Welcome to the training on Management of Overweight and Obesity in Children and Adolescents provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
The goal of this module is to equip Texas Health Steps providers and other health professionals to apply best practices in the assessment, treatment, and prevention of overweight and obesity in children and adolescents from birth through age 20.
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Assess patients’ risk factors for overweight and obesity as part of routine checkups.
- Apply best practices in the diagnosis, treatment, and management of overweight and obesity.
- Employ practical intervention strategies to help prevent overweight and obesity by promoting healthy nutrition, physical activity, and lifestyle habits.
- Assess and address weight bias in your practice.
Note: In this module, the term “parent” also includes guardians and other caregivers. The terms “young people” and “youth” encompass children and adolescents.
Please note this module expires on 11/5/2022.
This module was released on 11/5/2019.
Continuing Medical Education
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hour(s) of Continuing Nursing Education.
The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded 1.50 contact hour(s) of Continuing Social Work Education.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.50 hour(s) for attendance.
Certified Community Health Worker
The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.50 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support.
- Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
- Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
- Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
AbilityPath.org: Online hub and community unites professionals and parents from around the globe to learn, share, and support the ongoing healthy development of children and youth with special needs and disabilities. Advice, tool kits, and practical tips available in English and Spanish. (n.d.).
Addressing Food Insecurity: A Toolkit for Pediatricians. Variety of tools and resources to help pediatricians screen for food insecurity, and connect families to support and resource services. (2019). From the AAP and the Food Research and Action Center. http://frac.org/aaptoolkit OK 5-29-19
Before, Between & Beyond Pregnancy: Information and educational resources about women’s health, including how to incorporate preconception counseling into your practice. (2019). From the National Preconception Health & Health Care Initiative.
BMI Percentile Calculator for Child and Teen: Provides BMI and the corresponding BMI-for-age percentile based on the CDC growth charts for children ages 2 through 19 years. (2019). From the CDC.
BMI Calculator for Adults (ages 20 and older). (2018). From the CDC.
Clinical Growth Charts: Reflect modifications in the format of the individual charts. Available for boys and girls. (2017). From the CDC.
Eat More Color: Downloadable infographic showing the five main color groups and the fruits and vegetables within each group. (n.d.). From the American Heart Association.
How to Make a Family Media Plan: How-to for families to set goals and limits for media use by their children and adolescents. (2016). From the AAP.
Initial History Questionnaire: Printable questionnaire to obtain patient and family history. (2010). From the AAP.
Motivational Interviewing: Overview of MI, including background, methods, and assessing readiness for change. (n.d.). From the Texas Pediatric Society.
Motivational Interviewing training. Change Talk: Childhood Obesity: Free clinical training simulation to help build motivational interviewing skills. Available online and for mobile devices. (n.d.). From the AAP and Kognito.
Next Steps: A Practitioner’s Guide of Themed Follow-up Visits to Help Patients Achieve a Healthy Weight: Handy references, available in both English and Spanish, that outline a series of planned follow-up visits to teach evidence-based weight management strategies that can lead to success for practitioner and patient. (2013). From the AAP.
Obesity Prevention Program: Works to make healthy choices easier for all Texans wherever they live, work, and play. (2019). From the Texas Department of State Health Services (DSHS).
Obesity Toolkit: Practical guidelines to aid pediatricians in the prevention, early recognition, and clinical care of children and adolescents with overweight or obesity issues. (n.d.). From the Texas Pediatric Society.
Policy Opportunity Tool: Designed for healthcare professionals with experience in advocacy who are interested in focusing their efforts on obesity prevention. (n.d.). From the AAP.
Texas Medicaid Providers Procedure Manual: Providers’ principal source of information about Texas Medicaid. Regularly updated to reflect the most recent policy and procedure changes. (2019). From the Texas Medicaid & Healthcare Partnership.
Programs Promoting Healthy Eating and Physical Activity
Alliance for a Healthier Generation: Resources for families and communities that empower children to develop lifelong healthy habits.
ChooseMyPlate: Variety of online tools, resources, and print materials you can distribute to patients at preventive medical checkups for guidance about healthy eating. Some are available in Spanish and all can be downloaded for free. (2019). From the U.S. Department of Agriculture.
