NGHC: Childhood Nutrition and Growth (2013)

Citation:
 
Study Design:
Class:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:

To provide recommendations that will promote consistent practices in monitoring growth and assessing atypical patterns of linear growth and weight gain in infants, children and adolescents.

Inclusion Criteria:

Not described in executive summary.

Exclusion Criteria:

Not described in executive summary.

Description of Study Protocol:

Recruitment

Searches of the MEDLINE, CINAHL and EBM review databases were conducted using the following key words: 

  • Anthropometry
  • Child growth
  • Child health
  • Failure to thrive
  • Growth
  • Growth assessment
  • Growth charts
  • Growth monitoring
  • Height
  • Nutritional status.

This executive summary did not specify whether study quality was assessed. Nor did it describe type of interventions, outcomes and populations investigated.

Design

Consensus statement.

Data Collection Summary:

Not applicable.

Description of Actual Data Sample:
  • Initial N: Number of identified articles not described.
  • Attrition (final N): Number of included articles not described.
  • Location: Canada.
Summary of Results:

Recommendations

  • Serial measurements of recumbent length (birth to two to three years) or height (two years and older), weight and head circumference (birth to two years) should be part of scheduled well-baby and well-child health visits. This will help identify disturbances in rates of weight gain or physical growth.
    • Although the ideal number of health maintenance visits for children has not been established, current recommendations are that they be organized according to the immunization schedule, with additional visits within the first month and also at nine months of age (i.e., within one to two weeks of birth; at one, two, four, six, nine, 12, 18 and 24 months; and at four to six years)
    • The frequency for monitoring older children and adolescents is not known, however it seems reasonable to continue monitoring growth on an annual basis at primary care visits for the early identification and referral of a child whose growth appears abnormal
    • More frequent monitoring may be indicated in cases where potential or real growth concerns are identified or a child’s response to therapy is being monitored
    • Children who are not brought for the recommended well-baby and well-child health visits should be measured during unwell visits (I recommendation).
  • To yield accurate measurements, weights and measures should be obtained using calibrated, well-maintained quality equipment and standardized measurement techniques
    • An individual child’s measurements should be recorded in the data table of a consistent growth chart appropriate for the child’s age and sex and then plotted to identify any disturbances in height or weight gain
    • When plotting anthropometric measurements of premature infants, corrected age should be used at least until 24 to 36 months of age. To identify major shifts in growth patterns, interpretation of plotted measurements should consider their percentile rank, their relationship to each other, recommended cut-off values, parental heights (for stature measurements) and comparison with previous percentile ranks (B recommendation).
  • Growth charts from the CDC (www.cdc.gov/nchs/about/major/nhanes/growthcharts/charts.htm) are recommended for use by Canadian family physicians, pediatricians, dietitians, nurses and other health professionals until internationally diverse growth charts have been reviewed and are available in Canada (I recommendation)
  • Health care providers are encouraged to take the time to teach children and their caregivers how to interpret the growth chart (I recommendation)
  • Growth of breastfed infants can be evaluated on the CDC growth charts by taking into account the type of feeding. Health care providers should be aware of the potential differences in growth between breastfed and formula-fed infants (B recommendation).
  • BMI-for-age is recommended to screen children two years or older to identify those who may be at risk for conditions and illnesses related to excess body fat (B recommendation)
  • BMI is an anthropometric index of weight and height, defined as body weight in kilograms divided by height in meters squared
    • For Canadian children, the CDC BMI-for-age charts are recommended for use in clinical and community settings
    • Use of the international BMI chart is recommended when comparing prevalence data for BMI for international populations (I recommendation).
  • Traditional measures of underweight, such as percentage ideal body weight or weight-for-length/stature percentile (available for use up to approximately five years of age), continue to be recommended until the validity of using BMI to assess underweight is established (to calculate percentage ideal body weight (%IBW), plot length or height on growth chart to identify length- or height-forage percentile, locate IBW as the weight at the same percentile as the height for the same age and sex, divide actual weight by ideal body weight and multiply by 100 (%IBW= actual weight / IBW x 100). Alternatively, in children two years and older, BMI-for-age may be used to screen for underweight, with an awareness of the existing limited experience of its role in underweight assessment (I recommendation).
  • The following cut-offs are recommended as guidance for further assessment, referral or treatment, but not as diagnostic criteria for labelling children:
    • Shortness or stunting: Length-for-age or height-for-age less than the third percentile (I recommendation)
    • Underweight or wasting: BMI-for-age less than the fifth percentile, body weight 89% or less of ideal or weight-for-length or stature less than the third percentile (charts available from birth to five years) (I recommendation)
    • Overweight: BMI-for-age between the 85th and 95th percentile (I recommendation)
    • Obesity: BMI-for-age at 95th percentile or higher (B recommendation).
  • Given the rising prevalence of pediatric obesity and the associated short- and long-term health risks, routine screening for obesity is recommended as part of the pediatric health maintenance visit (I recommendation)
  • Children suspected to be overweight, with a BMI-for-age more than or at the 85th percentile with complications of obesity or with a BMI-for-age more than or at the 95th percentile, with or without complications, should undergo evaluation and possible treatment (I recommendation). A family-centered approach is recommended to promote healthy eating and physical activity and reduce sedentary activity (B recommendation).
Author Conclusion:

Implications for health care professionals include:

  • The need for accessible training for practitioners on performing accurate and reliable anthropometric measurements using the new CDC growth charts and calculating and interpreting BMI in children and adolescents
  • The demand for resources including:
    • Accurate (and sometimes portable) measuring equipment
    • Population health strategies for the prevention of excessive weight gain
    • Treatment programs for pediatric obesity
    • Health care professionals trained in behavior modification therapy.
  • The need for professional organizations and health agencies to collaborate by publicizing the gravity of the obesity epidemic and reminding their members to address the problem with the public. This includes maximizing the limited community resources to realize healthy outcomes for children.
Funding Source:
Not-for-profit
Dietitians of Canada, Canadian Paediatric Society, The College of Family Physicians of Canada, and Community Health Nurses Association of Canada
Other non-profit:
Reviewer Comments:

The executive summary did not provide a great deal of detail about the review. Specifically, it is not known how many articles were included, what types of studies were reviewed and how the authors used the review to form recommendations.

Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? Yes
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? Yes
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? No
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? No
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes