August 2013 3 Growth Grid Categories I nfants and children lt 24 months of age Children 24 months and older Pregnant women Which grids do we show Infants and children lt 24 months of age ID: 542846
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Slide1
Growth Grids
August 2013Slide2
3 Growth Grid Categories
I
nfants
and children < 24 months of age
Children 24 months and older
Pregnant womenSlide3
Which grids do we show?
Infants and children < 24 months of
age
Length-for-age
Weight-for –length
Children 24 months and
older
Height-for-age
BMI-for-ageSlide4
Growth Grids Cheat Sheet
Tells you which growth grids to show depending on the age of the client.
The grids that you should not show are in grey font.
Tells you the cut-offs for short stature, underweight and overweight.Slide5
Test Your Knowledge
Which Growth Grids Do We Show for Each Client?Slide6
How To Explain a Growth Grid for a
Premie
What
grids s
Wei
LenSlide7
How to Explain a Growth Grid for an Overweight Child
Birth to 23 Months
2.3
rd
percentile weight-for-length
2 – 5 Years
5
th
percentile BMI-for-age
No changes Slide8
Other Sample Growth Grids
How to explain
Is their growth normal or not?
Do any of the measurements seem incorrect?
Do they need to be referred to the RD?Slide9
Short Stature
Birth to 23 Months
2.3
rd
percentile length-for-age
2 – 5 Years
5
th
percentile Height-for-age
No changes Slide10
At Risk of Short Stature
Birth to 23 Months
> 2.3
rd
percentile and 5
th
percentile length-for-age
2 – 5 Years
> 5
th
percentile and 10
th
percentile Height-for-age
No changes Slide11
High Weight-for-Length
Birth to 23 Months
97.7
th
percentile weight-for-length Slide12
Overweight
2 – 5 Years
85
th
percentile and < 95
th
percentile BMI-for-age
Same definition as the current risk ‘At Risk of Becoming Overweight’Slide13
Obese
2 – 5 Years
95
th
percentile BMI-for-age
Same definition as the current risk “Overweight”Slide14
Thyroid Disorders
Hyperthyroidism
Hypothyroidism
Additional medical conditions include, but not limited to the following
Congenital Hypothyroidism
Infants born with an under active thyroid
Congenital Hyperthyroidism
Excessive thyroid hormone at birth
Postpartum ThyroiditisSlide15
Inborn Errors of Metabolism
More specifically defines ‘inborn errors of metabolism’
Expanded the list of examplesSlide16
Explaining Growth Grids
What is important to include when explaining growth grids?
What do you think the caregiver needs to know?Slide17
Pick a partner!Slide18
Practice Explaining Grids
Take turns
Determine what the risks, are based on the grids. How would you explain the risks without using the risk name.
Explain the grids
What did your partner say that you think worked well?
What do you think should have been said, avoided or explained differently?Slide19
What does following a curve mean?Slide20
Explaining Grids
How did you or your partner explain the girds?
What did you think worked well?Slide21
Beginning the Grid Explanation
Have you ever seen a/this grid before?
Opens up the conversation about behavior change/the situationSlide22
BMI
Calculation used to compare a child’s weight, height and age.
Used to determine if they are gaining to fast or too slow.
Used to determine
how they are
growing/developingSlide23
Weight-for-Length
BMI-for-Age
Can show if child is getting
enough to eat or not.
May
be getting too many snacks, getting too many calories.
May
not be getting enough to eatSlide24
Explaining Risks
Overweight (weight/length) – gaining weight faster than what is recommended/expected
Overweight (BMI/age) – gaining
weight
faster
than
compared to other children their same age
Short Stature – dropped %tile – not growing as fast as they were
General – Recommended weight is expected between these lines, your child falls _____. What are your thoughts about it?Slide25
Example of What to Say
Single point: length/
h
t-for-age
This is your child’s growth chart. Have you ever seen one before?
P: This one shows how tall
<child’s name>
is compared to other <boys> his same age.
C: He is close to the <90
th
percentile>. This means that if we had 100 <boys> his same age and lined them up from the shortest to the tallest, he would be taller than about <90> and shorter than <10>.
E: We like to see children above the 10
th
percentile so we don’t have any concerns about his growth right now. How do you feel about that? (What are your thoughts?)
We
will be following his growth over the next few years to make sure he continues to grow well. (Save education for later)Slide26
Example of What to Say
BMI-for-age < 5
th
%ile
P: This chart shows how heavy your child is compared to other <boys> his same age.
C: He is <below the 5
th
percentile>. This means that if we had 100 <boys> his same age and lined them up from the heaviest to the thinnest, he would be
smaller/thinner/lighter
than most of them.
E: It looks like his growth has been falling off over the last 6 months and he is not gaining
weight.
How do you feel about that? (What are your thoughts?) (Save education for later)Slide27
Example of What to Say
Weight-for-length
95
th
%ile
P: This chart shows how heavy or thin your child is compared to other <boys> his same height.
C: He is at the <95
th
percentile>. This means that if we had 100 <boys> his same
height
and
lined them up
from the thinnest to the heaviest, he would be heavier than most of them.
E: This means that he is gaining weight more
quickly then expected. How do you feel about that? (What are your thoughts?) (Save education for later)Slide28
Explaining Grids - Repeat
With your partner
Try one of the examples discussed to explain the growth grids
Switch and let your partner explain the grids
How did that feel?
What did you try?