Status Rekam Medis Pediatric

Nama :
No. RM/Ruang :
Tanggal Masuk :
Dokter :
I. Identitas Pribadi
Nama Pasien :
Umur :
Jenis Kelamin :
Orangtua
- Ayah - Ibu
o Nama : o Nama :
o Usia : o Usia :
o Pekerjaan : o Pekerjaan :
o Pendidikan : o Pendidikan :
Alamat :
Agama/Suku :
II. Riwayat Penyakit Saat Ini
Keluhan Utama :
Keluhan Tambahan :
Telaah :
Riwayat Penyakit yang Pernah diderita :

Riwayat Penyakit dalam Keluarga :

Riwayat Penggunaan Obat :

Riwayat Alergi Obat :

Riwayat Kelahiran : Normal Vacum Forceps Sectio Caesaria

a. Ditolong oleh : Dokter Bidan Lainnya
b. Keadaan Saat Lahir: Segera Menangis Tidak Segera Menangis
c. BBL:________gram PBL:___________cm LK:________cm
Riwayat Imunisasi: BCG Polio___kali Hepatitis B____kali
DPT___kali Campak____kali Lainnya:
Riwayat Perkembangan: Menegakkan Kepala ___bulan Duduk ____bulan

Membalikkan Badan ___bulan Berdiri ___bulan

Berbicara ___bulan Merangkak ___bulan
Berjalan ___bulan

Lainnya:
 RIWAYAT NUTRISI
0-6 bulan
ASI : kali/hari
Lainnya : _____________________________________________________________
______________________________________________________________________
6-8 bulan
ASI : kali/hari
Makan Pagi/Siang/Malam : kali/hari
Makanan Selingan (Snacks) : kali/hari
Lainnya________________________________________________________________
______________________________________________________________________
8-12 bulan
ASI : kali/hari
Makan Pagi/Siang/Malam : kali/hari
Makanan Selingan (Snacks) : kali/hari
Lainnya________________________________________________________________
______________________________________________________________________
12-23 bulan
ASI : kali/hari
Makan Pagi/Siang/Malam : kali/hari
Makanan Selingan (Snacks) : kali/hari
Lainnya _______________________________________________________________
______________________________________________________________________
 PEMERIKSAAN FISIK
I. Keadaan Umum
Kesan Keadaan Sakit:
Sensorium: Kualitatif:______________ Kuantitatif:_____________
Nadi :__________x/i Reguler Irreguler
Pernafasan :__________x/i
Temperatur :__________0C
Tekanan Darah :__________mmHg
Data Antropometri
Berat Badan : kg
Tinggi Badan : cm
Lingkar Lengan Atas : cm
Lingkar Kepala : cm
Status Gizi
BB/Umur :
TB/Umur :
BB/TB :
Lingkar Lengan Atas :
Lingkar Kepala :
II. Pemeriksaan Fisik
Kulit
a. Sianosis :
b. Ikterus :
c. Pucat :
d. Turgor :
e. Edema :
f. Lainnya :
Rambut :
Kepala : Normal Mikrosefali Makrosefal Lainnya______
a. Wajah
Dismorfik : Ya Tidak Lainnya_____________
 b. Mata
Palpebra
- Edema : Ya Tidak
- Lainnya_________________________________________
Konjungtiva
- Pucat : Ya Tidak
- Hiperemis : Ya Tidak
- Sekret : Ya Tidak
- Lainnya_________________________________________
Sklera
- Ikterus : Ya Tidak
- Lainnya
Pupil
- Isokor : Ya Tidak
- Refleks Cahaya : ______________
- Lainnya_________________________________________
c. Hidung :
d. Mulut
Bibir :
Gusi :
Palatum :
Lidah :
Tonsil :
Faring :
Lainnya ____________________________________________
e. Telinga :
Leher
a. Kelenjar Getah Bening
- Pembesaran : Ya Tidak
- Jumlah : Tunggal Multipel
- Ukuran : .........cm
 - Konsistensi : Lunak Keras
b. Kaku Kuduk : Positif Negatif
c. Lainnya
Thoraks
a. Paru
- Inspeksi :
- Palpasi :
- Perkusi :
- Auskultasi :
b. Jantung
- Auskultasi : _________________________________________
Gallop Murmur
Abdomen
a. Inspeksi :
b. Palpasi
- Nyeri Tekan : Ya Tidak Lokasi______________
- Tugor :
- Ascites :
- Hepar :
- Lien :
- Massa :
c. Perkusi :
d. Auskultasi :
Ekstremitas : Hangat/Dingin Oedema
CRT Lainnya_____________
Genitalia :
Anus/Rectum :
P. Neurologis
a. R. Fisiologis :
b. R. Patologis :
c. R. Meningeal :
 d. Kekuatan Otot :
e. Nervus Kranialis :

