Children and Adolescents

Supporting healthy behaviours in childhood and adolescence

Assess growth patterns and encourage healthy habits

Measuring growth is part of standard, routine paediatric clinical practice. Regular growth assessments make it easier to recognise an abnormal growth trajectory and identify children and adolescents who are at risk of developing overweight and obesity.[1] [2] 

Family-based approaches to behavior change are particularly effective when it comes to children.[3] During adolescence this will be dependent on age and maturity. A more individualised approach may be appropriate as peers exert a stronger influence on decision-making, and young individuals begin to exercise more autonomy in making health-related choices beyond the family home.[4]  

Learning and sustaining healthy behaviors during childhood and adolescence sets the foundation for healthy adulthood.  

Ask and Assess

  • Measure weight and height, and plot on growth charts. Investigate any rapid changes.    
  • Assess modifiable behaviours: intake of fruit, vegetables and sugary drinks, family meal environments, take-away/eating out frequency, screen time, physical activity/active play, sleep routine.
  • If clinical concern exists, conduct developmental, psychosocial and socio-environmental assessment. 

Advise and Assist

  • Discuss identified risk factors, focusing on those that are modifiable. Share resources as appropriate. 
  • Use positive, health-focused language that minimises judgement. 
  • Encourage the family to adopt healthy behaviours together.   
  • Co-design an action plan with the child and family.

Arrange and Ask Again

  • Arrange growth monitoring appointments (opportunistic, minimum yearly). 
  • Explore dietary, behavioural and parenting programs that may benefit the family. 
  • Arrange referrals for children at risk of unhealthy weight gain to local health programs and/or recommend the PODSQUAD app. 
  • For children living with obesity, provide 25 hours of primary care support over 6 months using local services (leisure centres etc) and other professionals as needed.   
  • Refer to specialist services if indicated: e.g., severe obesity BMI classification; presence of comorbidities, suspicion of secondary obesity. 

Resource Library

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
Class Age Group Description
Overweight 0 – 2yrs (WHO) Weight-for-height > 2 SD above WHO Child Growth Standards Median
2 – 18yrs (CDC) 85th to 95th %ile
Obese 0 – 2yrs (WHO) Weight-for-height > 3 SD above WHO Child Growth Standards Median
2 – 18yrs (CDC) ≥ 95th %ile
*There is no consensus on the definition of severity of obesity, the most recent International Obesity Taskforce (IOTF) recommendations suggested these definitions:
• Class 2 obesity: BMI ≥120% of the 95th percentile or ≥35 kg/m2 (CDC BMI charts)
• Class 3 obesity: BMI ≥140% of the 95th percentile or ≥40 kg/m2 (CDC BMI charts), or BMI Z score >3.5

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

Resource
Author
ASK
Before you start the conversation
Holland Bloorview
ASSESS GROWTH
How to accurately use a stadiometer
NSW Government
How to accurately weigh a child
NSW Government
Equipment required for weights (Over 2)
Royal Children's Hospital Melbourne
Measuring waist circumference (VIDEO)
British Heart Foundation
Growth Charts: 2-20 CDC
CDC
Z scores 2-5 years - boys
CDC
Z scores 2-5 years - girls
CDC
Healthy weight calculator
NSW health
ASSESS HEALTH BEHAVIOUR
ESSA screening tool: Pre-exercise screening system for young people
ESSA
Potential Eating Disorder assessment tool
EDQ

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:

Class Age Group Description
Overweight 0 – 2yrs (WHO) Weight-for-height > 2 SD above WHO Child Growth Standards Median
2 – 18yrs (CDC) 85th to 95th %ile
Obese 0 – 2yrs (WHO) Weight-for-height > 3 SD above WHO Child Growth Standards Median
2 – 18yrs (CDC) ≥ 95th %ile
*There is no consensus on the definition of severity of obesity, the most recent International Obesity Taskforce (IOTF) recommendations suggested these definitions:
• Class 2 obesity: BMI ≥120% of the 95th percentile or ≥35 kg/m2 (CDC BMI charts)
• Class 3 obesity: BMI ≥140% of the 95th percentile or ≥40 kg/m2 (CDC BMI charts), or BMI Z score >3.5

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

Resource
Author
NUTRITION
Healthy Eating for Children
DoH
Planning a healthy lunchbox
Queensland Government
Kai for the Whanau, family recipe book
Children's Health Queensland
Healthy Eating Habits for Teenagers
Raising Children's Network
PHYSICAL ACTIVITY
24-hour movement guidelines
DoH
Physical Activity: Getting Children Involved
Raising Children's Network
Physical Activity for Pre-teens and Teenagers
Raising Children's Network
SCREEN TIME
Managing Screen time
eSaftey Commissioner
HEALTH BEHAVIOURS
8-Healthy Habits for Children aged 2-17
NSW Government
WEIGHT MANAGEMENT
Weight management in Adolescents
Sydney Children's Hospitals Network
SLEEP
Sleep and Young People
Orygen
Get enough sleep
Headspace
BODY CONFIDENCE
6 ways to be body confident
Butterfly Foundation