Comprehensive School Physical Activity Program: Offers a number of health and physical fitness resources, including professional development tools such as workshops, webinars, and podcasts. From Shape America (Society of Health and Physical Educators).
Fuel Up to Play 60: Supports student participation in creating positive changes in their schools, such as improving opportunities to eat nutrient-rich foods and get at least 60 minutes of physical activity every day. From the National Dairy Council and National Football League, in collaboration with the USDA.
Healthy Active Living for Families: Positive, family-focused messages on obesity prevention and physical activity counseling specific to developmental stages of infancy, toddlerhood, and early childhood. Included are handouts specifically developed for Spanish-speaking families. From the AAP.
HealthyChildren.org: Parenting website committed to the best physical, mental, social health, and well-being for all children. Resources include parental guidance and health-related programs, policies, guidelines, and publications. From the AAP.
Healthy Living Challenge: Resources include printable calendars in English and Spanish promoting healthy living. The calendars offer a month’s worth of health-related daily challenges. From the Michael & Susan Dell Center for Healthy Living.
Kids Eat Right: Articles, videos, and tools on nutrition. From the Academy of Nutrition and Dietetics. From the Academy of Nutrition and Dietetics.
Move Your Way: Physical activity campaign to promote the Physical Activity Guidelines for Americans. Includes tips, tools, videos, and fact sheets to help parents motivate children to become more active. From the U.S. Department of Health and Human Services.
President’s Council on Fitness, Sports & Nutrition: Works to increase sports participation among youth of all backgrounds and abilities and to promote healthy and active lifestyles for all Americans. From the U.S. Department of Health & Human Services.
School Health Guidelines: Research and best practice guidelines for promoting healthy nutrition and physical activity in schools. From the CDC.
Afshin, A., Sur, P. J., Fay, K. A., Cornaby, L., Ferara, G., Salama, J. S., . . . Murray, C. J. L. (2019). Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study. The Lancet, April 3.
American Academy of Pediatrics (AAP):
- Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents. (2017). 4th edition.
- Bright Futures: Nutrition. (2019). 3rd edition.
- Childhood Obesity in Primary Care. (2018). Module 1: Childhood Obesity Epidemic and the Role of the Primary Care Provider.
- Children and Media: Tips from the American Academy of Pediatrics. (2018).
- Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. (2007).
- HALF Implementation Guide. (n.d.).
- Healthy Sleep Habits: How Many Hours Does Your Child Need? (2018).
- How Children Develop Unhealthy Food Preferences. (2017).
- How to Make a Family Media Use Plan. (2016).
- Policy Statement. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), e827–e841.
- Policy Statement. (2017). Fruit Juice in Infants, Children, and Adolescents: Current Recommendations. Pediatrics, 139(6).
- Policy Statement. (2016). Media and Young Minds. Pediatrics, 138(5), e20162591.
- Policy Statement. (2016). Media Use in School-Aged Children and Adolescents. Pediatrics, 138(5), e20162592.
- Policy Statement. (2018). Pediatricians and Public Health: Optimizing the Health and Well-Being of the Nation’s Children.
- Policy Statement. (2015). Promoting Food Security for All Children. Pediatrics, 136(5).
- Policy Statement. (2019). Public Policies to Reduce Sugary Drink Consumption in Children and Adolescents.
- Policy Statement. (2015). Snacks, Sweetened Beverages, Added Sugars, and Schools.
- Policy Statement. (2002, reaffirmed 2008). The Medical Home. Pediatrics, 110, 184–186.
- Prevention of Pediatric Overweight and Obesity. (2003, reaffirmed 2006). Committee on Nutrition. Pediatrics, 112(2).
American Heart Association:
- How to Eat More Fruit and Vegetables. (2017).
- Limit Screen Time and Get Your Kids (and the Whole Family) Moving. (2018).
American Medical Association. (2017). Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. Journal of the American Medical Association, 317(23), 2417–2426.
Carlson, J. A., Schipperijn, J., Kerr, J., Saelens, B. E., Natarajan, L., Frank, L. D., Glanz, K., Conway, T. L., Chapman, J. E., Cain, K. L., & Sallis, J. F. (2016). Locations of Physical Activity as Assessed by GPS in Young Adolescents. Pediatrics, 137(1), 2015–2430.
