Add growth velocity, feeding guidance, BMI classification to well visits
- Growth reference data by age (newborn through 21y): expected weight/length/HC gains per day/month/year, puberty growth spurt details - Feeding/nutrition guidance by age: formula amounts, breastfeeding frequency, solid food introduction timeline, juice limits, milk transitions, calorie needs - BMI/obesity classification per AAP 2023 CPG + CDC Extended BMI: Underweight, Healthy, Overweight, Obesity Class I/II/III with action items (≥120% and ≥140% of 95th percentile thresholds) - Weight-for-length guidance for children <2 years - "By Visit" panel now shows growth reference + feeding guidance + BMI table - Well visit AI prompt updated to include growth assessment, BMI classification, and feeding counseling in generated notes - Backend injects age-appropriate growth/nutrition data into AI context
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5 changed files with 406 additions and 6 deletions
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@ -348,6 +348,21 @@ body{font-family:'Inter',system-ui,sans-serif;background:var(--g50);color:var(--
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.wv-status-range{background:var(--blue-light);color:var(--blue-dark);}
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.wv-screen-name{font-size:13px;color:var(--g700);}
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/* Growth & Feeding */
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.wv-growth-box{display:flex;flex-direction:column;gap:8px;}
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.wv-growth-item{display:flex;gap:8px;align-items:baseline;font-size:13px;line-height:1.5;padding:6px 10px;background:var(--g50);border-radius:8px;}
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.wv-growth-label{font-weight:600;color:var(--g700);min-width:120px;white-space:nowrap;}
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.wv-feeding-list{margin:0;padding-left:20px;font-size:13px;line-height:1.7;color:var(--g700);}
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.wv-feeding-list li{margin-bottom:4px;}
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/* BMI Classification */
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.wv-bmi-table{display:flex;flex-direction:column;gap:6px;}
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.wv-bmi-row{display:grid;grid-template-columns:160px 1fr 1fr;gap:8px;padding:8px 12px;background:var(--g50);border-radius:8px;font-size:12px;align-items:center;}
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.wv-bmi-label{font-weight:700;font-size:13px;}
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.wv-bmi-range{color:var(--g600);}
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.wv-bmi-action{color:var(--g600);font-style:italic;}
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.wv-bmi-note{margin-top:8px;font-size:11px;color:#6b7280;display:flex;align-items:flex-start;gap:6px;}
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@media(max-width:768px){.wv-bmi-row{grid-template-columns:1fr;}}
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/* Notes */
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.wv-notes-box{background:var(--blue-light);border-radius:8px;padding:12px 16px;font-size:13px;color:#1e40af;display:flex;align-items:flex-start;gap:8px;}
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.wv-empty,.wv-loading{color:var(--g400);font-size:14px;padding:20px 0;text-align:center;}
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@ -1703,6 +1703,245 @@ const NEWBORN_SCREENING = {
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notes: "Exact panel varies by state. For complete current list: https://www.hrsa.gov/advisory-committees/heritable-disorders/rusp/index.html and https://www.babysfirsttest.org/"
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};
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// ─── GROWTH VELOCITY & EXPECTED GAINS (AAP / WHO / Nelson Textbook) ─────────
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// Sources: AAP Bright Futures, WHO Growth Standards, Nelson Textbook of Pediatrics
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const GROWTH_REFERENCE = {
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newborn: {
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weight: "Expect 5-7% weight loss in first 3-5 days, regain birth weight by 10-14 days. Gain ~20-30 g/day (⅔–1 oz/day) in first month.",
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length: "Grow ~1.5 cm/week (~0.6 in/week) in first month.",
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headCirc: "Head circumference grows ~0.5 cm/week in first month.",
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feeding: [
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"Breastfeeding: 8-12 times per 24 hours on demand, both breasts each feeding",
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"Formula: 1-2 oz (30-60 mL) per feeding, 8-12 feedings/day in first week; increases to 2-3 oz per feeding by end of first month",
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"No water, juice, or other liquids",
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"Vitamin D supplementation: 400 IU/day starting in first few days of life for all breastfed and partially breastfed infants"
