Clinical audit in the pediatric primary care office and overweight prevention in toddlers

Abstract

Background: Clinical audit is a process by which physicians or other health care professionals perform a regular and systematic review of their clinical practice and amend it, when necessary. An internal audit allows to review the activities carried out by professionals, in order to assess the appropriateness, effectiveness, efficiency and safety of the services provided. Aim of this study was to apply the process of clinical audit to the obesity/overweight care in toddlers. After the correction of the nutritional errors that were considered potentially responsible for the excess weight gain, the effect of the changes of dietary advice on the frequency of overweight/obesity was assessed in a cohort of children aged 24-36 months. Methods: Three Italian primary care pediatricians set up the audit strategy by recognizing the high prevalence of overweight and obesity in the entire cohort of toddlers born in 2005, 2006 and 2007 (Pre-Audit group, age 24-36 months old) under their care. By reviewing their clinical practice, they changed the protocol of weaning and feeding up to 36 months, mainly reducing protein and sugar excess. The change involved the cohorts of toddlers born in the years 2010, 2011 and 2012 (Post-Audit group). Results: Change in the approach of pediatricians to children's diet yielded a reduction of the frequency of overweight/obesity in children between 24 and 36 months of life from 26.3% in the Pre-Audit group to 13.9% in the Post-Audit group (p < 0.0001). Conclusion: Clinical audit revealed high rates of obesity/overweight among toddlers. The practice developed a new strategy for nutritional counseling, which was effective in reducing the frequency of overweight/obesity in young children.

Consulta de enfermagem à saúde da criança através de um projeto de extensão: perfil dos atendimentos

“…No início da vida de uma criança, os fatores nutricionais influenciam mais no ganho de peso do que os fatores ambientais, sendo indispensável a atuação dos profissionais da saúde em fornecer orientações corretas na introdução alimentar e alertar sobre os riscos no desenvolvimento da obesidade infantil. No sul da Itália, existe uma prevalência de sobrepeso e obesidade infantil, sendo a mais alta do país, o que salienta a necessidade de ter medidas educativas e uma reavaliação cuidadosa das recomendações dadas aos familiares durante esse momento de introdução alimentar 15 .…”

Nutritional counselling and risk factors for obesity: an observational study in toddlers.

“…For instance, a systematic review of systematic reviews on the effects of nutritional exposure or interventions in children under 3 years, underscored the promising effect of lowering the protein intake of infant formula or complementary food on the risk of later OW/OB [13]. Indeed, a previous study conducted by primary care pediatricians demonstrated that simple but speci c dietary advices, focused on the choice and amount of food with low protein content and sugar, were associated to a reduction of the frequency of OW and OB in toddlers living in an Italian region with high prevalence of OW/OB [14].…”