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:

Resource
Author
HEALTHY HABITS
Podsquad
HWQld
Healthy Kids Club
Children's Health Queensland
WEIGHT ASSESSMENT AND MANAGEMENT
Clinical Tests
Obesity Medicine Association
Health pathways
Queensland Government
MENTAL HEALTH
Helplines and Online Counselling Services
AIFS
Eating Disorder Plan GP
InsideOut
SLEEP
Sleep Ninja (App)
Black Dog Institute
PARENTING SUPPORT
Triple P - Positive Parenting Program - children
Triple P
Triple P - Positive Parenting Program - adolescents
Triple P
NUTRITION
Dietitian
Dietitians Australia
PHYSICAL ACTIVITY
Exercise Professional
ESSA

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:

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

Resource
Format
Author
CHILDHOOD AND ADOLESCENCE
Project ECHO - Healthy Kids Series
Online Platform
Health and Wellbeing Queensland
Referral Pathway
PDF
Health and Wellbeing Queensland
Weight4Kids
eLearning modules
NSW Government
How can health services strengthen support for children affected by overweight and obesity and their families?
Journal Article
Public Health Research and Practice
Tackling Childhood obesity – Part 1 Video
Video
RACGP & NSW health
5As of paediatric obesity management
Videos
Obesity Canada
Appraisal of Clinical Care Practices for Child Obesity Treatment. Part I: Interventions
Journal Article
AAP
Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Interventions
Journal Article
AAP
Childhood Obesity: From diagnosis to treatment
E-Learning
WorldObesity
Child Growth E-learning
eLearning
RCH Melbourne
Implementing routine growth assessments
eLearning
NSW Government
How to accurately use a stadiometer
PDF
NSW Health
How to plot and interpret growth charts
Webpage
RCH Melbourne
Z scores explained
Webpage
Ellyn Satter Institute
Plotting BMI for kids
Video
NSW Health
ADOLESCENCE
Risk taking behaviour in adolescents
Webpage
RACGP
RACGP - Adolescent Overweight and Obesity management
PDF
RACGP
RACGP - Engaging with adolescents about healthy weight and lifestyle
Video
RACGP
Youth Friendly communication
Video
NSW Government
EATING DISORDERS
Understanding Eating Disorders
PDF
EDQ
Eating Disorders Core Skills for GPs
eLearning
National EDC
Eating disorders - a professional resource for GPs
PDF
National EDC
GENERAL SKILLS
5As: Ask, assess, advise, assist and arrange
PDF
RACGP
5As of Obesity Management
Video
Obesity Canada
SCOPE E-learning for obesity
E-learning
WorldObesity
Brief interventions for a healthy lifestyle
E-learning
Insight - Qhealth
Brief Interventions: Nutrition and Physical Activity
E-learning
Insight - Qhealth
Motivational Interviewing RACGP
Journal Article
RACGP
Motivational Interviewing
Webpage and videos
Healthify He Puna Waira
Weight stigma and obesity
Video
Yale University
EQUITY
Working with people with a disability
PDF
Metro South

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:

Resource
Author
NUTRITION
Australian Dietary Guidelines
NHMRC
PHYSICAL ACTIVITY
Physical activity and exercise guidelines for children and young people
DoH
EATING DISORDER
Clinical Guidelines for Therapeutic Interventions in Eating Disorders
EDQ
Management of eating disorders for people with higher weight
NEDC
PREVENTION
Guidelines for preventive activities in general practice
RACGP
WEIGHT MANAGEMENT
Clinical Practice Guidelines for the management of overweight and obesity
DoH
Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity
AAP
FEEDS Framework for Effective & Efficient Dietetic Services: Obesity
NEMO: Qhealth
Adolescence
Youth Health Resources: Healthy Lifestyle Guideline
NSW Government

References

  1. Moukhaiber P, Alexander S. Childhood weight issues. Seeking better health outcomes. Endocrinology Today. 2018; 7:26-31. 
  2. National Health and Medical Research Council. Clinical Practice Guidelines for the Management of overweight and obesity in Adults, Adolescents and Children in Australia. Canberra: NHMRC. 2013. 
  3. Enright G, Allman-Farinelli M, Redfern J. Effectiveness of Family-Based Behavior Change Interventions on Obesity-Related Behavior Change in Children: A Realist Synthesis. Int J Environ Res Public Health. 2020 Jun 8;17(11):4099. doi: 10.3390/ijerph17114099. PMID: 32521815; PMCID: PMC7312889. 
  4. Miller M, Damarell R, Bell L, Moores C, Miller J, Matwiejczyk L. 2017. Community-based approaches to adolescent obesity: An Evidence Check rapid review brokered by the Sax Institute. 

Clinicians Hub is brought to you by Health and Wellbeing Queensland in partnership with Allied Health Profession’s Office of Queensland, Clinical Excellence Queensland.

Last updated 4 January 2024