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Archives of Disease in Childhood, 1975, 50, 142.

Revised standards for triceps and subscapular

skinfolds in British children
J. M. TANNER and R. H. WHITEHOUSE
From the Department of Growth and Development, Institute of Child Health, University of Lcn ion

Tanner, J. M., and Whitehouse, R. H. (1975). Archives of Disease in Childhood,

50, 142. Revised standards for triceps and subscapular skinfolds in British
children. Revised centile standards are given for triceps and subscapular skinfold
measurements in boys and girls aged from one month to 19 years. The school age
data are based on London mesurements made in 1966, and the infant data on Midland
Infant Welfare Clinic figures in 1966-67. All centiles are above those given in the
earlier standards published in 1962, and particularly so in infancy. It is emphasized
that the standards represent what is, not what ought to be.

The standards at present used for subcutaneous skinfold measurements are possible). One site is on a
fat measured by skinfold calipers in children (Tanner limb, the other on the trunk; since considetable differ-
and Whitehouse, 1962) are based on measurements ences occur between body and limb fat in growth
made some 15 years ago. We now therefore curves, and in reaction to certain hormones (see Tanner
and Whitehouse, 1967), both should be measured.
present a new set of centiles based on more recent
presenta.
dlata.
The triceps skinfold is measured half-way down the
left arm, which should hang relaxed at the subject's
side. The tips of the acromial process and the olecra-
Technique and sites of measurement non are palpated, and a point halfway between marked
The skinfolds are measured by picking up a fold of
skin and subcutaneous tissue between the thumb and
forefinger, initially placed about 2 cm apart on the skin,
and pinching it away from the underlying muscle in the
manner shown in Fig. 1 and 2. The width of the skin-
fold is measured with a caliper designed to give a constant
pressure of 10 g/mm' over its entire opening range
(Tanner and Whitehouse, 1955). The instrument is
held as illustrated, the jaws are applied to the skinfold
just under the pinch point and the right hand is allowed
to relax entirely its grip on the handle so that the jaws can
exert their full pressure. The left hand maintains the
pinch throughout the measurement. This usually re-
sults in a stable reading up to 20 mm, but above this the
measurement registered sometimes decreases as the mea-
surer watches the dial. A firmer grip by the left hand
may prevent this: if not, then the reading should be
taken two seconds after the caliper is applied. The
dial of the caliper illustrated (Holtain Skinfold Caliper)
is calibrated to 0-2 mm, but the measurement can be
conveniently estimated to the last completed 0w 1 mm.
Skinfolds can only be measured accurately at sites
where a proper fold can be raised clear of the tissues
underneath. The two sites considered here are the
most satisfactory ones and can be cleanly picked up in J
all but the most obese children (in whom no valid ..-.
Received 24 July 1974. FIG. 1.-Measurement of triceps skinfold.
142
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Revised standards for triceps and subswapular skinfolds in British children 143
The sources of the standards are:
(a) One month to 1 year, 200 children followed
longitudinally in Bakewell, Derbyshire Infant Welfare
Clinics, by kind permission of the late Dr. B. Hutchin-
son-Smith (1973) and Dr. R. A. Dixon (personal com-
munication, 1974).
(b) 1 to 5 years; London Institute of Child Health
group of the International Children's Centre Longi-
tudinal Growth Study: 50-100 children of each sex each
year; three measurers. Random sample of children
born in the West Central Area of London.
(c) 5 to 19 years; ILEA survey of London school-
children 1966 (unpublished). Approximately 1000
children of each sex at each year of age; nine measurers
all trained by the authors over 2-day period. A random
sample of London schools was taken and all children
measured. At ages above 16, technical schools were
selected.
Construction and use of the standards
The standards (Fig. 3, 4, 5, 6) were constructed in the
same way as the earlier onZs (Tanner and Whitehouse,
1962). They are cross-sectional in type so that an
individual's curve of growth may show steeper rises and
falls, especially in infancy and at puberty (see discussion
FIG. 2.-Measurement of subscapular skinfold. in Tanner, Whitehouse, and Takaishi, 1966). The
centile lines have been smoothed graphically.
on the skin. The skinfold is picked up over the posterior
surface of the triceps muscle on a vertical line passing Discussion
upwards from the olecranon in the axis of the limb, and
the caliper jaws are applied at the marked level. Care These standards are only applicable to measure-
should be taken to locate the site right on the back of the ments taken with the Harpenden or Holtain caliper,
arm, truly above the olecranon, for different values are using correct technique. By international agree-
obtained halfway round the arm. ment all skinfold calipers are supposed to exert a
The subscapular skinfold is picked up just below the constant pressure of 10 g/mm2 at all openings
angle of the left scapula with the fold either in a vertical (Weiner and Lourie, 1969). Calipers such as the
line or slightly inclined, in the natural cleavage line of the Best or Lange, which exert greater pressures and
skin. have different shapes of contact surface produce
The accuracy of measurements is such that a trained
individual should duplicate his readings to within different readings, the difference varying with sex
± 5% in tw3-thirds or more of all repeated measure-
and site (Clegg and Kent, 1967; Parizkova and
ments (Edwards et al., 1955). Differences between Goldstein, 1970).
different observers may be considerably greater than The left side of the body is used, following an
this, however, unless great care is taken in training the international convention established by anthro-
observers together and in keeping them so trained. This pologists some 80 years ago, and re-emphasized in
is due to individual differences in the manner of locating the protocol of the International Biological Pro-
and picking up the skinfold (see Ruiz, Colley, and gramme (Weiner and Lourie, 1969). Unfortunately
Hamilton, 1971). a more recent convention of using the right side has
Because the values obtained with the skinfold caliper grown up among certain nutritionists; it is uncertain
give a markedly non-gaussian frequency distribution
it is necessary for most purposes to transform them to a how much difference this may make in the use of
log scale before use. The most appropriate trans- the standards.
formation, which serves reasonably well for all sites and Changes from 1962 standards. In general
ages, and both sexes, is:
all the centiles are higher than those of the previous
Skinfold transform = 100 logl0 (reading in 0 1mm - standards. This is particularly so in the first 2
18). years. The new triceps 50th centiles at 1 year old
A table of the transformation is given in Edwards approximate the old 95th (boys) and 75th (girls).
et al. (1955). Both scales are given in the standards,
The new subscapular centiles show an earlier peak
however, so that plotting of the untransformed measure- in infancy than the old ones, at 6 months rather than
ment is all that is required. 1 year. At 6 months the new 50th centiles
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144 Tanner and Whitehouse

