PENGUKURAN ANTHROPOMETRI

PADA
PENYIMPANGAN TUMBUH KEMBANG
ANAK

Moersintowarti B.Narendra
Divisi Tumbuh Kembang Anak dan Remaja
Fakultas Kedokteran / RSU Dr.Soetomo
Surabaya

Pendahuluan
Tumbuh kembang anak :
Proses berkesinambungan sejak konsepsi
hingga dewasa.
Dipengaruhi faktor2 genetik (nature) dan
lingkungan (nurture)biopsikososial !
Menyimpang bila ada hambatan/gangguan
proses intra uterinedewasa

Penyimpangan pertumbuhan
Perawakan

pendek (variasi normal,

malnutrisi, kelainan endokrin, kelainan
genetik)
Perawakan tinggi (variasi normal,sindroma
Marfan, Gigantisme)
Obesitas
Kelainan kongenital lainnya

GANGGUAN TUMBUH KEMBANG DI POLI TUMBUH KEMBANG

ANAK RSU DR.SOETOMO TH 1994-1999
NO. DIAGNOSIS 0-1 Th1-5 Th5-12 Th
1 Motorik terlambat 216 439
45
2 Gangguan bicara
4
87
26
3 Palsi serebral
24
68
11
4 Perawakan pendek 1
10
41
5 Downs syndrome 14
22
9
6 Obesitas
13
7
16
7 Retardasi mental
10
14
8 Kesukaran belajar
1
11
9 Mikropenis
2
6
4
10 Malnutrisi
1
5
3
11 Rubella syndrome
2
2
2
12 Hiperaktif
3
2
13 Sex ambigua
4
14 Pubertas precox
2
15 Hipothyroid
2
16 Achondroplasia
1
1
17 Rachitis
1
N

268

670

%
62,38
10,43
9.18
4.63
4.01
2.32
2.14
1.07
1.06
0.80
0.53
0.45
0.36
0.18
0.18
0.18
0.09
1122
184
(100%)

Datang sendiri : 487 (43,4%)

Kiriman dokter Poli Anak : 339
(30,2%)
Kiriman dokter luar/umum :
186 (16,6%)
Kiriman dokter Sp.A : 71
(6,6%)
Kiriman dokter Poli lain : 36
(3,2%)

Langkah-langkah manajemen
Tumbuh Kembang Anak
Pengukuran

anthropometri
(BB,TB,O-kep.,O-dada,O-lengan kiri,skinfold)
Penggunaan kurva pertumbuhan (KMS,NCHS)
Penilaian dan analisa status gizi & pertumbuhan
anak.
Penilaian perkembangan & maturasi
Intervensi (Preventif, Promotif,Kuratif,Rehab.)

Pengukuran Anthropometri
Berat

Badan
Tinggi Badan
Lingkaran Kepala
Lingkaran dada
Lingkaran lengan Kiri
Skinfold

Standard
Kurva

Gauss

Rerata (mean) SD
Persentil

2.5th

50th Percentile

97.5th

Standard
Berat

terhadap Umur ( kurva NCHS,KMS)

Tinggi terhadap umur (kurva NCHS)
Lingkaran kepala (kurva Nellhaus)
Lingkaran Lengan kiri (Wolanski, Depkes)
Skinfold (biceps, triceps, subscapular,
suprailiac)belum ada konsensus.
BMI (Body Mass Index)BB(kg)/TB(m)

Konsensus interpretasi

Kurva Pertumbuhan Downs Syndrome

Manajemen
Plot

pada kurva
Interpretasi
Intervensi

LINGKAR KEPALA/UMUR dan

BERAT BADAN/ TINGGI BADAN
PEREMPUAN 0-36 BULAN

LINGKAR KEPALA/UMUR dan

BERAT BADAN/ TINGGI BADAN
LAKI-LAKI 0-36 BULAN

KESIMPULAN
Cara

pengukuran anthropometri baku

Teratur see how they grow
Plot pada kurva konsensus sebagai
standard (reference)
Pendekatan holistik model biopsikososial
(penilaian pertumbuhan dan perkembangan)
Tatalaksana multidisipliner terpaduperan
orang tua sangat penting!

