Health and Wellbeing Programs – Health and Wellbeing Queensland

Children and Adolescents

A 'how-to' guide for prevention and early intervention of childhood obesity.

A child standing against a blackboard with height marks drawn in chalk. A giraffe is also drawn in white chalk on the blackboard.

Measuring growth and monitoring change

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 who are at risk of developing overweight and obesity. Serial measurements also normalise growth monitoring and provide an opportunity to discuss growth charts and healthy growth with the family in a standardised, non-stigmatising way.^{[10] [23]}

It is recommended that weight, length/height and BMI are measured, assessed and reviewed at least yearly^[24] in addition to the key milestone growth reviews in the Personal Health Record during the first two years of life. Growth should be monitored until age 18 years.^[25]

Using percentile charts to measure growth and monitor change

Growth status in children and adolescents (age 0-18 years old) is assessed 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.

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 2-18 years, use CDC growth charts** (calculate BMI-for-age, weight and height for age).^[26]
Link to Growth Charts

**Queensland Health use WHO chart for children 0-2 years and CDC growth charts for children 2-18 years of age

Growth Charts

Classification of Overweight and Obesity

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

Early Intervention for children and families

Early intervention is indicated if a child is at-risk of developing overweight or obesity from simple risk factors (see ‘Identifying risk’) identifiable in the first 1,000 days, or later in life if there is a family history of overweight and obesity and the family are demonstrating unhealthy lifestyle behaviours.

Ask and Assess

Assess child’s growth (BMI-for-age) and discuss growth pattern with famly (using growth charts)
Ask about current lifestyle behaviours (fruit and vegetables, sugary drink intake, family meals, take away/eating out, tv and screen time, physical activity/active play, sleep routines).

Advise and Assist

Discuss weight in a non-judgmental, sensitive manner.
Empower and encourage families to make healthy lifestyle changes. Provide healthy eating and physical activity advice and resources (increase fruit and vegetables intake, water as the main drink, avoid sugary drinks and fruit juices, promote family meals, reduce screen time, active play and vigorous physical activity , healthy sleep routines).

Arrange and Ask Again

Refer identified/at risk children and their families to allied health/healthy lifestyle programs or 13 HEALTH (note must request to speak with a child health nurse. Available 7d/week).
Refer to Healthier. Happier. website.

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