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Documentation of growth parameters and body mass index in a paediatric hospital
Elizabeth A Cummings1, Hyacinth John, Heather S Davis
1Departments of Pediatrics and.
Insights
Growth parameters like height and BMI are rarely documented in Canadian pediatric hospital records, hindering the use of new growth charts. Improved documentation practices are essential for effective child health monitoring.
Area of Science:
- Pediatric Health
- Clinical Documentation
- Growth Monitoring
Background:
- Canadian recommendations advocate for 2000 Centers for Disease Control and Prevention (CDC) growth charts and BMI-for-age for children.
- Limited data exists on the frequency of growth parameter documentation in hospital settings.
Purpose of the Study:
- To assess the documentation frequency of growth parameters in medical records at a tertiary care pediatric hospital.
Main Methods:
- A 14-day prospective audit of 491 patient charts from emergency departments and wards.
- Data collected included height/length, weight, head circumference, BMI/weight-for-height, and presence of growth charts.
- Clinic visit data was also reviewed for ward-admitted patients.
Main Results:
- Documentation of height/length was absent in emergency department charts and present in only 42% of ward charts.
- Body Mass Index (BMI) or weight-for-height were seldom recorded.
- Growth charts were found in a small fraction of ward (23%), clinic (1), and emergency department (1) charts.
Conclusions:
- Growth parameter documentation rates in the teaching hospital setting were critically low.
- Implementing new CDC growth charts necessitates education on BMI and improved practices for measuring height and utilizing growth charts.
- A conceptual framework is proposed to aid healthcare providers in counselling.
Background:
New recommendations suggest that the 2000 Centers for Disease Control and Prevention (CDC) growth charts and body mass index (BMI) for age be used for Canadian children. Little information is available on how often growth parameters are documented in hospital settings.
Objective:
To determine the frequency of documentation of growth parameters in the medical records of a tertiary care paediatric hospital.
Methods:
A prospective, 14-day audit of 491 charts of children seen in the emergency department (ED) or admitted to a ward was performed to determine the frequency of documentation of height/length, weight, head circumference, BMI or weight for height, and presence of growth charts. Similar data were sought from the most recent clinic visit for all ward charts.
Results:
Growth parameters, aside from weight, were infrequently documented in the medical record. Height/length was documented in no ED charts and in 42% of ward charts. BMI or weight for height were almost never found, and growth charts were present in only 23% of ward charts, one clinic chart and one ED chart.
Conclusions:
Rates of documentation of growth parameters in the teaching hospital setting were unacceptably low. Implementation of the use of the 2000 CDC growth charts will require not only education regarding BMI but also steps to encourage more regular measurement of height and use of shared growth charts in all areas of the hospital. A simple conceptualization framework for health care providers to use as a counselling tool is presented.
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