Centers for Disease Control and Prevention (CDC):
- Breastfeeding: Data, statistics, resources, and FAQs. (2019).
- Breastfeeding Report Card, United States. (2018).
- Childhood Obesity Causes and Consequences. (2016).
- Childhood Obesity Facts. (2018).
- Childhood overweight and obesity. (2018).
- Clinical growth charts. (2017).
- Comprehensive School Physical Activity Program. (2017). Physical Education and Physical Activity.
- Disability and Obesity. (2018).
- Get the Facts: Sugar-Sweetened Beverages and Consumption. (2017).
- Growth Charts. (2010).
- Growth Chart Training. (2015).
- Healthy Schools: Childhood Obesity Facts. (2018).
- Low-Energy-Dense Foods and Weight Management: Cutting Calories While Controlling Hunger. (n.d.).
- Making Health Easier. (2017).
- National Health and Nutrition Examination Survey. (2019).
- Physical Activity Basics. (2019).
- Physical activity: Community strategies. (2019).
- Reproductive Health: Teen Pregnancy. (2019).
- Stats of the State of Texas. (2018). National Center for Health Statistics.
- WHO growth standards are recommended for use in the U.S. for infants and children 0 to 2 years of age. (2010).
Child Mind Institute. (n.d.). How to Help Teenagers Get More Sleep.
Common Sense. (2018). Social Media, Social Life.
Cooksey-Stowers, K., Schwartz, M. B., & Brownell, K. D. (2017). Food Swamps Predict Obesity Rates Better Than Food Deserts in the United States. International Journal of Environmental Research and Public Health, (14)11, 1366.
Dallacker, M., Hertwig, R., & Mata, J. (2018). Parents’ considerable underestimation of sugar and their child’s risk of overweight. International Journal of Obesity, 42, 1097–1100.
DeBoer, M. D., Scharf, R. J., & Demmer, R. T. (2013). Sugar-Sweetened Beverages and Weight Gain in 2- to 5-Year-Old Children. Pediatrics, 132(3).
Dolton, P., & Xiao, M. (2016). The Intergenerational Transmission of Body Mass Index across Countries. University of Sussex.
Dye, B. A., Thornton-Evans, G., Xianfen, L., & Iafolla, T. J. (2015). Dental caries and sealant prevalence in children and adolescents in the United States, 2011–2012. NCHS data brief, No. 191. Hyattsville, MD: National Center for Health Statistics.
Foster, B. A., & Weinstein, K. (2019). Moderating Effects of Components of Resilience on Obesity Across Income Strata in the National Survey of Children's Health. Academic Pediatrics, 19(1), 58–66.
Hale, L., & Guan, S. (2014). Screen time and sleep among school-aged children and adolescents: A systematic literature review. Sleep Medicine Reviews, 21, 50–58.
Harvard T. H. Chan School of Public Health:
- Obesity Prevention Source: Child Obesity. (n.d.).
- Obesity Prevention Source: Physical Activity. (n.d.).
- Obesity Prevention Source: Prenatal and Early Life Influences. (n.d.).
- Obesity Prevention Source: Sleep. (n.d.).
Hong, Y. H., & Chung, S. (2018). Small for gestational age and obesity related comorbidities. Annals of Pediatric Endocrinology & Metabolism, 23(1), 4–8.
Imperial College London, & World Health Organization. (2017). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128-9 million children, adolescents, and adults. The Lancet, 390(10113), 2627–2642.
Kang, M. J. (2018). The adiposity rebound in the 21st century children: meaning for what? Korean Journal of Pediatrics, 61(12), 375–380.
March of Dimes. (2015). Caffeine in Pregnancy.
Mayo Clinic. (2017). Weight loss: Feel full on fewer calories.
Michael & Susan Dell Center for Healthy Living:
- Child Obesity in Texas: School Physical Activity and Nutrition Survey (2015–2016). (2018).
- Healthy Children, Healthy State: Child Obesity Crisis in Texas. (2019).
- Latest Resources. (2019).
Miller, A. L., Gearhardt, A. N., Retzloff, L., Sturza, J., Kaciroti, N., & Lumeng, J. C. (2018). Early Childhood Stress and Child Age Predict Longitudinal Increases in Obesogenic Eating Among Low-Income Children. Academic Pediatrics, 18(6), 685–691.
