Growth Charts/ percentile charts

Ok, we'll try to keep this simple, but want to inform you nonetheless..

The charts your baby is most likely to be "plotted" on are outdated. Bring your own copy of the new charts just in case.

All clinics should have these, but dont. Before now charts were based on taking the weight gain of a formula fed baby as the norm, the 2006 charts (below) use a curve based on the leaner weight gain of a breastfed baby, so takes breastfeeding as the norm. Now you know!

Firstly we at the breastway would like to point out the lack of significance of these charts in normal, healthy babies. They are only charts, and merely represent a distribution of data that has come before us. They are NOT a measurement of how “well” your baby is doing, as we are often led to believe.

Much confusion and angst surrounds this issue, so we thought we should put in some proper information for you babes regarding this subject…

Put simply, there are 3 types of growth plot charts around, a “CDC” one and 2 WHO ones (old and new). There are now updated WHO ones which is what we as breastfeeders are interested in, and what we’re going to tell you about. Most clinics measure your baby and plot on the CDC charts or outdated (formula based) WHO charts. which take into account the very different growth pattern of a formula fed baby, and so, your breastfed baby may end up incorrectly assessed. We’re hoping to stop this practice. The WHO (2006 release) charts are what we need and should have access to in clinics – Im afraid you may need to bring your own.. but that’s why we’re here, right? To reasssure you and say “print them and show them off!”

The data for breastfed babies is also very different to that of formula fed babies, and these charts are often not what is used when your breastfed baby is being weighed and plotted on a chart. Print the appropriate chart here for your breastfed baby as per their age, and bring it to your “weigh-in”.

Here are the charts you need:

(the 0-6 months are more detailed than 0-2 but that’s the only difference, 0-2 are more than adequate on the detail front)

The following links provide access to the first and second set of the WHO child growth standards (0-60 months):(for interest and education purposes!)

Put simply, up until 2006, the only charts available (sadly still in use) consider formula as the norm for infant feeding. The new charts consider breastfeeding to be the norm. Happy days!

Growth Charts: for your information and sanity:

A growth chart isn't a test, where you are striving to get your baby into the 100th percentile. The growth charts show us the statistical distribution of weight, height , etc. in a particular set of babies (or children or adults). So if a baby is in the 50th percentile for weight on the CDC charts, it means that half of the babies of the same age are heavier and half are lighter; if a baby is in the 10th percentile for height, then 90% of babies of the same age are taller and 10% are shorter. Healthy babies, just like adults, can come in all shapes and sizes - a baby in the 3rd percentile can be just as healthy and normal as a baby in the 97th percentile.

What doctors are generally looking for on a growth chart is that baby stay relatively consistent in their growth pattern this may not happen with the current growth charts. Growth charts are only one part of the puzzle, however, and must be evaluated along with other factors, including:

• What size are baby's parents? What were their growth patterns as babies? What about baby's siblings or other family members?
• Is baby gaining consistently, even if it's not on a curve?
• Is baby meeting developmental milestones on or near target?
• Is baby alert, happy, active?
• Is baby showing other signs of adequate milk intake – wet and dirty nappies?

Many health professionals are not familiar with the normal weight gain patterns of breastfed babies, and rely too much upon standard growth charts.

Healthy breastfed infants tend to grow more rapidly than formula-fed infants in the first 2-3 months of life and less rapidly from 3 to 12 months. All growth charts available at this time include data from infants who were not exclusively breastfed for the first 6 months (includes formula-fed infants and those starting solids before the recommended 6 months). Because many doctors are not aware of this, they see the baby dropping in percentiles on the growth chart and often come to the faulty conclusion that the baby is not growing adequately. At this point they often recommend that the mother (unnecessarily) supplement with formula or solids, and sometimes recommend that they stop breastfeeding altogether. Even if you know that your baby is perfectly healthy and doesn't follow these unnecessary recommendations, she ends up worrying for no reason.

Information for health professionals or more reading:

What is the connection between the new WHO Child Growth Standards and infant and young child feeding practices?

The growth of an infant is strongly linked to how he or she is fed. The nutritional, immunological and growth benefits of breastfeeding have been proven, and so the breastfed infant is the natural standard for physiological growth. The adequacy of human milk to support not only healthy growth but cognitive development and long term health provided a clear rationale for basing the new Standards on breastfed infants.