DIAGNOSA BANDING
1. ____________________________
2. ____________________________
3. ____________________________
4. ____________________________
5. ____________________________

DIAGNOSA SEMENTARA

TERAPI SEMENTARA

PEMERIKSAAN PENUNJANG
DIAGNOSA KERJA

TERAPI

DIAGNOSA AKHIR
RESUME

Medan, ...................................... 20
DPJP

( )
 Length-for-age BOYS
Birth to 6 months (percentiles)

97th

70 85th 70

50th

15th
65 65

3rd
Length (cm)

60 60

55 55

50 50

45 45
Weeks 0 1 2 3 4 5 6 7 8 9 10 11 12 13
Months 3 4 5 6
Age (completed weeks or months)
WHO Child Growth Standards
 Length-for-age BOYS
6 months to 2 years (percentiles)

95 95

97th

85th
90 90

50th

85 15th 85

3rd
Length (cm)

80 80

75 75

70 70

65 65

Months 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11
1 year 2 years
Age (completed months and years)
WHO Child Growth Standards
 Length-for-age BOYS
Birth to 2 years (percentiles)

95 95
97th
85th
90 90

50th

85 15th 85

3rd
80 80

75 75
Length (cm)

70 70

65 65

60 60

55 55

50 50

45 45
Months 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11
Birth 1 year 2 years
Age (completed months and years)
WHO Child Growth Standards
 Height-for-age BOYS
2 to 5 years (percentiles)

120 120
97th

115 85th 115

110 50th 110

105 15th 105

Height (cm)

3rd
100 100

95 95

90 90

85 85

80 80
Months 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 6 6
2 years 3 years 4 years 5 years
Age (completed months and years)
WHO Child Growth Standards
 Length/height-for-age BOYS
Birth to 5 years (percentiles)

120 120
97th
115 85th 115

110 50th 110

105 15th 105

3rd
100 100

95 95
Length/Height (cm)

90 90

85 85

80 80

75 75

70 70

65 65

60 60

55 55

50 50

45 45
Months 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10
Birth 1 year 2 years 3 years 4 years 5 years
Age (completed months and years)
WHO Child Growth Standards
 Weight-for-age BOYS
Birth to 6 months (percentiles)

10 10
97th

9 9
85th

8 50th 8

7 15th 7
Weight (kg)

3rd
6 6

5 5

4 4

3 3

2 2

Weeks 0 1 2 3 4 5 6 7 8 9 10 11 12 13
Months 3 4 5 6
Age (completed weeks or months)
WHO Child Growth Standards
 Weight-for-age BOYS
6 months to 2 years (percentiles)

16 16

15 97th 15

14 14
85th

13 13

50th
12 12
Weight (kg)

11 11
15th

10 10
3rd

9 9

8 8

7 7

6 6
Months 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11
1 year 2 years
Age (completed months and years)
WHO Child Growth Standards
 Weight-for-age BOYS
Birth to 2 years (percentiles)

16 16

15 97th 15

14 14
85th
13 13

12
50th 12

11 11
15th
Weight (kg)