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]
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},
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"1mo": {
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weight: "Gain ~20-30 g/day (⅔–1 oz/day). Should double birth weight by 4-5 months.",
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length: "Grow ~3-4 cm/month (~1.2-1.6 in/month).",
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headCirc: "Head circumference grows ~1.5-2 cm/month.",
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feeding: [
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"Breastfeeding: 8-12 times per 24 hours, ~15-20 min per breast",
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"Formula: 3-4 oz (90-120 mL) per feeding every 3-4 hours",
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"No water, juice, cereal in bottle, or solids",
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"Continue Vitamin D 400 IU/day if breastfed"
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]
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},
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"2mo": {
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weight: "Gain ~20-30 g/day. Average ~5-6 kg (~11-13 lb) by 2 months.",
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length: "Grow ~3-4 cm/month.",
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headCirc: "Head circumference grows ~1.5-2 cm/month.",
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feeding: [
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"Breastfeeding: 6-10 times per 24 hours, may begin longer stretches at night",
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"Formula: 4-5 oz (120-150 mL) per feeding, 6-8 feedings/day (~24-32 oz/day total)",
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"No water, juice, or solids yet — exclusive breast milk or formula until 6 months",
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"Continue Vitamin D 400 IU/day if breastfed"
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]
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},
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"4mo": {
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weight: "Gain ~15-20 g/day. Should double birth weight around 4-5 months.",
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length: "Grow ~2-3 cm/month (~1 in/month).",
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headCirc: "Head circumference grows ~1 cm/month.",
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feeding: [
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"Breastfeeding: 5-8 times per 24 hours",
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"Formula: 5-6 oz (150-180 mL) per feeding, 5-6 feedings/day (~28-36 oz/day total)",
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"May introduce pureed single-ingredient foods (iron-fortified cereals, pureed vegetables, fruits) at 4-6 months if showing readiness signs",
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"Signs of readiness: good head control, sitting with support, showing interest in food, loss of tongue-thrust reflex",
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"Early allergen introduction (peanut protein) recommended at 4-6 months for high-risk infants (per AAP/NIAID guidelines)",
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"No juice, honey, or cow's milk"
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]
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},
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"6mo": {
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weight: "Gain ~10-15 g/day. Should double birth weight by now; will triple by 12 months.",
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length: "Grow ~1.5-2.5 cm/month. Average length increases ~50% from birth by 12 months.",
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headCirc: "Head circumference grows ~0.5-1 cm/month.",
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feeding: [
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"Begin complementary foods (pureed/mashed): iron-fortified cereals, vegetables, fruits, meats",
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"Introduce variety of textures and flavors — one new food every 3-5 days to watch for allergies",
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"Early allergen introduction: peanut, egg, dairy, wheat, soy, fish — per AAP guidelines to reduce allergy risk",
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"Breastfeeding: continue on demand, 4-6 times/day alongside solids",
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"Formula: 24-32 oz/day total, may decrease as solids increase",
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"May offer sips of water from open or straw cup with meals (2-4 oz/day)",
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"No juice before 12 months (AAP recommendation), no honey, no cow's milk as main drink"
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]
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},
