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The Royal College of Paediatrics and Child Health state that childhood obesity is the gravest health issue children are facing today, predicting that half of the 10-year-olds will be affected by 20201 and emphasising that all health professionals have a collective responsibility in tackling this. Acute paediatricians have a duty to identify and manage childhood obesity, as with other comorbid conditions. Many paediatricians are, however, reluctant to broach this subject with parents in the acute setting due to concerns regarding receptiveness; yet parents have previously stated that they would want to be told if their child was found to be overweight while in the hospital.2 As studies show a poor correlation between parents’ perceived child weight status and actual weight status, we cannot rely on parents to recognise obesity themselves.3 Obesity also impacts on medical management, such as prescription of drugs based on ideal body weight.
We conducted a regional audit to establish whether height, weight and body mas index (BMI) centile are recorded, and whether overweight (BMI >91th centile) children are correctly identified and managed in Children’s Assessment Units (CAUs).
The medical records of all children aged >2 years attending five CAUs within the West Midlands over 72 hours were examined. Data including height, weight and BMI centile were recorded. A quality improvement package (QIP) was introduced, consisting of an educational presentation delivered to the medical team, and educational posters in CAU. Re-audit was performed in three of the centres at least 3 weeks later.
One hundred and thirty-one children were included in the initial study. Weight and height were recorded in 115 (87%, range 65%–100%) and 45 (34%, range 0%–80%) children, respectively. No child had a recorded BMI centile; one child was documented as being overweight although no action was taken. Using height and weight data, we were able to calculate BMI centiles in 44 (34%) children; of these, 14 (32%) had a BMI above the 91st centile. Following the QIP, weight, height and BMI centile were recorded in 45/48 (93%), 14/48 (29%) and no children, respectively (figure 1). There was no significant difference in anthropometric data recorded before and after the QIP (weight p=0.41, height p=0.59, BMI p=1).
In conclusion, there is a large difference between the best and worst performing centres in height and weight documentation; however, all centres were poor at identifying overweight children, with simple educational interventions ineffective at improving this.
Attendance at CAU is an opportunity for recognition and optimisation of comorbid conditions, ‘making every contact count’. However, the identification of overweight children at CAU attendance is poor. Simple educational interventions have been ineffective and more sustained educational programmes may be required to change behaviour. How paediatricians act has a large impact on parents: we cannot expect them to prioritise their child’s obesity if we do not do the same. With childhood obesity as the gravest health issue currently facing children today, we are doing them a disservice by not acknowledging this. Further work must be done to identify barriers to recognising overweight children in CAUs and establish how to tackle them.
Contributors KH, EW and JK conceived the project idea. All authors approved the study design. HM, WC, SE, NM, AA and SI collected data and implemented the quality improvement project. All authors contributed to the writing of the final manuscript; all authors approved the final manuscript prior to submission.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
Data sharing statement No additional data is available elsewhere.
Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ‘BMJ Publishing Group’. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.