215.73 Pediatric Growth Charts Overview
Transcript Of 215.73 Pediatric Growth Charts Overview
Eligibility
Overview
Revised 10/1/18 Replaces version dated 10/1/17
215.73 Pediatric Growth Charts
Policy
A single plot of height-for-age and weight-for-age allows you to compare the child’s height and weight to children of the same age and sex. A length-forweight chart or a BMI-for-age chart provides information about the child’s proportions. Continued use of the growth chart provides a visual portrayal of the child’s growth pattern. This policy describes how to calculate a child’s age and BMI and how to plot and evaluate pediatric growth charts.
In this policy
This policy covers the following topics.
Topic Calculating A Child’s Age Calculating BMI Plotting Pediatric Growth Charts Adjusting for Gestational Age for Premature Infants Evaluating Pediatric Growth Charts
See Page 2 3 4 5 6
Iowa Department of Public Health/WIC CERTIFICATION Policy and Procedure Manual
Page 1
215.73
Calculating A Child’s Age
10/1/18
Introduction
The data system will calculate a child’s age in months in order to plot the growth charts. This section describes how to manually calculate age.
Procedure
The data system calculates a child’s age as described in the table below. Follow these steps if you must manually calculate a child’s age.
Step
Action
Example 1
1
Write child’s birth year, month and day
Year Month
Day
under year, month and day of clinic visit. Visit date 18
7
15
Birthdate 16
7
20
2
Subtract birthdate from clinic visit date.
Year Month
Day
Visit date 18 17 7 6 18 15 45
Note: Borrow 30 days from the month Birthdate 16
7
20
column or 12 months from the year
Child’s age 1
11
25
column if needed.
3
Multiply years by 12 and add to number One year, 11 months, 25 days equals 23
of months.
months, 25 days.
4
Round child’s age up or down based on 23 months, 25 days would be rounded
the number of days as follows:
to 24 months.
1-15 days: round down
16+ days: round up
Example 2
5
Round the child’s age for accurate
plotting on the growth chart.
IF plotting on… THEN round
to nearest…
0-36 month chart Month
2-5 year chart 1/6 year
A 28-month old child measured with a
(2 month increments) standing height would be plotted on the
line corresponding to 28 months.
2-20 year chart ¼ year
The same child would be plotted on the
line corresponding to 2 year 3 months
(27 months).
Page 2
10/1/18
Calculating BMI
215.73
Purpose Using the calculator
CDC table
Body mass index-for-age (BMI-for-age) is the recommended parameter for monitoring the growth of children 24 months and older. The data system automatically calculates BMI.
To manually calculate BMI using pounds and inches, follow the steps below.
Step
Action
1 Convert any fractions to decimals.
Examples: 37 pounds, 4 ounces = 37.25 pounds 41 ½ inches = 41.5 inches
2 Insert the values into the following formula: [weight (lb) / height(in) / height(in)] X 703 = BMI
Example: (37.25 lb / 41.5 in / 41.5 in) X 703 = 15.2
Note: See Policy 215.74 for decimal conversions for inches and ounces.
A reference table for estimating BMI values for children 2-5 years can be downloaded from the CDC website at www.cdc.gov/growthcharts.
Page 3
215.73
10/1/18
Plotting Pediatric Growth Charts
Policy
The data system plots anthropometric measurements based on the 2006 WHO growth standards for birth to < 24 months and the 2000 NCHS/CDC growth charts for > 24 months for the appropriate age and sex group. This includes all premature infants who have attained a gestational age of at least 40 weeks.
Data system plots charts
The data system will plot the pediatric growth charts automatically. These charts can be viewed and printed.
Growth charts
There are three growth charts, corresponding to the child’s age and/or sex:
0-24 Months
2-5 Years
· Weight for age
· Weight for age
· Length for age
· Stature for age
· Weight for length
· BMI for age
Measurements plotted
There are three parameters plotted for each child: · Length- or stature-for-age, · Weight-for-age, · Weight-for-length (for <24 months) or BMI-for-age (for 24 months).
Page 4
10/1/18
215.73
Adjusting for Gestational Age for Premature Infants
Policy
Measurements will be adjusted for gestational age until the age of 2 years for: Premature infants (<38 weeks’ gestation) who have reached equivalent age of
40 weeks’ gestation, and Children born at <38 weeks’ gestation.
Data system adjusts for age
The data system will automatically adjust for gestational age either when: • A > 2-week difference is identified between the baby’s actual date of birth and the expected date of birth that is completed on their enrollment panel or • if on the baby’s birth measurement anthro panel record, the diagnosed weeks gestation is filled in as being 37 weeks or less.
Assignment of risk for short stature
The data system assigns nutrition risk criteria for short stature for premature infants and children up to 24 months based on adjusted gestational age.
Charts for premies and VLBW/LBW infants
The data system will not plot or evaluate growth measurements for infants born prematurely (37 weeks gestation) and those who were low birth weight (5.5 lb.) who have not reached the equivalent age of 40 weeks gestation on the NCHS/CDC growth charts.
