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

Assessing Child Growth Using Body Mass Index (BMI)-for-Age Growth Charts. Adapted by the State of California CHDP Nutrition Subcommittee from materials developed by California Department of Health Care Services  Children’s Medical Services Branch Centers for Disease Control and Prevention

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

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  1. Assessing Child Growth Using Body Mass Index (BMI)-for-Age Growth Charts Adapted by the State of California CHDP Nutrition Subcommittee from materials developed by California Department of Health Care Services  Children’s Medical Services Branch Centers for Disease Control and Prevention Maternal and Child Health Bureau May 2011

  2. Training Objectives By the end of this presentation, 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 percentile • interpret weight category • record results on PM 160

  3. Obesity Trends in Children and Teens Receiving CHDP Exams Ages 5 to < 20 Customize chart with PedNSS data from your county. See User Guide. CDC Pediatric Nutrition Surveillance System (PedNSS) Data, 2000-2009. Accessed online at www.dhcs.ca.gov/services/chdp/Pages/PedNSS2009.aspx (accessed 9/30/10).

  4. Childhood Overweight and Obesityby Age Group[Insert Your County Name] 2009 Customize chart with PedNSS data from your county. See User Guide. CDC Pediatric Nutrition Surveillance System (PedNSS) Data, 2009. Accessed online at www.dhcs.ca.gov/services/chdp/Pages/PedNSS2009.aspx (accessed 9/30/10).

  5. Childhood Overweight and Obesityby EthnicityCalifornia 2009 [Insert Your County Name] Children Aged 5 to < 20 years Customize chart with PedNSS data from your county. See User Guide. CDC Pediatric Nutrition Surveillance System (PedNSS) Data, 2009. Accessed online at www.dhcs.ca.gov/services/chdp/Pages/PedNSS2009.aspx (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? • Lifetime tracking tool • Age 2 years through adulthood • Examines weight, stature and age • Screening for health and nutrition status • Early indicator of other health risk factors • Hyperlipidemia • Elevated insulin • High blood pressure

  8. Body Mass Index-for-Agefor Children and Teens • Recommended by • Centers for Disease Control • American Academy of Pediatrics • Expert Committee • USPSTF • White House Task Force • Required by • CHDP • Health Plans

  9. Body Mass IndexCutoff Values for Adults • Standard weight categories • Same for all ages • Same for men and women

  10. For Children, BMI Changes with AgeExample: Child’s growth tracking along 95th percentile

  11. BMI for Children and Teens • Age- and sex-specific • Plot BMI on growth chart to find percentile • Weight status determined by percentile

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

  13. CDCGrowth Charts Tip: Download and print from www.cdc.gov/growthcharts/ Formula to calculate BMI Percentile lines5th - 10th - 25th - 50th 75th - 85th - 90th - 95th Published May 30, 2000 (modified 2000-2001)

  14. How to Read and Interpretthe 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 pattern, further assessment may be needed

  15. Adiposity Rebound • The increase in BMI that occurs after it reaches its lowest point, usually between ages 4 to 6 • Normal growth pattern ↑BMI AGE →

  16. Adiposity ReboundChild following 10th percentile curve At what age does the BMI reach its lowest point? ↑BMI AGE →

  17. Adiposity ReboundChild following 85th percentile 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 percentile < 5 yearsis a red flag ↑BMI AGE →

  19. Early Adiposity Rebound Without Intervention With Intervention ↑BMI ↑BMI AGE → AGE →

  20. Excessive Adiposity Rebound • Excessive adiposity rebound is related to higher BMI in adulthood • Increasing BMI percentiles crossing major percentile linesare red flags ↑BMI AGE →

  21. Steps to Plot BMI-for-age • Select appropriate growth chart • Measure standing height accurately • Measure weight accurately • Determine BMI value • Determine BMI-for-age percentile • Record BMI percentile on PM 160 • 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 CorrectlyStep 2:Measure Standing HeightRecord on growth chart and PM 160 453

  24. Chart Carlos CorrectlyStep 3:Measure WeightRecord on growth chart and PM 160 453 04308

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

  26. Chart Carlos CorrectlyStep 4A:Determine BMI Value • Find height on inner wheelTIP: 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 left! Method 2: Using aBMI calculation wheel

