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name: langcare-pediatric-growth description: > Assesses pediatric growth by plotting weight, height/length, head circumference, and BMI against WHO (0-2 years) and CDC (2-20 years) growth chart percentiles. Flags growth faltering, obesity, and failure to thrive. Use when asked about pediatric growth, growth chart, growth percentiles, FTT, childhood obesity, or weight-for-age.

Pediatric Growth Assessment

When to Use This Skill

Use when a clinician needs to evaluate a pediatric patient's growth trajectory against age-appropriate percentile charts.

Clinical Workflow

1. Use fhir_read to retrieve Patient demographics (birthDate for age calculation, gender for sex-specific charts)
2. Use fhir_search to pull Observation resources for weight (LOINC 29463-7), length/height (LOINC 8302-2 height, 8306-3 body length), head circumference (LOINC 9843-4), and BMI (LOINC 39156-5) over time
3. Determine chart set: WHO (0-2 years), CDC (2-20 years) -- see references/who-cdc-percentiles.md
4. Plot current and historical measurements against sex-specific percentile curves
5. Calculate percentiles and Z-scores for current measurements
6. Identify growth concerns: weight-for-age <3rd percentile (failure to thrive), BMI >85th (overweight), BMI >95th (obese), crossing >2 major percentile lines (growth faltering or acceleration), head circumference <3rd or >97th
7. Use fhir_search to pull Condition resources for underlying diagnoses affecting growth
8. Present growth dashboard with current percentiles, trajectory, and flagged concerns

FHIR Resources

• Patient -- Age and sex for chart selection
• Observation -- Weight (29463-7), height (8302-2), length (8306-3), head circumference (9843-4), BMI (39156-5)
• Condition -- Growth-related diagnoses (FTT, obesity, short stature, endocrine conditions)

FHIR Query Examples

Pull Growth Measurements

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&code=29463-7,8302-2,8306-3,9843-4,39156-5&_sort=date&_count=100")

Clinical Guidelines

• WHO growth standards (0-2 years): international reference for breastfed infants
• CDC growth charts (2-20 years): US reference population
• AAP guidelines for failure to thrive evaluation
• AAP Expert Committee recommendations for childhood obesity

Interpretation Guide

• Use WHO charts for 0-2 years (based on breastfed infant norms), CDC charts for 2-20 years
• Percentile thresholds: <3rd concerning for undernutrition, 3rd-85th normal, 85th-95th overweight, >95th obese
• Track trajectory: crossing 2+ major percentile lines in either direction warrants evaluation
• Head circumference: <3rd may indicate microcephaly, >97th may indicate macrocephaly or hydrocephalus (monitor closely in first 18 months)
• For premature infants: use corrected gestational age until 24 months (corrected = chronological age minus weeks premature)
• BMI interpretation for children: use BMI-for-age percentile, not adult BMI categories

Safety

• Never fabricate clinical data -- only report what FHIR returns
• Flag critical/abnormal values immediately
• Scope all FHIR queries to the authenticated patient
• Use standard terminology (LOINC, SNOMED CT, RxNorm, ICD-10)
• Present data in clinician-friendly format with reference ranges