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"9mo": {
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weight: "Gain ~10-13 g/day.",
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length: "Grow ~1.5 cm/month.",
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headCirc: "Head circumference grows ~0.5 cm/month.",
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feeding: [
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"3 meals of soft table foods + 1-2 snacks/day; finger foods encouraged (soft pieces, dissolvable puffs)",
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"Breastfeeding or formula: continue 3-5 times/day (~24-30 oz formula/day)",
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"Encourage self-feeding and cup drinking",
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"No juice before 12 months, no honey, no cow's milk as drink",
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"Iron-rich foods important: fortified cereals, meats, beans"
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]
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},
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"12mo": {
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weight: "Should have tripled birth weight (~10 kg / 22 lb average). Gain ~200-250 g/month (~7-8 oz/month) in second year.",
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length: "Average 75 cm (29.5 in). Grow ~1 cm/month (~0.5 in/month) in second year.",
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headCirc: "Head circumference grows ~0.25-0.5 cm/month.",
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feeding: [
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"Transition to whole cow's milk: 16-24 oz/day (no more than 24 oz to prevent iron deficiency anemia)",
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"Wean from bottle by 12-15 months — use open cup or straw cup",
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"3 meals + 2 snacks/day of table foods, chopped/small pieces",
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"May introduce 100% fruit juice: max 4 oz/day (AAP), offer only with meals in a cup, not a bottle",
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"Honey now safe (after age 1)",
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"Avoid choking hazards: whole grapes, hot dogs, nuts, raw carrots, popcorn, hard candy",
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"Continue Vitamin D 600 IU/day if <16 oz whole milk/day"
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]
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},
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"15mo": {
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weight: "Gain ~200-250 g/month. Average ~11 kg (24 lb).",
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length: "Grow ~1 cm/month.",
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feeding: [
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"Whole cow's milk 16-24 oz/day; no more than 24 oz",
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"3 meals + 2 snacks/day; family foods with appropriate modifications",
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"100% juice max 4 oz/day with meals only",
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"May be a picky eater — continue offering variety without pressure",
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"Wean completely from bottle if not yet done"
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]
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},
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"18mo": {
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weight: "Gain ~200 g/month. Average ~11-12 kg (24-26 lb).",
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length: "Grow ~1 cm/month. Average ~82 cm (32 in).",
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feeding: [
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"Whole cow's milk 16-24 oz/day (switch to low-fat/skim at age 2 per AAP if no concerns)",
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"3 meals + 2 snacks/day; continue offering diverse foods",
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"100% juice max 4 oz/day with meals",
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"Self-feeding with utensils encouraged; expect messiness",
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"Limit added sugars and sodium; avoid sugar-sweetened beverages"
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]
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},
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"24mo": {
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weight: "Average ~12-13 kg (26-29 lb). Should have quadrupled birth weight. Gain ~2-2.5 kg/year through early childhood.",
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length: "Average ~86-87 cm (34 in). Grow ~7-8 cm/year (~3 in/year) ages 2-5.",
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bmiClassification: true,
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feeding: [
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"Transition to low-fat (1%) or skim milk per family preference/growth; 16-20 oz/day",
