Growth and Development Screening - PowerPoint Presentation

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Growth and Development Screening

Cindy Harrah ARNP, MSNNicklaus Children’s Hospital

Bmi screening Mandates

FL Statute 381.0056(4)(a)(6-9)Provision of screeningsFlorida Administrative Code Chapter 64F-6.003

Grade level mandates for screening

Growth and Development

FirstThirdSixthNinthOptional for StateRequired for TCT

Procedure for Height and weight

WeightStandard Scale-calibrated for accuracyRemove bulky clothing Subtract 1 pound for remaining clothing

Record to the nearest ½ pound

Height

Remove shoes if possibleSubtract ½ inch if unable to remove shoesWall mount or StadiometerHeels, buttocks, and shoulder blades against surfaceRight angle block to crown of head

Bmi calculation

Calculation of BMI and BMI PercentileCHEERCDC School Tools

CDC BMI calculator

Manual

BMI = Weight (kg) ÷ Stature (cm) ÷ Stature (cm) x 10,000 BMI = Weight (lb) ÷ Stature (in) ÷ Stature (in) x 703

Growth Charts

Gender specific

Correlates with body fat

Not a direct measureTrend growth/weight patternsMay indicate potential for health problem

Obesity Definition based on BMI

PediatricsObese - BMI> 95% for gender and age

At risk/overweight -

BMI=85-94%

AdultsObese – BMI> 30Overweight – BMI=25-30

BMI and Cheer

Enter screening results in CHEERIncluding opt outIndicate referral < 5% automatic referral

> 95% referral

Excludes athletic build

BP requiredPrint appropriate letterNow available in CHEER

BMI procedure

BMI Results Interpretation< 5% UnderweightAutomatic referral

5->85% Healthy Weight

85->95% Overweight

At risk for health problemsReferral at RN discression95% ObeseAutomatic referral

Excludes students with athletic build (RN

discrestion

)

Requires Blood PressureBMI results letters generated and sent to parent

Referral

Non-referral

Maintain confidentiality

Nutrition Education materials distributed to student and parent

Special Considerations

UnderweightShould be evaluated by RNUnderlying causeDisease process

Neglect

Financial resources

DepressionBody imageProvide education

Special Considerations

ObeseConsider muscle mass/athletic buildAt risk for health problemsMonitor Blood PressureRepeat abnormal

Depression

Provide Education

Common Effects of Obesity

Type 2 Diabetes is almost entirely attributable to obesity. Obese children are reported to be 12 times more likely to have high fasting blood insulin levels.

Orthopedic complications are due to the fact that bones and cartilage are in the process of development and are not strong enough to bear excess weight.

Hypertension is due to

elevated blood pressure levels that have been found to occur about 9 times more frequently among obese children.Social Difficulties obese children are often stereotyped as “unhealthy, unsuccessful & lazy”.

Students may be teased or verbally abused by other children and can become excluded from being a part of social groups and/or other activities

.

Lower academic achievement/scores

77% of obese children will be obese adults while only 7% of non-obese children will be obese adults

Health consequences of obesity

CDC 2015 Youth Risk Behavior Surveillance Physical Activity Middle School

CDC 2015 Youth Risk Behavior Surveillance Dietary habits Middle

School

Percentage of High School Students Who Had Obesity,* 1999-2015

†

* ≥ 95th percentile for body mass index, based on sex- and age-specific reference data from the 2000 CDC growth charts

†

Increased 1999-2015 [Based on linear and quadratic trend analyses using logistic regression models controlling for sex, race/ethnicity, and grade (p < 0.05). Significant linear trends (if present) across all available years are described first followed by linear changes in each segment of significant quadratic trends (if present).]

Note: This graph contains weighted results.

National Youth Risk Behavior Surveys, 1999-2015

BMI Follow up

Identify all referred students CHEER reportTracking tool3 Follow up attempts requiredLetter first follow up

Track all subsequent contacts

BMI Follow Up

Complete versus incomplete referralComplete referralReturned MD Letter ideal

Healthy Lifestyle Intervention

RN level

CHEER documentationEncounterFollow upIncomplete ReferralParent contact establishedRefusal of intervention/PCP care/nutrition consult

PCP appointment not completed

No parent contact

Student withdrawn from school

Healthy lifestyle Intervention

Previously- Obesity InterventionCompleted by RN Referred

students

>

95%Intervention (service code 5054)Parental Consent requiredHealth education and counselingIndividual Health Care PlanCompletion of one goal5 servings of fruits/vegetables<

2 hours of screen time

1 hour or more of physical activity

No sweetened beverages

Document BMI follow-up in cheer

Open original screeningAdd follow up Complete

Healthy Lifestyle Intervention (

Obesity Intervention)

Returned signed PCP referral letterIncompleteNo parent contactParent contacted only

Document in cumulative

Health recordScreening results documented in cumulative health recordHealth Jacket (DOH-3041)

Record dates of screening, referral, and outcome

Record results, referral and outcome in narrative*

Screening form (optional) placed in health jacketResults, referral, and outcome documented on form onlyRecommend stapling to Health Jacket

Resources

Center for Disease ControlFlorida School Health Administrative Guidelines (2012-update pending)Manual For School Health FacilitatorsSchool Health Service Plan Miami Dade County