Bright Futures Nutrition Tools
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1 8/1/ :07:23 AM 5864_ER_RED 1 Bright Futures Nutrition Tools Michelle Futrell, MS, RD, LDN Nutrition Consultant School Health Unit C&Y/WCH/NCDPH Michelle.futrell@dhhs.nc.gov (919) Objectives: 1. Highlight standard components of a nutrition assessment 2. Integrate nutrition assessment components with BF s strategies 3. Address nutrition & health needs of your agency and clients 3
2 4 Nutrition Assessment Key Components Bright Futures Nutrition APA, 3 rd Edition 2011 A. Infants B. Children Ages 1 to 10 C. Adolescents Ages 11 to 21 BF s Nutrition Questionnaires [A-C] can be used: 1. By clients to complete before meeting with provider and used as a practical starting point 2. By health care provider to complete during meetings with client(s) to identify areas of nutrition concern 3. To determine additional screening needed 5 BF Nutrition Tool: A - Infants Nutrition and Child development Signs of hunger and fullness Breast milk or formula Introduction of liquid & solid foods Dental concerns Nutrient Supplementation [Fe, Fl] Socio-economic impact 6
3 7 BF Nutrition Tool B - Children Ages Appetite and growth Meal patterns Food safety Nutrient supplementation Socio economic Physical activity Screen time BF Nutrition Tool C - Adolescents Ages Eating Behaviors Food Choices Food Resources Weight & Body Image Physical Activity Lifestyle 8 BF Nutrition Tools: D-K D. Key Indicators of Nutrition Risk for Children and Adolescents E. Screening for Elevated Blood Lead Levels F. Stages of Change A Model for Nutrition Counseling G. Strategies for Health Professionals to Promote Healthy Eating Behaviors H. Basics for Handling Food Safety I. Tips for Fostering a Positive Body Image Among Children and Adolescents J. Nutrition Resources K. Federal Nutrition Assistance Programs 9
4 10 BF Nutrition Tool D - Key Indicators of Nutrition Risk for Children & Adolescents Food Resources Lifestyle Food Choices Eating Behaviors Weight and Body Image Growth Physical Activity Criteria for Further Screening & Assessment Food Resources > Red Flags! Food Insecurity Food skills Inadequate cooking facilities 11 Lifestyle Alcohol, tobacco and substance abuse Dietary supplements Fad diets Behavioral & Lifestyle Factors Faster paced lifestyles o More women in the workforce o Less time for meal preparation o Less opportunity for family meals o More sedentary behaviors o Less daily physical activity 12
5 13 Family Meal Patterns Breakfast Breakfast skipping assoc w/ increased abdominal adiposity Daily consumption inversely assoc w/ OW/OB prevalence in yr old children Family Meals Eating on the run = higher intake of soda, fast food, total & sat fat; lower intake of several healthier foods. Family meals during early adolescence may contribute to formation of healthful eating habits 5 yrs later Alexander KE, et. al. May Panagiotakos DB et. al. Nov Gleason PM, et. al. Feb Larson NI, et. al. Jan Obesity (Silver Spring) Nov :11. Food Choices > Red Flags! Consumption of: < 2 servings of fruits per day < 3 servings of vegetables per day < 6 servings of grains per day <2 servings of milk and milk products per day < 2 servings of meat or meat alternatives Excessive amount of fat 14 15
6 16 Calorie Content of Selected Fast Foods McD s Double Quarter Pounder w/ Cheese 740 McD s French Fries, Large 500 Ruby Tuesday Bella Turkey Beef 1145 Burger King Triple Whopper w/ Cheese 1230 Baskin Robbins Oreo Cookies n Cream Shake 1130 Cinnabon Classic Cinnamon Roll 813 Kcals. Outback Cheese Fries w/ ranch dressing Eating Behaviors Appetite Fast foods Skipped meals Food jags Children consume more: o Calories, snacks, soda o Meals away from home o Meals and snacks from the refrigerator and microwave Result: Parents have less control over their children s eating habits NHANES ( & ) 18
7 19 Weight & Body Image > Red Flags! Unhealthy Behaviors Concerns about body shape/size Significant weight changes Social & Psychological Impact Teasing Self-Esteem/Depression Lower Academic Achievement Discrimination & The Pain of Obesity Former severely obese patients: 100 % preferred to be deaf, dyslexic, diabetic or have heart disease or bad acne than to be obese again Leg amputation was preferred by 91.5% and blindness by 89.4% 100% preferred to be a normal weight person rather than a severely obese multimillionaire 20 Psychosocial Assessment Readiness to change Low self esteem, depression Family discord, poor peer socialization Eating disorders 21
