Assess growth patterns and encourage healthy habits

In all children, routine assessment of length/height, and weight should be completed at all health checks, child health nurse visits or GP consults.  Track these on growth charts and compare to previous assessments.  Identify rapid or inconsistent changes in growth patterns and changes in centile ranks (weight-for-length for age <2 years and BMI-for-age > 2 years).

Completing these assessment at every visit helps to normalise these as part of routine care, and provides an opportunitiy to discuss health growth with the family in a non-stigmatising way, regardless of where a child sits on a growth trajectory.

Using percentile charts to monitor change

• Healthy growth in children and adolescents (age 0-18 years old) can only be assessed properly using age- and sex- specific reference values, as the appropriate ratio of weight to height varies during development. Measuring growth should always be contextualised to a child’s clinical condition and be conducted in conjunction with clinical, developmental, psychosocial and behavioural assessment.
• For children 0-2 years, use WHO growth charts (calculate weight, length and weight for length for age) Using the BMI-for-age growth chart is not recommended for children younger than age 2 years.
• For children and adolescents 2-18 years, use CDC growth charts (calculate BMI-for-age, weight and height for age).^[6] 
• Link to Growth Charts

Resources below can assist you to raise the topic of weight with families, and accurately measure growth:

Advise, assist and empower your patients and families.

When a child or adolescent has experienced rapid weight gain or weight is identified as being in the overweight or obese category, treatment and management should be implemented.

Goals of treatment include improvements in sustainable health behaviours, preventing further weight gain (weight maintenance) and in some cases where appropriate, weight reduction, for example:

• Overweight: For children that are still growing, focus on health behaviours to allow for weight maintenance whilst growth continues. (i.e. BMI will gradually decline as height increases).¹This may not be appropriate for adolescents who have already experienced their pubertal growth spurt.
• Obesity: Goal is often weight loss however initially via the introduction and focus on health behaviours. Most children and adolescents with obesity will require a comprehensive multicomponent and often prescriptive advice to promote a decrease in energy intake.

Best Practice Guidelines encourage 25 hours of support over 6 months for effective weight management intervention.  This may not be achievable as an individual practitioner however can be shared across a team that includes health and non-health professionals (e.g. teachers or coaches).

It is important to advise families of the importance of growth trajectory rather than one off assessments.  Positive lifestyle changes that are sustainable are going to help children and families to be healthier in the long-term rather than quick-fix diets or restrictive diets. Work with families to create SMART goals that they feel are achievable and sustainable, and which are more likely to become habits.

Healthy eating:

The Australian Guide to Healthy Eating is a food selection guide that visually represents to proportion of the five food groups recommended for consumption each day.  It is useful as an education tool on where diets can be improved.

The Healthy eating for children resource outlines the amount of food and drinks children are recommended to consume each day, along with tips and information

Physical Activity

The Australian 24-hour Movement Guidelines for children and young people 5-17 years, includes recommendations for incorporating physical activity and minimising sedentary behaviour in a 24-hour period as well as recommendations for sleep.

Further resources below can be used to educate and advise families to adopt healthy behaviour changes that will help them work towards achieving their health goals:

When supporting families with weight management, it is important to arrange follow-up appointments to continue to measure and monitor progress and reflect on support required.

Some families may benefit from Podsquad, a free, play-centric wellbeing program that supports children and families as they build better health and lifestyle habits together.

Up-to-date information about the assessment and management of a range of conditions can be found on HealthPathways. HealthPathways is delivered across Queensland thanks to the support of Clinical Excellence Queensland, and you can find your local HealthPathways website here.

Programs and resources listed below may help facilitate health behaviour change for families, or provide additional support and management where appropriate:

Health professionals providing childhood services (e.g. health workers, medical, nursing, practice nurse and allied health professionals) can upskill in best-practice prevention, treatment and management of children and adolescents with overweight or obesity and their families to provide specialist care, locally.

Our ECHO® Learning Series ‘Healthy Kids’ focuses on supporting professionals to deliver best-practice care to the families in their communities. The series provides mentoring, evidence-based advice, and support to professionals who consult with children and young people who may have overweight or obesity, so they can deliver care with empathy, confidence and success.

Our Clincians Hub Podcast series discuss practical integration of prevention and treatment into daily clinical practice. The series explores how to raise health concerns with families, how to complete brief health behaviour assessments and how to provide advice and support for families across Queensland.

The Referral Pathway is a quick reference guide that supports primary health care providers to monitor and assess child growth, refer patients to appropriate services, and deliver interventions.

Further resources to upskill in prevention, treatment and management of paediatric overweight and obesity can be found below:

Healthy eating:

The Australian Dietary Guidelines resource summarises the key recommendations and the underlying evidence supporting food, diet and health relationships.

Physical Activity

The Australian Physical Activity and exercise guidelines for children 5-17 includes recommendations for amount and type of activity.

Further clinical guidelines which may assist clinicians supporting the prevention, early intervention and management of overweight and obesity in childhood and adolescence are included below: