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Assessing Child Growth Using the Body Mass Index (BMI)-for-age Growth Charts: A Training for Health Care Providers PowerPoint PPT Presentation


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Assessing Child Growth Using the Body Mass Index (BMI)-for-age Growth Charts: A Training for Health Care Providers. Adapted by the CHDP Bay Area Nutrition Subcommittee (BANS) from Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion

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Assessing Child Growth Using the Body Mass Index (BMI)-for-age Growth Charts: A Training for Health Care Providers

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Assessing Child Growth Using the

Body Mass Index (BMI)-for-age Growth Charts:

A Training for Health Care Providers

Adapted by the CHDP Bay Area Nutrition Subcommittee (BANS) from

Centers for Disease Control and Prevention

National Center for Chronic Disease Prevention and Health Promotion

Division of Nutrition and Physical Activity

Maternal and Child Nutrition Branch

March 2006


BMI-for-age Growth Chart is:

  • considered standard practice by the American Academy of Pediatrics.

  • now required as part of the well-child exam for children ages 2 through 19 by the Child Health and Disability Prevention (CHDP) Program.


Training Objectives

  • Understand BMI and how it is useful to screen for normal growth

  • Learn how to plot BMI on the BMI-for-age growth charts

  • Learn how to assess a child’s growth using BMI-for-age growth charts for early identification of childhood overweight


No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1985

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1986

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1987

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1988

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1989

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1990

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1991

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1992

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1993

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1994

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1995

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1996

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


No Data <10% 10%–14% 15%–19% ≥20

Obesity Trends* Among U.S. AdultsBRFSS, 1997

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


No Data <10% 10%–14% 15%–19% ≥20

Obesity Trends* Among U.S. AdultsBRFSS, 1998

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


No Data <10% 10%–14% 15%–19% ≥20

Obesity Trends* Among U.S. AdultsBRFSS, 1999

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


No Data <10% 10%–14% 15%–19% ≥20

Obesity Trends* Among U.S. AdultsBRFSS, 2000

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)


Obesity Trends* Among U.S. AdultsBRFSS, 2001

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%


Obesity Trends* Among U.S. AdultsBRFSS, 2002

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%


Obesity* Trends Among U.S. AdultsBRFSS, 2003

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%


Pediatric Nutrition Surveillance System (PedNSS) Growth Statistics forCity and County of San Francisco 2004BMI for age > 95% for Children 2-4 Years

All Races 17.90%

not enough data


Pediatric Nutrition Surveillance System (PedNSS) Growth Statistics forCity and County of San Francisco 2004BMI for age > 95% for Children 5-19 Years

All Races 19.20%

White 17.90%


What is BMI?

  • A number that compares a child’s weight to her height

  • Body Mass Index (BMI) =

    Weight (kg) / Height (m)²

  • BMI is an effective SCREENING tool; alone it is nota diagnostic tool


BMI is Not the Same for Adults and Children

  • Adult BMI is evaluated by use of cut-off numbers; for example BMI >30 is indicative of adult obesity

  • There are no BMI cut-off numbers for children. The BMI number must be plotted on the BMI-for-age growth chart

  • The BMI for children is useful only when it is plotted on the “BMI-for-age Growth Chart”


For Children, BMI Changes with Age

BMI

BMI

Example:

95th percentile tracking

Age BMI

2 yrs 19.3

4 yrs 17.8

9 yrs 21.0

13 yrs 25.1

Boys: 2 to 20 years

BMI

BMI


Importance of Using BMI-for-age

  • Tracking tool for body size starting at age 2 years through adulthood

  • Only indicator that examines weight, stature AND age for a child on a single growth chart

  • Correlates with clinical risk factors for chronic disease including hyperlipidemia, elevated insulin, and high blood pressure


BMI is Only an Indirect Measure of Body Fat


Using BMI-for-age Percentiles to Assess Risk

> 95th percentileOverweight

85th to < 95thRisk of percentileoverweight

< 5th percentileUnderweight


What is a Percentile?