8 22 BMI: Adults Normal Overweight > 30 Obese > 40 Severe Obesity BMI-for-Age: Children ages 2-20 < 5 th percentile Underweight 5 th -84 th percentile Healthy Weight 85 th -94 th percentile Overweight > 95 th percentile Obese Use BMI Percentiles, not fixed cutoffs Age and Gender Specific 23 24
9 25 Perceptions of Obesity Qualitative and quantitative research indicates that: Obesity in children is often not perceived by parent or caregiver; AND Many health care providers fail to use the BMI-forage growth charts to assess children. Polling Question: Alice is 4 yrs old Is her BMI -for-age? a) Obese b) Overweight c) Normal weight d) Underweight Photo from UC Berkeley Longitudinal Study, Answer Measurement: Age = 4 yrs Ht. = 99.2 cm (39.2 in) Wt kg (38.6 lb) BMI = 17.8 Alice s BMI-for-age is in the 90 th -95 th percentile b) Overweight Plotted BMI-for age: Girls 2 to 20 years 27
10 28 Why Collect BMI Measurements for Health Check Surveillance: Trends Awareness for parents Identify risk of obesity Monitor effects of anticipatory guidance & care plans Screening: Detect those at risk for weight related health problems Correct misconceptions of parents & children about children s weight Motivate parents and children to make healthy lifestyle changes Increase awareness of clinical staff Expert Committee on Child & Adolescent Obesity General Recommendations Measure BMI %tile annually in all children Assess medical and behavioral risks, and attitudes related to overweight/obesity If BMI %tile normal, provide patient-centered counseling for prevention (motivational interviewing) If BMI %tile elevated, use a staged approach for treatment Pediatrics, December, U.S. Preventive Services Task Force Screening Recommendations for Obesity in Children & Adolescents Screen children 6-18 for obesity using BMI Comprehensive, moderate to high intensity interventions can improve BMI Intervention should include counseling on o Diet o Physical Activity o Behavioral Management Pediatrics, vol.125, No. 2, February 2010, pgs
11 31 Advantages of BMI o Easy to measure o Data are available in charts and records o Good correlation with body fat Limitations of BMI o Not a measure of body composition o Does not specify location of body fat deposition Additional Measures o Waist circumference NC Health Check Billing Code Guide: ICD-9-CM Coding for BMI Effective July 2011 V85.51 < 5 th Percentile Failure to Thrive V th 85 th Percentile V th 95 th Percentile Overweight V85.54 >95 th Percentile Obese World Health Organization [WHO] Growth Charts With trainings TBA 32 Physical Activity vs. Physical Inactivity 33
12 34 Physical Activity Assessment Sedentary Activities Activity Preferences Barriers to Increasing PA AAP Policy Statement 2006 Physical Activity Promotion: Promote physical activity Dissuade children from sedentary activities Provide suitable role models Pediatrics 2006:117(5): How much physical activity do children need? CDC Recommends: Children and adolescents should do 60 minutes (1 hour) or more of physical activity each day The American Heart Association recommends: All children age 2 and older should participate in at least 60 minutes of enjoyable, moderate-intensity physical activities every day that are developmentally appropriate and varied. If your child or children don't have a full 60-minute activity break each day, try to provide at least two 30-minute periods or four 15-minute periods in which they can engage in vigorous activities appropriate to their age, gender and stage of physical and emotional development. 35 Environmental Factors Effects on Diet Pervasive Fast Food Access: drive thru, take out, order in, eat and run Super-sizing: more calories per serving, encourages overeating School meal/a la Carte and vending policies: support consumption of low nutrient, energy dense foods Food marketing practices: advertising of calorie dense foods to children and teens 36