Growth Velocity Curve

Cm/year

Thyroid

Sex steroid

GH

Infant

Childhood

Puberty

Growth rate by age

1-6

mo : 18 - 22 cm/yr
6-12 mo : 14 18 cm/yr
1 yr
: 11 cm/yr
2 yr
: 8 cm/yr
3 yr
: 7 cm/yr
4 puberty : 5 6 cm/yr
Puberty

(boy)
Puberty (girl)

: 4.5 - 10.3 cm/y.

: 4.5 - 9.6 cm/y.

Growth rate by age

Subnormal:
<4y
<6y
6 puberty

: < 7 cm/y.
: < 6 cm/y.
: < 4.5 cm/y.

Evaluation of growth
Anthropometry:

reprodusibility.

reliability &

o Training.
o Equipment.
o Plotting.

Absolute

height / Plotting.

o 2SD - -3SD
: 80% normal variant.
o < -3SD
: 80% pathologic.

evaluation . . .
Height

velocity

o Measurement at 6 mos interval.

o Deceleration / crossing percentiles on

age > 2 y-puberty: indicates pathologic

until proven otherwise.
o Normal velocity indicates normal
growth.

Bone Age
Greulich

& Pyle

o Comparison of left wrist.

o Prediction of FH after 6 years.
o Table Bayley & Pinneau.

Tanner Whitehouse

II

o Maturation of ossification center.

o More reliable : scoring system.
o Complicated.

Grow th Chart
195
190

97

185
180

50

175

Potensi Tinggi Genetik

170
165

160
155
150
145

Height
(cm)

140
135
130
125
120
115
110
105
100
95

CA

HA

90
85
80
2

10

12

14

Age (years)

16

18

Grow th Chart
195
190
185

Potensi Tinggi Genetik

180
175

97
50

170

165
160
155
150
145

Height
(cm)

140

th
w
o
r
G

135
130
125
120

a
h
C

el
n
n

115
110
105
100
95
90
85
80
2

10

12

14

Age (years)

16

18

Growth Disorders
Normal height velocity:
Familial

short stature
Constitutional delay in growth and
development

Poor height velocity:

Usually

pathological
Proportionate
Disproportionate

Familial Short Stature

Grow th Chart
195

Constitutional Delay of Growth & Puberty

190
185
180
175
170
165
160
155
150
145

Height
(cm)

140
135
130
125
120
115
110
105
100
95
90
85
80
2

10

12

14

Age (years)

16

18

Pathological short stature

Proportionate:

IUGR
syndromes
chronic illness
drugs
psychsocial deprivation
Disproportionate: Syndromes (partic Turner S)
hypothyroidism
Skeletal dysplasias

IUGR/SGA
Intrauterine

growth retardation or small for

gestational age.
Very common.
Birth weight <10th PC for gestational age.
Catch-up growth above 3rd PC usually occurs by
6 mos of age but may drag on to 2 yrs.
Short stature by 2 yrs usually associated with
short final height.
As a group these children do not reach MPHs.
Approx 10% become short adults.

Turner Syndrome
Consider in

all girls with unexplained short

stature or Ht below MPH range.
Commonest feature is short for MPH
(100%).
50% will only have short stature as clinical
feature.
Present with short stature, poor HV or
delayed puberty.

Growth
&
Stature
A
B
Growth Chart

Height
(cm)

Growth Chart

195

195

190

190

185

185

180

180

175

175

170

170

165

165

160

160

155

155

150

150

145

145

Height
(cm)

140
135

140
135

130

130

125

125

120

120

115

115

110

110

105

105

100

100

95

95

90

90

85

85

80

80
2

10

12

14

Age (years)

16

18

Who does need more attention?

10

12

14

Age (years)

16

18

TERIMA KASIH