Miller, M. A., Kruisbrink, M., Wallace, J., Ji, C., & Cappuccio, F. P. (2018). Sleep duration and incidence of obesity in infants, children, and adolescents: a systematic review and meta-analysis of prospective studies. Sleep, 41(4).
Miller, W. R. & Rollnick, S. (2013). Motivational Interviewing, Third Edition. Guilford Press.
National Collaborative on Childhood Obesity Research (NCCOR). 2018. NCCOR updates the Measures Registry with 188 new measures to support childhood obesity research.
National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Talking with patients about weight loss: Tips for primary care providers.
Palad, C. J., Yarlagadda, Y., & Stanford, F. C. (2019). Weight stigma and its impact on paediatric care. Current Opinion in Endocrinology & Diabetes and Obesity, 26(1), 19–24.
Papadopoulou, E., Botton, J., Brantsæter, A., Haugen, M., Alexander, J., Meltzer, H. M., Bacelis, J., Elfvin, A., Jacobsson, B., & Sengpiel, V. (2018). Maternal caffeine intake during pregnancy and childhood growth and overweight: results from a large Norwegian prospective observational cohort study. BMJ Open, 8(3).
Partnership for a Healthier America. (n.d.). Facts About Childhood Obesity.
Paruthi, S., Brooks, L. J., D’Ambrosio, C., Hall, W. A., Kotagal, S., Lloyd, R. M., Malow, B. A., Maski, K., Nichols, C., Quan, S. F., Rosen, C. L., Troester, M. M., & Wise, M. S. (2016). Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine, 12(6), 785–786.
Patel, A. I., Madsen, K. A., Maselli, J. H., Cabana, M. D., Stafford, R. S., & Hersh, A. L. (2010). Under-diagnosis of Pediatric Obesity during Outpatient Preventive Care Visits. Academic Pediatrics, 10(6), 405–409.
Pearson, N., Biddle, S. J. H., Griffiths, P., Johnston, J. P., & Haycraft, E. (2018). Clustering and correlates of screen-time and eating behaviours among young children. BMC Public Health, 18(1), 753.
Pew Research Center. (2018). Teens, Social Media & Technology.
Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews, 16(4), 319–326.
Polk, S., Thornton, R., Caulfield, L., & Muñoz, A. (2016). Rapid infant weight gain and early childhood obesity in low-income Latinos and non-Latinos. Public Health Nutrition, 19(10), 1777–1784.
Pont, S. J., Puhl, R., Cook, S. R., & Slusser, W. (2017). Stigma Experienced by Children and Adolescents With Obesity. Pediatrics, 140(6).
Puhl, R. M., Peterson, J. L., & Luedicke, J. (2011). Parental Perceptions of Weight Terminology That Providers Use With Youth. Pediatrics, 128(4), e786–e793.
Rajan, T. M. and Menon, V. (2017). Psychiatric disorders and obesity: A review of association studies. Journal of Postgraduate Medicine, 63(3), 182–190.
Reims, K. G., & Ernst, D. (2016). Using Motivational Interviewing to Promote Healthy Weight. Family Practice Management, 23(5), 32–38.
Reynolds, A., Mann, J., Cummings, J., Winter, N., Mete, E., & Te Morenga, L. (2019).
Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. The Lancet, 393(10170), 434–445.
Robert Wood Johnson Foundation:
- The State of Obesity. (2018). Adult Obesity in the United States.
- The State of Obesity. (2018). Food Insecure Children.
Robinson, T. N., Banda, J. A., Hale, L., Shirong Lu, A., Fleming-Milici, F., Calvert, S. L., & Wartella, E. (2017). Screen Media Exposure and Obesity in Children and Adolescents. Pediatrics, 140(2).
Rollins, B. Y., Loken, E., Savage, J. S., & Birch, L. L. (2014). Effects of restriction on children’s intake differ by child temperament, food reinforcement, and parent’s chronic use of restriction. Appetite, 73, 31–39.
Rudd Center for Food Policy & Obesity:
- Food Marketing. (2019). University of Connecticut.