  27. Chart Carlos Correctly Step 4B:Determine BMI ValueRecord on growth chart

  28. Chart Carlos CorrectlyStep 5: Determine BMI-for-Age %ile • Find age on horizontal axis • Find BMI valueon vertical axis • Mark point of intersection • Estimate BMI percentile TIP: Use a transparent growth chart plotting aid

  29. Chart Carlos CorrectlyStep 6:Record BMI Percentile on PM 160 • Estimate a whole number between 1 and 99 that best represents the percentile point plotted on the growth chart 45304308 2 5

  30. Chart Carlos CorrectlyStep 7A:Determine Weight Category

  31. Chart Carlos CorrectlyStep 7B: Record Abnormal Results • On PM 160, enterfollow up code in appropriate column under “PROBLEM SUSPECTED” • Enter diagnosis under “COMMENTS/PROBLEMS” • Underweight • Overweight • Obese

  32. Accurate Measurements Are Critical • BMI for 5 year old boy • Weight: 43.5 lb • Height: 43.0 in • BMI= 16.5 • BMI-for-age =75-84th percentile • Normal range • If height is inaccurate: • Weight: 43.5 lb • Height: 42.5 in • BMI = 17.0 • BMI-for-age = 85-94th percentile • Overweight range

  33. Practice Using BMI-for-Age Growth Charts Liz - 4 yrs Gabriela - 4 yrs Pete - 4 yrs Photos from UC Berkeley Longitudinal Study, 1973

  34. Plot Pete Perfectly FIRST STEPS Select appropriate growth chart Measure standing height Measure weight

  35. Plot Pete Perfectly NEXT STEP Determine BMI Value

  36. Plot Pete Perfectly NEXT STEP • DetermineBMI-for-age percentile

  37. Plot Pete Perfectly 41004300 9 6 NEXT STEP • Record BMI Percentile on PM 160 • Estimate a whole number between 1 and 99 that best represents the percentile point plotted on the growth chart

  38. Plot Pete Perfectly FINAL STEP • Determine category and record on PM 160 if needed • Enter follow up code in appropriate column under “PROBLEM SUSPECTED” • Enter diagnosis under “COMMENTS/PROBLEMS” • Underweight • Overweight • Obese (03) Obese

  39. Let’s Look at Liz FIRST STEPS Select appropriate growth chart Measure standing height Measure weight

  40. Let’s Look at Liz NEXT STEP Determine BMI Value

  41. Let’s Look at Liz NEXT STEP DetermineBMI-for-age percentile

  42. Let’s Look at Liz NEXT STEP • Record BMI Percentile on PM 160 • Estimate a whole number between 1 and 99 that best represents the percentile point plotted on the growth chart 39103700 8 7

  43. Let’s Look at Liz FINAL STEP • Determine category and record on PM 160 if needed • Enter follow up code in appropriate column under “PROBLEM SUSPECTED” • Enter diagnosis under “COMMENTS/PROBLEMS” • Underweight • Overweight • Obese (03) Overweight

  44. Graph Gabriela’s Growth FIRST STEPS Select appropriate growth chart Measure standing height Measure weight

  45. Graph Gabriela’s Growth NEXT STEP Determine BMI Value

  46. GraphGabriela’s Growth NEXT STEP • DetermineBMI-for-age percentile

  47. Graph Gabriela’s Growth NEXT STEP • Record BMI Percentile on PM 160 • Estimate a whole number between 1 and 99 that best represents the percentile point plotted on the growth chart 41003204 0 3

  48. Graph Gabriela’s Growth FINAL STEP • Determine category and record on PM 160 if needed • Enter follow up code in appropriate column under “PROBLEM SUSPECTED” • Enter diagnosis under “COMMENTS/PROBLEMS” • Underweight • Overweight • Obese (03) Underweight

  49. 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 percentile • interpret weight category • record results on PM 160

  50. Color-coded BMI Charts • 5210Let’sGo!www.letsgo.org/ • Eat Smart, Move MoreNorth Carolinawww.eatsmartmovemorenc.com/ • National Initiativefor Children’s Healthcare Qualitywww.nichq.org/> Childhood Obesity

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