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For family practitioners and pediatricians: Do you check the growth chart at every visit, i.e. a patient comes in for conjunctivitis. Do you check the growth chart?

At all well child checks and if the parents ask at sick visits.

Thank you for responding. I have been burned that way a few times.

The patient comes in at 4 years old and is on the 90% for height. Then he comes in 14 months and 18 months. At the ear infection 14 months later, he is at the 45% and at the conjunctivitis sick visit at 18 months, he is at the 35%. He had no showed for his 5 year when he would have been at the 48% and you would have been concerned about growth failure. You didn't miss anything, because you can't be expected to check heights in between visits. But you/I didn't check at the sick visits even though we got his height. So at 6 years old, you get his height and it is at the 25%.

You check his thyroid and his TSH is 500. So, when you look at the growth chart it looks like you didn't catch it until he went from the 90% to the 25%.

I don't know if the answer is to get a height and weight at every visit and always check the growth chart or to always get a weight and sometimes get a height but always check if you get a height.

The growth chart I am bringing up is an actual patient of mine. If I had checked the height at the sick visit, I would have diagnosed it then. In residency, there was this one attending who would always say, "if you aren't going to look at your vital signs, then don't get them." We could debate if a height is a vital sign but you get the idea.

I have been trying to check heights (even moreso to have my CMA check the growth chart when she puts the height in -- but you do have to go to a different page -- not a big deal, but...)

but I continue to get busy and forget to check the growth chart at Hand, Foot and Mouth visits and acne visits, etc.

Anyone else?

I try to get a height at least once a year, sometimes to the consternation of my staff. Sometimes I change it to a preventive visit in case I don't see them again for a year. A number of children's growth plates close early but they generally don't have elevated TSH

This one was like 700 with FT4 < 0.3 which sounds like zero. Not sure how she was even alive. But she looked great.

We get a height and weight at every visit, and the nurses are trained to visualize the growth chart and only present to the provider with deviations > 5%. So, we have the MAs screen at every visit, but the are only presented at WCC.

Side note: I do wish you could have height and weight percentiles on the most recent encounter tabs to quickly scroll back through trends.

What we also need is for AC to automatically select the Z code for BMI percentile based on the BMI of the visit. (AC already does this for well checkup codes based on patient's age, so they should be able to do the BMI codes!) The BMI percentile Z code is a HEDIS measure and several of our provider incentives programs will pay big bucks for having this code in the claim. Right now we are manually selecting the correct code:
Z68.51 percentile <5
Z68.52 percentile 5 to <85
Z68.53 percentile 85 to <95
Z68.54 percentile 95 and higher