- Parents’ Reports of Fast-Food Purchases for Their Children: Have They Improved? (2018). University of Connecticut.
Ruffman, T., O’Brien, K. S., Taumoepeau, M., Latner, J. D., & Hunter, J. A. (2016). Toddlers’ bias to look at average versus obese figures relates to maternal antifat prejudice. Journal of Experimental Child Psychology, 142,195–202.
Saari, A., Virta, L. J., Sankilampi, U., Dunkel, L., & Saxen, H. (2015). Antibiotic Exposure in Infancy and Risk of Being Overweight in the First 24 Months of Life. Pediatrics, 135(4), 617–626.
SanGiovanni, C., McElligott, J., Morella, K., & Basco, W. Jr. (2017). Underdiagnosis and Lower Rates of Office Visits for Overweight/Obese Pediatric Patients in Rural Compared with Urban Areas. Southern Medical Journal, 110(7), 480–485.
Schwecher, L. (2018). Poor Sleep in Babies Linked to Higher Risk for Obesity Later in Life. Sleepopolis.
Singh, M. K., Leslie, S. M., Packer, M. M., Zaiko, Y. V., Phillips, O. R., Weisman, E. F., Wall, D. M., Jo, B., & Rasgon, N. (2019). Brain and behavioral correlates of insulin resistance in youth with depression and obesity. Hormones and Behavior, 108, 73–83.
Skinner, A. C., Payne, K., Perrin, A. J., Panter, A. T., Howard, J. B., Bardone-Cone, A., Bulik, C. M., Steiner, M. J., & Perrin, E. M. (2017). Implicit Weight Bias in Children Age 9 to 11 Years. Pediatrics, 140(1).
Skinner, A. C., Ravanbakht, S. N., Skelton, J. A., Perrin, E. P., & Armstrong, S. C. (2018). Prevalence of Obesity and Severe Obesity in US Children, 1999–2016. Pediatrics, 141(3).
Stark, C. M., Susi, A., Emerick, J., & Nylund, C. M. (2019). Antibiotic and acid-suppression medications during early childhood are associated with obesity. Gut, 68, 62–69.
Sutaria, S., Devakumar, D., Yasuda, S. S., Das, S., & Saxena, S. (2018). Is obesity associated with depression in children? Systematic review and meta-analysis.
Archives of Disease in Childhood, 104, 64–74.
Sylvetsky-Meni, A. C., Gillepsie, S. E., Hardy, T., & Welsh, J. A. (2015). The Impact of Parents’ Categorization of Their Own Weight and Their Child’s Weight on Healthy Lifestyle Promoting Beliefs and Practices. Journal of Obesity, 2015(307381).
Taylor, R. W., Gray, A. R., Heath, A. M., Galland, B. C., Lawrence, J., Sayers, R., Healey, D., Tannock, G. W., Meredith-Jones, K. A., Hanna, M., Hatch, B., & Taylor, B. J. (2018). Sleep, nutrition, and physical activity interventions to prevent obesity in infancy: follow-up of the Prevention of Overweight in Infancy (POI) randomized controlled trial at ages 3.5 and 5 y. The American Journal of Clinical Nutrition, 108(2), 228–236.
Texas Department of State Health Services (DSHS):
- Anticipatory Guidance–A Guide for Providers. (2019).
- Child Health Clinical Record Forms. (2018).
- Periodicity Schedule. (2019).
- School Health Advisory Councils. (2019).
- Texas Health Steps Provider Information website (2018).
- Texas Women, Infants, and Children Program. (n.d.). Benefits of breastfeeding.
- Texas Women, Infants, and Children Program. (n.d.). Your one stop breastfeeding resource.
Texas Medicaid & Healthcare Partnership. (2019). Texas Medicaid Provider Procedures Manual.
Thomas, K., & Urrego, F. (2017). Are Pediatricians Diagnosing Obese Children? The Ochsner Journal, 17(1), 80–82.
Tobin, E. T., Hulkower, R. L., & Kaminski, J. W. (2017). Behavioral health integration in pediatric primary care: Considerations and opportunities for policymakers, planners, and providers. Milbank Memorial Fund report.
