Documentation of growth parameters and body mass index in a paediatric hospital

In March 2004, the Canadian Paediatric Society (CPS) published a position statement regarding the use of growth charts for the assessment and monitoring of growth in Canadian infants and children (1). The statement acknowledged the pre-eminent role of growth assessment in defining health and nutritional status in children and recommended the use of the 2000 Centers for Disease Control and Prevention (CDC) growth charts as the growth reference. Body mass index (BMI) for age was recommended for general use as a screen for overweight in children aged two to 20 years (1). This is similar to recent recommendations of the American Academy of Pediatrics to calculate and plot BMI once a year in all children (2). There is, however, little information on how often growth parameters are currently documented in hospital settings. One audit of medical records from paediatric specialty clinics from 1973 in a university medical centre found that growth charts were deficient in 45% of cases (3). An audit of emergency room charts in 1997 found that children were weighed before drugs were prescribed in only two of 100 cases (4). A recent survey of community paediatricians in North Carolina, USA, revealed that although the use of BMI for age was more likely to lead to the identification of weight problems, most paediatricians still used a combination of weight and height charts, a practice that may lead to underestimation of childhood overweight (5). The introduction of new growth charts provides an opportunity to examine our approach to alterations in normal growth. While the prevalence of growth problems such as short stature has not increased, the prevalence of children who are overweight or at risk for overweight in Canada has risen and become a major public health concern (6). Routine measurement using accurate techniques, an appropriate growth reference and BMI for age form the basis for approaching this problem. Health care professionals then require tools to assist them in addressing the pressing issues of assisting families to maintain or achieve a healthy BMI. Before the introduction of the 2000 CDC growth charts at the IWK Health Centre, Halifax, Nova Scotia, we undertook an audit of the frequency of documentation of growth parameters in hospital charts. In the present paper, we report the results of the audit and present the “Green Zone”, a conceptual framework we have developed for health care providers that links the importance of healthy eating, healthy activity and BMI.