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"3 meals + 2 snacks/day; follow MyPlate guidelines",
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"100% juice max 4 oz/day",
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"Limit added sugars to <25 g/day; avoid sugar-sweetened beverages",
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"Serve age-appropriate portions: ~1 tablespoon per year of age per food group",
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"Family meals together when possible — positive mealtime environment"
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]
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},
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"30mo": {
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weight: "Gain ~2-2.5 kg/year (~4.5-5.5 lb/year).",
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length: "Grow ~7-8 cm/year (~3 in/year).",
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bmiClassification: true,
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feeding: [
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"Low-fat or skim milk ~16-20 oz/day",
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"MyPlate: fruits, vegetables, grains, protein, dairy at each meal",
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"100% juice max 4-6 oz/day (ages 1-3: max 4 oz; ages 4-6: max 6 oz)",
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"Limit ultra-processed foods, fast food, and sugary snacks"
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]
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},
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"3y": {
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weight: "Average ~14-15 kg (31-33 lb). Gain ~2 kg/year.",
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length: "Average ~95 cm (37 in). Grow ~6-7 cm/year (~2.5 in/year).",
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bmiClassification: true,
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feeding: [
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"Low-fat milk; total dairy ~2 cups/day",
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"MyPlate portions; ~1,000-1,400 calories/day",
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"100% juice max 4 oz/day",
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"Encourage water as primary beverage",
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"Limit added sugars <25 g/day"
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]
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},
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"4y": {
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weight: "Gain ~2-2.5 kg/year. Average ~16-17 kg (35-37 lb).",
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length: "Grow ~6-7 cm/year. Average ~102 cm (40 in).",
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bmiClassification: true,
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feeding: [
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"~1,200-1,600 calories/day depending on activity",
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"100% juice max 4-6 oz/day",
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"Fat-free or low-fat milk and dairy products",
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"Encourage 5+ servings of fruits/vegetables daily",
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"Limit screen time during meals; promote family meals"
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]
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},
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"5y": {
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weight: "Gain ~2-2.5 kg/year. Average ~18-20 kg (40-44 lb).",
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length: "Grow ~5-7 cm/year. Average ~109 cm (43 in).",
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bmiClassification: true,
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feeding: [
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"~1,200-1,800 calories/day depending on activity",
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"100% juice max 4-6 oz/day (age 4-6: max 6 oz)",
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"Encourage independence in food choices from healthy options",
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"Model healthy eating behaviors"
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]
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},
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"6y_to_10y": {
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weight: "Gain ~2-3 kg/year (4.5-6.5 lb/year) until puberty. Preadolescent weight gain may accelerate.",
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length: "Grow ~5-6 cm/year (~2-2.5 in/year) until puberty.",
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bmiClassification: true,
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feeding: [
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"~1,400-2,200 calories/day based on age, gender, and activity level",
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"100% juice max 8 oz/day (ages 7+)",
