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What Is PedNSS/PNSS?
PedNSS Health Indicators
Data on specific health indicators are collected for infants and
children who go to public health clinics for routine care, nutrition
education, and supplemental food. Anemia, breastfeeding status, low and
high birthweight, short stature, underweight, overweight, at risk of
overweight, TV/video viewing, and household smoking are key indicators of
nutritional status collected by the PedNSS. In the United States, weight
and height are routinely measured to assess the nutritional status of
children, and anemia is routinely assessed in children as an indicator of
iron deficiency, the most common micronutrient deficiency. The definition
of each indicator and the rationale for collecting the indicator are
described below:
Birthweight
- Low birthweight (<2500 grams or <5.5
pounds) is the single most important factor affecting neonatal
mortality and is a determinant of post-neonatal mortality (NAS,
1985). Infants weighing less than 2500 grams are almost 40
times more likely to die during their first four weeks of life
than are infants of normal birthweight (Paneth,
1995). Although the infant mortality rate in the United States
declined from 26 per 1000 live births in 1960 to 7 per 1000 live
births in 1999, the nation ranks behind most industrialized countries
for this health indicator. Low birthweight infants who survive
are at increased risk for health problems ranging from neurodevelopmental
handicaps to lower respiratory tract conditions (Paneth,
1995).
- High birthweight (HBW) is defined as a birthweight of >4000 grams. This reflects the WIC Nutrition Risk
Criteria (IOM, 1996) which
is based on a generally accepted intrauterine growth reference > the
90th percentile weight for gestational age at birth (ACOG
Technical Bulletin, 1991). High birthweight usually occurs
in full-term or post-term infants but can occur in preterm infants. HBW puts infants at increased risk for birth injuries such as shoulder
dystocia and infant mortality rates are higher among full-term
infants who weigh more than 4000 grams than infants weighing between
3000 and 4000 grams.
Review the definition of Birthweight and its prevalence calculation.
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Growth Indicators
- Short stature is defined as a length or stature < 5th
percentile on the CDC age- and gender-specific length or stature
reference (CDC, 2000). Length/stature-for-age
describes linear growth relative to age. Short stature, also referred
to as low-length/height-for age or stunting, is used as an indicator
of chronic malnutrition and it reflects the long-term health and
nutritional history of a child. The child may be short due to poor
nutrition and repeated infections. In some children short stature
may be related to factors such as lower birthweight or short parental
stature. The WIC Nutrition Risk Criteria (IOM,
1996) defines short stature as < 10th percentile
in accordance with the preventive emphasis of the program.
- Underweight is defined as weight-for-length < 5th
percentile based on the CDC gender-specific weight-for-length reference
for children less than 2 years of age and Body Mass Index (BMI
)-for-age < 5th percentile for children 2 to 20 years of age
based on the CDC gender-specific BMI-for-age reference (CDC,
2000). BMI is weight in kilograms divided by height in meters
squared (kg/m2). Underweight, also referred to as thinness
or wasting, is used as an indicator of acute malnutrition and it
reflects recent starvation, persistent diarrhea, or both. The WIC
Nutrition Risk Criteria (IOM, 1996)
defines underweight as <10th percentile weight-for-length
or BMI-for-age in accordance with the preventive emphasis of the
program.
- Overweight is defined as weight-for-length >95th
percentile based on the CDC gender-specific weight-for-length reference
for children less than 2 years of age and Body Mass Index (BMI
)-for-age >95th percentile for children 2 to 20 years
of age based on the CDC gender-specific BMI-for-age reference (CDC,
2000). BMI-for-age is not recommended for use in the United
States before 2 years of age to assess growth. High BMI values
at young ages have a weak association with adolescent or adult
obesity (Whitaker et al.,
1997; Guo et al., 1994).
Overweight may indicate excess energy intake, low energy expenditure
or both. The contribution of these factors to overweight has not
been determined. Health problems associated with childhood overweight
among children over the age of 2 include high blood pressure, high
cholesterol, glucose intolerance, orthopedic disorders, and psychosocial
disorders. In addition, longitudinal studies show that overweight
in children over the age of 2 years is associated with overweight
in adulthood.
- Risk of Overweight: Expert committees have recommended
a two-level screening for overweight among children 2 years and
older. The recommendations are to use BMI-for-age at or above the
95th percentile to define overweight and between the 85th and 95th
percentile to define at risk of overweight (Himes
and Dietz, 1994; Barlow
and Dietz; 1998; Bellizzi
and Dietz, 1999). Use of the 95th percentile identifies children
with a significant likelihood of persistence of overweight into
adulthood (Whitaker et al.,
1997; Guo et al., 1994).
