether the child's nutritional status is good or not.

GPA also makes it easier for you and the medical team to monitor your little one's growth and development.

This is because with the growth chart, the increase in height and weight of the child will be easier to see.

There are several categories used to assess a child's nutritional status using GPA, including:

Measuring the nutritional status of children aged 0-5 years

The graph used to measure the nutritional status of children aged less than 5 years is the WHO 2006 chart (cut off z score).

The use of the 2006 WHO chart is differentiated based on male and female sex:

1. Weight based on age (BW / U)

This indicator is used by children aged 0-60 months, with the aim of measuring body weight according to the child's age.

BB / U assessment is used to find out the likelihood of a child being underweight, very underweight, or overweight.

However, this indicator usually cannot be used if the age of the child is not known with certainty.

The nutritional status of children based on weight / age, namely:

Normal weight: -2 SD to +1 SD
Underweight: -3 SD to <-2 SD
Extremely underweight: <-3 SD
Risk of overweight:> +1 SD

Children who are classified as more likely to have growth problems.

Try to double check using the indicator BB / TB or BMI / U.

2. Nutritional status of height based on child's age (TB / U)

This indicator is used by children aged 0-60 months, with the aim of measuring height according to the child's age.

The TB / U assessment is used to identify the cause if the child has a short stature.

However, the TB / U indicator can only be used for children aged 2-18 years in a standing position.

Meanwhile, if the age is under 2 years, the measurement uses the body length indicator or PB / U lying down.

If a child over 2 years of age is measured for height by lying down, the TB value should be reduced by 0.7 centimeters (cm).

The nutritional status of children based on height / age, namely:

Height:> +3 SD
Normal height: -2 SD to +3 SD
Short (stunting): -3 SD to <-2 SD
Very short (severe stunting): <-3 SD

3. Weight based on height (BW / TB)

This indicator is used by children aged 0-60 months, with the aim of measuring body weight according to the child's height.

This measurement is generally used to classify children's nutritional status.

The nutritional status of children based on weight / height, namely:

Malnutrition (severely wasted): <-3 SD
Malnutrition (wasted): -3 SD to <-2 SD
Good nutrition (normal): -2 SD to +1 SD
Risk of overnutrition:> +1 SD to +2 SD
More nutrition (overweight):> +2 SD to +3 SD
Obesity:> +3 SD

Example of a Child Growth Chart (GPA) with the BB / U indicator for boys. Source: WHO

Example of Child Growth Chart (GPA) with BB / U indicators for girls. Source: WHO

Measuring the nutritional status of children aged 5-18 years

Measurement of the nutritional status of children over 5 years of age can use the CDC 2000 rule (percentile measure)..

The percentile is used to describe the child's BMI score.

Body mass index is used at this age because at that time children experience different height and weight gain even though they are the same age.

So, the comparison of the child's height and weight will be seen based on their age.

An example of a graph of BMI assessment categories with percentiles according to the child's age can be seen in the following figure:

Example of a Boy Growth Chart for BMI. Source: Centers for Disease Control and Prevention (CDC).

Example of Growth Chart for Girls for BMI. Source: Centers for Disease Control and Prevention (CDC).

Meanwhile, the BMI assessment categories for children over the age of 5 are:

Malnutrition (thinness): -3 SD to <-2 SD
Good nutrition (normal): -2 SD to +1 SD
More nutrition (overweight): +1 SD to +2 SD
Obesity:> +2 SD

Measuring the nutritional status of children using the GPA method is not as easy as using the body mass index (BMI) as in adults.

To make it easier and more accurate, you can find out the progress of your child's nutritional status by routinely taking measurements to doctors, midwives, and posyandu.

What are the problems with nutritional status in children?

There are several categories used to classify children's nutritional status, such as:

1. Stunting

Stunting is a disruption in the growth and development of a child which makes his height stunted so that it is not suitable for children his age.

Symptoms of a child who is stunted include:

The child's posture is shorter than their peers
Body proportions may appear normal, but the child looks younger or smaller for his age
Low weight for her age
Stunted bone growth

2. Marasmus

Marasmus is a nutritional deficiency that occurs because children do not get energy intake for a long time.

Typical symptoms that appear in children with marasmus are:

The weight of the child is dropping rapidly
Wrinkled skin like an old person
Concave stomach
Tends to cry

If your little one experiences this, immediately consult a doctor.