10 10
3rd
9 9

8 8

7 7

6 6

5 5

4 4

3 3

2 2

Months 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11
Birth 1 year 2 years
Age (completed months and years)
WHO Child Growth Standards
 Weight-for-age BOYS
2 to 5 years (percentiles)

24 24
97th
23 23

22 22

21 85th 21

20 20

19 19
50th
18 18
Weight (kg)

17 17

16 15th 16

15 15

3rd
14 14

13 13

12 12

11 11

10 10

9 9

Months 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 6 6
2 years 3 years 4 years 5 years
Age (completed months and years)
WHO Child Growth Standards
 Weight-for-age BOYS
Birth to 5 years (percentiles)

24 97th 24

22 22
85th
20 20

18
50th 18

16 15th 16
Weight (kg)

14
3rd 14

12 12

10 10

8 8

6 6

4 4

2 2

Months 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10
Birth 1 year 2 years 3 years 4 years 5 years
Age (completed months and years)
WHO Child Growth Standards
 Weight-for-length BOYS
Birth to 2 years (percentiles)

22 22
97th

20 85th 20

18
50th 18

15th
16 16
3rd

14 14
Weight (kg)

12 12

10 10

8 8

6 6

4 4

2 2

45 50 55 60 65 70 75 80 85 90 95 100 105 110

Length (cm)
WHO Child Growth Standards
 Weight-for-height BOYS
2 to 5 years (percentiles)

28 28

97th
26 26

85th
24 24

50th
22 22

20
15th 20

3rd
Weight (kg)

18 18

16 16

14 14

12 12

10 10

8 8

6 6

65 70 75 80 85 90 95 100 105 110 115 120

Height (cm)
WHO Child Growth Standards
 BMI-for-age BOYS
Birth to 2 years (percentiles)

21 21

20 20

19 19

97th
18 18

17 85th 17
BMI (kg/m2)

16 16
50th

15 15

15th
14 14
3rd

13 13

12 12

11 11

10 10

Months 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11
Birth 1 year 2 years
Age (completed months and years)
WHO Child Growth Standards
 BMI-for-age BOYS
2 to 5 years (percentiles)

19 19

18 97th 18

17 17

85th
BMI (kg/m2)

16 16

50th
15 15

14 14
15th

13 3rd 13

Months 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 6 6
2 years 3 years 4 years 5 years
Age (completed months and years)
WHO Child Growth Standards
 BMI-for-age BOYS
Birth to 5 years (percentiles)

21 21

20 20

19 19

18 97th 18

17 17
85th
BMI (kg/m2)

16 16

15
50th 15

14 15th 14

13 3rd 13

12 12

11 11

10 10

Months 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10
Birth 1 year 2 years 3 years 4 years 5 years
Age (completed months and years)
WHO Child Growth Standards
 Length-for-age GIRLS
Birth to 6 months (percentiles)

70 97th 70

85th

50th
65 65

15th

3rd
Length (cm)

60 60

55 55

50 50

45 45
Weeks 0 1 2 3 4 5 6 7 8 9 10 11 12 13
Months 3 4 5 6
Age (completed weeks or months)
WHO Child Growth Standards
 Length-for-age GIRLS
6 months to 2 years (percentiles)

97th

90 85th 90

50th
85 85

15th

80 3rd 80
Length (cm)

75 75

70 70

65 65

60 60
Months 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11
1 year 2 years
Age (completed months and years)
WHO Child Growth Standards
 Length-for-age GIRLS
Birth to 2 years (percentiles)

95 95

97th
90 85th 90

50th
85 85
15th

80 3rd 80

75 75
Length (cm)

70 70

65 65

60 60

55 55

50 50

45 45
Months 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11
Birth 1 year 2 years
Age (completed months and years)
WHO Child Growth Standards
 Height-for-age GIRLS
2 to 5 years (percentiles)

120 120
97th

115 115
85th

110 110
50th

105 105
15th
Height (cm)

