Growth and Development Screening Cindy Harrah ARNP, MSN Nicklaus Children’s Hospital

Bmi screening Mandates FL Statute 381.0056(4)(a)(6-9) Provision of screenings Florida Administrative Code Chapter 64F- 6.003 Grade level mandates for screening Growth and Development First Third Sixth Ninth Optional for State Required for TCT

Procedure for Height and weight Standard Scale-calibrated for accuracy Remove bulky clothing Subtract 1 pound for remaining clothing Record to the nearest ½ pound Height Remove shoes if possible Subtract ½ inch if unable to remove shoes Wall mount or Stadiometer Heels, buttocks, and shoulder blades against surface Right angle block to crown of head

Bmi calculation Calculation of BMI and BMI Percentile Growth Charts CHEER CDC 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 measure Trend growth/weight patterns May indicate potential for health problem

Obesity Definition based on BMI Pediatrics Obese - BMI> 95% for gender and age At risk/overweight - BMI=85-94% Adults Obese – BMI> 30 Overweight – BMI=25-30

BMI and Cheer Enter screening results in CHEER Indicate referral Including opt out Indicate referral < 5% automatic referral > 95% referral Excludes athletic build BP required Print appropriate letter Now available in CHEER

BMI procedure BMI Results Interpretation < 5% Underweight Automatic referral 5->85% Healthy Weight 85->95% Overweight At risk for health problems Referral at RN discression 95% Obese Excludes students with athletic build (RN discrestion) Requires Blood Pressure BMI results letters generated and sent to parent Referral Non-referral Maintain confidentiality Nutrition Education materials distributed to student and parent

Special Considerations Underweight Should be evaluated by RN Underlying cause Disease process Neglect Financial resources Depression Body image Provide education

Special Considerations Obese Consider muscle mass/athletic build At risk for health problems Monitor Blood Pressure Repeat 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† These are results from the National Youth Risk Behavior Surveys, 1999-2015. This slide shows percentages from 1999 through 2015 for high school students who had obesity ( ≥ 95th percentile for body mass index, based on sex- and age-specific reference data from the 2000 CDC growth charts). The percentage for 1999 is 10.6. The percentage for 2001 is 10.5. The percentage for 2003 is 12.0. The percentage for 2005 is 13.0. The percentage for 2007 is 12.8. The percentage for 2009 is 11.8. The percentage for 2011 is 13.0. The percentage for 2013 is 13.7. The percentage for 2015 is 13.9. 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). For this behavior, based on linear and quadratic trend analyses using logistic regression models controlling for sex, race/ethnicity, and grade (p < 0.05), the prevalence increased from 1999 to 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 report Tracking tool 3 Follow up attempts required Letter first follow up Track all subsequent contacts

BMI Follow Up Complete versus incomplete referral Complete referral Returned MD Letter ideal Healthy Lifestyle Intervention RN level CHEER documentation Encounter Follow up Incomplete Referral Parent contact established Refusal of intervention/PCP care/nutrition consult PCP appointment not completed No parent contact Student withdrawn from school

Healthy lifestyle Intervention Previously- Obesity Intervention Completed by RN Referred students > 95% Intervention (service code 5054) Parental Consent required Health education and counseling Individual Health Care Plan Completion of one goal 5 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 screening Add follow up Complete Healthy Lifestyle Intervention (Obesity Intervention) Returned signed PCP referral letter Incomplete No parent contact Parent contacted only

Document in cumulative Health record Screening results documented in cumulative health record Health Jacket (DOH-3041) Record dates of screening, referral, and outcome Record results, referral and outcome in narrative* Screening form (optional) placed in health jacket Results, referral, and outcome documented on form only Recommend stapling to Health Jacket

Resources Center for Disease Control Florida School Health Administrative Guidelines (2012-update pending) Manual For School Health Facilitators School Health Service Plan Miami Dade County