As a departure, then, from previous growth reference charts used to measure babies and children, the new WHO Child Growth Standards are based on the premise that the breastfed baby is the norm for healthy growth among infants. Until now, existing child growth references were based on infants who were breast and/or artificially fed, but this variable was not controlled for in these early studies.

Because breastfed babies are lean babies, the shape of the curve in the new WHO Child Growth Standards differs from these earlier references, particularly during the first six months of life when growth is rapid.

Additionally, the children selected in the study were fed after the first six months according to guidelines for complementary feeding recommended in the Global Strategy for Infant and Young Child Feeding.

What is the Global Strategy for Infant and Young Child Feeding?

Infant and young child feeding is a cornerstone of care for childhood development. WHO and UNICEF jointly developed the Global Strategy for Infant and Young Child Feeding in 2002 as a guide for countries to develop policies addressing feeding practices and the nutritional status, growth, health, and therefore the very survival, of infants and children.

The Strategy states that breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants. It recommends that infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, they should receive adequate and safe complementary foods while breastfeeding continues up to two years or beyond.

Complementary food is the additional food and drink rich in nutrients that is recommended for children at the end of the first six months of life. The transition from exclusive breastfeeding to complementary feeding typically covers the period from 6 to 18-24 months of age, and is a very vulnerable period. It is the time when malnutrition starts in many children. Thus it is essential that infants receive appropriate, adequate and safe complementary foods to ensure the right transition from breastfeeding to the full use of family foods.

The Strategy is based on evidence that nutrition plays a crucial role in the early months and years of life and the importance of appropriate feeding practices in achieving optimal health. Lack of breastfeeding can set up risk factors for ill-health. The life-long impact may include poor school performance, reduced productivity, impaired intellectual and social development, or chronic diseases.

Inadequate infant growth due to poor nutrition leads to under-nutrition in children in many developing countries, which if followed later in life by an increased intake of calories e.g. carbohydrates, fats, etc., could result in overweight or obesity. It is not uncommon to see an under-nourished child in the same household as an overweight adult. This is becoming known as the 'double burden of malnutrition'.

How will the new WHO Child Growth Standards support implementation of the Global Strategy on Infant and Young Child Feeding?

The Standards are a crucial new tool for monitoring infant and child growth and for evaluating efforts to implement the Global Strategy. As such, they provide a means to advocate for protection, promotion and support of breastfeeding and adequate complementary feeding.

Full implementation of the objectives of the Global Strategy will enable supportive environments for mothers to breastfeed their children. The new Child Growth Standards provide the necessary measurement and evaluation tool for parents, caregivers, health practitioners, policymakers and advocates with which to monitor healthy growth, ensure timely screening and treatment, recommend and follow positive nutritional practices.

Current WHO Charts  as listed as pdf above:

Girls : birth to 6 months:

http://www.who.int/childgrowth/standards/cht_wfa_girls_p_0_6.pdf

Girls: birth to 2 years WHO

http://www.who.int/childgrowth/standards/cht_wfa_girls_p_0_2.pdf

Girls: 2-5 years

http://www.who.int/childgrowth/standards/cht_wfa_girls_p_2_5.pdf

birth to 5 http://www.who.int/entity/childgrowth/standards/cht_wfa_girls_p_0_5.pdf

Boys:

Birth to 6 months: http://www.who.int/childgrowth/standards/cht_wfa_boys_p_0_6.pdf

Birth to2: http://www.who.int/entity/childgrowth/standards/cht_wfa_boys_p_0_2.pdf

6 mo to 2: http://www.who.int/entity/childgrowth/standards/cht_wfa_boys_p_6_2.pdf

2 to 5: http://www.who.int/entity/childgrowth/standards/cht_wfa_boys_p_2_5.pdf

Birth to 5: http://www.who.int/entity/childgrowth/standards/cht_wfa_boys_p_0_5.pdf

Further reading on latest WHO new charts and policies plus media releases for 2006 charts:

http://www.who.int/nutrition/media_page/en/

References

1. WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: length/height-for-age, weight-for-age, weight-for length,weight-for-height and body mass index-for-age: methods and development. Geneva: World Health Organization, 2006.

2. WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight and age. Acta

Paediatr Suppl. 2006;450:76–85.

3. Garza C, de Onis M. WHO Multicentre Growth Reference Study Group. Rationale for developing a new international growth reference.

Food Nutr Bull. 2004;25: Suppl 1:S5–14.

4. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, GuoSS, Wei R, Mei Z, Curtin LR, Roche AF, Johnson CL. CDC growthcharts: United States. Advance data from vital and health statistics,no. 314. Hyattsville (MD): National Center for Health Statistics;

2000.

5. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM,Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL. 2000 CDC growth charts for the United States: methods and development. Vital Health

Stat 11. 2002 May;(246):1–190.

6. Dibley MJ, Goldsby JB, Staehling NW, Trowbridge FL. Developmentof normalized curves for the international growth reference:

historical and technical considerations. Am J Clin Nutr. 1987;46:736–48.

7. de Onis M, Yip R. The WHO growth chart: historical considerationsand current scientific issues. Bibl Nutr Dieta. 1996;53:74–89.

8. WHO Multicentre Growth Reference Study Group. Enrollment andbaseline characteristics in the WHO Multicentre Growth Reference

Study. Acta Paediatr Suppl. 2006;450:7–15.

9. de Onis M, Garza C, Victora CG, Onyango AW, Frongillo EA, MartinesJ, WHO Multicentre Growth Reference Study Group. The WHO Multicentre Growth Reference Study: planning, study design and

methodology. Food Nutr Bull. 2004;25 Suppl 1:S15–26.

10. de Onis M, Onyango AW, Van den Broeck J, Chumlea WC, Martorell R, WHO Multicentre Growth Reference Study Group. Measurement and standardization protocols for anthropometry used in the construction

of a new international growth reference. Food Nutr Bull. 2004;25 Suppl 1:S27–36.

11. Onyango AW, Pinol AJ, de Onis M, WHO Multicentre Growth Reference Study Group. Managing data for a multicountry longitudinal

study: experience from the WHO Multicentre Growth Reference Study.Food Nutr Bull. 2004;25: Suppl 1:S46–52.

12. WHO Multicentre Growth Reference Study Group. Reliability ofanthropometric measurements in the WHO Multicentre Growth

Reference Study. Acta Paediatr Suppl. 2006;450:38–46.

13. WHO Multicentre Growth Reference Study Group. Assessment ofdifferences in linear growth among populations in the WHO MulticentreGrowth Reference Study. Acta Paediatr Suppl. 2006;450:56–65.

14. Borghi E, de Onis M, Garza C, Van den Broeck J, Frongillo EA,Grummer-Strawn L, Van Buuren S, Pan H, Molinari L, et al.

Construction of theWorld Health Organization child growth standards:selection of methods for attained growth curves. Stat Med. 2006;25:

247–65.

15. Mei Z, Scanlon KS, Grummer-Strawn LM, Freedman DS, Yip R,Trowbridge FL. Increasing prevalence of overweight among US

WHO standards and CDC 2000 charts 147

16. Hediger ML, Overpeck MD, Ruan WJ, Troendle JF. Early infant feedingand growth status of US-born infants and children aged 4–17 mo:analyses from the third National Health and Nutrition ExaminationSurvey, 1988–1994. Am J Clin Nutr. 2000;72:159–67.

17. de Onis M, Onyango AW. The Centers for Disease Control andPrevention 2000 growth charts and the growth of breast-fed infants.Acta Paediatr. 2003;92:413–9.

18. Working WHO Group on Infant Growth. An evaluation of infantgrowth. Geneva: World Health Organization, 1994.

19. Dewey KG, Peerson JM, Brown KH, Krebs NF, Michaelsen KF, PerssonLA, Salmenpera L, Whitehead RG, Yeung DL. Growth of breast fed infants deviates from current reference data: a pooled analysis of US,

Canadian, and European datasets. Pediatrics. 1995;96:495–503.

20. Mei Z, Yip R, Grummer-Strawn LM, Trowbridge FL. Development of aresearch child growth reference and its comparison with the current ninternational growth reference. Arch Pediatr Adolesc Med. 1998;152:

471–9.

21. WHO. Diet, nutrition and the prevention of chronic diseases. Report ofa Joint WHO/FAO Expert Consultation. Technical Report Series No.916. Geneva: World Health Organization, 2003.