100 3rd 100

95 95

90 90

85 85

80 80

Months 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 6 6
2 years 3 years 4 years 5 years
Age (completed months and years)
WHO Child Growth Standards
 Length/height-for-age GIRLS
Birth to 5 years (percentiles)

120 120
97th
115 85th 115

110 50th 110

105 15th 105

100 3rd 100

95 95
Length/Height (cm)

90 90

85 85

80 80

75 75

70 70

65 65

60 60

55 55

50 50

45 45
Months 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10
Birth 1 year 2 years 3 years 4 years 5 years
Age (completed months and years)
WHO Child Growth Standards
 Weight-for-age GIRLS
Birth to 6 months (percentiles)

10 10

97th
9 9

85th
8 8

50th
7 7
Weight (kg)

15th
6 6
3rd

5 5

4 4

3 3

2 2

Weeks 0 1 2 3 4 5 6 7 8 9 10 11 12 13
Months 3 4 5 6
Age (completed weeks or months)
WHO Child Growth Standards
 Weight-for-age GIRLS
6 months to 2 years (percentiles)

15 15
97th

14 14

13 85th 13

12 12

50th
11 11
Weight (kg)

10 15th 10

3rd
9 9

8 8

7 7

6 6

5 5
Months 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11
1 year 2 years
Age (completed months and years)

WHO Child Growth Standards

 Weight-for-age GIRLS
Birth to 2 years (percentiles)

15 97th 15

14 14

85th
13 13

12 12
50th
11 11

15th
10 10
Weight (kg)

3rd
9 9

8 8

7 7

6 6

5 5

4 4

3 3

2 2

Months 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11
Birth 1 year 2 years
Age (completed months and years)
WHO Child Growth Standards
 Weight-for-age GIRLS
2 to 5 years (percentiles)

25 25
97th
24 24

23 23

22 22
85th
21 21

20 20

19 19

50th
Weight (kg)

18 18

17 17

16 16
15th
15 15

14 3rd 14

13 13

12 12

11 11

10 10

9 9

Months 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 6 6
2 years 3 years 4 years 5 years
Age (completed months and years)
WHO Child Growth Standards
 Weight-for-age GIRLS
Birth to 5 years (percentiles)

97th
24 24

22 22
85th
20 20

18 50th 18

16 16
15th
Weight (kg)

14 3rd 14

12 12

10 10

8 8

6 6

4 4

2 2

Months 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10
Birth 1 year 2 years 3 years 4 years 5 years
Age (completed months and years)
WHO Child Growth Standards
 Weight-for-length GIRLS
Birth to 2 years (percentiles)

22 97th 22

20
85th 20

50th
18 18

15th
16 16
3rd

14 14
Weight (kg)

12 12

10 10

8 8

6 6

4 4

2 2

45 50 55 60 65 70 75 80 85 90 95 100 105 110

Length (cm)
WHO Child Growth Standards
 Weight-for-height GIRLS
2 to 5 years (percentiles)

28 28
97th

26 26
85th

24 24

50th
22 22

15th
20 20
3rd
Weight (kg)

18 18

16 16

14 14

12 12

10 10

8 8

6 6

65 70 75 80 85 90 95 100 105 110 115 120

Height (cm)
WHO Child Growth Standards
 BMI-for-age GIRLS
Birth to 2 years (percentiles)

21 21

20 20

19 19

97th
18 18

17 17
85th
BMI (kg/m2)

16 16

50th
15 15

14 15th 14

3rd
13 13

12 12

11 11

10 10

Months 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11
Birth 1 year 2 years
Age (completed months and years)
WHO Child Growth Standards
 BMI-for-age GIRLS
2 to 5 years (percentiles)

19 19

97th

18 18

17 85th 17
BMI (kg/m2)

16 16

50th
15 15

14 14
15th

13 13
3rd

12 12
Months 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 6 6
2 years 3 years 4 years 5 years
Age (completed months and years)
WHO Child Growth Standards
 BMI-for-age GIRLS
Birth to 5 years (percentiles)

