Langcare Pediatric Growth

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