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"Water and low-fat milk as primary beverages",
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"Encourage whole grains, lean protein, fruits, vegetables",
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"Limit sugar-sweetened beverages, fast food, and ultra-processed snacks",
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"Teach nutrition label reading"
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]
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},
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"11y_to_14y": {
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weight: "Puberty weight gain: Girls ~7-25 kg total over puberty (peak ~8-9 kg/year). Boys ~7-30 kg total (peak ~9 kg/year, typically 1-2 years after girls).",
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length: "Puberty growth spurt: Girls ~8-14 cm/year (peak ~11-12 years, ~2 years after breast development). Boys ~10-14 cm/year (peak ~13-14 years). Girls typically complete growth ~2 years after menarche; boys by ~17-18 years.",
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bmiClassification: true,
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feeding: [
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"~1,800-3,200 calories/day depending on gender, pubertal stage, and activity",
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"Calcium: 1,300 mg/day (critical for peak bone mass during puberty)",
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"Iron: 8-15 mg/day (increased need in menstruating adolescents)",
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"Healthy body image counseling — avoid restrictive dieting",
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"Screen for disordered eating behaviors",
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"Limit sugar-sweetened beverages and energy drinks",
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"No caffeine >100 mg/day for ages 12-18"
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]
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},
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"15y_to_21y": {
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weight: "Late pubertal changes; growth velocity slowing. Most girls have reached adult weight; boys may gain until 18-21.",
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length: "Girls: most have reached adult height by 15-16. Boys: may grow until 18-21. Final height typically within 2 inches of mid-parental height.",
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bmiClassification: true,
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feeding: [
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"~2,000-3,200 calories/day based on activity level",
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"Calcium: 1,300 mg/day through age 18, then 1,000 mg/day",
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"Iron: 11 mg/day (males), 15 mg/day (females, menstruating)",
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"Healthy relationship with food; screen for eating disorders (SCOFF tool)",
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"Vegetarian/vegan diets need B12, iron, zinc, calcium supplementation assessment",
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"Avoid energy drinks; limit caffeine to <100 mg/day (12-18) or <400 mg/day (18+)",
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"Promote meal planning and cooking skills for independence"
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]
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}
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};
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// ─── BMI / WEIGHT CLASSIFICATION (AAP 2023 CPG + CDC Extended BMI) ──────────
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// Source: AAP Clinical Practice Guideline for Evaluation and Treatment of
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// Children and Adolescents with Obesity (Pediatrics 2023;151(2):e2022060640)
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// CDC Extended BMI-for-Age Percentiles (Pediatrics 2023;152(3):e2023062285)
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const BMI_CLASSIFICATION = {
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appliesAge: "Ages 2-20 years (use weight-for-length <2 years)",
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categories: [
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{ label: "Underweight", range: "BMI < 5th percentile", color: "#60a5fa", action: "Evaluate for nutritional deficiency, chronic illness, or eating disorder" },
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{ label: "Healthy Weight", range: "BMI 5th to < 85th percentile", color: "#34d399", action: "Reinforce healthy habits" },
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{ label: "Overweight", range: "BMI 85th to < 95th percentile", color: "#fbbf24", action: "Motivational interviewing, dietary counseling, activity assessment" },
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{ label: "Obesity (Class I)", range: "BMI ≥ 95th percentile but < 120% of 95th", color: "#fb923c", action: "Intensive health behavior and lifestyle treatment (IHBLT); comorbidity screening: fasting glucose/HbA1c, lipid panel, ALT, BP" },