13 37 Environmental Factors Effects on Physical Activity Urban Sprawl: people live fare from work, shops and schools only accessible by car Communities not walk or bike friendly Limited access to recreation facilities Safety Concerns: Few kids walk to school Less daily physical education in schools Increased attraction of sedentary activities: computers, video games, television 38 Environmental Factors Effects Continued Our obesogenic environment: o Encourages over-consumption of energy dense foods o Discourages physical activity o Encourages sedentary time These lifestyle changes are the fundamental cause of the obesity epidemic 39
14 40 BF Nutrition Tool E - Screening for Elevated Blood Lead Levels Risk Factors Screening Medicaid Anticipatory Guidance 41 BF Nutrition Tool F - Stages of Change Nutrition Counseling Precontemplation Contemplation Preparation Action Maintenance 42
15 BF Nutrition Tool G - Promoting Healthy Eating Behaviors Communication Factors Environmental Factors Readiness to Change Action Plans General Strategies 43 BF Nutrition Tool H - Handling Food Safely Shopping Storage Preparation Thawing Cooking Serving Leftovers Refreezing 44 BF Nutrition Tool I - Fostering Positive Body Image Among Children and Adolescents Child or Adolescent Parents Health Professional 45
16 46 Children with Special Health Care Needs a) Obesity b) Diabetes Mellitus c) Eating Disorders d) Hyperlipidemia e) Hypertension f) Food Allergy g) Nutrition and Sports h) Obesity i) Oral Health j) Vegetarian Eating Practices Nutrition Resources US Department of Agriculture US Department of Health and Human Services BF Nutrition Tool K - Federal Nutrition Assistance Programs Child and Adult Care Food Program (CACFP) Commodity Supplemental Food Program (CSFP) Early Head Start and Head Start Nutrition Assistance Program (NAP) for Puerto Rico School Breakfast Program Special Milk Program (SMP) Emergency Food Assistance Program (TEFAP) Expanded Food and Nutrition Education Program (EFNEP) Food Distribution Programs on Indian Reservations (FDPIR) National School Lunch Program (NSLP) Supplemental Nutrition Assistance Program (SNAP) Special supplemental Nutrition Program for Women, Infants and Children (WIC) Summer Food Service Program (SFSP) 47 Nutrition Assessment Calculate & Plot BMI Medical Risk Behavior Risk Psycho/Social Concerns Health History & Exam Growth Sedentary Time Dietary Habits Family Concern Patient Concern Parental Obesity Family History Physical Activity Environmental Concerns Labs As Needed 48
17 49 50 Thank You 51
18 52 Documenting Nutrition Assessment on BF Forms The Initial History provides risk information regarding family history The Pre-Visit Forms assists clinicians in collecting information on parental concerns & nutritional risks The Visit forms summarizes the overall nutritional assessment, identifies nutritional red flags and a plan of care to address the identified concerns or red flags The BFTRK forms bring an age specific focus to the nutritional assessment Where/How the components of the nutritional assessment are documented varies by age EHR documentation must document the same nutritional assessment components Documenting Nutrition Assessment on BF Forms Parental Concerns Staying Healthy Anemia Risk Assessment Age-specific nutrition focus 53 Documenting Nutrition Assessment on BF Forms 1, 6 & 12 Months 54
19 55 Documenting Nutrition Assessment on BF Forms Complete based on your assessment of all components Assessment requires RN or higher level provider decision making 2 Years 7-8 Years Documenting Nutrition Assessment on BF Forms Further assessment back of page Adolescent Risk Assessment HEADSSS Ages Documenting Nutrition Assessment on BF Forms 57
20 Documenting Nutrition Assessment on BF Forms Examples: > 95 percentile disordered eating such as pica or anorexia Note: No flag on Anticipatory Guidance Examples: Nutrition or medical referral parent agrees to limit fast food to once per week weight check 4 weeks 2 Year Visit
21 61 Documenting Nutrition Assessment on BF Forms Reminders regarding CEH for this session Return to the Bright Futures Training Website and click on Evaluation After completing the application, provide the session CLUE (the clue is case sensitive) You will be directed to the certificate form, add your name and print your certificate If you need assistance, please Elizabeth Mizelle at
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