22. de Onis M, Dasgupta P, Saha S, Sengupta D, Blo¨ ssner M. The NationalCenter for Health Statistics reference and the growth of Indianadolescent boys. Am J Clin Nutr. 2001;74:248–53.

23. WHO Multicentre Growth Reference Study Group. Breastfeeding in theWHO Multicentre Growth Reference Study. Acta Paediatr Suppl.2006;450:16–26.

24. WHO Multicentre Growth Reference Study Group. Complementaryfeeding in the WHO Multicentre Growth Reference Study. Acta

Paediatr Suppl. 2006;450:27–37.

25. American Academy of Pediatrics Policy Statement. Breastfeeding andthe use of human milk. Pediatrics. 2005;115:496–506.

26. Dewey KG, Cohen RJ, Nommsen-Rivers LA, Heinig MJ, WHOMulticentre Growth Reference Study Group. Implementation of the

WHO Multicentre Growth Reference Study in the United States. FoodNutr Bull. 2004;25 Suppl 1:S84–89.

27. WHO Multicentre Growth Reference Study Group. Assessment ofdifferences in linear growth among populations in the WHO MulticentreGrowth Reference Study. Acta Paediatr Suppl. 2006;450:56–65.

CDC Growth Charts: United States, Published May 30, 2000.

WHO Working Group on Infant Growth. An Evaluation of Infant Growth: a summary of analyses performed in preparation for the WHO Expert Committee on Physical Status: the use and interpretation of anthropometry. (WHO/NUT/94.8). Geneva: World Health Organization, 1994.

Standard growth charts

Growth velocity charts 

Growth Charts from KidsGrowth.com. CDC Growth charts, plus charts for children born prematurely, and children with Down Syndrome, Turner Syndrome and Cerebral Palsy.

Child Growth Charts of height weight and body mass index from halls.md. The growth charts available on this web page are derived from NHANES III data (a comprehensive survey of the American population during years 1988-1994). This data was re-analyzed and re-plotted for the halls.md growth charts.

Growth Charts Training Modules on accurately weighing and measuring infants & children from the US Maternal and Child Health Bureau

CDC Growth Chart Training Modules Growth charts and breastfed babies

Growth Patterns of Exclusively Breast-Fed Infants discusses and charts differences in the CDC Growth charts and growth of exclusively breastfed babies (may require free Medscape registration)

Growth Curves for Breastfed Babies, from the Breastfeeding Basics short course.

Preliminary Growth Charts for Breastfed Babies from the ProMoM website

de Onis M, Garza C, Victora CG, Bhan MK, Norum KR, ed. The WHO Multicentre Growth Reference Study (MGRS): Rationale, planning, and implementation. (PDF Part 1 - 2.23 MB; PDF Part 2 - 1.64 MB; Entire PDF - 7.8 MB) Food and Nutrition Bulletin. 2004; 25(1s).

de Onis M, Onyango AW. The Centers for Disease Control and Prevention 2000 growth charts and the growth of breastfed infants. Acta Paediatr. 2003 Apr;92(4):413-9.

World Health Organization Is Revising Growth Charts. [Pediatric News 32(1): 1, 1998. © 1998 International Medical News Group.] by Sharon WorcesterDeOnis M, Garza C, and Habicht J-P. Time for a new growth reference. Pediatrics. 1997: 100(5) e8.

WHO Working Group on Infant Growth. An Evaluation of Infant Growth: a summary of analyses performed in preparation for the WHO Expert Committee on Physical Status: the use and interpretation of anthropometry. (WHO/NUT/94.8). Geneva: World Health Organization, 1994.

de Onis M, Onyango AW. The Centers for Disease Control and Prevention 2000 growth charts and the growth of breastfed infants. Acta Paediatr. 2003 Apr;92(4):413-9.

World Health Organization Is Revising Growth Charts. [Pediatric News 32(1): 1, 1998. © 1998 International Medical News Group.] by Sharon Worcester

DeOnis M, Garza C, and Habicht J-P. Time for a new growth reference. Pediatrics. 1997: 100(5) e8.

WHO Working Group on Infant Growth. An Evaluation of Infant Growth: a summary of analyses performed in preparation for the WHO Expert Committee on Physical Status: the use and interpretation of anthropometry. (WHO/NUT/94.8). Geneva: World Health Organization, 1994.