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{ label: "Severe Obesity (Class II)", range: "BMI ≥ 120% to < 140% of 95th percentile (or BMI ≥ 35)", color: "#f87171", action: "IHBLT; consider pharmacotherapy (≥12 years); comorbidity screening; sleep study if symptomatic; assess psychosocial impact" },
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{ label: "Severe Obesity (Class III)",range: "BMI ≥ 140% of 95th percentile (or BMI ≥ 40)", color: "#dc2626", action: "IHBLT; consider pharmacotherapy (≥12y) and metabolic/bariatric surgery (≥13y); comprehensive comorbidity evaluation; behavioral health" }
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],
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underTwo: "For children < 2 years: use WHO weight-for-length chart. Weight-for-length ≥ 97.7th percentile indicates high weight status. No BMI classification for under 2.",
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comorbidityScreening: [
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"Fasting glucose or HbA1c (for type 2 diabetes risk — screen starting at age 10 or puberty onset if BMI ≥85th %ile)",
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"Fasting lipid panel",
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"ALT (for nonalcoholic fatty liver disease — screen starting at age 9-11 if BMI ≥85th %ile)",
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"Blood pressure at every visit",
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"Polysomnography if symptoms of obstructive sleep apnea",
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"Mental health screening (depression, anxiety, bullying, stigma)"
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],
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notes: "Use CDC Extended BMI-for-Age growth charts for children with BMI >97th percentile to better track changes over time. The 98th percentile on extended charts approximates 120% of the 95th percentile in older children/adolescents."
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};
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// ─── EXPORTS ──────────────────────────────────────────────────────────────────
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if (typeof module !== "undefined" && module.exports) {
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module.exports = {
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@ -1715,5 +1954,7 @@ if (typeof module !== "undefined" && module.exports) {
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AAP_FOOTNOTES,
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DYSLIPIDEMIA_SCHEDULE,
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NEWBORN_SCREENING,
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GROWTH_REFERENCE,
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BMI_CLASSIFICATION,
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};
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}
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@ -208,6 +208,27 @@
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}
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window.wvSwitchSubtab = switchSubtab;
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// ─── Map visit ID to GROWTH_REFERENCE key ─────────────────────────────────
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function getGrowthDataForVisit(visitId) {
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if (typeof GROWTH_REFERENCE === 'undefined') return null;
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// Direct match
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if (GROWTH_REFERENCE[visitId]) return GROWTH_REFERENCE[visitId];
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// Map visit IDs to growth reference keys
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var mapping = {
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'newborn': 'newborn', '3-5d': 'newborn',
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'1mo': '1mo', '2mo': '2mo', '4mo': '4mo', '6mo': '6mo', '9mo': '9mo',
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'12mo': '12mo', '15mo': '15mo', '18mo': '18mo',
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'24mo': '24mo', '30mo': '30mo',
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'3y': '3y', '4y': '4y', '5y': '5y',
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'6y': '6y_to_10y', '7y': '6y_to_10y', '8y': '6y_to_10y', '9y': '6y_to_10y', '10y': '6y_to_10y',
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'11y': '11y_to_14y', '12y': '11y_to_14y', '13y': '11y_to_14y', '14y': '11y_to_14y',
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'15y': '15y_to_21y', '16y': '15y_to_21y', '17y': '15y_to_21y', '18y': '15y_to_21y',
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'19y': '15y_to_21y', '20y': '15y_to_21y', '21y': '15y_to_21y'
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};
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var key = mapping[visitId];
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return key ? GROWTH_REFERENCE[key] : null;
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}