3. Kwashiorkor

Slightly different from marasmus, kwashiorkor is a nutritional deficiency resulting from low protein intake.

In fact, protein plays an important role as a substance to build and repair damaged body tissue.

The characteristic of kwashiorkor usually does not make the child's weight drop dramatically.

This is because the child's body has a lot of fluids so that the body weight remains normal, even though the child is actually thin.

Other kwashiorkor symptoms include:

Skin discoloration
Hair hair like corn
Swelling (edema) in several parts, such as the legs, hands, and stomach
Round, puffy face (moon face)
Decreased muscle mass
Diarrhea and weakness

Immediately consult a doctor if your child has the signs above.

4. Marasmus-kwashiorkor

Marasimus-kwashiorkor is a combination of the conditions and symptoms of marasmus and kwashiorkor.

This condition is usually caused by diet, especially due to insufficient intake of certain nutrients such as calories and protein.

Children who experience marasmus-kwashiorkor will experience symptoms such as:

Very thin body
There are signs of wasting in several parts of the body. For example, loss of tissue and muscle mass, as well as bone which is immediately visible on the skin as if it is not covered with flesh.
Experiencing fluid buildup in several parts of the body (ascites).

Consult a doctor if your little one has the symptoms above.

5. Wasting (skinny)

Children are said to be thin (wasting) if their weight is far below normal or not according to their height.

The indicator that is usually used to determine wasting is body weight for height (BW / TB), for ages 0-60 months.

Wasting is also often referred to as acute or severe malnutrition.

This condition is usually caused by the child not getting enough nutrition, or experiencing a disease that causes weight loss, such as diarrhea.

The symptom that appears when a child is losing is that the body looks very thin due to low body weight.

6. Underweight (less weight)

Underweight indicates the condition of the child's underweight when compared to his age.

The indicator that is usually used to determine underweight is weight for age (BW / U) for children 0-60 months.

Meanwhile, children aged 5-18 years use the body mass index for age (BMI / U).

The most obvious sign when a child is underweight is that he looks thin and underweight when compared to his peers.

This happens because the amount of energy intake that enters is not equivalent to the energy out.

Child withunderweight usually more susceptible to infectious diseases, difficulty concentrating, easily tired, so that they do not have energy during activities.

7. Overweight (overweight)

Son said overweight (overweight) when his weight is not proportional to his height.

This condition will certainly make the child's body look fat and less than ideal.

In addition to having a fat body, children with excess weight also have a characteristic waist and hip circumference above normal.

This condition also often makes children experience severe fatigue and muscle and joint pain.

The worse,overweight risk of making children suffer from various diseases.

Diseases that may arise include heart disease, stroke, diabetes, to musculoskeletal disorders such as arthritis.

Always try to provide healthy food for children, bring school supplies, and healthy snacks for children to optimize their nutritional needs.

If the child has difficulty eating, you can give the child milk so that there is still nutritional intake.

8. Obesity

Obesity is not the same as obesity because the weight of obese children means that they are far above the normal range.

This can be caused by an imbalance between the energy that enters the body (too much) and what the body releases (too little).

In other words, obesity can be defined asoverweight at a more severe level because there is a buildup of fat tissue throughout the body.

Obesity in children is characterized by a very fat posture, even to the point of making it difficult to move and do a lot of activity.

Children who are obese also usually get tired easily even though they have only been doing activities for a while.

Things that need to be done so that the nutritional status of children is in good condition

Checking the nutritional status and overall body health should start at least from one month old.

In order to ensure that their growth and development is going well, there is nothing wrong with regularly visiting doctors, midwives, and posyandu routinely even until the child grows up.

If you take your little one to the doctor regularly, you usually get a maternal health book (KIA) or a health card (KMS).

These books and cards will make it easier for you to monitor your little one's growth and development so that the child's health condition can be checked optimally.

If you see any abnormalities in the child's development, treatment can be done as early as possible.

By regularly carrying out checks, the child's nutritional status can develop better.

The nutritional status of children is classified as good when the growth graph indicators are in the normal range.

This means that weight is according to age and height, as well as height according to age and body weight.

The child also does not appear thin, very thin, obese, or even obese.

This condition indicates that the daily nutritional intake is adequate and in accordance with their activities.