How to Accurately Weigh and Measure Children for the CHDP Well-child Exam September 2007 Talking Points: The work you do is very important because you are critical in determining the health status of a child. Today we’re going to talk about a job that you’re very familiar with, weighing and measuring children. This is a routine job that can be very difficult especially when the office is busy or chaotic. When you do a job over and over throughout the day, especially under time constraints, it is often natural to stop paying attention to your technique as you fall into a routine. The purpose of this training is to help you focus back on the details so you can keep your technique sharp. Developed by the Statewide CHDP Nutrition Subcommittee from the on-line training module: “Accurately Weighing & Measuring Infants, Children and Adolescents: Technique” U.S. Dept. of Health and Human Services; Health Resources and Services Administration; Maternal and Child Health Bureau http://depts.washington.edu/growth/

9 Million Kids Are Overweight Talking Points: With the obesity epidemic, the importance of measuring children to assess risk has really come into focus. 2005 2000

Overweight & Obese Children California children ages 2 to <5 years Talking Points: What does the picture look like in ‘X’ county? All of you are seeing many overweight children in the clinic. When we look at the data on pediatric BMI of CHDP children, 2 to less than 5 years of age in our county, we see in fact that what you are experiencing is supported by the data. The data that you are looking at comes directly from the height and weight measurements you take in clinic. The measurements that are recorded on each clinic’s PM160s are sent to the CDC and compiled into a report that is then made available to each county. Background Information: This slide provides an example of one way to display PedNSS data. You may arrange your data in any format that works for you. Website reference for current PedNSS data: http://www.dhs.ca.gov/pcfh/cms/onlinearchive/pdf/chdp/informationnotices/2005/chdpin05d/contents.htm Go to: Table 16B, Growth Indicators by Race/Ethnicity and Age, Children aged 2 to < 5 years. Use the most current data to report on the incidence of overweight and obesity in your county. Show data for the most prevalent races in your county. 2005 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report

Overweight & Obese Children California children ages 5 to <20 years Talking Points: This slide presents a picture of the percentage of children in ‘X’ County, 5 through 19 years of age, who are overweight and obese (85th - <95th and > 95th percentile BMI-for-age) by ethnicity. Background Information: Note: This slide represents children 5 through 19 years, whereas the previous slide represented children 2 to < 5 years of age. Again, you may arrange your data in any format that works for you, keeping in mind that PedNSS data is divided into two age categories. Website reference for current PedNSS data: http://www.dhs.ca.gov/pcfh/cms/onlinearchive/pdf/chdp/informationnotices/2005/chdpin05d/contents.htm Go to: Table 16B, Growth Indicators by Race/Ethnicity and Age, Children aged 5 through 19 years. Use the most current data to report on the incidence of overweight and obesity in your county. 2005 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report

Agenda Importance of accuracy Challenges Video: Standard technique Practicing proper technique Background Information: Allowing for participants to share ‘Additional Items’ of concern enables you to tailor your presentation to your audience.

Measurements You Take are Important Height, length, and weight tell providers if a child has a: Growth problem Feeding problem Emotional or social problem at home Illness Talking Points: Growth provides a window into a child’s life: Growth reflects illness such as infection, feeding problems, and emotional/social problems at home.

Measurements You Take are Important 95% 90% 5 year old boy Weight: 43.5 lb Height: 43 in BMI= 16.5 BMI-for-age = 75-84th %tile Inaccurate height measurement: 42.5 in BMI=17 BMI-for-age = 85-94th %tile 85% 75% 50% Talking Points: Measurements obtained by standard technique produce accurate results. Proper growth screening depends on accuracy. The type of error displayed in this example can easily happen if a child slouches (demonstrate by slouching to show how much height differs compared to when standing tall)

Your Measurements Guide Providers In-depth Medical Assessment Your Measurements Weight Height Age Plot Obese Overweight BMI % Growth Chart + Extra tests Normal Talking Points: As you can see, taking height and weight measurements is the first step in a long process. Errors at the 1st step can result in false assignment of risk, extra work for the provider, and unnecessary worry for the parent. Underweight - Note in chart “No Therapeutic Action”

Your Measurements Guide Many Others BMI % Growth Chart WIC Schools Parents PedNSS Data Your Measurements Weight Height Age Plot HeadStart Talking Points: Many different people depend and rely on the weights and heights taken in a provider's office, so it's important to carefully and accurately measure: WIC computers automatically classify children based on your measurements. School nurses refer students and plan programs based on your measurements. Parents and children modify feeding and physical activity behaviors based on your measurements. The obesity data (PedNSS) tht we looked at earlier comes directly from the height and weight measurements you take in the clinic. All these groups expect that the measurements that come from your office are accurate, in fact they assume that your measurements are more reliable than measurements taken anywhere else.

It’s difficult to weigh and measure children… “What challenges do you face?” Background Information: This is an important sharing time with your audience. Use this information to individualize your training. (Refer to speaker handout found in your training packet for common challenges and how to approach them.)

Before you begin: 1. Determine equipment needed for patient 2. Check equipment: clean; safe; good repair 3. Balance scale to zero Background Information: Infants and children require different equipment Reassure staff that if equipment is damaged or unsuitable, you will provide the office manager with information that will help resolve the problem. Equipment must be calibrated yearly according to HRSA* guidelines. Your equipment must have proof of calibration on the equipment. *HRSA (Health Resources and Services Administration) is part of the U.S. Dept of Health and Human Services and helps provide health resources for medically underserved populations.

Measure Lying or Standing? Length (Lying) Unable to stand without assistance Use Birth - 36 months growth chart Stature (Standing) Able to stand without assistance Use 2-20 years growth chart

Measuring Length Talking Points: 2 critical points to remember from the video are: 1. Assistant or parent holds head firmly against headboard, and 2. With one hand, hold infant knees down, straightening the hips and knees

Measuring Stature (Height) Talking Points: Heels, buttocks, and shoulder blades touch the wall or measuring surface. Head looks straight ahead.

Weighing Infants and Toddlers Talking Points: Use the Birth - 36 month growth chart  Up to 36 months if unable to stand without assistance

Alternate Weighing Method 1. Weigh parent and child 2. Weigh parent alone 3. total weight - parent’s weight = child’s weight Talking Points: If a child is too scared or too squirmy to be weighed on his own, use this alternate weighing method. Or, you may measure a child later in the appointment when they may be calmer.

Weighing Children and Adolescents Undergarments Gown Lightweight outer clothing Socks/bare feet Talking Points: Shoes can add 2 pounds to a child’s weight Heavy clothes and shoes can change a child’s BMI

Privacy Considerations In a private area or exam room: Remove clothes; offer gown Take measurements Discuss results Talking points: Your clinic should have a clear procedures for assuring the privacy of patients.

Please visit: http://depts.washington.edu/growth/ For training modules: “Accurately Weighing & Measuring Infants, Children and Adolescents: Equipment & Technique” U.S. Dept. of Health and Human Services Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau

Practice Time Talking Points: Let’s practice standard technique on your equipment. Background information: Have staff weigh and measure each other and a doll instead of an infant, and assess their technique and ability to read results.