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// ─── BY VISIT panel ───────────────────────────────────────────────────────
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function renderVisitPanel(visitId) {
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var data = (typeof PERIODICITY !== 'undefined') ? PERIODICITY[visitId] : null;
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@ -306,6 +327,46 @@
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html += '</div>';
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}
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// ── Growth Reference & Feeding Guidance ──
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var growthData = getGrowthDataForVisit(visitId);
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if (growthData) {
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html += '<div class="wv-section">';
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html += '<h4 class="wv-section-title"><i class="fas fa-chart-line"></i> Expected Growth</h4>';
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html += '<div class="wv-growth-box">';
|
||||
if (growthData.weight) html += '<div class="wv-growth-item"><span class="wv-growth-label">⚖️ Weight</span><span>' + esc(growthData.weight) + '</span></div>';
|
||||
if (growthData.length) html += '<div class="wv-growth-item"><span class="wv-growth-label">📏 Length/Height</span><span>' + esc(growthData.length) + '</span></div>';
|
||||
if (growthData.headCirc) html += '<div class="wv-growth-item"><span class="wv-growth-label">🧠 Head Circumference</span><span>' + esc(growthData.headCirc) + '</span></div>';
|
||||
html += '</div>';
|
||||
|
||||
if (growthData.feeding && growthData.feeding.length) {
|
||||
html += '<h4 class="wv-section-title" style="margin-top:8px;"><i class="fas fa-utensils"></i> Feeding & Nutrition Guidance</h4>';
|
||||
html += '<ul class="wv-feeding-list">';
|
||||
growthData.feeding.forEach(function (f) {
|
||||
html += '<li>' + esc(f) + '</li>';
|
||||
});
|
||||
html += '</ul>';
|
||||
}
|
||||
|
||||
html += '</div>';
|
||||
}
|
||||
|
||||
// ── BMI / Weight Classification (ages 2+) ──
|
||||
if (growthData && growthData.bmiClassification && typeof BMI_CLASSIFICATION !== 'undefined') {
|
||||
html += '<div class="wv-section">';
|
||||
html += '<h4 class="wv-section-title"><i class="fas fa-weight-scale"></i> BMI / Weight Classification (AAP 2023)</h4>';
|
||||
html += '<div class="wv-bmi-table">';
|
||||
BMI_CLASSIFICATION.categories.forEach(function (cat) {
|
||||
html += '<div class="wv-bmi-row" style="border-left:4px solid ' + cat.color + ';">';
|
||||
html += '<div class="wv-bmi-label"><strong>' + esc(cat.label) + '</strong></div>';
|
||||
html += '<div class="wv-bmi-range">' + esc(cat.range) + '</div>';
|
||||
html += '<div class="wv-bmi-action">' + esc(cat.action) + '</div>';
|
||||
html += '</div>';
|
||||
});
|
||||
html += '</div>';
|
||||
html += '<div class="wv-bmi-note"><i class="fas fa-circle-info"></i> ' + esc(BMI_CLASSIFICATION.notes) + '</div>';
|
||||
html += '</div>';
|
||||
}
|
||||
|
||||
// ── Notes ──
|
||||
if (data.notes) {
|
||||
html += '<div class="wv-section wv-notes-box"><i class="fas fa-circle-info"></i> ' + esc(data.notes) + '</div>';
|
||||
|
|
|
|||
|
|
@ -9,6 +9,55 @@ var PROMPTS = require('../utils/prompts');
|
|||
var { authMiddleware } = require('../middleware/auth');
|
||||
var logger = require('../utils/logger');
|
||||
|
||||
// Load growth reference and BMI classification data
|
||||
var scheduleData;
|
||||
try {
|
||||
scheduleData = require('../../public/js/pediatricScheduleData');
|
||||
} catch(e) {
|
||||
scheduleData = {};
|
||||
}
|
||||
var GROWTH_REFERENCE = scheduleData.GROWTH_REFERENCE || {};
|
||||
var BMI_CLASSIFICATION = scheduleData.BMI_CLASSIFICATION || {};
|
||||
|
||||
// Map visit age text to GROWTH_REFERENCE keys
|
||||
function getGrowthRefForAge(ageStr) {
|
||||
if (!ageStr) return null;
|
||||
var a = ageStr.toLowerCase().trim();
|
||||
// Direct key matches
|
||||
var directKeys = ['newborn', '1mo', '2mo', '4mo', '6mo', '9mo', '12mo', '15mo', '18mo', '24mo', '30mo', '3y', '4y', '5y'];
|
||||
for (var i = 0; i < directKeys.length; i++) {
|
||||
if (a.indexOf(directKeys[i]) !== -1) return GROWTH_REFERENCE[directKeys[i]] || null;
|
||||
}
|
||||
// Age-based range matching
|
||||
var ageMatch = a.match(/(\d+)\s*(month|mo|year|y|yr)/i);
|
||||
if (ageMatch) {
|
||||
var num = parseInt(ageMatch[1]);
|
||||
var unit = ageMatch[2].toLowerCase();
|
||||
if (unit === 'month' || unit === 'mo') {
|
||||
if (num <= 1) return GROWTH_REFERENCE['1mo'];
|
||||
if (num <= 3) return GROWTH_REFERENCE['2mo'];
|
||||
if (num <= 5) return GROWTH_REFERENCE['4mo'];
|
||||
if (num <= 8) return GROWTH_REFERENCE['6mo'];
|
||||
if (num <= 11) return GROWTH_REFERENCE['9mo'];
|
||||
if (num <= 14) return GROWTH_REFERENCE['12mo'];
|
||||
if (num <= 17) return GROWTH_REFERENCE['15mo'];
|
||||
if (num <= 23) return GROWTH_REFERENCE['18mo'];
|
||||
if (num <= 29) return GROWTH_REFERENCE['24mo'];
|
||||
if (num <= 35) return GROWTH_REFERENCE['30mo'];
|
||||
}
|
||||
if (unit === 'year' || unit === 'y' || unit === 'yr') {
|
||||
if (num <= 3) return GROWTH_REFERENCE['3y'];
|
||||
if (num <= 4) return GROWTH_REFERENCE['4y'];
