Tools for the Dig:Using ABC(E) including the new growth grids

“A” Anthropometrics

• Nothing is changing about the conversational approach to the “A” assessment, you will now just have new aids in AIM to help you

• Growth charts are an important aid used in nutrition assessment to help interpret growth. There are new charts for children birth-2 years old that will be in AIM

• Prenatal weight gain grids are an important aid used in nutrition

assessment to interpret the rate of pregnancy weight gain and will now be in AIM

Discussion

• How do you use growth charts and pregnancy grids now?

• When do you show growth charts to parents or pregnancy grids to moms?

• How do you describe them to women or caregivers?

Pediatric Growth Chart History

1 reference refers to how children HAVE grown in a particular time and place

2 standard refers to how children SHOULD grow regardless of time or place

1 reference refers to how children HAVE grown in a particular time and place

2 standard refers to how children SHOULD grow regardless of time or place

Differences you will notice between WHO & CDC charts

• WHO charts range from 2nd percentile to 98th percentile

• CDC charts will continue to range from 5th percentile to 95th percentile

• In general, less children will plot below 5th percentile and more will plot above the 95th percentile weight-for-length on WHO grids

• In general, more infants will be below 5th percentile length-for- age on WHO charts

Recommendations

• American Academy of Pediatrics (AAP), National Institutes of Health (NIH) and CDC recommend national use of WHO charts from birth to 2 years and continued use of the CDC charts from 2 to 20 years

• USDA has implemented these same recommendations for WIC nutrition assessment

Arizona Implementation WHO and CDC charts

• WHO Charts added to AIM for Birth-2 yr olds, CDC charts will remain for 2-5 year olds

• AIM will select and plot the appropriate charts based on age of child

• We know most parents do not understand percentiles, or incorrectly interpret what they mean

• Effective communication with parents avoids referring to the percentile number and focuses more on the velocity of growth over time, or the range of “normal”

Arizona Implementation Pregnancy Weight Grids

• Pregnancy weight gain grids added to AIM

• AIM will select and plot the appropriate grid based on the pre-pregnancy BMI

• Can be utilized as a nutrition education aid when mom is interested in discussing pregnancy weight gain

New Risk Factors

103 103.1 and 103.2 • 103.1

– IEN, IPN, IFF, C1 wt/length < 2nd percentile (WHO)– C2, C3, C4 BMI/age < 5th percentile (CDC)

• 103.2– IEN, IPN, IFF, C1: wt/length > 2nd% but < 5th%

(WHO)– C2, C3, C4: BMI/age >5th % but < 10th % (CDC)

Now

HR

New Risk Factors

114• IEN, IPN, IFF, C1: Family history of BMI > 30*

• C2, C3, C4: BMI/age > 85th % but < 95th % (CDC) OR Family history of high BMI > 30*

• *AIM will auto-calculate family history risk if weight for mom entered on same day as child and the two are linked, but can also be hand assigned

New Risk Factors

115

IEN, IPN, IFF, and C1: Weight/length > 98th percentile (WHO)

New “High Risks”

111

PG1, PG2, EN, PN, P: Pre-pregnancy BMI was > 25

113

C2, C3, C4: BMI/age > 95th percentile

HR

HR

“B”, “C”, “E”

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Having Conversations about Weight and Growth

“A” Assessment

• In the lab, you ask mom “how do you feel about Ally’s growth?”

• Mom replies “ok, she seems a little small compared to my niece, but other than that it’s fine”

• You ask “what has the Dr. said about her growth?”

• Mom responds, “nothing much he says she is fine”

AIM

• Ally’s BMI for age is < 5 percentile

• AIM assigns 103.1

Initial Shovel Full

• What would you say about Ally’s growth to mom as you look at growth chart?– In general we look for growth to plot

somewhere between these lines, Ally is plotting here today

– We only have one measurement to look at today, what is more important is how she will grow over time, next month we’ll measure her again and see if she stays on a healthy track for her

Digging Deeper

• What things that come to mind that you may want to dig deeper about in your assessment?– Recent illness?– Growth history of Ally and family members?– Physical activity levels?– Concerns about eating, what is meal time

like?

Under the Surface

• What may be under the surface for mom?– Worried?– Is she doing something wrong?– Tired of hearing that Ally is small?

“A” Assessment

• In the lab, you ask mom “how do you feel about Maria’s growth?”

• Mom replies “Good! She’s always hungry and we just started solids and she loves them!”

• You ask “what has the Dr. said about her growth?”

• Mom responds, “she said that she is growing great!”

AIM

• Maria’s wt/length is > 98th percentile

• AIM assigns 115

Initial Shovel Full

• What would you say about Maria’s growth to mom?– In general we look for growth to plot

somewhere between these lines, Maria is plotting here today

– We only have one measurement to look at today, what is more important is how she will grow over time, next month we’ll measure her again and see if she stays on a healthy track for her

Digging Deeper

• What things that come to mind that you may want to dig deeper about in your assessment?– Growth history for Maria? Other family

members?– Concerns about feeding?– Hunger cues?– Feeding routine? Amounts?

Under the Surface

• What may be under the surface for mom?– Worried?– Guilt?– Is she doing something wrong?– Tired of hearing that Maria is big?– Happy, big babies are healthy babies?

Getting out of Traffic

Things we know about AIM

Look of Growth Charts

• There are times that the plot on the grid doesn’t seem to match the numerical percentile….

YOU CAN TRUST THE NUMERICAL PERCENTILE

Look of Growth Charts

Pregnancy Weight Grids

• Pregnancy grids will not plot anything under “zero” so any weight loss below pre-pregnancy weight will not plot

APPROPRIATE RISK FACTOR WILL STILL CALCULATE

Pregnancy Weight Grids

Pregnancy Weight Grids

Out of State Transfers

• AIM will accept cert start dates that are more than 6 months out allowing children from states with 1 year certs to transfer in appropriately

• What we know…transferring children that were on AZ WIC, left the state and come back, take home message.. Change “application date” to current date instead of the original date

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Take Home Messages

• Effective communication does not include the percentile number in growth conversations with families

• Baby behavior messaging and information does not change what information you gather during your ABC(E) Assessment

Questions?