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

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

3. 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

4. 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

5. 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

6. 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

7. 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

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

9. Special Considerations
Obese
Consider muscle mass/athletic build
At risk for health problems
Monitor Blood Pressure
Repeat abnormal
Depression
Provide Education

10. 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

11. Health consequences of obesity

12. CDC 2015 Youth Risk Behavior Surveillance Physical Activity Middle School

13. CDC 2015 Youth Risk Behavior Surveillance Dietary habits Middle School

14. Percentage of High School Students Who Had Obesity,* 1999-2015†
These are results from the National Youth Risk Behavior Surveys, 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 The percentage for 2001 is The percentage for 2003 is The percentage for 2005 is The percentage for 2007 is The percentage for 2009 is The percentage for 2011 is The percentage for 2013 is 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 [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,

15. BMI Follow up Identify all referred students
CHEER report
Tracking tool
3 Follow up attempts required
Letter first follow up
Track all subsequent contacts

16. 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

17. 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

18. 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

19. 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

20. 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