The growth of these infants may be assessed using a growth chart for low birth weight or very low birth weight infants consistent with the protocols of the local medical community where the WIC clinic operates. An example of such a chart is the Infant Health and Development Program (IHDP). The state WIC office is not providing electronic or hard copies of this chart.
Manual calculation
The table below describes how to calculate gestation-adjusted age.
Step
Action
Example
1 Document infant’s gestational age in weeks. Gestational age at birth = 30 weeks
2 Subtract the gestational age in weeks from
40 – 30 = 10 weeks adjustment for
40 weeks (gestational age of term infant) to
prematurity
determine adjustment for prematurity in weeks.
3 Subtract the adjustment for prematurity in
Chronological age today = 12 weeks
weeks from the infant’s chronological postnatal
age to determine the child’s gestation-adjusted 12 – 10 = 2 weeks gestation-adjusted
age.
age
Page 5
215.73
Evaluating Pediatric Growth Charts
10/1/18
Introduction
A series of measurements is needed to accurately evaluate a child’s growth. This section provides guidelines for evaluating pediatric growth charts.
Guidelines
Interpret each of the three graphs after considering the information provided by the other two. If you observe any of the following growth patterns, consider the corresponding factors.
Pattern · Length/age <2.3rd percentile · Weight/age <2.3rd percentile · Weight/length <2.3rd percentile · BMI-for-age 5th percentile
· Stature/age >95th percentile · Weight/age >95th percentile · Weight/length >97.7th percentile · BMI-for-age between 85th-94th percentiles · BMI-for-age 95th percentile Movement over two growth channels for any measurement
Note: Growth channels are indicated by the 2nd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 98th percentile lines on the Birth to <24 months’ charts. The 85th percentile appears on the 2-5 Years chart. Flat growth curve for any measurement
Factors to Consider · Parents’ size · Recent illness · Appetite · Recent growth spurt · Child’s growth pattern · Parents’ size · Expected growth spurt · Family stress · Usual growth pattern
· Changes in environment · Family history of obesity · Family history of short stature · Recent or chronic illness
· Changes in environment · Recent illness · Family history of short stature
Note: When discussing growth charts with caregivers, ask them if it would be helpful to go over the growth chart. Reinforce that children grow differently and at different rates and that all are normal. Focus on behaviors, not outcomes.
References
· Nutritional Screening of Children: A manual for screening and follow-up. U.S. Department of Health and Human Services Public Health Service. DHHS Publication No. (HSA) 81-5114.
· www.cdc.gov/growthcharts
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10/1/18
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215.73
Page 7
Overview
Revised 10/1/18 Replaces version dated 10/1/17
215.73 Pediatric Growth Charts
Policy
A single plot of height-for-age and weight-for-age allows you to compare the child’s height and weight to children of the same age and sex. A length-forweight chart or a BMI-for-age chart provides information about the child’s proportions. Continued use of the growth chart provides a visual portrayal of the child’s growth pattern. This policy describes how to calculate a child’s age and BMI and how to plot and evaluate pediatric growth charts.
In this policy
This policy covers the following topics.
Topic Calculating A Child’s Age Calculating BMI Plotting Pediatric Growth Charts Adjusting for Gestational Age for Premature Infants Evaluating Pediatric Growth Charts
See Page 2 3 4 5 6
Iowa Department of Public Health/WIC CERTIFICATION Policy and Procedure Manual
Page 1
215.73
Calculating A Child’s Age
10/1/18
Introduction
The data system will calculate a child’s age in months in order to plot the growth charts. This section describes how to manually calculate age.
Procedure
The data system calculates a child’s age as described in the table below. Follow these steps if you must manually calculate a child’s age.
Step
Action
Example 1
1
Write child’s birth year, month and day
Year Month
Day
under year, month and day of clinic visit. Visit date 18
7
15
Birthdate 16
7
20
2
Subtract birthdate from clinic visit date.
Year Month
Day
Visit date 18 17 7 6 18 15 45
Note: Borrow 30 days from the month Birthdate 16
7
20
column or 12 months from the year
Child’s age 1
11
25
column if needed.
3
Multiply years by 12 and add to number One year, 11 months, 25 days equals 23
of months.
months, 25 days.
4
Round child’s age up or down based on 23 months, 25 days would be rounded
the number of days as follows:
to 24 months.
1-15 days: round down
16+ days: round up
Example 2
5
Round the child’s age for accurate
plotting on the growth chart.
IF plotting on… THEN round
to nearest…
0-36 month chart Month
2-5 year chart 1/6 year
A 28-month old child measured with a
(2 month increments) standing height would be plotted on the
line corresponding to 28 months.
2-20 year chart ¼ year
The same child would be plotted on the
line corresponding to 2 year 3 months
(27 months).
Page 2
10/1/18
Calculating BMI
215.73
Purpose Using the calculator
CDC table
Body mass index-for-age (BMI-for-age) is the recommended parameter for monitoring the growth of children 24 months and older. The data system automatically calculates BMI.
