Assessing Child Growth Using Body Mass Index (BMI)- for- Age Growth Charts

Transcription

1 Assessing Child Growth Using Body Mass Index (BMI)- for- Age Growth Charts Adapted by the State of California CHDP Nutri8on Subcommi;ee from materials developed by California Department of Health Care Services - Children s Medical Services Branch Centers for Disease Control and Preven8on Maternal and Child Health Bureau May 2011

2 Training Objec8ves By the end of this presenta8on, you will be able to: describe the use of Body Mass Index (BMI) as a screening tool for overweight and obesity calculate or determine BMI value from measured weight and height plot BMI value on the growth chart determine BMI- for- age percen8le interpret weight category record results on PM 160

3 Obesity Trends in Children and Teens Receiving CHDP Exams Ages 5 to < % 95th percentile CDC Pediatric Nutri8on Surveillance System (PedNSS) Data, Accessed online at (accessed 9/30/10). [Insert County] California Expected Level Customize chart with PedNSS data from your county. See User Guide.

4 Childhood Overweight and Obesity by Age Group [Insert Your County Name] 2009 % overweight or obese th %ile 85th - < 95th %ile < 5 Yrs 5-8 Yrs 9-11 Yrs Yrs 15 - < 20 Yrs Customize chart with PedNSS data from your county. See User Guide. Age Group CDC Pediatric Nutri8on Surveillance System (PedNSS) Data, Accessed online at (accessed 9/30/10).

5 Childhood Overweight and Obesity by Ethnicity California 2009 [Insert Your County Name] Children Aged 5 to < 20 years % overweight or obese White Black Customize chart with PedNSS data from your county. See User Guide. Hispanic American Indian/Alaskan Native Asian Pacific Islander Filipino 95th %ile 85th - < 95th %ile CDC Pediatric Nutri8on Surveillance System (PedNSS) Data, Accessed online at (accessed 9/30/10).

6 What Is Body Mass Index? A number that compares an individual s weight to height Body Mass Index (BMI) = Weight (kg) / Height (m)² As an indirect measure, a screening test for body fatness

7 Why Use BMI- for- Age? Life8me tracking tool Age 2 years through adulthood Examines weight, stature and age Screening for health and nutri8on status Early indicator of other health risk factors Hyperlipidemia Elevated insulin High blood pressure

8 Body Mass Index- for- Age for Children and Teens Recommended by Centers for Disease Control American Academy of Pediatrics Expert Commi;ee USPSTF White House Task Force Required by CHDP Health Plans

9 Body Mass Index Cutoff Values for Adults Standard weight categories Same for all ages Same for men and women Weight Status Obese BMI 30.0 and above Overweight Normal Underweight Below 18.5

10 For Children, BMI Changes with Age Example: Child s growth tracking along 95 th percen8le Age BMI Value

11 BMI for Children and Teens Age- and sex- specific Plot BMI on growth chart to find percen8le Weight status determined by percen8le Weight Status Category Obese Overweight Normal Underweight Percen8le Range 95 th percen8le 85 th to < 95 th percen8le 5 th to < 85th percen8le < 5 th percen8le

12 What is a Percen8le? 50 th 85 th 5 th 95 th Major Percen8le Divisions

13 CDC Growth Charts Tip: Download and print from Formula to calculate BMI Percen8le lines 5 th - 10 th - 25 th - 50 th 75 th - 85 th - 90 th - 95 th Published May 30, 2000 (modified )

14 How to Read and Interpret the Growth Chart A single point on the curve indicates current status A series of BMI plots are needed to determine the growth trend If growth deviates from the expected growth pa;ern, further assessment may be needed

15 Adiposity Rebound The increase in BMI that occurs aier it reaches its lowest point, usually between ages 4 to 6 Normal growth pa;ern BMI AGE

16 Adiposity Rebound Child following 10 th percen8le curve At what age does the BMI reach its lowest point? BMI AGE

17 Adiposity Rebound Child following 85 th percen8le curve At what age does the BMI reach its lowest point? BMI AGE

18 Early Adiposity Rebound Early adiposity rebound (before age 5) is related to higher BMI in adulthood An increase in BMI percen8le < 5 years is a red flag BMI AGE

19 Early Adiposity Rebound Without Interven8on With Interven8on BMI AGE BMI AGE

20 Excessive Adiposity Rebound Excessive adiposity rebound is related to higher BMI in adulthood BMI AGE Increasing BMI percen8les crossing major percen8le lines are red flags

21 Steps to Plot BMI- for- age 1. Select appropriate growth chart 2. Measure standing height accurately 3. Measure weight accurately 4. Determine BMI value 5. Determine BMI- for- age percen8le 6. Record BMI percen8le on PM Determine weight category