Twenge, J. M., Martin, G. N., & Spitzberg, B. H. (2018). Trends in U.S. Adolescents’ Media Use, 1976–2016: The Rise of Digital Media, the Decline of TV, and the (Near) Demise of Print. Psychology of Popular Media Culture. American Psychological Association.
University of Michigan. (2018). Stress eating can start in early childhood, may lead to extra weight later. Vice President for Communications, Michigan News.
U.S. Department of Agriculture, & U.S. Department of Health and Human Services. (2015). 2015-2020 Dietary Guidelines for Americans.
U.S. Department of Health and Human Services:
- Dietary Guidelines for Americans 2015–2010, 8th Edition. (2015).
- Healthy People 2020. (2019). Data2020.
- Office of Adolescent Health. (2016). Trends in Teen Pregnancy and Childbearing.
- Office on Women’s Health. (2019). Making the decision to breastfeed.
- Physical Activity Guidelines for Americans. (2018). 2nd edition.
U.S. Surgeon General. (2015). Step it Up! The U.S. Surgeon General’s Call to Action for Walking and Walkable Communities.
U.S. Surgeon General. (2011). The Surgeon General’s call to action to support breastfeeding.
U.S. Department of Agriculture, Economic Research Service. (2018). Food Prices and Spending.
Wang, G., Johnson, S., Gong, Y., Polk, S., Divall, S., Radovick, S., Moon, M., Paige, D., Hong, X., Caruso, D., Chen, Z., Mallow, E., Walker, S. O., Mao, G., Pearson, C., Wang, M., Zuckerman, B., Cheng, T. L., & Wang, X. (2016). Weight Gain in Infancy and Overweight or Obesity in Childhood across the Gestational Spectrum: a Prospective Birth Cohort Study. Scientific Reports, 6(29867).
Wang, L., Collins, C., Ratliff, M., Xie, B., & Wang, Y. (2017). Breastfeeding Reduces Childhood Obesity Risks. Childhood Obesity, 13(3).
Waters, H. & Graf, M. (2018). America’s Obesity Crisis: The Health and Economic Costs of Excess Weight. Milken Institute.
Williams, A. S., Ge, B., Petroski, G., Kruse, R. L., McElroy, J. A., & Koopman, R. J. (2018). Socioeconomic Status and Other Factors Associated with Childhood Obesity. Journal of the American Board of Family Medicine, 31(4), 514–521.
World Health Organization (WHO):
- Association between Characteristics at Birth, Breastfeeding and Obesity in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative – COSI 2015/2017. (2019). Obesity Facts, 12, 226–243.
- Childhood overweight and obesity. (n.d.).
- Guideline: Sugars intake for adults and children. (2015).
- Increasing breastfeeding could save 800,000 children and US$ 300 billion every year. (n.d.).
Younger Meek, J. & Hatcher, A. J. (2017). The Breastfeeding-Friendly Pediatric Office Practice. Pediatrics, 139(5).
The medical definitions provided in this module were obtained or adapted from the Mayo Clinic, Medical Dictionary by TheFreeDictionary, Merriam-Webster, the Prader-Willi Syndrome Association, and the U.S. National Library of Medicine.
Learn to provide age-appropriate nutritional assessments and counseling that promote healthy growth and development.
Managing Type 1 Diabetes: The Early Days
Get practical guidance about how to help young patients and their families learn to manage type 1 diabetes.
Managing Type 1 Diabetes: The Early Days
Get practical guidance about how to help young patients and their families learn to manage type 1 diabetes.
Implement best clinical practices to identify and treat exercise-induced dyspnea, apply an algorithm to clear athletes to return to play, and determine when specialty care is necessary.
Building a Comprehensive and Effective Medical Home
Learn how and why to create and sustain a medical home in your primary care practice.
Texas Health Steps Guidance
Texas Health Steps Guidance
Anticipatory guidance—age-appropriate education and counseling—is a required component of every Texas Health Steps preventive medical and dental checkup. Texas Health Steps offers age-appropriate education and counseling topics so providers can assist patients, families, and caregivers to understand growth, development, and healthy practices. Texas Health Steps recommends that health-care providers personalize anticipatory guidance depending on the needs of their patients. Anticipatory guidance topics should be individualized and prioritized based on questions and concerns of the child or adolescent and their parent or guardian. Specific guidance should also be based on findings obtained during the health history and physical exam.
