anthropometric measurement training...7/17/2020 1 anthropometric measurement training michigan wic...

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ANTHROPOMETRIC MEASUREMENT TRAININGMichigan WIC 2019‐20

Anthropometric

LINKSLINKS

Agenda

PowerPointPgs. 1 ‐ 36

ManualPgs. 1 ‐ 43

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Worksheet 1

Worksheet 2

Worksheet 3

Worksheet 4

Worksheet 5

ATTACHMENTS

Measurement Training

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Use measuring equipment correctly, read measurement values accurately, observe client privacy

Evaluate plotting values on age and sex Specific growth charts

To record measurements and round accurately for data entry in MI‐WIC

Develop consistency in measuring techniques and data entry methods

Provide basic measuring equipment care

ObjectivesTraining will be able to

Anthropometric Measurement Training Overview

WHO/CDC Growth Charts

Recording Values

Preterm Infants

MI‐WIC Data Entry

Prenatal Weight Gain

Measurement Procedures

Risk Codes

Evaluations

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This Photo by Unknown Author is licensed under CC BY‐NC‐ND

POLICY 1.02STATE OF MICHIGAN

WIC MISSION AND VISION

Evaluate Values on Growth

Chart

Record Measurement

Values

Measure Physical Growth

AnthropometricMeasurement

Activities

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2

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Infants Children Women

Record Form

MI‐WIC

Gain Grid

NCHS/CDC Growth Charts (B < 24 Months or 2‐5 Years)

Prenatal Weight

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Anthropometric TrainingWhy do we need Anthropometric training?

Person Off Street

15 Minutes!

Weight

Head Circumference

Height

Stature (Standing Height)

Length (lying down)

Common

MeasurementsHuman Body

Anthropometric MeasurementsRequired for a WIC Nutrition Assessment

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CLUESHealth and Nutritional Well‐being

GROWTHNormal or Delayed

WEIGHTNormal, Overweight or Underweight

PREGNANCY/POSTPARTUMWeight Gain or Loss

DETERMINATION OF RISK FACTORSFor Care Plan Development

Accurate BodyMeasurements

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OVERMEASUREMENTImpression of excessive leanness of fatness

UNDER MEASUREMENTImpression of shortness or thinness

Inaccurate BodyMeasurements

A half (1/2) inch measurement error can change a child’s ranking from the 10th percentile to below the 5th percentile length‐for‐age.

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Anthropometric TrainingKey Point #1

The major focus of AnthropometricTraining is to learn procedures and techniques that will result in…

Consistent Measurement Techniques

Improved Accuracy

Reduced Errors Over Time

*Use Recumbent (lying down) Length Board Cont…

Infants (Birth to 12 Months)* Children (12 to 24 Months)*

Length, Weight and Head Circumference at certification and mid‐cert evaluation (I‐Eval)

Length, weight and head circumference atCertification, mid‐cert evaluation (C‐Eval) and recertification

Anthropometric Risk Determination Policy 2.15

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Use Stadiometer (Standing) If child must be measured recumbently (laying down), record measurement, check “?” box, make

entry in ‘Comments’. Measurement will plot as red asterisk but risk code will not be assigned

Children: 2 to 5 Years Women

Stature and weight at certification, mid‐cert evaluation (C‐Eval) and recertification

Stature and weight at certificationand recertification

Anthropometric Risk Determination Policy 2.15

Exhibit of Growth Charts

Boys (Birth <24 Months of Age): WHO GROWTH CHART Form DCH ‐ 0313a

Boys (2 to 5 Years of Age):CDC GROWTH CHART Form DCH ‐ 0313b

Girls (Birth < 24 Months of Age): WHO GROWTH CHART Form DCH ‐ 0313c

Girls (2 to 5 Years of Age):CDC GROWTH CHART Form DCH ‐ 0313c

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Check ‘UNK’ if a measurement is not known and enter a comment

Check ‘?’ if measurement could not be taken according to procedure and enter a comment

For example, if a child is uncooperative and must be measured recumbently (laying down), record the measurement, check “?” box, make entry in ‘Comments’. Measurement will plot as red asterisk but risk code will not be assigned

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Before saving Anthropometric Measurement for the Cert visit, enter Weeks Gestation.