In addition, using the 95th percentile cutoff point few children
are incorrectly considered overweight but many overweight children
are missed. Classifying children at risk of overweight between
the 85th to the 95th identifies overweight children that may have
been missed by the 95th percentile cutoff point.
[Read More :
interactive training modules that describe the CDC Growth Charts and commonly
used anthropometric indices and evaluation criteria used to assess growth.]
Review the definition of Growth Indicators and its prevalence calculation.
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Anemia
- Anemia, a low hemoglobin (Hb) concentration
or low hematocrit (Hct) level, is defined by age- and gender-specific
cutoff values based on the 5th percentile from the third National
Health and Nutrition Examination Survey for a healthy population
(CDC, 1998). Children aged 1 to 2 years are
considered anemic if their Hb concentration is less than 11.0 g/dL
or Hct level is less than 33.0%; children aged 2 to 5 years are
considered anemic if their Hb concentration is less than 11.1 g/dL
or their Hct level is less than 33.3% (CDC, 1998).
Because persons residing at higher altitudes have higher hemoglobin
and hematocrit values, these values are automatically adjusted
for altitude. Anemia is often used as an indicator of iron deficiency,
the most
common
nutritional
deficiency in the world (DeMaeyer,
1989). Iron deficiency is associated with developmental delays
and behavioral disturbances in children (Pollitt,
1993; Idjradinata and
Pollitt, 1993; Lozoff et
al., 1991). Anemia associated with iron deficiency represents
the final stage of iron deficiency when the production of hemoglobin
(and other iron-containing functional compounds) falls below normal
levels due to insufficient iron (Baynes,
1994).
[Read
More for anemia cutoff values and recommendations to prevent and control
iron deficiency in the United States]
Review the definition of Anemia and its prevalence calculation.
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Breastfeeding
- Breastfeeding Initiation is determined by Ever
Breastfed while Breastfeeding Duration is determined
by Breastfed at least 6 Months and Breastfed at least 12 Months:
These breastfeeding practices were chosen in order to track three
of the Healthy People 2010 objectives (USHHS,
2000). Breastfeeding continuation through the age of 18 months
is also reported at weekly and monthly intervals. The nutritional,
immunologic, allergenic, economic, and psychological advantages
of breast feeding are well recognized. Breastfeeding is nutritionally
superior to any alternative infant feeding method and provides immunity to many
viral and bacterial diseases; enhances infants immunologic defenses;
prevents or reduces risk of respiratory and diarrheal diseases;
promotes correct development of jaws, teeth, and speech patterns;
decreases tendency toward childhood obesity; and facilitates maternal-infant
attachment (Jacobi and Levin, 1993; AAP,
1997).
- Exclusive Breastfeeding is determined using responses from the
Introduction to Supplementary Feeding data item. This data item indicates
the age of the child when he or she was first fed something other than
breastmilk and denotes the level of exclusive breastfeeding in the PedNSS
population. Exclusive breastfeeding is defined as an infant's consumption of
human milk with no supplementation of any type (including infant formula, cow’s
milk, juice, sugar water, baby food and anything else, even water) except for
vitamins, minerals, and medications. This definition is consistent with that of
the American Academy of Pediatrics Policy Statement on Breastfeeding and the Use
of Human Milk (AAP 2005), and the World Health Organization (WHO 2004).
Review the definition of Breastfeeding and its prevalence calculation.
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Health Risk Behaviors
- TV/Video Viewing: Television viewing has been
shown to increase overweight in children by displacing physical
activity and increasing caloric intake (Robinson,
1999). This indicator is defined as the number of hours per
day a child over the age of 2 spends sitting and watching television
or videotapes on a typical day. This indicator is used to assess the amount
of time children aged 2 and older spend viewing television and
videotapes, and can be used to monitor the national health objective
to increase the proportion of children who view TV 2 or fewer hours
per day. The American Academy of Pediatrics recommends that parents
be encouraged to limit their children’s TV viewing to no
more than 1 to 2 hours per day (AAP,
2001). Viewing more than 5 hours per day has been associated
with increased incidence of overweight among older children compared
with those watching 0–2 hours (Gortmaker
et al, 1996).
- Smoking in the Household: This indicator is
defined as anyone in the household who currently smokes at the
time of the child’s visit. Secondary or passive smoke is
a risk factor associated with poor growth in young children. Children
exposed to environmental tobacco smoke have higher rates of lower
respiratory illness during their first year of life, higher rates
of middle ear effusion, and higher rates of sudden infant death
syndrome. Additionally, children with asthma whose parents smoke
have more severe symptoms and more frequent asthma episodes (AAP,
1997). The national health objectives call for a reduction
in the proportion of children who are regularly exposed to tobacco
smoke at home.
Review the definition of TV Viewing and its prevalence calculation.
Review the definition of Smoking in Household and its prevalence calculation.
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