HeartSmartKids (HSK) and Childhood Obesity Guidelines

HeartSmartKids helps offices implement the assessment and prevention aspects of national guidelines from the AAP, AMA, NHLBI, and HealthTeamWorks quickly and efficiently.

HeartSmartKids helps offices:

• implement assessment guidelines on BMI, BP, and lifestyle
• more effectively communicate weight and lifestyle risks to families
• assess lifestyle and deliver recommendations to Spanish-speaking families
• learn and use the techniques of Motivational Interviewing (MI)

SCREENING

HeartSmartKids implements the Growth, Blood Pressure, History, and Lab screening sections of the screening guidelines.

The HeartSmartKids kiosk assesses family lifestyle behavior using questions drawn from the HealthTeamWorks Healthy Lifestyle Screening Tool. The kiosk or tablet is likely located in the waiting room or measurement area. Parents or teens can use the kiosk independently, without the need for staff supervision.
Once the family has completed the interview, they proceed as usual with their office visit. Prior to provider counseling, staff can create the HeartPrint summary (discussed below) on any office computer with a web browser. The HeartPrint summary presents the screening results for lifestyle factors (e.g. nutrition, activity, smoke exposure), BMI, blood pressure, and lab screening.

Screening Summary - The HeartPrint

The HeartPrint is a compact summary of a child’s cardiovascular risks, and carries many elements of the state and national guidelines. A sample HeartPrint summary is shown below. 

Growth - BMI status and trends

The largest element of the HeartPrint is the standard CDC growth charts. These charts indicate where a child’s height, weight, and BMI are compared to established growth standards. In addition, the child’s measurements and exact percentiles for height, weight, and BMI are printed at the top of the HeartPrint. A BMI percentile between the 85th and 94th percentile is considered overweight. Above the 95th percentile is considered obese. 

Just as important as the absolute percentile is the BMI trend. An abnormal trend in BMI percentile can be an opportunity for preventive counseling before a child becomes underweight, overweight or obese. Offices can easily add previous measurements to a HeartPrint to note trends - please see the online HSK documentation.

Blood Pressure

The HeartSmartKids system automatically calculates the prehypertensive (90th percentile) blood pressure level for a child’s age, sex, and height. This value is presented at the top of the HeartPrint. If staff has entered the child’s blood pressure and it is higher than the 90th percentile a small heart will indicate risk and staff can follow protocol for repeat measurements and followup.

History

The History section of the guidelines refers to gathering an updated family medical history and lifestyle data. This information is collected by the HeartSmartKids kiosk and presented in the top right corner of the HeartPrint. Small heart flags indicate values that exceed guidelines and are good areas to begin lifestyle counseling.

Lab Screening

The national guidelines give recommendations for lab tests based on a child’s BMI and age. These recommendations appear in the Provider Guidance section of the HeartPrint, discussed below.

COUNSELING AND PROMOTION OF HEALTHY BEHAVIORS

The basis for prevention and treatment of childhood obesity lies in effective counseling of families to motivate healthy behaviors. National guidelines encourage use of healthy living messages and patient-centered counseling techniques such as Motivational Interviewing (MI). The HeartPrint includes information and tools to help providers with this difficult task.

Besides the plotting page, the HeartSmartKids system produces recommendation pages for both Patient and Provider. Examples of both pages are shown on the next page.

Patient recommendations

The Patient sheet carries lifestyle information tailored to the family. If the child is overweight or obese, a short note discusses weight status. Following this are recommendations for small steps toward healthier behaviors in nutrition and activity. These recommendations are intended to enhance, not replace, a discussion about the family’s motivations, barriers, and goals.

The patient sheet, along with a copy of the growth charts, is intended to be taken home by the family for communication with other family members, goal-setting, and self-assessment.

Provider Guidance

The Provider sheet carries information for effective screening, counseling, and referral. This information includes:

• a copy of the recommendations that appeared on the patient sheet. These recommendations will always be in English, even if the patient’s version was in Spanish.
• a summary of the readiness, confidence, and importance answers for effective Motivational Interviewing.
• tips or an outline for implementing the office-specific protocol for counseling normal/overweight/obese children.
• Lab screening and weight target suggestions based on age and BMI.
• information on an overweight/obese referral, if the office has one.