21 21

20 20

19 19
97th
18 18

17 85th 17
BMI (kg/m2)

16 16

50th
15 15

14 14
15th

13 13
3rd

12 12

11 11

10 10

Months 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10
Birth 1 year 2 years 3 years 4 years 5 years
Age (completed months and years)
WHO Child Growth Standards
 Birth to 36 months: Boys NAME
Length-for-age and Weight-for-age percentiles RECORD #

Birth 3 6 9 12 15 18 21 24 27 30 33 36
in cm AGE (MONTHS)
cm in
41 41 L
40 95 40 E
100 90 100 N
39 39
75 G
38 38
95 50 95 T
37 37 H
25
36 36
90 10 90
35 5 35
34
85
33
32 95 38
80 17
31
L 90 36
30
E 75 16
N
29
75
34
G 28
70 15
T 27 32
H 26 50
65 14
25 30 W
24 25 E
60 13
23 28 I
10 G
22 55 12 H
5 26
21 T
20 50 11 24
19
18 45 10 22
17
16 40 9 20
15
8 18

16 16
7 AGE (MONTHS)
kg lb
12 15 18 21 24 27 30 33 36
14
6 Mothers Stature Gestational
W Fathers Stature Age: Weeks Comment
E 12
Date Age Weight Length Head Circ.
I 5 Birth
G 10
H
T
4
8
3
6
2
lb kg
Birth 3 6 9
Published May 30, 2000 (modified 4/20/01).
SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
 Birth to 36 months: Boys
Head circumference-for-age and NAME
Weight-for-length percentiles RECORD #

Birth 3 6 9 12 15 18 21 24 27 30 33 36
in cm AGE (MONTHS) cm in H
E
95 A
52 90 52
D
20 75 20
50 50 C
50
I
25 R
H 19 19
48 48 C
E 10 U
A 5 M
D 18 46 46 18 F
E
R
C 44 44 E
I 17 17 N
R C
C 42 42 E
U 16
M 40 50
F 22 48
E
15 38 21 46
R
E 20 44
N 36 19 42
14
C
E
95
18 40
34 90
17 38
13 75
36
32 50
16
34
12 25 15
30 10 32
5 14
30 W
13 28 E
12 I
26 G
24 11 11 24 H
22 10 10 22 T
20 9 9 20
18 8 8 18
16 7 7 16
W
E 14 14
6 6
I 12 12
G 5 5
10 kg lb
H 4 LENGTH
T 8 cm
64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98100
6 3
26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 in
4 2
Date Age Weight Length Head Circ. Comment
2 1
lb kg
cm 46 48 50 52 54 56 58 60 62
in 18 19 20 21 22 23 24

Published May 30, 2000 (modified 10/16/00).

SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
 2 to 20 years: Boys NAME
Stature-for-age and Weight-for-age percentiles RECORD #

12 13 14 15 16 17 18 19 20
Mothers Stature Fathers Stature cm in
Date Age Weight Stature BMI*
AGE (YEARS) 76
95
190
74
90
185 S
75
72
180 T
50 70 A
175 T
25 68 U
170 R
10 66
165 E
in cm 3 4 5 6 7 8 9 10 11 5
64
160 160
62 62
155 155
S 60 60
T 150 150
A 58
T 145
U 56
140 105 230
R
54
E 135 100 220
52
130 95 95 210
50
125 90 200
90
48 190
120 85
46 180
115 80
75
44 170
110 75
42 160
105 50 70
150 W
40
100 65 140 E
25
38 I
95 60 130 G
10
36 90 5 H
55 120
T
34 85 50 110
32 80 45 100
30
40 90
80 35 35 80
W 70 70
30 30
E 60 60
I 25 25
G 50 50
H 20 20
40 40
T
15 15
30 30
10 10
lb kg AGE (YEARS) kg lb
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Published May 30, 2000 (modified 11/21/00).
SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
2 to 20 years: Boys NAME
Body mass index-for-age percentiles RECORD #

Date Age Weight Stature BMI* Comments

BMI

35

34

33

32

31

30
95
29

BMI 28
90
27 27
26 85 26
25 25
75
24 24

23 23
50
22 22

21 21
25
20 20
10
19 19
5
18 18

17 17

16 16

15 15

14 14

13 13

12 12

2
kg/m AGE (YEARS) kg/m2
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Published May 30, 2000 (modified 10/16/00).

SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
 NAME
Weight-for-stature percentiles: Boys RECORD #

Date Age Weight Stature Comments kg lb

76
34
33
72
32
31 68
30
29 64
28
lb kg 27 60
95
26 26
56 56
25 25
90
24 85 24
52 52
23 75 23

48 22 22 48
50
21 21
25
44 20 20 44
10
5
19 19
40 18 18 40

17 17
36 36
16 16
15 15
32 32
14 14
13 13
28 28
12 12

24 11 11 24
10 10
20 9 9 20
8 8
lb kg STATURE kg lb
cm 80 85 90 95 100 105 110 115 120

in 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47

Published May 30, 2000 (modified 10/16/00).

SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
Lampiran 3. Tabel Tekanan Darah Untuk Anak Laki-laki Berdasarkan Usia dan
Persentil Tinggi Badan

Universitas Sumatera Utara

 Birth to 36 months: Girls NAME
Length-for-age and Weight-for-age percentiles RECORD #

Birth 3 6 9 12 15 18 21 24 27 30 33 36
in cm AGE (MONTHS)
cm in
41 41 L
40 40 E
100 95 100
39 90 39 N
38 G
75 38
95 95 T
37 50 37 H
36 25 36
90 90
35 10 35
5
34
85
33
32 38
80 95 17
31
L 30 36
75 90 16
E
N
29
34
G 28
70 75
15
T 27 32
H 26 65 14
25 50 30 W
24 E
60 13
23 25 28 I
G
22 55 12 H
10 26
21 5 T
20 50 11 24
19
18 45 10 22
17
16 40 9 20
15
8 18

16 16
7 AGE (MONTHS)
kg lb
12 15 18 21 24 27 30 33 36
14
6 Mothers Stature Gestational
W Fathers Stature Age: Weeks Comment
E 12
Date Age Weight Length Head Circ.
I 5 Birth
G 10
H
T
4
8
3
6
2
lb kg
Birth 3 6 9
Published May 30, 2000 (modified 4/20/01).
SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
 Birth to 36 months: Girls
Head circumference-for-age and NAME
Weight-for-length percentiles RECORD #

Birth 3 6 9 12 15 18 21 24 27 30 33 36
in cm AGE (MONTHS) cm in H
E
A
52 52
D
95
20 90 20
50 50 C
75 I
50 R
H 19 19
48 48 C
E 25 U
A 10 M
D 18 46 5 46 18 F
E
R
C 44 44 E
I 17 17 N
R C
C 42 42 E
U 16
M 40 50
F 22 48
E
15 38 21 46
R
E 20 44
N 36 19 42
14
C 95
E 18 40
34 90
17 38
13 75 36
32 16
50 34
12 25
15
30 32
10 14
5 30 W
13 28 E
12 I
26 G
24 11 11 24 H
22 10 10 22 T
20 9 9 20
18 8 8 18
16 7 7 16
W
E 14 14
6 6
I 12 12
G 5 5
10 kg lb
H 4 LENGTH
T 8 cm
64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98100
6 3
26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 in
4 2
Date Age Weight Length Head Circ. Comment
2 1
lb kg
cm 46 48 50 52 54 56 58 60 62
in 18 19 20 21 22 23 24

Published May 30, 2000 (modified 10/16/00).

SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
 2 to 20 years: Girls NAME
Stature-for-age and Weight-for-age percentiles RECORD #

12 13 14 15 16 17 18 19 20
Mothers Stature Fathers Stature cm in
Date Age Weight Stature BMI*
AGE (YEARS) 76
190
74
185 S
72
180 T
70 A
95
175 T
90
68 U
170 R
75 66
165 E
in cm 3 4 5 6 7 8 9 10 11 50
64
160 25 160
62 62
155 10 155
60 5 60
150 150
58
145
56
140 105 230
54
S 135 100 220
T 52
A 130 95 210
50
T 125 90 200
U
48 190
R 120 85
E 95 180
46
115 80
44 170
110 90 75
42 160
105 70
150 W
40 75
100 65 140 E
38 I
95 60 130 G
50
36 90 H
55 120
25 T
34 85 50 110
10
32 80
5
45 100
30
40 90
80 35 35 80
W 70 70
30 30
E 60 60
I 25 25
G 50 50
H 20 20
40 40
T
15 15
30 30
10 10
lb kg AGE (YEARS) kg lb
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Published May 30, 2000 (modified 11/21/00).
SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
2 to 20 years: Girls NAME
Body mass index-for-age percentiles RECORD #

Date Age Weight Stature BMI* Comments

BMI

35

34

33

32

95
31

30

29

BMI 28
90

27 27
26 85 26
25 25

24 75 24

23 23

22 22
50
21 21

20 20
25
19 19
10
18 5
18

17 17

16 16

15 15

14 14

13 13

12 12

2
kg/m AGE (YEARS) kg/m2
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Published May 30, 2000 (modified 10/16/00).

SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
 NAME
Weight-for-stature percentiles: Girls RECORD #

Date Age Weight Stature Comments kg lb

76
34
33
72
32
31 68
30
29 64
28
lb kg 27 60
95
26 26
56 56
25 90 25
24 85 24
52 52
23 75 23

48 22 22 48
50
21 21

44 20 25 20 44
19 10 19
5
40 18 18 40

17 17
36 36
16 16
15 15
32 32
14 14
13 13
28 28
12 12

24 11 11 24
10 10
20 9 9 20
8 8
lb kg STATURE kg lb
cm 80 85 90 95 100 105 110 115 120

in 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47

Published May 30, 2000 (modified 10/16/00).

SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
Lampiran 4. Tabel Tekanan Darah Untuk Anak Perempuan Berdasarkan
Usia dan Persentil Tinggi Badan

Universitas Sumatera Utara

 Contoh Jadwal Makan pada Bayi dan Balita
0-6 bulan ASI Eksklusif
Energi dari MPASI Makanan Selingan
Umur Makanan Utama
per hari (Snacks)
6-8 bulan 200 kkal (30%) 2-3 x 1-2 x
9-11 bulan 350 kkal (50%) 3-4 x 1-2 x
12-24 bulan 550 kkal (70%) 3-4 x 1-2 x

Usia
Jadwal
6-8 bulan 9-11 bulan 12-23 bulan
06.00 ASI ASI ASI
08.00 Makan Pagi Makan Pagi Makan Pagi
10.00 ASI/Makanan Selingan ASI/Makanan Selingan ASI/Makanan Selingan
12.00 Makan Siang Makan Siang Makan Siang
14.00 ASI ASI ASI
16.00 Makanan Selingan Makanan Selingan Makanan Selingan
18.00 Makan Malam Makan Malam Makan Malam
20.00 ASI ASI ASI
24.00 ASI* ASI* ASI*
03.00 ASI* ASI* ASI*

Keterangan :