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FIG. 5.-Subscapular skinfold standard, boys. FIG. 6.-Subscapular skinfold standard, girls.
 Downloaded from http://adc.bmj.com/ on March 16, 2016 - Published by group.bmj.com

Revi.sed standards for triceps and subscapular skinfolds in British children 145
approximate the old 95th, for both sexes. At REFERENcEs
school age, however, the shift is much less, the Clegg, E. J., and Kent, C. (1967). Skinfold compressibility in
young adults. Human Biology, 39, 418.
new 50th being at about the position of the old Edwards, D. A. W., Hammond, W. H., Healy, M. J. R., Tanner,
55th-60th. J.. M., and Whitehouse, R. H. (1955). Design and accuracy
of calipers for measuring subcutaneous tissue thickness.
Actual not optimal. Finally it must be British Journal of Nutrition, 9, 133.
Hutchinson-Smith, B. (1973). Skinfold thickness in infancy in
emphasized that these standards aim to represent relation to birthweight. Developmental Medicine and Child
the actual centiles observed and imply nothing as Neurology, 15, 628.
Parizkova, J., and Goldstein, H. (1970). A comparison of skinfold
to the desirability or undesirability of a population measurements using the Best and Harpenden calipers. Human
having this distribution of subcutaneous fat. Biology, 42, 436.
Ruiz, L., Colley, J. R. T., and Hamilton, P. J. S. (1971). Measure-
Certainly children at either extreme should be ment of triceps skinfold thickness: an investigation of sources
regarded as at risk, the 3rd centile child being of variation. British Journal of Preventive and Social Medicine,
perhaps undernourished, and the 97th being 25, 165. ¢
Tanner, J. M., and Whitehouse, R. H. (1955). The Harpenden
certainly obese. Probably an optimally-nourished skinfold caliper. American Journal of Physical Anthropology,
population would have 3rd and 10th centiles a little 13, 743.
Tanner, J. M., and Whitehouse, R. H. (1962). Standards for sub-
above these, 50th centiles a little below, and 90th cutaneous fat in British children. Percentiles for thickness
and 97th much below. The marked peak in infancy of skinfolds over triceps and below scapula. British Medical
may reflect excessive use of bottle and baby food; Journal, 1, 446.
Tanner, J. M., and Whitehouse, R. H. (1967). The effect of human
in Swedish breast-fed babies the 50th centile peaks growth hormone on subcutaneous fat thickness in hyposomato-
are about 2 mm lower (P. Karlberg, personal com- trophic and panhypopituitary dwarfs. Journal of Endo-
crinology, 39, 263.
munication, 1974). Tanner, J. M., Whitehouse, R. H., and Takaishi, M. (1966).
Standards from birth to maturity for height, weight, height
We are most grateful to the late Dr. B. Hutchinson- velocity, and weight velocity; Btitish children 1965. Archives of
Smith for permission to use her infant data, and to Disease in Childhood, 41, 454, 613.
Weiner, J. S., and Lourie, J. A. (1969). Human Biology: A Guide
Dr. R. A. Dixon for generously giving us his computa- to Field Methods, p. 12. International Biological Programme
tions of the infant centiles. Handbook No. 9. Blackwell Scientific Publications, Oxford.
The caliper is obtainable from Holtain Ltd., Cross-
well, Crymmych, Pembs., U.K., and the charts from Correspondence to Professor J. M. Tanner, Depart-
Creaseys of Hertford Ltd., Bull Plain, Herts., U.K.
Fig. 1 reproduced by permission of the Editors of the ment of Growth and Development, Institute of Child
Archives. Health, 30 Guilford Street, London WClN 1EH.
 Downloaded from http://adc.bmj.com/ on March 16, 2016 - Published by group.bmj.com

Revised standards for triceps and

subscapular skinfolds in British
children.
J M Tanner and R H Whitehouse

Arch Dis Child 1975 50: 142-145

doi: 10.1136/adc.50.2.142

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