 Infants and children < 24 months of age  Children 24 months and older  Pregnant women

 Infants and children < 24 months of age › Length-for-age › Weight-for –length  Children 24 months and older › Height-for-age › BMI-for-age

 Tells you which growth grids to show depending on the age of the client.  The grids that you should not show are in grey font.  Tells you the cut-offs for short stature, underweight and overweight.

 Which Growth Grids Do We Show for Each Client?

 What grids s › Wei › Len

 Birth to 23 Months ›  2.3 rd percentile weight-for-length  2 – 5 Years ›  5 th percentile BMI-for-age › No changes

 How to explain  Is their growth normal or not?  Do any of the measurements seem incorrect?  Do they need to be referred to the RD?

 Birth to 23 Months ›  2.3 rd percentile length-for-age  2 – 5 Years ›  5 th percentile Height-for-age › No changes

 Birth to 23 Months › > 2.3 rd percentile and  5 th percentile length- for-age  2 – 5 Years › > 5 th percentile and  10 th percentile Height- for-age › No changes

 Birth to 23 Months ›  97.7 th percentile weight-for-length

 2 – 5 Years ›  85 th percentile and < 95 th percentile BMI- for-age › Same definition as the current risk ‘At Risk of Becoming Overweight’

 2 – 5 Years ›  95 th percentile BMI-for-age › Same definition as the current risk “Overweight”

 Hyperthyroidism  Hypothyroidism Additional medical conditions include, but not limited to the following  Congenital Hypothyroidism › Infants born with an under active thyroid  Congenital Hyperthyroidism › Excessive thyroid hormone at birth  Postpartum Thyroiditis

 More specifically defines ‘inborn errors of metabolism’  Expanded the list of examples

 What is important to include when explaining growth grids?  What do you think the caregiver needs to know?

 Take turns  Determine what the risks, are based on the grids. How would you explain the risks without using the risk name.  Explain the grids  What did your partner say that you think worked well?  What do you think should have been said, avoided or explained differently?

 How did you or your partner explain the girds?  What did you think worked well?

 Have you ever seen a/this grid before?  Opens up the conversation about behavior change/the situation

 Calculation used to compare a child’s weight, height and age.  Used to determine if they are gaining to fast or too slow.  Used to determine how they are growing/developing

 Can show if child is getting enough to eat or not. › May be getting too many snacks, getting too many calories. › May not be getting enough to eat

 Overweight (weight/length) – gaining weight faster than what is recommended/expected  Overweight (BMI/age) – gaining weight faster than compared to other children their same age  Short Stature – dropped %tile – not growing as fast as they were  General – Recommended weight is expected between these lines, your child falls _____. What are your thoughts about it?

This is your child’s growth chart. Have you ever seen one before? P: This one shows how tall is compared to other his same age. C: He is close to the. This means that if we had 100 his same age and lined them up from the shortest to the tallest, he would be taller than about and shorter than. E: We like to see children above the 10 th percentile so we don’t have any concerns about his growth right now. How do you feel about that? (What are your thoughts?) We will be following his growth over the next few years to make sure he continues to grow well. (Save education for later)

P: This chart shows how heavy your child is compared to other his same age. C: He is. This means that if we had 100 his same age and lined them up from the heaviest to the thinnest, he would be smaller/thinner/lighter than most of them. E: It looks like his growth has been falling off over the last 6 months and he is not gaining weight. How do you feel about that? (What are your thoughts?) (Save education for later)

P: This chart shows how heavy or thin your child is compared to other his same height. C: He is at the. This means that if we had 100 his same height and lined them up from the thinnest to the heaviest, he would be heavier than most of them. E: This means that he is gaining weight more quickly then expected. How do you feel about that? (What are your thoughts?) (Save education for later)

 With your partner › Try one of the examples discussed to explain the growth grids › Switch and let your partner explain the grids  How did that feel?  What did you try?