Umur 6-8 bulan : MPASI berupa makanan saring atau lumat

Umur 9-11 bulan : MPASI berupa makanan kasar/makanan keluarga yang dimodifikasi
Umur 12-23 bulan : MPASI berupa makanan keluarga
Makanan selingan dapat berupa buah atau lainnya
Anak yang tidak mendapat ASI atau ASI donor diberikan susu formula bayi (0-12 bulan) atau
susu formula pertumbuhan (1-3 tahun)
 Glasgow Coma Scale
RESPONSE SCORE
EYE
Membuka mata spontan (normal) 4
Dengan kata-kata akan membuka mata bila diminta 3
Membuka mata bila diberikan rangsangan nyeri 2
Tidak membuka mata walaupun dirangsang nyeri 1
VERBAL
Memiliki orientasi baik karena dapat memberi jawaban dengan baik dan
5
benar pada pertanyaan yang diajukan (nama,umur, dll)
Memberikan jawaban pada pertanyaan tetapi jawabannya seperti bingung 4
Memberikan jawaban pada pertanyaan tetapi jawabannya hanya berupa
3
kata-kata yang tidak jelas
Memberikan jawaban berupa suara yang tidak jelas bukan merupakan kata 2
Tidak memberikan jawaban berupa suara apapun 1
VERBAL BAYI DAN ANAK 4 tahun
Bicara jelas atau tersenyum menuruti perintah 5
Menangis tapi bisa dibujuk 4
Menangis tidak bisa dibujuk 3
Gelisah, agitasi 2
Tidak ada respon 1
MOTORIK
Dapat menggerakkan seluruh ekstremitas sesuai dengan permintaan 6
Dapat menggerakkan ekstremitas secara terbaras karena nyeri (lokasi nyeri) 5
Respons gerakan menjauhi rangsang nyeri (menarik karena nyeri) 4
Fleksi ekstremitas karena nyeri 3
Ekstensi ekstremitas karena nyeri 2
Tidak ada respons berupa gerak 1
TOTAL 15
Nilai 12-14 Gangguan Kesadaran Ringan
Nilai 9-11 Gangguan Kesadaran Sedang
Nilai 8 Coma
 NORMAL VITAL SIGNS

Usia HR (x/menit) RR (x/menit) TD (mmHg)

Prematur 120 - 170 40 - 70 55-75/35-45
0-3 bulan 100 - 150 35 - 55 65-85/45-55
3-6 bulan 90 - 120 30 - 45 70-90/50-65
6-12 bulan 80 - 120 25 - 40 80-100/55-65
1-3 tahun 70 - 110 20 - 30 90-105/55-70
3-6 tahun 65 - 110 20 - 25 95-110/60-75
6-12 tahun 60 - 95 14 - 22 100-120/60-75
12 tahun 55 - 85 12 18 110-135/65-85

Nelson 20th PKB Surabaya 2014 Bogor Pediatric Update 2015

Rektal (To) Suhu Normal Demam
Nilai Normal Aksila 36C-37,4C Suhu rektal : 38C (100,4F)
36,6C 37,9C (97,9F Oral 36,7C-37,7C Suhu M.Timpani : 38C
100,2F) Rektal 36,9C-37,9C (100,4F)
Demam T 38C Suhu pagi paling rendah dan Suhu Oral : 37,8C (100F)
(100,4F) paling tinggi pada sore hari dengan Suhu aksila : 37,5C (99,5F)
perbedaan sekitar 0,5C Demam dibagi 3 :
Suhu aksila 1C lebih rendah dari - D. rendah : 37,3C-38C
suhu rektal - D. sedang : 38,1C-39C
Pengukuran suhu 3 menit - D. tinggi : 39,1C-41C
- Hipertermi : > 41C
 STATUS GIZI
Rasio BB menurut PB/TB Rasio BB menurut PB/TB
Usia 0-5 tahun (WHO) Usia > 5 tahun 18 tahun (CDC)
Gizi buruk < -3SD >120% : obesitas

Gizi Kurang < -2SD s/d -3SD 110-120% : Gizi lebih

Gizi Baik -2 SD s/d +2SD 90-110% : Normal
Berisiko Gizi Lebih > +1SD
70-90% : Gizi Kurang
Gizi Lebih > +2SD s/d +3SD
<70% : Gizi Buruk
Obesitas > +3SD
 FOLLOW UP

Hari/Tanggal S O A P