Category Archives: Pediatric Providers

Infant Risk Screen

What is the Healthy Start Infant Risk Screen?

Florida’s Healthy Start Infant Risk Screening Instrument is a simple, brief questionnaire that helps the birthing facility identify infants who are at increased risk of post-neonatal or infant mortality during the first year of life or at risk for adverse health and developmental outcomes.

Infants with a score of 4 or more are approximately 6 times more likely to die within the first year after birth! So, early intervention is key.

Who has to be Screened?

Florida State Statute, 383.14 (FAC 64-C), written in 1991, states that the Healthy Start Infant Risk Screen is offered to parents or guardians of all infants born in Florida before leaving the delivering facility. In other words, it’s the law!

What is the Birthing Facility’s Role?

  1. Make sure the parent or guardian is offered the confidential Infant Risk Screening. Approach the screening in a positive manner and be available to answer questions and correct any misinformation about Healthy Start. Give the patient the brochure entitled, “Healthy Start Infant Risk Screening” (available in English and Spanish). Encourage every parent or guardian to consent to the screening questions (though screening is voluntary). Completion of the questions helps assure that infants at risk receive the services they need, and provides for a strong data base for the county and state of Florida that can be used in enhancing maternal and child services. Completion of these questions also helps bring in additional funding to Sarasota County for services. Consent for the screening must be documented 1) on the Birth Certificate in the upper left hand corner, and 2) in the appropriate blanks on the Infant Risk Screen form. If consent is refused, it still must be documented on those two forms.
    In either case, the mother’s and infant’s data at the top of the form and the “Check One” section at the end of the form must be completed legibly, and then the form must be signed and dated by the provider. Please fill in every blank or box in those sections.
  2. Instructions for completing and scoring the screen are on the back pages of the screening form. Please note that “Hispanic” is not a race (it is an ethnicity) and does not affect the answer to Item 30 on the Birth Certificate, “Mother’s race is unknown, other than white, or multiple races selected.”
  3. Encourage every new mother to participate in Healthy Start when the answers indicate the infant is at high risk (a score of 4 or more). Healthy Start services are not income based; research shows that risks can span all income levels. Give them Sarasota County’s Healthy Start Coalition brochure which lists our services.
  4. If the infant does not score a four or more, yet you have concerns about domestic violence, substance abuse, history of abuse or neglect, lack of basic needs, etc., you can make a referral to Healthy Start for reason other than score, with the parent/guardian’s permission. “Patient Desires” or “participated during pregnancy” are not reasons for referral in the absence of the named risk factors.
  5. A parent or guardian can also request Healthy Start services if the score is less than four by calling 861-2905.
  6. After discussing the findings with the parent or guardian, give them the green copy, put the pink copy on the chart, and along with the birth certificate send the white and yellow copies of the screen within 5 days to: Sarasota County Health Department, P.O. Box 2658, Sarasota, FL, 34230. If Birthtype ® is used, you will need to photocopy three additional sheets and have the patient sign each, then distribute according to the color code. If the parent or guardian has answered the questions and agreed to participate, she will be contacted by the Healthy Start Program and offered services based on her level of risk.

What Does “High-Risk” Mean?

“High Risk” means there are environmental or medical risk factors, including physical, social or economic factors, in the baby’s life that increases the risk of death in the first year, or contribute to poor health and development.

Risk factors for infants include: maternal age less than 18; maternal age over 18 but education is less than 12th grade; mother race is other than white, unknown, or multiple races; mother is not married; the number of prenatal visits is zero, one, or unknown; infant weighs less than 2000 Gms; mother used tobacco or alcohol during pregnancy; or the infant has an abnormal condition or congenital anomaly.

What are Healthy Start Services?

Healthy Start services are free to Healthy Start clients or their parents. Services provided by Healthy Start Care Coordinators (who are nurses or social workers) include care coordination, home visiting, and referrals to wraparound services such as: psychosocial counseling, smoking cessation programs, breastfeeding education, nutrition counseling and parenting education. Referrals are also made to appropriate agencies for food, clothing, baby items, etc.

What is the Difference between the Healthy Start Coalition and the Healthy Start Program?

The Healthy Start Coalition of Sarasota County is a non-profit organization which helps set priorities to meet local needs in maternal and infant health. Members of the community are invited to serve on the Coalition or any of its committees. The Coalition also administers all service contracts. Our phone number is 941-373-7070.

