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133
The main issue is to estimate the general well-being of the
child. Such general assessment cannot as a rule be based upon
any single criterion such as any ratio of age, sex, height and
weight, but should also have regard to other data derived from
clinical observation; for example, the general appearance, facies,
carriage, posture; the condition of the mucous membranes; the
tone and functioning of the muscular system; and the amount of
subcutaneous fat. An alert cheerful child, with bright eyes and
a good colour, may usually be accepted as well-nourished without
demur. On the other hand, a child who appears dull, listless and
tired, who has a muddy complexion or stands slackly, is at once
under suspicion and should be further examined. Too much reliance
on a single sign may lead to error. It is the general impression
which decides the issue.