Growth Assessment and Action

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Growth Assessment and Action

• A strategy for early detection of growth
  faltering plus
• Maternal, Child Youth Health
• September 2008

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Growth Assessment and Action is the strategy
which includes

• The monitoring of individual childrens growth,
  through a standardised growth assessment
  schedule.
• The development of Action Plans to address an
  individual childs growth faltering.
• Providing all communities with information on the
  nutritional status of their children and support
  any child health initiatives resulting from this
  feedback.

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Growth Monitoring

• The aim of routine growth surveillance is to-
• identify children who are not growing well (early
  detection)
• put interventions in place to reverse the short
  and long term effects of malnutrition.

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Training slide Plot Growth on Road To Health Chart

• No weight gain for 1 month

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• That mothers/carers will bring their well
  children voluntarily to the clinic (where sick
  people go).
• Alternatively clinic staff will recall children
  according to the GAA plan.
• Both groups understand and value growth
  monitoring of children.
• And if they dont understand it they can be
  educated.
• MCYH nurses who are responsible for training
  staff can reach all staff in a timely manner
  (consider turnover of clinic staff).

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What is a Growth Action Plan ?

• A plan worked out in partnership with
  carers when the nurse/AHW finds a child who is
  growth faltering
• Not gaining weight
• Losing weight
• Not putting on enough weight
• 
  

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As per CARPA, but updated format

• Medical assessment can be possible cause
• Identify (other) cause(s)-
• Feeding practice- eg breast feeding, eating
  solids, what food, when, how much?
• Socio-economic eg Carers and family, money, food,
  housing, other support available.
• Allow family to explore these issues plus their
  strengths.

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Action PlanAs per CARPA, but updated format

• Identify community resources
• Discuss action to take eg who can help
• Calculate expected weight gain goal
• Agree on action, document.
• Note-Documentation changes have included
  stickers instead of lengthy plans, but now
  electronic PCIS software which has GAA but not
  Action Plans (to be developed).

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Training slide Ask About

• Recent illness, eg diarrhoea/vomiting
• Breast feeding
• Foods and drinks how much and how often?

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Medical Checklist Sticker goes in Progress Notes
in the childs Medical Record
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GROWTH FALTERING IN THE 0-5 YEAR OLDS When
children arent gaining weight, take a history
do the MEDICAL CHECKLIST
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Training slide Identify the possible cause of
growth faltering

• Growth faltering is often the result of a
  combination of medical, social and environmental
  issues

• Allow the family to explore these issues
• Identify available resources

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Child Health Resources Available To My Community
Community Resources Womens Centre Strong Women
Workers (SWSBSC) Mental Health Workers Shop
What food/price? Housing Manager Centrelink
School Playgroup
Family Resources Strong Grandparents Lots of
Aunties A Truck for Hunting
Child Parents
Health Centre Resources Baby Clinic Community
Based Workers (MCYH) Health workers Doctor Nurses
Resources Outside the Community FACS
Nutritionists MCYH Alcohol Other
Drugs Environmental Health Paediatrician Hospital
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Training slide Agree on the Action

• Discuss with the parents and family what actions
  may help
• Document in the Progress Notes who is involved in
  the discussion

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Growth Action Plan Sticker goes into the Progress
Notes in the childs Medical Record
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Training slide Review The Child Weekly

• Place a Progress Growth Action Plan Sticker
  in the Progress Notes for each weekly review

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Training slide Review Growth Action Plan

• Review a Growth Action Plan after
• 1 month (4 weeks) for children under 6 months of
  age
• 2 months (8 weeks) for children aged between 6
  months and 5 years

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Training slide Continuing Growth Action

• If the child has not reached the target weight
  discuss with the Doctor, Paediatrician and FACS
• It may be necessary to commence another Growth
  Action Plan
• The child may need hospitalisation
• Continue to involve the family, Health Worker and
  other resources

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• RANs are interested in child family health,
  trained in GAA and know how to work in
  partnership with families.
• RANs have an interest and understanding of
  Aboriginal world view and the impact of culture
  on health decisions.
• Communication (English literacy of carer) is
  adequate to engage at a level of conversation
  that allows for partnership.
• In any one day RANs are also able to multi-task
  between acute, emergency care, chronic health
  with brief interventions and all the other
  nursing specialties whilst working an on-call
  roster.
• Alternatively AHWs are skilled, willing (and
  culturally able) to take on these portfolios.

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• DCHS and CARH have a comprehensive primary health
  care (PHC) focus (rather than selective PHC).
• Staff numbers are adequate and equipped to move
  their practice beyond the clinic confines, ie
  work in the community and with other services.
• Other services exist to whom clinic staff can
  refer eg for domestic violence, alcohol, mental
  health.
• There is community level health promotion to
  address issues relevant to each communities needs
  (which have been identified).
• There is promotion and provision for two way
  learning so that health service providers
  understand their clients world view.

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GAA Data Collection occurs once a year over a six
month period from the 15th October 16th April

Example of GAA Data Collection Form
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• One whole of NT Annual Report
• Individual Community reports, containing a
  variety of graph displays
• Discussion of reports with clinic staff and
  interested community groups

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• That Data is collected and recorded accurately.
• There is a broad enough coverage to be
  statistically reliable.
• That the feedback to the community is
  understandable and has meaning that will
  stimulate change.
• Change in incidence rates alone reflect degree of
  effectiveness or reach of programs.

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• The CRCATH funded (with in-kind support from the
  Dept of Health Community Services) research
  project Community Action to promote child growth
  in Gapuwiyak, 2002 provided recommendations to
  DHCS regarding the GAA Program.
• One aim was to use the study to improve the GAA
  program across the NT.

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• Following slides are from training presentation

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Average Weight Gains For Children Under 5 Years

• 
  CARPA, p111

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Complete the Medical Checklist

• Follow the Medical Checklist chart (Maternal,
  Child Youth Health,2006).
• Document test results, treatment and completion
  date on the Medical Checklist Sticker.
• Other related documentation should be written in
  the Progress Notes.
• Aim to complete the Medical Checklist within 1
  week and start any treatment as per CARPA.
• Review the child weekly.
• Refer to a Doctor.

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It will take at least 1 week to complete the
Medical Checklist. During this time talk with the
parents and family

• Identify social and environmental issues
• Discuss childs growth and health. Do they agree
  that there is a problem?
• Encourage the family to explore possible causes
  of growth faltering
• Some common problems can be found in CARPA,
  p111 or Growth Action Planning Social
  Environmental Issues leaflet (Maternal, Child
  Youth Health, 2007)

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Document on the Growth Action Plan Sticker

• Document the possible causes of growth faltering
  on the Sticker, eg UTI,Grandmother in hospital,
  no food.
• Document the action to be taken on the Sticker,
  eg treat UTI, Auntie to help, buy food before
  playing cards.
• Record the weight and the weekly target weight
  gain on the Sticker.
• Select 4 or 8 weeks target weight - 4 weeks for
  babies under 6 months, and 8 weeks for those over
  6 months. Refer to CARPA, p111 or Growth Action
  Planning Social Environmental Issues leaflet
  (Maternal, Child Youth Health,2007) for average
  weekly weight gains.
• Offer the family a copy of this documentation.

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Document on the Progress Growth Action Plan
Sticker

• Record Week Number, i.e. how many weeks the child
  has been on a Growth Action Plan.
• Talk with the family and document the progress of
  the action that has been taken.
• Record weight and check if the weekly target
  weight gain has been reached.
• Document any changes needed in the action in the
  what needs to happen now section.
• Discuss the Progress Growth Action with the
  family.
• If there is no improvement discuss with a Doctor.

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