Growth Chart Use

Case Study Worksheet

2014

Background information for completing the case studies

The following case studies were developed to support health professionals working in public health and ambulatory care settings become familiar with the Canadian Pediatric Endocrine Group (CPEG) growth charts and accompanying resources. Each case study includes:

a well child clinic scenario including plotted growth measurements; and

questions addressing how to interpret the child’s growth pattern, additional information to consider, key messages for families, dialogue examples, and actions/next steps required.

An answer guide to assist with discussion of the case studies is available for reference when reviewing the case studies. The information provided in the case study answer guide is

based on the information and growth measurements provided in the case study. The

interpretation of growth in a real life situation may differ from what is presented in the

answer guide based on additional information collected and professional judgment. Further detail on topics such as growth chart selection, interpreting growth patterns and recommended cut-off points, key messages and actions are available in the following resources:

Protocol: Growth Chart Use

Summary Sheet: Growth Monitoring Summary Sheet Health professionals are encouraged to attend training sessions being provided throughout Alberta on: Growth Chart Use.

Case Study #1: Baby Samuel – 12 months Baby Samuel was born at term and was formula fed from about 3 days of age onwards. Solid foods were introduced just before 6 months; however mom reports that Sam does not eat many solid foods and those that he does eat are a soft or pureed texture. Sam was transitioned from infant formula with iron to whole milk at 9 months of age. Mom indicates that Sam has had several recent ear infections and seemed to have a decreased appetite during the ear infections.

Length-for-age

Weight-for-age

Weight-for-length

Refer to the Protocol (section 5) and Summary Sheet to assist with answering the questions below.

1. How would you describe Sam’s growth pattern?

Length-for-age:

Weight-for-age:

Weight-for-length:

2. In order to explore all the factors that may be influencing Sam’s growth, what

additional information would you consider and/or discuss with his parent(s) [i.e.

Standard Discussion Points]?

3. Based on all the information gathered above, what conclusions would you draw

and how would you use this to facilitate goal setting and provide support to the

family/parent(s)? Specifically, consider the following:

What is the key message for the family? What additional information about pediatric growth patterns and CPEG growth charts would you consider when assessing this child?

Can you think of any examples of dialogue or language you could use when discussing Sam’s growth with his parent(s).

4. What actions/next steps would you take?

Case Study #2: Baby Stacie – 6 months

Baby Stacie was born at term. She was breastfed exclusively from birth and introduced to solid foods at around five months of age. Mom expressed concern about Stacie’s growth at the 6 month visit. She said she wondered if she should discontinue breastfeeding and try to improve Stacie’s weight gain with formula and more solid foods. Mom also stated that she thought Stacie was ready for solid foods at 5 months of age but is worried as Stacie does not take the amount of solid foods she was expecting her to.

Length-for-age

Weight-for-age

Weight-for-length

Refer to the Protocol (section 5) and Summary Sheet to assist with answering the questions below.

1. How would you describe Stacie’s growth pattern?

Length-for-age:

Weight-for-age:

Weight-for-length:

2. In order to explore all the factors that may be influencing Stacie’s growth, what

additional information would you consider and/or discuss with her parent(s) [i.e.

Standard Discussion Points]?

3. Based on all the information gathered above, what conclusions would you draw

and how would you use this to facilitate goal setting and provide support to the

family/parent(s)? Specifically, consider the following:

What is the key message for the family? What additional information about pediatric growth patterns and CPEG growth charts would you consider when assessing this child?

Can you think of any examples of dialogue or language you could use when discussing Stacie’s growth with her parent(s).

4. What actions/next steps would you take?

Case Study #3: David – 5 years of age David’s parents bring him to the health centre for his pre-kindergarten immunizations. David is weighed and measured and his measurements are plotted on a BMI-for-age growth chart. The public health nurse asks some routine questions about eating and activity. David’s parents do not provide a lot of information about his eating and activity, simply saying that they think he is growing well and they do not have any questions or concerns.

BMI-for-age

Refer to the Protocol (section 5) and Summary Sheet to assist with answering the questions below.

1. How would you describe David’s growth pattern?

BMI-for-age:

2. In order to explore all the factors that may be influencing David’s growth, what

additional information would you consider and/or discuss with her parent(s) [i.e.

Standard Discussion Points]?

3. Based on all the information gathered above, what conclusions would you draw

and how would you use this to facilitate goal setting and provide support to the

family/parent(s)? Specifically, consider the following:

What is the key message for the family? What additional information about pediatric growth patterns and CPEG growth charts would you consider when assessing this child?

Can you think of any examples of dialogue or language you could use when discussing David’s growth with his parent(s).

4. What actions/next steps would you take?