Clinical measurements

Normal temperature range

  • Do not use tympanic thermometer if person has hole in eardrum

Table 2.1 Normal temperature ranges

Respiratory rate (RR) and heart rate (pulse)

  • Listen to heart sounds in same places as you do an ECG
  • If heart sounds unusual or different from other children or adults
    • Get colleague to check
    • Check notes to see if detected before. If new — refer for assessment

Table 2.2 Respiratory rate and pulse rate by age

Taking BP reading — adults

Attention

  • Never check BP on limb with AV fistula
  • Normal BP for an adult varies depending on gender, age and levels of fitness 
  • As a general principle
    • Systolic pressure should be less than 130mmHg
    • Diastolic pressure should be less than 80mmHg 
  • Best if person has 
    • Not smoked or drunk tea, coffee or caffeine soft drinks for 30 minutes
    • Been sitting quietly for at least 10 minutes
  • If part of cardiovascular examination or no previous recording — check BP on both arms
    • Attention to difference in recording (if any) and then use the arm with the higher reading

What you do

  • Choose right sized cuff for person’s arm
    • Depends on length and circumference (width) of upper arm. Inflatable air bladder in cuff must have —width at least 40% of arm circumference and length at least 80% of arm circumference. Almost long enough to go all the way around arm
  • Sit person comfortably with arm resting on table or pillow, just above level of their waist
  • Make sure air bladder is flat, fixed firmly and right over artery in upper arm
  • If manual recording make sure  
    • Stethoscope bell is put right over brachial artery in elbow crease
    • Manometer/mercury needle level on zero when you start to blow up cuff
  • If you can’t hear systolic or diastolic sounds the first time — make sure you let all the air out of cuff, wait one minute before trying again
  • Adults diastolic (last sound you hear) reading is taken from time sound disappears 

Taking BP reading — children

Attention

  • Try to take BP when child content. If child upset — may need to repeat when settled
  • Cuff needs to cover ⅔ of child’s upper arm. If cuff too narrow or too wide — reading may be wrong

Remember: Diastolic reading taken in children when sound changes from clear to muffled (sound sometimes continues to 0 in children)

What you do

  • Follow same general principles as for adults
  • Diagnosis of high BP requires high measurement on more than 1 occasion
  • BP depends on height — Table 2.3 and Table 2.4. Assume child is on 50th percentile for height and adjust target if child is very short or very tall
    • Subtract 5mmHg for children on the 5th percentile height-for-age
    • Add 5mmHg for children on 95th percentile height-for-age
  • Medical consult if BP outside of target

Table 2.3 BP — girls under 18 years (percentiles)

BP levels for girls — data table

Table 2.4 BP — boys under 18 years (percentiles)

BP levels for boys — data table

Body measurements — adults

Body mass index (BMI) and waist circumference are better indicators of disease risk than weight

Calculating Body Mass Index (BMI) for adults

What you need

  • Correctly calibrated standing scales
  • Something to measure height accurately (eg stadiometer)

What you do

  • Calculate BMI — weight (kg) ÷ height2 (m)
    • For example — 82kg ÷ (1.63 x 1.63m) = 82 ÷ 2.66 = 30.83 OR see Table 2.5
  • See Table 2.6 for interpretation and actions

Table 2.5 BMI chart for men and women over 18 years

Table 2.6 BMI Interpretation and actions  

Measuring waist

  • Do not use waist measurement for children under 10 years or pregnant women
  • Some people have normal BMI but bigger than normal waist circumference. This is a risk — advise to lose weight, be active
  • For children 10-17 years, use waist for height ratio

Attention

  • Adults can have a normal BMI but still have an unhealthy abdominal fat (pot belly) or have a higher BMI because of muscular build. A higher BMI may be more acceptable for people over 65 years
  • Large waist measurement associated with increased risk of some cancers, heart disease and type 2 diabetes

What you do

  • Put tape between lowest rib and top of hipbone, roughly in line with the belly button — Figure 2.1
  • Make sure tape is snug, without pressing into skin. Keep it even, don’t let it slope down on one side
  • Ask person to breathe out normally and measure against skin

Figure 2.1  
  • See table Table 2.7 for interpretation of results and actions

Table 2.7  Waist circumference interpretation and actions

Measuring growth in children and youth
  • Check weight AND length/height

  • Also check

    • Head circumference — 0–2 years
    • BMI — 2–17 years

    • Waist for height ratio — 10–17 years

Weight

  • Measure and record weight in file notes at each visit
  • Babies, children under 2 years — on baby scales, naked (no nappy or singlet)
  • 2–5 years — on adult scales, wearing dry nappy or underpants only
  • 5 years and over — on adult scales in light clothing and no shoes

Length or height

  • Babies and children under 2 years — lying down (length) with 2 people holding, using fixed board or measuring mat, without nappy
  • 2 years and over — standing up (height) using stadiometer, without shoes. Record to nearest 0.1cm

Waist for height

  • Use for children and youth over 10 years to assess risk of chronic disease
  • Measure waist on a horizontal line 2cm above belly button
  • Divide waist measurement (cm) by height (cm)
  • Refer for further assessment if result more 0.5

BMI

  • Calculate BMI — weight (kg) ÷ height2 (m)
    • For example — 22kg ÷ (1.1 x 1.1m) = 22 ÷ 1.22 = 18
  • Plot BMI on chart by age and gender
    • Below -2 z score for age and gender — underweight
    • Above +1 z score for age and gender — overweight (5–19 years), risk of overweight (2–5 years)
    • Above +2 z score for age and gender — obese (5–19 years), overweight or obese (0–5 years)
    • OR use WHO Anthro calculator to work out z score 

Table 2.8   BMI-for-age — girls 2–5 years (z score)

WHO child growth standards

Table 2.9 BMI-for-age — boys 2–5 years (z score)

WHO child growth standards

Table 2.10   BMI-for-age — girls 5–19 years (z score)

WHO child growth standards

Table 2.11   BMI-for-age — boys 5–19 years (z score)

WHO child growth standards

 © WHO BMI-for-age charts. https://www.who.int/tools/growth-reference-data-for-5to19-years/indicators/bmi-for-age August 2022. Used with permission.

Supporting resources

  • WHO — Measuring and weighing a child
  • WHO Anthro calculator