NU225 Unit 2 Growth Chart Interpretation Example

Climbing Across the Lines While Height Holds Its Channel: A Growth Chart Interpretation of a Composite Girl From Four to Ten Whose BMI-for-Age Rose Above the 97th Percentile, and What a Falling Height Line Would Have Meant

[Student Name]

Purdue University Global

NU225: Pediatric Nursing

Unit 2 Growth Chart Interpretation

[Instructor Name]

[Date]

The child and every measured value are composite and bracketed; percentiles are read from the CDC charts named in the text, and the paper is an exercise in interpretation, not a diagnosis.

The Measurements

Seven annual well-child visits, ages four to ten, all values from the composite case:

1. Age 4: height [104] cm, weight [17.0] kg, BMI [15.7], BMI-for-age [62nd] percentile.

2. Age 5: height [111] cm, weight [19.5] kg, BMI [15.8], [64th] percentile. Height velocity [7] cm per year.

3. Age 6: height [117] cm, weight [23.0] kg, BMI [16.8], [82nd] percentile. Velocity [6].

4. Age 7: height [123] cm, weight [27.6] kg, BMI [18.2], [91st] percentile. Velocity [6].

5. Age 8: height [129] cm, weight [33.6] kg, BMI [20.2], [94th] percentile. Velocity [6].

6. Age 9: height [135] cm, weight [40.8] kg, BMI [22.4], [97th] percentile. Velocity [6].

7. Age 10: height [141] cm, weight [49.3] kg, BMI [24.8], above the [97th] percentile. Velocity [6].

Stature-for-age and BMI-for-age were plotted on the CDC 2000 charts for girls aged 2 to 20.

Why Percentiles and Not Raw BMI

A BMI of 16 means something different at four than at ten, because BMI normally falls through the preschool years and rises again through childhood. Children's BMI is therefore read as a percentile for age and sex. Her raw BMI rose from [15.7] to [24.8], but some rise is expected; the finding is that she crossed upward through the 75th, 85th, 90th and 95th percentile lines, moving from a healthy weight range at four to the obesity range by eight.

The Early Rebound, Dated

In most children BMI reaches its lowest point and turns upward again, the adiposity rebound, at around six years. Her BMI dipped slightly from four to five and turned up at five to six. Researchers who followed children from infancy found that an early rebound was associated with a higher risk of obesity later in childhood and adolescence (Rolland-Cachera et al., 1984). Her rebound, at about five, came about a year earlier than usual and began the steady climb across the lines.

Two Lines Read as a Pair

Her height stayed near the [75th] percentile at every visit, with a steady velocity of about [6] cm a year. A child gaining weight from more energy taken in than used usually grows normally or even a little tall for age. A child whose weight rises while her height falls across percentile lines is different: endocrine causes such as low thyroid function or excess cortisol slow linear growth while adding weight.

A rising BMI line with a steady height line points toward intake and activity; a rising BMI line with a falling height line points toward a gland.

Her steady height channel therefore makes an endocrine cause less likely, though the provider decides what testing is needed.

Curves for the Top of the Chart

Above the 97th percentile, the standard CDC curves bunch together and stop showing change well. In December 2022 CDC released extended BMI-for-age charts that express very high BMI as a percentage of the 95th percentile, which spreads out the top of the chart (Hales et al., 2022). At age ten, the 95th percentile BMI for girls is about [23.0], so her [24.8] is about [108] percent of the 95th percentile, well short of the severe range, which starts at 120 percent. Using the extended chart gives the provider and family a number that can show change at the next visit even if she stays above the 97th percentile.

What the Nurse Would Report

The summary for the provider: BMI-for-age crossed upward through four major percentile lines from age five to ten after an early adiposity rebound, now above the 97th percentile at about [108] percent of the 95th; height steady near the 75th percentile with normal velocity. Questions for the visit include diet, physical activity, screen time, sleep and family history, along with blood pressure.

Words Chosen With a Family in Mind

When talking with her and her parents, the nurse avoids labels such as "obese" directed at the child and instead talks about the growth chart, health and habits the whole family can change together. Weight-related teasing and shame can make eating patterns worse. Plotting her on the chart in front of her parents, showing the steady height line as well as the rising BMI line, can show that she is growing well while explaining why her weight is a concern (Perry et al., 2022).

Limits

These are seven single measurements. Errors in measuring height or weight, such as shoes left on, can move a percentile. The chart shows a pattern but not its cause, which needs a history and examination. A single high reading after an illness or a growth spurt can also mislead, which is why the trend across seven visits carries more weight than any one point on it.

References

Hales, C. M., Freedman, D. S., Akinbami, L., Wei, R., & Ogden, C. L. (2022). Evaluation of alternative body mass index (BMI) metrics to monitor weight status in children and adolescents with extremely high BMI using CDC BMI-for-age growth charts (Vital and Health Statistics, Series 1, No. 197). National Center for Health Statistics. https://doi.org/10.15620/cdc:121711

Perry, S. E., Hockenberry, M. J., Cashion, K., Alden, K. R., Olshansky, E., & Lowdermilk, D. L. (2022). Maternal child nursing care (7th ed.). Elsevier.

Rolland-Cachera, M. F., Deheeger, M., Bellisle, F., Sempé, M., Guilloud-Bataille, M., & Patois, E. (1984). Adiposity rebound in children: A simple indicator for predicting obesity. The American Journal of Clinical Nutrition, 39(1), 129-135. https://doi.org/10.1093/ajcn/39.1.129