50th Percentile

85th

5th

95th


CDC Standardized Growth Chart

Formula to calculate BMI

Percentiles (5th,10th,25th, 50th, 75th,85th,90th,95th)

Published May 30, 2000


Using BMI-for-age Percentiles to Assess Risk

> 95th percentileOverweight?

85th to < 95thRisk of percentile overweight?

< 5th percentileUnderweight?

Growth acceleration or deceleration across 2 percentile lines


What is “Adiposity” Rebound (AR)?

  • A rebound or increase in BMI that occurs after it reaches its lowest point, usually between ages 4 to 6.

  • Normal pattern of growth

  • An early "adiposity" rebound, occurring before ages 4 to 6, is associated with obesity in adulthood.

BMI


Normal “Adiposity” Rebound

Early “Adiposity” Rebound

BMI

BMI


Steps to Plot BMI-for-age

  • Obtain accurate weight and height measurements

  • Select the appropriate growth chart

  • Record the data

  • Calculate BMI

  • Plot measurements

  • Interpret plotted measurements


BMI

BMI

Boys: 2 to 20 years

BMI

BMI

  • Obtain Accurate Weight and Height Measurements

  • Accurate Measurements are Critical

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


2. Select the Appropriate Growth Chart

  • For ages birth to 36 months old:

    • “Length-for-age,” and “Weight-for-age”

    • “Weight-for-length,” and “Head Circumference-for-age”

  • For ages 2 to 20 years:

    • “Weight-for-age,” and “Stature-for-age”

    • Body Mass Index “BMI-for-age”


3. Record Data


4. Calculate BMI

English:

Wt (lbs.) ÷Ht (in.) ÷ Ht (in.) x 703

Metric:

Wt (kg.) ÷Ht (cm.) ÷ Ht (cm.) x 10,000


4. Calculate BMI

  • Use a Pediatric BMI Wheel


5. Plot Measurements

95th

85th

75th

50th

BMI

5th

Age


6. Interpret the BMI-for-age Chart

  • Need a series of BMI plots to determine the growth trend

  • If growth deviates from expected growth pattern, further assessment may be needed


Practice using “BMI-for-age” Growth Chart

Pete (3 y)

Gabriella (4 y)

Liz (4 y)

Photos from UC Berkeley Longitudinal Study, 1973


Please Plot Pete Perfectly

Measurements for Pete:

Age= 3 y 3 wks

Weight= 41 lbs (18.6 kg)

Height= 39.7 in (100.8 cm)

Find BMI, plot, & interpret growth trend

BMI= Wt ( lbs) ÷ Ht (in) ÷ Ht (in) x 703

Photo from UC Berkeley Longitudinal Study, 1973


BMI

BMI

Boys: 2 to 20 years

BMI

BMI

Answers: Pete’s “BMI-for-age”

BMI=18.3

  • Interpretation:

  • BMI-for-age = >95th percentile

  • Overweight

  • Of 100 boys the same age, more than 95 have a lower BMI-for-age


Let’s Look at Liz

Liz


Liz’s - BMI

17.7

Liz


2-3-02


Graph Gabriella’s Growth


Gabriella’s BMI


Please Identify Overweight Children on PM160

Put comments here

ex: overweight, > 95th % BMI


References

  • Guidelines for Overweight in Adolescent Preventive Services (Am J Clin Nutr 1994;59:307-316)

  • Obesity Evaluation and Treatment: Expert Committee Recommendations (Pediatrics 1998 Sept;(102)3:e 29)

  • Assessment of Childhood and Adolescent Obesity: International Obesity Task Force (Am J Clin Nutr 1999, 70,suppl)

  • Centers for Disease Control and Prevention Website (www.cdc.gov/growthcharts)

  • American Academy of Pediatrics Policy Statement: Prevention of Pediatric Overweight and Obesity (Pediatrics 2003 Aug (112)2; 424-430)


Please visit:

www.cdc.gov/growthcharts/

  • For additional training materials related to the growth charts

  • For tools related to the growth charts

  • To download the growth charts


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