Texas Health Steps offers Anticipatory Guidance-A Guide for Providers, which includes guidance topics for every age group birth through 20 years. It mirrors anticipatory guidance topics included on the Texas Health Steps Child Health Clinical Record Forms.
Families and caregivers of children with chronic medical conditions face complex challenges and extended stress. Providing long-term care for a child with a disability or chronic illness can take a physical, emotional, and financial toll. It also requires a time commitment that can be difficult to achieve.
As a pediatric health-care provider, you “have a responsibility to recognize caregiver burden (Adelman, Tmanova, Delgado, Dion & Lachs, 2014). Research has shown that caregivers are at increased risk for depression, anxiety, and other negative health effects of what can be a crushing responsibility. At each pediatric checkup, make it part of your routine to inquire whether family or caregivers have questions or concerns about their roles, their own health, or navigating the health-care system.
The health of your young patients and the health of their caregivers are interwoven.
Caregivers who feel overwhelmed may not be able to provide appropriate care for a child in need. You must be alert to outcries for help or signs of health problems related to caregiving, including loss of sleep and diet imbalance. Open communication allows you to be a sounding board for caregivers who are struggling with their duties. At the same time, be on the watch for signs of fatigue or stress in caregivers who try to project an “all’s well” attitude even when they are having problems.
Your role includes providing practical counseling about stress and offering resources designed to help families and caregivers cope.
Top 10 Caregiver Coping Skills
Sharing this Top Ten list of coping skills can help caregivers learn strategies that may reduce stress:
- Understand your feelings.
- Express your emotions.
- Educate yourself about your child’s illness or condition.
- Keep communications open.
- Talk to other parents.
- Focus on the strengths and goals that are achievable.
- Believe in your child.
- Establish routines.
- Maintain your sense of humor! There is no co-pay for laughter!!
- Remember that taking care of yourself is caring for your family.
Source: Parent to Parent of New York State
Resources to share with families and caregivers
Aging and Disability Resource Centers (ADRCs) operated by Texas Health and Human Services (Texas HHS). The centers are welcoming and offer information about state and federal health benefits as well as local programs and services. The trained staff can connect caregivers with services such as home care, meals, transportation, legal help, attendant care, respite support, and housing. Visit the ADRC website for a list of resource center locations in Texas.
Family Support Services, a program to help families care for children with special health-care needs at home. Services are provided by the Children with Special Health Care Needs (CSHCN) Services Program, a branch of the Texas Department of State Health Services.
Navigate Life Texas, a multilingual website created by parents for parents of children with disabilities and special health-care needs. This unique site offers comprehensive, relevant, and reliable information for families, professionals, advocates, and anyone working with children who have disabilities and their families. Sponsored by the Texas Interagency Task Force on Children with Special Needs.
Take Time Texas, a website offered by Texas HHS that includes a state inventory of respite services.
Texas Parent to Parent offers peer support for parents of children with special health-care needs.
All Medicaid managed care organizations (MCOs) provide case management services (called service management for STAR members with special health-care needs). In the other Medicaid managed care programs, everyone gets some level of case management. Patients should first be referred to the plan’s service coordinator and then referred to Case Management for Children and Pregnant Women if patient needs cannot be met by the plan’s services. Health plans are also required to make appropriate referrals to case management services.
For patients enrolled in STAR Medicaid, STAR Health, or Fee-For-Service (FFS) Medicaid, providers can make a referral by one of these methods:
- Calling 877-847-8377 (877-THSteps).
- Contacting a case manager (“Find a Case Manager” web page accessed from the Resources for this module).
- Submitting the Case Management Referral Form (the form is also accessed from Resources).
For patients enrolled in STAR Kids:
- Health Plan service coordinators and others can refer by submitting the STAR Kids Case Management Request Form (the form is also accessed from Resources).
Early Childhood Intervention (ECI) is a statewide program for families with children birth through 35 months who have disabilities and developmental delays. All health-care providers are required by federal and state regulations to refer children 35 months and younger to the local ECI program as soon as possible but no later than seven days after the suspicion or identification of a developmental delay.