Agencies must have consistent method of determining weeks gestation (Anthropometric Measurement Procedures Manual).

Weeks Gestation must be recorded in weeks of completed gestation(ie, 39 weeks, 6 days recorded as39 weeks gestation).

Entering Weeks Gestation

Accurate Weeks Gestation is essential – determines way growth percentiles are calculated. Cannot be changed in MI‐WIC after day of entry!


Weeks of Gestation must be entered accurately in order for growth chart percentiles to be correctly calculated in MI‐WIC.

WIC Policy: Clinics must have consistent procedurefor determining Gestation Age.

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WHO (Boys & Girls) Growth Charts* Longitudinal study * Hypothesis ‐ breastfed infants grow differently

than formula‐fed infants * Studied Breastfed infants in 6 countries throughout

the world * Families followed study protocol for the duration of the study * Data collected provided the information needed to construct

new growth grids * Breastfed infants and children do grow differently than formula‐fed infants.

GraphsFor Plotting

Data SheetIncluded

On Charts

Length‐for‐age

Weight‐for‐age

Head circumference‐for‐age

Weight‐for‐length

WHO Growth Charts:Birth < 24 Months (Boys & Girls)

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WHOCharts

CDC Growth Charts2‐5 Years (Boys & Girls)

Data sheet included on chartsData sheet included on charts

Graphs for plotting:Graphs for plotting:

Stature‐for‐ageStature‐for‐age

Weight‐for‐ageWeight‐for‐age

BMI‐for‐ageBMI‐for‐age

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CDC GROWTH CHARTS

VLBW (Boys & Girls)Infants that were born < 1500 grams (VLBW) may also be assessed for growth using the IHDP VLBW charts in addition to the CDC growth charts. The VLBW charts are now optional for educational purposes.

Gestation‐Adjusted Age (GAA) is bottom axis on 3 charts plotted for age.

Chart may be printed

Data Sheet Included on Charts

Same Plot Graphs as Birth < 24 Months:

Length‐for‐age

Weight‐for‐age

Head Circumference‐for‐age

Weight‐for‐length

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VLBWCharts

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GestationalAge Adjustment

If an infant is born at 32 weeks, subtract that number from 40

40 weeks – 32 = 8 Weeks

Gestational –adjusted age is 4 months when the chronological age is 6 months

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Adjustment for Preterm

Growth will not begin plotting on WHO Growth Charts until infant reaches 40 weeks gestation adjusted age. Percentiles are shown in pink

in MI‐WIC if adjusted for prematurity.

VLBW charts will plot growth for infants up to 2 months preterm

Note: Adjustments for gestational age are Not used when using the 2‐5 years charts

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CHAT

MI‐WIC Input Boxes

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The measurements of infants born less than or equal to 1500 grams (3 lbs. 5 oz.) are plotted on the VLBW chart in MI‐WIC. This chart uses

metric values only.

The VLBW chart does not assign risks but does give parents an idea of how well their child is growing in

relation to other VLBW babies

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Adjustments for Preterm are made in MI‐WIC through 23 months of age

The WHO Birth <24 Month and VLBW charts (if < 1500 grams) are the default growth charts.

Measurements in MI‐WIC are not adjusted for preterm after 24 months of age.

Measurements of any child over the chronological age of 2 are plotted on the 2‐5 year old chart.

Converting Metric to English

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Understanding BMI‐For‐Age

BMI means Body Mass Index

Simple formula that combines weight

and height

The formula is: the weight divided by the

square of the height x 703

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Bottom Axis: Age (heavy 1 yr., faint ½ yr., 3 mo. Hatch mark – nearest month)

Side Axis: BMI (Faint lines = 0.2 –nearest 0.1 BMI)

The BMI‐for‐Age Chart

Case Study of Sam for BMI‐for‐Age

Date Age Weight Height BMI Comment

Mother’s Height _______Father’s Height________

GestationalAge__________ Weeks

4/4/20 3 yrs 7 mos 37 lb 4 oz 41.5 in 15.2

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Sam’s BMI‐for‐age is at the 29th %tile so it falls within the normal range.

