1. Tools for the Dig: Using ABC(E) including the new growth grids

2. “A” Anthropometrics Nothing is changing about the conversational approach to the “A” assessment, you will now just have new aids in AIM to help you Growth charts are an important aid used in nutrition assessment to help interpret growth. There are new charts for children birth-2 years old that will be in AIM Prenatal weight gain grids are an important aid used in nutrition assessment to interpret the rate of pregnancy weight gain and will now be in AIM

3. Discussion How do you use growth charts and pregnancy grids now? When do you show growth charts to parents or pregnancy grids to moms? How do you describe them to women or caregivers?

4. Pediatric Growth Chart History 1 reference refers to how children HAVE grown in a particular time and place 2 standard refers to how children SHOULD grow regardless of time or place 1 reference refers to how children HAVE grown in a particular time and place 2 standard refers to how children SHOULD grow regardless of time or place

5. Differences you will notice between WHO & CDC charts WHO charts range from 2 nd percentile to 98 th percentile CDC charts will continue to range from 5 th percentile to 95 th percentile In general, less children will plot below 5 th percentile and more will plot above the 95 th percentile weight-for-length on WHO grids In general, more infants will be below 5 th percentile length-for- age on WHO charts

6. Recommendations American Academy of Pediatrics (AAP), National Institutes of Health (NIH) and CDC recommend national use of WHO charts from birth to 2 years and continued use of the CDC charts from 2 to 20 years USDA has implemented these same recommendations for WIC nutrition assessment

7. Arizona Implementation WHO and CDC charts WHO Charts added to AIM for Birth-2 yr olds, CDC charts will remain for 2-5 year olds AIM will select and plot the appropriate charts based on age of child We know most parents do not understand percentiles, or incorrectly interpret what they mean Effective communication with parents avoids referring to the percentile number and focuses more on the velocity of growth over time, or the range of “normal”

8. Arizona Implementation Pregnancy Weight Grids Pregnancy weight gain grids added to AIM AIM will select and plot the appropriate grid based on the pre-pregnancy BMI Can be utilized as a nutrition education aid when mom is interested in discussing pregnancy weight gain

9. New Risk Factors 103103.1 and 103.2 103.1 –IEN, IPN, IFF, C1 wt/length < 2 nd percentile (WHO) –C2, C3, C4 BMI/age < 5 th percentile (CDC) 103.2 –IEN, IPN, IFF, C1: wt/length > 2 nd % but < 5 th % (WHO) –C2, C3, C4: BMI/age >5 th % but < 10 th % (CDC) Now HR

10. New Risk Factors 114 IEN, IPN, IFF, C1: Family history of BMI > 30* C2, C3, C4: BMI/age > 85 th % but 30 * * AIM will auto-calculate family history risk if weight for mom entered on same day as child and the two are linked, but can also be hand assigned

11. New Risk Factors 115 IEN, IPN, IFF, and C1: Weight/length > 98 th percentile (WHO)

12. New “High Risks” 111 PG1, PG2, EN, PN, P: Pre-pregnancy BMI was > 25 113 C2, C3, C4: BMI/age > 95 th percentile HR

13. “B”, “C”, “E”

14. Having Conversations about Weight and Growth 14

15. “A” Assessment In the lab, you ask mom “how do you feel about Ally’s growth?” Mom replies “ok, she seems a little small compared to my niece, but other than that it’s fine” You ask “what has the Dr. said about her growth?” Mom responds, “nothing much he says she is fine”

16. AIM Ally’s BMI for age is < 5 percentile AIM assigns 103.1

17. Initial Shovel Full What would you say about Ally’s growth to mom as you look at growth chart? –In general we look for growth to plot somewhere between these lines, Ally is plotting here today –We only have one measurement to look at today, what is more important is how she will grow over time, next month we’ll measure her again and see if she stays on a healthy track for her

18. Digging Deeper What things that come to mind that you may want to dig deeper about in your assessment? –Recent illness? –Growth history of Ally and family members? –Physical activity levels? –Concerns about eating, what is meal time like?

19. Under the Surface What may be under the surface for mom? –Worried? –Is she doing something wrong? –Tired of hearing that Ally is small?

20. “A” Assessment In the lab, you ask mom “how do you feel about Maria’s growth?” Mom replies “Good! She’s always hungry and we just started solids and she loves them!” You ask “what has the Dr. said about her growth?” Mom responds, “she said that she is growing great!”

21. AIM Maria’s wt/length is > 98 th percentile AIM assigns 115

22. Initial Shovel Full What would you say about Maria’s growth to mom? –In general we look for growth to plot somewhere between these lines, Maria is plotting here today –We only have one measurement to look at today, what is more important is how she will grow over time, next month we’ll measure her again and see if she stays on a healthy track for her

23. Digging Deeper What things that come to mind that you may want to dig deeper about in your assessment? –Growth history for Maria? Other family members? –Concerns about feeding? –Hunger cues? –Feeding routine? Amounts?

24. Under the Surface What may be under the surface for mom? –Worried? –Guilt? –Is she doing something wrong? –Tired of hearing that Maria is big? –Happy, big babies are healthy babies?

25. Getting out of Traffic

26. Things we know about AIM

27. Look of Growth Charts There are times that the plot on the grid doesn’t seem to match the numerical percentile…. YOU CAN TRUST THE NUMERICAL PERCENTILE

28. Look of Growth Charts

29. Pregnancy Weight Grids Pregnancy grids will not plot anything under “zero” so any weight loss below pre- pregnancy weight will not plot APPROPRIATE RISK FACTOR WILL STILL CALCULATE

30. Pregnancy Weight Grids

32. Out of State Transfers AIM will accept cert start dates that are more than 6 months out allowing children from states with 1 year certs to transfer in appropriately What we know…transferring children that were on AZ WIC, left the state and come back, take home message.. Change “application date” to current date instead of the original date

33. Take Home Messages Effective communication does not include the percentile number in growth conversations with families Baby behavior messaging and information does not change what information you gather during your ABC(E) Assessment 33

34. Questions?