To qualify for ECI services, a child must have:
- A qualifying medically diagnosed condition that has a high probability of resulting in a developmental delay. For more information, visit the ECI Qualifying Diagnosis Search web page.
- An auditory or visual impairment as defined by the Texas Education Agency (TEA) rule at 10 TAC Section 89.1040.
- A documented delay of at least 25 percent in one or more of the following areas of skills and development: gross motor, communication, cognition, fine motor, social, emotional, or self-help. Or, a documented delay of at least 33 percent when the delay occurs only in expressive language.
- A qualitative determination of delay, as indicated by responses or patterns that are disordered or qualitatively different from what is expected for the child’s age.
To refer a child, providers should use the ECI Provider Referral and Feedback form. The form, which requires a parent or guardian signature, helps ensure that ECI’s evaluation results and service plan are shared with the referring provider.
To refer families for services, providers can call the local ECI program.
Texas Health Steps requires that all federal- and state-mandated checkup components be documented in the medical record in order for the checkup to be considered complete and to qualify for provider reimbursement. Any checkup component that is not completed must be noted in the medical record, along with the reason it was not completed and a plan to complete it. The medical record must also contain documentation of all screening tools used, screening results, and referrals. Texas Health Steps child health clinical record forms are optional but are recommended to assist providers with documentation of all required checkup components. Providers should be aware that Texas Health Steps checkups are subject to retrospective review and recoupment if the medical record does not include all required documentation.
A medical home is the patient’s primary point of contact when accessing health care. The medical home concept was developed by the American Academy of Pediatrics (AAP) and is promoted by Texas Health Steps. A medical home is defined as one in which care is accessible, family-centered, continuous, comprehensive, compassionate, coordinated, and culturally effective. It is a partnership between a child, the family or caregiver, and the child’s primary health-care setting. The primary health-care setting can be a physician’s office, a hospital outpatient clinic, a school health center, a community health center, or a health department clinic.
Providers who need assistance finding a specialist or subspecialist who accepts patients enrolled in Medicaid can find a specialist or subspecialist by using the Texas Medicaid & Healthcare Partnership (TMHP) Online Provider Lookup or by calling the Texas Health Steps toll-free help line for providers at 800-964-2777 Monday through Friday from 8 a.m. to 6 p.m. Central Time. Select option 3 to speak with a representative.
Providers can access a set of child health clinical record forms to document Texas Health Steps preventive medical checkups. The set includes a form for each checkup under the Texas Health Steps Periodicity Schedule, for patients from up to 5 days old through 20 years. Providers can save or print the forms.
Each form includes the required components for that age’s checkup, along with space for documenting routine, non-required components of a medical checkup. The backside of the form includes a helpful list of suggested anticipatory guidance topics and checklists such as the Hearing Checklist for Parents and Lead Risk Factors.
Texas Health Steps is the preventive care services program for children birth through 20 years who are enrolled in Medicaid. Texas Health Steps provides regular checkups and screenings as part of the Early and Periodic Screening, Diagnosis, and Treatment program, also known as EPSDT.
In Texas, EPSDT is known as Texas Health Steps, which includes the preventive care components—or Early and Periodic Screening (EPS)—of the total EPSDT service. Required medical checkups and preventive care services are provided in accordance with the latest Texas Health Steps Periodicity Schedule, which is modeled after the one developed by the American Academy of Pediatrics (AAP). Additional checkup components are required in Texas to meet federal and state guidelines, and checkups are encouraged as part of the medical home. The Periodicity Schedule specifies when each of the checkup components is due. Providers should always refer to the latest schedule available. To download a PDF of the Periodicity Schedule online, visit the Texas Health Steps Provider Information web page.
The Texas Medicaid & Healthcare Partnership (TMHP) updates the TMPPM monthly. The policy updates are published on the TMHP website and in banner messages, which appear weekly on a provider’s Remittance and Status Report as well as on the website. Providers can find updates on the web page in two ways:
Release Notes—Changes to the TMPPM arranged by date, with most recent at the top of the list.
Change History—Changes to the TMPPM arranged by chapter. (If a chapter has not changed, it will not appear on the list).
NOTE: Providers should always check the TMHP website for the current TMPPM, banner messages, and policy and procedures updates. Archived versions of the TMPPM will remain online for reference purposes.