Sam’s BMI Plotted on Boy’s BMI‐for‐Age Chart

Boys: 2 to 20 years

BMI BMI

BMI BMI

This chart shows that Sam is heavier for his height than 29 % of other boys his own age. Or, 71 % of boys his age are heavier for their height than Sam.

Interpretation

BMI in MI‐WIC

BMI is automatically calculated in MI‐WIC if stature measurement is used (C2‐C5).

BMI‐for‐age charts are the default option when the 2‐5 yr. charts are displayed. Choose this option to display weight‐for‐length charts by selecting the “Prev. Graph”

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Use of BMI

BMI: “It is used to judge whether an individual is appropriate for their height.”

CDC “Background Information on United States Growth Charts”‐ CDC Website

The larger the BMI number, the heavier the individual is in proportion to their height. If 2 people are the same height, then the person with the higher BMI will also weigh more.

Prenatal Weight‐Gain

Navigateto lab

Enter Height and Weight on grid, save

Select“Height/Weight” Tab

DisplayPrenatal Weight Gain Chart by selecting “Prenatal Chart” button at bottom of screen.

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Anthropometric TrainingSix Steps to Accurate Measures

1 2 3

4 5 6

Measure

Correctly

Carefully Confirm

Measurement

Say Measurement Out Loud

Record

Exactly as

on device

Convert Correctly

For MI‐WIC

Enter Correctly

In MI‐WIC

Recording Measurement ValuesStature, Recumbent Length & Head Circumferenceon the recording form.

Write values in inches and fractions on recording Form exactly as indicated by measuring device

Determine Confirming Measurement

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What is a Confirming Measurement2 Consecutive Measurements within the following parameters:

Recumbent Length2/16th or 1/8th inch or less

Stature2/16th or 1/8th inch or less

Infant Weight1 ounce or less

Child or Adult Weight¼ pound or 2 tenths (.2) pound less


Measurement values must be recorded in the units of the measurement device

Do not transpose or round numbers before recording themas they are read from the instrumentEXACTLY

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Converting Measurementsinto MI‐WIC Units

Convert for data entry

Enter inches and fractions in sixteenths

MI WICthinks/calculates all measurements in 16ths

Length, height, and head circumference

measurements are calculated by the 1/16th inch

1 pound

equals 16 ounces

MI‐WIC Units

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Converting MeasurementsInto MI‐WIC Units

If height (or length or head circumference) measurement is a value other than 1/16th, you must convert it into MI‐WIC units

For example, ½ inch is how many 16ths?

Do the MI‐WIC conversion and enter the recording form

1/16 1

(2/16) 1/8 2

3/16 3

(4/16) 2/8 1/4 4

5/16 5

(6/16) 3/8 6

7/16 7

(8/16) 4/8 1/2 8

9/16 9

(10/16) 5/8 10

11/16 11

(12/16) 6/8 3/4 12

13/16 13

(14/16) 7/8 14

15/16 15

16/16 0

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RecordingMeasurement Values Weight Record the

actual measurement

value on recording form

Write in pounds,

ounces and fractions or decimal on

recording form exactly as read on equipment

Enter actual pound, ounce and ounce fraction or tenth of an

ounce

Round ounce fraction to

nearest ounce in MI‐WIC

Some scales are more sensitive and display to the nearest tenth ounce, e.g.,

19lbs 2.8 oz

Some scales round to the nearest ounce for you

If your scale reads to the tenth ounce, you must do

the rounding

Rounding (Infant Scale)The sensitivity of infant scales is to the nearest ounce

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If the last digit is lessthan ½ fractional or .5 digital, round down

If the last digit is greater than ½ fractional or .5 digital, round up

14 lbs 2 1/4 oz27 lbs 7 5/8 oz7 lbs 7.6 oz6 lbs 9.2 oz

Rounding (Infant Scale)

Converting Measurements into MI‐WIC Units Beam Balance Scales (C2‐Adult)

It is necessary to change the pound fraction to ounces:

1/4 Pound enter as 04 ounces



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Converting Measurements into MI‐WIC Units Digital Scales (C2‐Adult)

.2 Pound equivalent to 03 ounces




Enter pounds with decimal, click ‘Tab’ and MI‐WIC will convert decimal to ounces

DO NOT USE ‘TAB’ With infant C1 that measure fraction of an ounce


If your weight measurement device measures in decimals for fraction of pounds how do you enter in MI‐WIC?