To manually calculate BMI using pounds and inches, follow the steps below.
Step
Action
1 Convert any fractions to decimals.
Examples: 37 pounds, 4 ounces = 37.25 pounds 41 ½ inches = 41.5 inches
2 Insert the values into the following formula: [weight (lb) / height(in) / height(in)] X 703 = BMI
Example: (37.25 lb / 41.5 in / 41.5 in) X 703 = 15.2
Note: See Policy 215.74 for decimal conversions for inches and ounces.
A reference table for estimating BMI values for children 2-5 years can be downloaded from the CDC website at www.cdc.gov/growthcharts.
Page 3
215.73
10/1/18
Plotting Pediatric Growth Charts
Policy
The data system plots anthropometric measurements based on the 2006 WHO growth standards for birth to < 24 months and the 2000 NCHS/CDC growth charts for > 24 months for the appropriate age and sex group. This includes all premature infants who have attained a gestational age of at least 40 weeks.
Data system plots charts
The data system will plot the pediatric growth charts automatically. These charts can be viewed and printed.
Growth charts
There are three growth charts, corresponding to the child’s age and/or sex:
0-24 Months
2-5 Years
· Weight for age
· Weight for age
· Length for age
· Stature for age
· Weight for length
· BMI for age
Measurements plotted
There are three parameters plotted for each child: · Length- or stature-for-age, · Weight-for-age, · Weight-for-length (for <24 months) or BMI-for-age (for 24 months).
Page 4
10/1/18
215.73
Adjusting for Gestational Age for Premature Infants
Policy
Measurements will be adjusted for gestational age until the age of 2 years for: Premature infants (<38 weeks’ gestation) who have reached equivalent age of
40 weeks’ gestation, and Children born at <38 weeks’ gestation.
Data system adjusts for age
The data system will automatically adjust for gestational age either when: • A > 2-week difference is identified between the baby’s actual date of birth and the expected date of birth that is completed on their enrollment panel or • if on the baby’s birth measurement anthro panel record, the diagnosed weeks gestation is filled in as being 37 weeks or less.
Assignment of risk for short stature
The data system assigns nutrition risk criteria for short stature for premature infants and children up to 24 months based on adjusted gestational age.
Charts for premies and VLBW/LBW infants
The data system will not plot or evaluate growth measurements for infants born prematurely (37 weeks gestation) and those who were low birth weight (5.5 lb.) who have not reached the equivalent age of 40 weeks gestation on the NCHS/CDC growth charts.
The growth of these infants may be assessed using a growth chart for low birth weight or very low birth weight infants consistent with the protocols of the local medical community where the WIC clinic operates. An example of such a chart is the Infant Health and Development Program (IHDP). The state WIC office is not providing electronic or hard copies of this chart.
Manual calculation
The table below describes how to calculate gestation-adjusted age.
Step
Action
Example
1 Document infant’s gestational age in weeks. Gestational age at birth = 30 weeks
2 Subtract the gestational age in weeks from
40 – 30 = 10 weeks adjustment for
40 weeks (gestational age of term infant) to
prematurity
determine adjustment for prematurity in weeks.
3 Subtract the adjustment for prematurity in
Chronological age today = 12 weeks
weeks from the infant’s chronological postnatal
age to determine the child’s gestation-adjusted 12 – 10 = 2 weeks gestation-adjusted
age.
age
Page 5
215.73
Evaluating Pediatric Growth Charts
10/1/18
Introduction
A series of measurements is needed to accurately evaluate a child’s growth. This section provides guidelines for evaluating pediatric growth charts.
Guidelines
Interpret each of the three graphs after considering the information provided by the other two. If you observe any of the following growth patterns, consider the corresponding factors.
Pattern · Length/age <2.3rd percentile · Weight/age <2.3rd percentile · Weight/length <2.3rd percentile · BMI-for-age 5th percentile
· Stature/age >95th percentile · Weight/age >95th percentile · Weight/length >97.7th percentile · BMI-for-age between 85th-94th percentiles · BMI-for-age 95th percentile Movement over two growth channels for any measurement
Note: Growth channels are indicated by the 2nd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 98th percentile lines on the Birth to <24 months’ charts. The 85th percentile appears on the 2-5 Years chart. Flat growth curve for any measurement
Factors to Consider · Parents’ size · Recent illness · Appetite · Recent growth spurt · Child’s growth pattern · Parents’ size · Expected growth spurt · Family stress · Usual growth pattern
· Changes in environment · Family history of obesity · Family history of short stature · Recent or chronic illness
· Changes in environment · Recent illness · Family history of short stature
Note: When discussing growth charts with caregivers, ask them if it would be helpful to go over the growth chart. Reinforce that children grow differently and at different rates and that all are normal. Focus on behaviors, not outcomes.
References
· Nutritional Screening of Children: A manual for screening and follow-up. U.S. Department of Health and Human Services Public Health Service. DHHS Publication No. (HSA) 81-5114.
· www.cdc.gov/growthcharts
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10/1/18
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215.73
Page 7