|
||||
if (num <= 5) return GROWTH_REFERENCE['5y'];
|
||||
if (num <= 10) return GROWTH_REFERENCE['6y_to_10y'];
|
||||
if (num <= 14) return GROWTH_REFERENCE['11y_to_14y'];
|
||||
return GROWTH_REFERENCE['15y_to_21y'];
|
||||
}
|
||||
}
|
||||
if (a.indexOf('newborn') !== -1 || a.indexOf('birth') !== -1) return GROWTH_REFERENCE['newborn'];
|
||||
return null;
|
||||
}
|
||||
|
||||
// ── POST generate SSHADESS assessment summary ────────────────────────────
|
||||
router.post('/well-visit/shadess', authMiddleware, async function(req, res) {
|
||||
var start = Date.now();
|
||||
|
|
@ -141,6 +190,26 @@ router.post('/well-visit/note', authMiddleware, async function(req, res) {
|
|||
context += physicianMemories + '\n\n';
|
||||
}
|
||||
|
||||
// Add growth reference and feeding guidance for this age
|
||||
var growthRef = getGrowthRefForAge(patientAge || visitAge);
|
||||
if (growthRef) {
|
||||
context += 'GROWTH/NUTRITION GUIDANCE (AAP reference for this age):\n';
|
||||
if (growthRef.weight) context += 'Expected weight gain: ' + growthRef.weight + '\n';
|
||||
if (growthRef.length) context += 'Expected length/height gain: ' + growthRef.length + '\n';
|
||||
if (growthRef.headCirc) context += 'Expected head circumference gain: ' + growthRef.headCirc + '\n';
|
||||
if (growthRef.feeding && growthRef.feeding.length) {
|
||||
context += 'Feeding guidance:\n';
|
||||
growthRef.feeding.forEach(function(f) { context += ' - ' + f + '\n'; });
|
||||
}
|
||||
if (growthRef.bmiClassification && BMI_CLASSIFICATION.categories) {
|
||||
context += 'BMI Classification (AAP 2023 / CDC Extended BMI):\n';
|
||||
BMI_CLASSIFICATION.categories.forEach(function(c) {
|
||||
context += ' - ' + c.label + ': ' + c.range + ' → ' + c.action + '\n';
|
||||
});
|
||||
}
|
||||
context += '\n';
|
||||
}
|
||||
|
||||
var prompt = (noteStyle === 'short') ? PROMPTS.wellVisitShort : PROMPTS.wellVisitNote;
|
||||
|
||||
var result = await callAI([
|
||||
|
|
|
|||
|
|
@ -222,24 +222,38 @@ Chief Complaint:
|
|||
Interval History: (development, growth, behavior, school/activities, diet, sleep, safety since last visit — from transcript if provided)
|
||||
Review of Systems: (pertinent only; use physician ROS template if provided under PHYSICIAN TEMPLATES)
|
||||
Physical Examination: (use physician exam template if provided; include vital signs and measurements given)
|
||||
Growth Assessment: (if vitals/measurements provided: comment on growth velocity and percentile trends. For ages ≥2, include BMI percentile and weight classification per AAP 2023 guidelines:
|
||||
- Underweight: BMI <5th %ile
|
||||
- Healthy Weight: 5th to <85th %ile
|
||||
- Overweight: 85th to <95th %ile
|
||||
- Obesity Class I: ≥95th but <120% of 95th %ile
|
||||
- Severe Obesity Class II: ≥120% to <140% of 95th %ile (or BMI ≥35)
|
||||
- Severe Obesity Class III: ≥140% of 95th %ile (or BMI ≥40)
|
||||
For ages <2, use weight-for-length. If BMI or percentiles not provided, state "BMI classification deferred — percentiles not provided.")
|
||||
Screening Results: (list all screenings completed, results, validated tools used)
|
||||
Immunizations: (vaccines given today; note refusals or deferrals)
|
||||
Assessment:
|
||||
1. Well child visit — [age] [gender]
|
||||
2. [Any additional diagnoses]
|
||||
Plan: (anticipatory guidance, follow-up, referrals, next well visit)
|
||||
2. Growth: [comment on growth pattern — appropriate/concerning]
|
||||
3. [Any additional diagnoses]
|
||||
Plan:
|
||||
- Nutrition/Feeding: (age-appropriate feeding guidance discussed — if GROWTH/NUTRITION GUIDANCE provided below, summarize what was discussed)
|
||||
- Anticipatory guidance
|
||||
- Follow-up, referrals, next well visit
|
||||
Rules:
|
||||
- Do NOT fabricate screening results — only include what was explicitly provided
|
||||
- Use physician templates when supplied
|
||||
- Do not invent exam findings; state "deferred" if not provided`,
|
||||
- Do not invent exam findings; state "deferred" if not provided
|
||||
- Always include age-appropriate growth assessment and feeding/nutrition counseling in the plan
|
||||
- If growth/nutrition reference data is provided, incorporate relevant guidance into the plan as "anticipatory guidance provided"`,
|
||||
|
||||
wellVisitShort: `You are an expert pediatric physician.
|
||||
Generate a brief well child visit note (SOAP style). Keep concise.
|
||||
${CORE_RULES}
|
||||
S: Well child visit, brief interval history, parent concerns
|
||||
O: Vitals/measurements provided, exam findings (use template if provided)
|
||||
A: Well child, age-appropriate development, any additional diagnoses
|
||||
P: Vaccines, screenings, anticipatory guidance, follow-up`,
|
||||
O: Vitals/measurements provided, exam findings (use template if provided). Include growth assessment and BMI classification for ages ≥2.
|
||||
A: Well child, age-appropriate development, growth status, any additional diagnoses
|
||||
P: Feeding/nutrition guidance discussed, vaccines, screenings, anticipatory guidance, follow-up`,
|
||||
|
||||
// ======================== SICK VISIT NOTE ========================
|
||||
sickVisitNote: `You are an expert pediatrician. Generate a concise, professional sick visit note from the provided data.
|
||||
|
|
|
|||
Loading…
Reference in a new issue