Converting Measurements into MI‐WIC unitsC2‐AdultWeights: Special Decimal Feature

Use the special decimal feature!

Enter pounds, then decimal to two digits, click tab and MI‐WIC converts the decimal to ounces! (C2 through adult)

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MI‐WICData Entry(Lab/Height/Weight Tab)

Record the actual

measurement value on

recording form

Write in pounds,

ounces and fractions or decimal on

recording form exactly as read on equipment

Enter actual pound, ounce and ounce fraction or tenth of an

ounce

Convert into MI‐WIC Units

GUIDE TO ACCURATE MEASUREMENT

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Anthropometric TrainingSix Steps to Accurate Measures

1. Measure Correctly2. Say Measurement Out Loud3. Record Exactly4. Carefully Confirm Measurement5. Convert Correctly for MI‐WIC6. Enter data Correctly in MI‐WIC

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Worksheets #1 (Blue)Practice recording and converting exercises

Enter Confirming Measurein third column

Enter Confirming Measurein third column

Convert into MI‐WIC unitsand enter in fourth columnConvert into MI‐WIC unitsand enter in fourth column

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Recording Measurement Values ‐ Examples

Weight of 27 pounds 15‐3/4 ounces:

Record as 27 15‐3/4 on Measurement

Sheet & 28 lbs 0 oz. in MI‐WIC.

Weight of 52 ‐3/4 pounds:

Record as 52 ‐3/4 on Measurement

Sheet & 52 lbs 12 oz. in MI‐WIC.

Weight of 18.6 pounds:

Record as 18.6 on Measurement Sheet &

18.6 lbs in MI‐WIC, then TAB.

Stature of 4 feet 7‐5/8 inches:

Record as 55‐5/8 on Measurement

Sheet & 55 inches 10 (1/16) in MI‐WIC.

Length of 36‐2/8 inches:

Record as 36‐2/8 on Measurement Sheet

& 36 inches 4 (1/16) in MI‐WIC.

POLL

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Anthro in MI‐WIC

And maybe some things you didn’t want to know!

What’s under the hood!Everything you ever wanted

to know about Anthro in MI‐WIC

Enter Data and View Charts For:

MI‐WIC Measurement Exercises

(Worksheet #4 – Salmon)

Alice

Peter

Mary

Tom

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CHAT

Michigan WICFive‐Year‐Plan

Increase 1st trimester entry into WIC from 29.4% to 32.9%

Increase ideal PG weight gain from 29.8% to 31%

Reduce Low Birth Weight births From 10.2% to 9.0%

Increase BF Initiation 67.7% to 70.5%, 6 month duration from 20.5% to 23.0%

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Michigan WICFive‐Year‐Plan

Decrease early childhood obesity (2‐5 years) from 13.5% to 12.7%

Decrease low Hgbfrom 19% to 15% in children

Michigan WIC Top Risks

OVERWEIGHT PREPG7491/16420 42.4%

OVERWEIGHT PP10634/42562 39.5%

LOW MATERNAL WT GAIN 4128/16420 19.1%EARLY TERM 19825/85380 21.9%

SHORT INTRVAL PG9263/42562 21.5%

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Michigan WICTop Risks

HI MAT WT GAIN7159/40874

17.5%2020 LOW HGB

8346/42562PG 5.1%C1 10.9%

2019 LOW HGB31106/164845

PG 12.6%C 10.4%

H/O PRETERM BIRTH2885/40874 7.1%

MAT SMOKING5117/42562 10.6%

CLIENT BREAKDOWN

PG C BF PP I

2019 7.72020 7.2

2019 57.32020 58.4

2019 40.32020 42.9

2019 59.72020 56,1

2019 22.82020 22,4

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MI‐WIC HI RISK CODES

RISK #CLIENTS131 LOWMTRNL WT GAIN 2930/15262 19.2%

142 PRETERM BIRTH 8682/85520 10.2%

141 LBW 8402/85520 9.8%

113 OBESE CHILDREN 2‐5 5351/85651 6.2%

310 H/O PRETERM BIRTH 1088/15262 7.1%

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Most Common Risk Codes

SEVEN OF THE TOP most common Risk Codes

associated with Michigan WIC clients are Anthro Risk codes.