22 Chart Carlos Correctly Step 1: Select Appropriate Growth Chart Birth to 36 months: Boys or Girls Length- for- age Weight- for- age Head circumference Weight- for- length 2 to 20 years: Boys or Girls Stature- for- age Weight- for- age BMI- for- age

23 Chart Carlos Correctly Step 2: Measure Standing Height Record on growth chart and PM 160 Date Age Weight Stature BMI* 3 32 # 38 ½ # ¾ 4 5 3

24 Chart Carlos Correctly Step 3: Measure Weight Record on growth chart and PM 160 Date Age Weight Stature BMI* 3 32 # 38 ½ # ½ # 45 ¾

25 Chart Carlos Correctly Step 4A: Determine BMI Value Method 1: Using a calculator English measurements Wt (pounds) Ht (inches) Ht (inches) x 703 Metric measurements Wt (kg) Ht (cm) Ht (cm) x 10,000 TIP: Formulas are listed on the BMI- for- age chart

26 Chart Carlos Correctly Step 4A: Determine BMI Value Method 2: Using a BMI calcula8on wheel Find height on inner wheel TIP: Mark with your thumb and index finger Line up the height with weight on outer wheel Read BMI value in the window on the inner wheel TIP: Read decimal points from right to let!

27 Chart Carlos Correctly Step 4B: Determine BMI Value Record on growth chart Date Age Weight Stature BMI* 3 32 # 38 ½ # ½ # 45 ¾ 14.6

28 Chart Carlos Correctly Step 5: Determine BMI- for- Age %ile TIP: Use a transparent growth chart plovng aid Find age on horizontal axis Find BMI value on ver8cal axis Mark point of intersec8on Es8mate BMI percen8le

29 Chart Carlos Correctly Step 6: Record BMI Percen8le on PM 160 Es8mate a whole number between 1 and 99 that best represents the percen8le point plo;ed on the growth chart

30 Chart Carlos Correctly Step 7A: Determine Weight Category Weight Status Category Obese Overweight Normal Underweight Percen8le Range 95 th percen8le 85 th to < 95 th percen8le 5 th to < 85th percen8le < 5 th percen8le

31 Chart Carlos Correctly Step 7B: Record Abnormal Results On PM 160, enter follow up code in appropriate column under PROBLEM SUSPECTED Enter diagnosis under COMMENTS/ PROBLEMS Underweight Overweight Obese

32 Accurate Measurements Are Cri8cal BMI for 5 year old boy Weight: 43.5 lb Height: 43.0 in BMI= 16.5 BMI- for- age = th percen8le Normal range If height is inaccurate: Weight: 43.5 lb Height: 42.5 in BMI = 17.0 BMI- for- age = th percen8le Overweight range

33 Summary You are now able to: describe the use of BMI as a screening tool determine BMI value plot BMI value on the growth chart determine BMI- for- age percen8le interpret weight category record results on PM 160

34 Color- coded BMI Charts 5210 Let s Go! Eat Smart, Move More North Carolina Na8onal Ini8a8ve for Children s Healthcare Quality > Childhood Obesity

35 Growth Assessment Resources Essen8al clinical tools in training packet Resource handout lists sources for Online tutorials Online resources Growth charts Plotng aids BMI calculators and wheels CDC BMI Percen8le Calculator for Child and Teen CHOP Body Mass Index and Z- Score Calcula8on in Children Shape Up America! Childhood Obesity Assessment Calculator Soiware applica8ons

36 References American Academy of Pediatrics Policy Statement: Preven8on of Pediatric Overweight and Obesity. Pediatrics. 112: , h<p://aappolicy.aappublicabons.org/cgi/content/full/pediatrics;112/2/424 Assessment of Child and Adolescent Overweight and Obesity. Pediatrics 120: S193- S228, h<p://pediatrics.aappublicabons.org/cgi/content/full/120/supplement_4/s193 Expert Commi;ee Recommenda8ons Regarding the Preven8on, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. Pediatrics 120 : S164- S192, h<p://pediatrics.aappublicabons.org/cgi/content/abstract/120/supplement_4/s164 Recommenda8ons for Preven8on of Childhood Obesity. Pediatrics 120 : S229- S253, h<p://pediatrics.aappublicabons.org/cgi/content/abstract/120/supplement_4/s229 The Validity of BMI as an Indicator of Body Fatness and Risk Among Children. Pediatrics 124: S23- S34, h<p://pediatrics.aappublicabons.org/cgi/content/abstract/124/supplement_1/s23