Examination checklist

    Anthropometric measurements

    How to measure weight, length, height, head and arm circumference, body segments, arm span and limb length the way the skills station expects — and what each abnormal ratio points to.

    Pediatrics
    General and growth
    All colleges

    Mark sheet

    16 steps · 16 marks

    #StepWellPartlyNot
    1. 1Greets the caregiver and child, explains the measurements and gets consent1½0
    2. 2Checks the scale reads zero and weighs the child with clothes and shoes off, to the nearest 0.1 kg1½0
    3. 3For a frightened child, weighs the mother holding the child and subtracts the mother's weight1½0
    4. 4Under 2 years: measures length supine on an infantometer with an assistant holding the head against the headboard1½0
    5. 5Straightens the knees and brings the footboard flat against both soles; reads to the nearest 0.1 cm1½0
    6. 6From 2 years: measures standing height barefoot on a stadiometer with heels, buttocks and shoulder blades touching the board1½0
    7. 7Holds the head in the Frankfurt plane, lowers the headboard onto the crown and reads to the nearest 0.1 cm1½0
    8. 8Finds the midpoint between the acromion and the olecranon on the left arm and marks it1½0
    9. 9Measures MUAC at the midpoint with the arm hanging relaxed, tape snug but not compressing1½0
    10. 10Measures head circumference with a non-stretch tape over the supraorbital ridges and the occipital prominence, taking the largest of three readings1½0
    11. 11Measures lower segment from the top of the pubic symphysis to the floor, and derives upper segment by subtraction1½0
    12. 12Measures arm span fingertip to fingertip with the arms outstretched at shoulder level1½0
    13. 13Measures true limb length from the anterior superior iliac spine to the medial malleolus on both sides1½0
    14. 14Measures apparent limb length from the umbilicus to the medial malleolus on both sides1½0
    15. 15Plots every measurement on the correct WHO chart for sex and age1½0
    16. 16Interprets the results against expected values and thanks the caregiver1½0

    Summary of findings

    Report each measurement with its centile or z-score and a percentage of expected, then give the overall pattern.

    Emeka is a 9-month-old boy. His weight is 6 kg against an expected 9 kg — 67% of expected, below −3 SD. His length is 62 cm against 72 cm, 86% of expected, below −3 SD. His head circumference is 40 cm against 44 cm, below −2 SD. All three are reduced, with the head affected least. This is global growth failure with relative head sparing; my concern is chronic undernutrition or an underlying chronic illness, and I would also consider a congenital cause because the head is small.

    Differential diagnoses

    FindingCauses
    Upper-to-lower segment ratio above normal (short limbs)Achondroplasia and other skeletal dysplasias, rickets, untreated hypothyroidism, Turner syndrome
    Ratio below normal (long limbs)Marfan syndrome, Klinefelter syndrome, homocystinuria, delayed puberty or hypogonadism
    Arm span more than 5 cm above heightMarfan syndrome, Klinefelter syndrome
    True limb length unequalHip or femur disease, growth plate injury, hemihypertrophy (Beckwith–Wiedemann), Klippel–Trénaunay syndrome, neurofibromatosis, vascular malformations
    Only apparent length unequalPelvic tilt from scoliosis or a hip contracture
    Weight, length and head all small from birthCongenital infection, fetal alcohol exposure, chromosomal disorders

    Normal segment ratios: about 1.7 at birth, 1.3 at 3 years and 1.0 by about 7–10 years. Arm span is slightly less than height in young children, equal in adolescence and a few centimetres more in adult men.

    Investigations

    • Growth chart review — serial points and growth velocity matter more than one reading
    • Bone age (left hand and wrist X-ray) — delayed in constitutional delay, hypothyroidism and malnutrition; normal in familial short stature
    • Full blood count, urea and electrolytes, calcium, phosphate and alkaline phosphatase — chronic kidney disease, rickets
    • Thyroid function
    • Karyotype in any short girl, and where dysmorphism is present
    • Coeliac serology, HIV test and stool studies where there is diarrhoea or poor weight gain
    • Skeletal survey where limbs are disproportionate

    Treatment

    Treatment follows the cause. The immediate step is nutritional: classify by WHO criteria, start feeding support, treat infection and deficiencies, and review growth monthly. See Growth assessment.

    Examiner questions

    References

    • Kliegman RM, St Geme JW, Blum NJ, Tasker RC, Wilson KM, et al., eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia: Elsevier; 2025.
    • WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. Geneva: WHO; 2006.
    • World Health Organization. WHO guideline on the prevention and management of wasting and nutritional oedema (acute malnutrition) in infants and children under 5 years. Geneva: WHO; 2023.

    Updated September 18, 2026