Pediatric Weight Recording Standards
Children should be weighed in kilograms and the weight must be recorded in a prominent place on the medical record, preferably with the vital signs. 1
Recording Precision and Method
Infants (Unable to Stand)
- Record weight to the nearest 0.1 kg using an infant scale that allows the infant to lie down 1
- Undress the infant completely before weighing 1
- Place a clean paper liner in the scale tray and calibrate the scale to zero before each measurement 1
- Ensure the infant cannot touch walls or surrounding furniture during measurement, as this affects accuracy 1
Children (Able to Stand)
- Record weight to the nearest 0.1 kg using a standard scale 1
- Weigh children in light clothing without footwear 1
- Calibrate the scale to zero before measurement 1
- Position the child in the center of the platform with feet flat and heels touching, standing as erect as possible 1
- Read the measurement looking squarely at the increments rather than from an angle to avoid parallax error 1
Critical Safety Considerations
The use of kilograms is mandatory because medication dosing errors are a high-risk practice in pediatrics—simple misplacement of a decimal point can result in a 10-fold medication error. 1
Emergency Situations Exception
- For children requiring resuscitation or emergency stabilization who cannot be weighed, use a standardized method for estimating weight in kilograms 1
- Length-based estimation tools (such as the Broselow tape) demonstrate accuracy within 15% error for 79% of children, particularly for weights between 3.5-25 kg 2
- These estimation methods are more accurate than clinician guesses 3 and should be the default when direct weighing is impossible 4
Documentation Requirements
- Record the weight prominently with vital signs on the medical record to ensure visibility for all providers involved in medication prescribing 1
- Plot weight measurements on appropriate growth charts: WHO charts for children under 24 months, CDC charts for children 24 months and older 5, 6, 7
- Serial measurements should be obtained and plotted to assess growth velocity, which is more informative than single measurements 5, 7
Common Pitfalls to Avoid
- Never record weight in pounds—this increases the risk of dosing errors when providers must convert units during emergencies 1
- Do not rely on parental estimates alone without verification, as accuracy decreases significantly in children over 25 kg 2
- Avoid weighing children with shoes or heavy clothing, as this introduces systematic error 1
- Do not skip scale calibration, as uncalibrated scales are a common source of measurement error in resource-limited settings 3