FOUR OF THE MOSTCOMMON HI RISK CODES

are associated with increased infant mortality

This Photo by Unknown Author is licensed under CC BY‐SA‐NC

SCALES, INFANTOMETERS, STADIOMETERS, INSETRTION TAPES

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WASH HANDS BEFORE AND AFTER

WEIGHING AND MEASURING AN INFANT

Head Circumference Measurement

Children from birth to 24 months of age must havetheir head circumference measured

This procedure is used as a screening measurement for non‐nutrition related abnormalities (micro‐ and macrocephaly).

EQUIPMENT

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Taking HeadCircumferenceMeasurementsContinued

Procedure for WeighingInfants – Using Digital Scales

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RecumbentLength

Length is the height measurement taken of infants from birth < 24 months of age.

Length refers to the distance from the crown (top) of the head to the bottom of the feet when the infant is lying on his/her back.

Equipment

Infant recumbent length board

Disposable sheet to place on board

Taking Length Measurements(Continued)

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Infant Scale must be zero‐balanced with a paper sheet and dry diaper (medium size for balance‐beam scales).

Note: a balance beam scale can be zero‐balanced with a sheet and diaper once daily.

A digital scale MUST BE ZERO‐BALANCED for every weight taken,unless scale has re‐weigh function

Stature

Stature is the height measurement taken for people 2 years of age and older

Stature is defined as the distance from the crown (top) of the head to the bottom of the feet when the person is in the standing position.

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Procedure for Weighing Adults and Children 2 Years and Older

Proper Scale Posture


When using a digital scale, a zero balance must be done every time you weigh.For infants, put the sheet and dry diaper on the scale, zero balance,

then remove the dry diaper to weigh the child.

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Taking StatureMeasurementsProper Stature Posture

Taking StatureMeasurementsContinued

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Align client according to procedures for the client’s category and measurement

Infants and C‐1: Recumbent

Infants and C‐1: Head Circumference

C‐2 Through Adult: Stature


Confirming measurements are necessary for accuracy

Numerous errors, such as, transposing numbers, equipment failures or improper techniques can

be caught by confirming measurements.

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Scale Maintenance

Inspected AnnuallyInspected Annually

Pediatric sensitivity = 1 oz.Pediatric sensitivity = 1 oz.

Secure before moving scalesSecure before moving scales

Accurate at 10 and 100 lbs.Accurate at 10 and 100 lbs.

Adult Sensitivity = 1/4 lbs or 3.2 oz.Adult Sensitivity = 1/4 lbs or 3.2 oz.

Cleaned regularly with cleansing solution

If child soils equipment, should be disinfected with antiseptic immediately

Cleaning Measurement Equipment

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Use of improper equipment

Incorrectuse of

equipment

Inadequatemaintenance

Use of wrongGrowth Chart

PoorTechnique

Failure to doConfirming

measurements

Incorrect agecalculated

TransposingOf measurement

values

Common Measurement Errors

Common Measurement ErrorsImpact of Improper Measurement Errors

Inaccurate information about child’s growth

Misrepresentation of the nutritional status of the populationbeing screened

Example of stature board attached to wall 1 ½ inch too high – all children measured

shorter than they are

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To help prevent errors, say every measurement out loud and write it down immediately.


All measurement devices should be validatedwith an independent measurement. For example, the stature tape or stature board should be confirmed with a good quality

carpenter’s measuring tape or calibration rod.

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Use of Referral Data

• Infants and Children weight must be to the nearest ounce up to 2 years of age

• Head circumference to the nearest 1/16th but can be to the nearest 1/8th inch

• Weight, length or height, head circumference should be measured no more than 60 days prior to certification or Nutrition/Health evaluation

• Women‐the date of the weight should not be more than 60days and reflect their current certification type, e.g., if being certified as PG, the weight should have been taken while PG


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MICHIGAN WICAnthropometrics Training

Thank you for your attentionThank you for your attention

Please complete evaluationsAdd this training to your Staff Training in MI‐WICPlease complete evaluationsAdd this training to your Staff Training in MI‐WIC

Have a great day!Have a great day!

anthropometric measurement training...7/17/2020 1 anthropometric measurement training michigan wic...

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