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WHO Is Using the New Growth Charts?

Journal Watch Pediatrics & Adolescent Medicine February 16, 2011 | Van Niel, Cornelius W.

Byline: Cornelius W. Van Niel, MD The CDC recommends using 2006 WHO growth standards for children aged <24 months.

Differences Between CDC and WHO Growth Charts CDC growth charts are based on cross-sectional data for U.S. children. The only exclusion criterion was very low birth weight (no overweight measurements were excluded). Only half of these children had ever breast-fed, and only one third were still breast-fed at age 3 months. CDC growth charts represent a growth reference.

WHO growth charts were generated from children aged 0 to 5 years in six cities in diverse countries (Brazil, India, Norway, Ghana, Oman, and the U.S.). All children were generally healthy term singletons from families without low socioeconomic status.

Length-for-age curves for children from the six locations were nearly identical. Growth charts for children aged 0 to 2 years were based on longitudinal data from children who were primarily breast-fed through age 4 months and who were still breast-feeding at 12 months. Weight-for-length measurements >3 standard deviations (SD) above or below the median were excluded. Growth charts for children aged 2 to 5 years were based on cross-sectional data from children who were still breast-fed at age 3 months. Weight-for-length measurements >2 SD above or > 3 SD below the median were excluded. WHO growth charts represent a growth standard. this web site cdc growth charts

Differences in Practice Compared with formula-fed children, primarily breast-fed children grow faster during the first few months of life and then slower for the remainder of infancy. The WHO charts’ highest and lowest curves are at 2 SD above (97.7th percentile) and below (2.3rd percentile) the median, whereas the CDC charts use the 95th and 5th percentiles. When an actual group of U.S. children are plotted on the WHO and CDC charts, fewer children aged 6 to 23 months are classified as underweight on the WHO charts than on the CDC charts (using the 2.3rd and 5th percentile cutoffs, respectively; JW Pediatr Adolesc Med Dec 24 2008). However, a similar number of children have low length-for-age. go to web site cdc growth charts

Recommendations Children aged 0 to 2 years: The expert panel recommends using the WHO growth charts. Pediatricians use the CDC growth charts as standards to determine whether children’s growth is healthy, but these charts are actually a growth reference representing U.S. children during a 3-decade period. The WHO growth charts are preferable because they are a true growth standard based on a high-quality longitudinal study of growth under ideal conditions and ideal nutrition (breast milk during infancy). Current U.S. breast-feeding practices are actually closer to the WHO population than the CDC population.

Children aged 2 to 5 years: The expert panel recommends continuing to use the CDC 2000 growth charts. For this age range, the WHO and CDC data are both cross-sectional and represent similar breast-feeding duration. Conveniently, the CDC charts can be used through age 20.

Comment: More than 100 countries have already adopted the 2006 WHO growth standards. Should we? Pediatricians need to be aware that the WHO charts reflect optimal growth for primarily breast-fed infants, which experts argue is the standard by which to determine healthy growth. Fewer children aged <24 months will be considered to have "failure to thrive," according to the WHO growth charts, and this could avoid unnecessary work-ups and interventions. There is good rationale for making this change, but its consequences will need to be studied going forward.

Citation(s):

Van Niel, Cornelius W.