The Healthy Start Program of the Sarasota County Health Department is our sub-contractor for Care Coordination services and data entry. Care Coordination is the key to service provision for Healthy Start clients. A highly qualified staff assures that each client’s needs are addressed. The Healthy Start Program phone number 941-861-2905.

How Can the Healthy Start Coalition Help Me?

The Healthy Start Coalition of Sarasota County provides technical assistance and monitors quality on an ongoing basis. Any time you have a question or need to train a new employee, call the Coalition at 373-7070. During visits to your site, Coalition staff will also share with you screening data.

Sample Screening Form:

(Click image to view Full-Size)

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Your Community Liason

Jamee Thumm, Community Liaison for Sarasota County

Florida Statute §383.14 mandates that all prenatal care providers offer the Healthy Start Prenatal Screen at the first prenatal visit, and that all birthing facilities offer the Healthy Start Infant Screen after birth. It is the Coalition’s responsibility to inform health care providers of this responsibility and teach them how to complete the screen correctly.

Your Maternal-Child Healthcare Provider Liaison is responsible and available to provide training to you and your staff. The Liaison will also help troubleshoot screening issues and problems and keep you informed of your screening rates and errors. Regular visits are scheduled, but we know that there are often staff turnovers between visits, which cause loss of knowledge and information regarding the screening process.

Please call the Healthy Start Coalition Office at (941) 373-7070 ext 307 or email Jamee Thumm at to arrange training in your office. We are more than happy to assist you!

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WHO Growth Charts

WHO Growth Standards Are Recommended for Use in the U.S. for Infants and Children 0 to 2 Years of Age

The World Health Organization (WHO) released a new international growth standard statistical distribution  in 2006, which describes the growth of children ages 0 to 59 months living in environments believed to support what WHO researchers view as optimal growth of children in six countries throughout the world, including the U.S. The distribution  shows how infants and young children grow under these conditions, rather than how they do grow in environments that may not support optimal growth.


Why use WHO growth standards for infants and children ages 0 to 2 years of age in the U.S?

  • The WHO standards establish growth of the breastfed infant as the norm for growth.Breastfeeding is the recommended standard for infant feeding. The WHO charts reflect growth patterns among children who were predominantly breastfed for at least 4 months and still breastfeeding at 12 months.
  • The WHO standards provide a better description of physiological growth in infancy.Clinicians often use the CDC growth charts as standards on how young children should grow.  However the CDC growth charts are references; they identify how typical children in the US did grow during a specific time period.  Typical growth patterns may not be ideal growth patterns.  The WHO growth charts are standards; they identify how children should grow when provided optimal conditions.
  • The WHO standards are based on a high-quality study designed explicitly for creating growth charts.The WHO standards were constructed using longitudinal length and weight data measured at frequent intervals. For the CDC growth charts, weight data were not available between birth and 3 months of age and the sample sizes were small for sex and age groups during the first 6 months of age.

Downloadable PDFs of Growth Charts:

How different are the new standards from the old growth charts?

The new standards differ from any existing growth charts in a number of innovative ways. First the MGRS was designed to provide data that describe “how children should grow,” by including in the study’s selection criteria specific health behaviors that are consistent with current health promotion recommendations (e.g., breastfeeding norms, standard pediatric care, non-smoking requirements). This new approach is fundamentally different from that taken by the traditional descriptive references. By adopting a prescriptive approach, the protocol’s design went beyond an update of how children in presumably healthy populations grow at a specific time and place and explicitly recognizes the need for standards (i.e., devices that enable value judgments by incorporating norms or targets in their construction). Arguably, the current obesity epidemic in many developed countries would have been detectable earlier if a prescriptive international standard had been available 20 years ago.

Another key characteristic of the new standard is that it makes breastfeeding the biological “norm” and establishes the breastfed infant as the normative growth model. The previous reference was based on the growth of artificially-fed children.

The pooled sample from the 6 participating countries will allow the development of a truly international standard (in contrast to the previous international reference based on children from a single country) and reiterate the fact that child populations grow similarly across the world’s major regions when their needs for health and care are met.

These standards also include new innovative growth indicators beyond height and weight that are particularly useful for monitoring the increasing epidemic of childhood obesity, such as the skinfold thicknessess.

The study’s longitudinal nature will also allow the development of growth velocity standards. Health care providers will not have to wait until children cross an attained growth threshold to make the diagnosis of under-nutrition and overweight since velocity standards will enable the early identification of children in the process of becoming under- or over-nourished.

Lastly, the development of accompanying windows of achievement for six key motor development milestones will provide a unique link between physical growth and motor development.

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