Expect new guidance on monitoring children's growth

New recommendations by an expert panel sponsored by the Centers for Disease Control and Prevention (CDC), National Institutes of Health, and the American Academy of Pediatrics (AAP) regarding growth curves will be published for practicing pediatricians early next year, reported Laurence Grummer-Strawn, PhD, Chief of the Maternal and Child Nutrition Branch of the CDC.

The panel, which convened in June of 2006, will determine the role of the new standards developed as a result of the Multicentre Growth Reference Study (MGRS) conducted by the World Health Organization.

“Growth charts are intended as a reference to provide information for evaluating the attained size and growth status of children in the context of overall clinical assessment,” said Dr. Grummer-Strawn, presenting at the American Academy of Pediatrics National Convention and Exhibition. “However, growth charts are often used in practice as standards to determine abnormal growth or weight, or for other diagnostic purposes.”

Growth charts published by the National Center for Health Statistics were used for more than two decades before they were replaced by the CDC growth charts in 2000. The CDC charts are largely based on nationally representative samples of infants and children, and improved on the distinctions that previously existed between infant and childhood curves.

In contrast, the new WHO charts are designed to describe how children should grow, rather than describe how children do grow in a given setting and time. The charts are supported by data collected in Norway, Brazil, India, Ghana, Oman, and the United States of children cared for under defined optimal conditions regarding nutrition, environment, and care.

The data supporting the WHO and CDC charts have key differences, Dr. Grummer-Strawn pointed out. WHO data was longitudinal, gathered at frequent intervals, and included specific feeding requirements. CDC data was cross-sectional, did not include feeding requirements, and did not include data on children between birth and 3 months.

In comparison to the CDC 2000 reference, the WHO growth standards show:
• A similar mean length and tighter standard deviation in height for age
• Faster growth in weight for age from birth to 3 months, and slower growth from 3 to 18 months
• A BMI for age in infants and babies up to 23 months of age

Grummer-Strawn explained that the continued use of the CDC 2000 growth reference for school-age children and adolescents will be necessary because the new WHO standards only go up to 5 years of age. The WHO child growth standards can be viewed at http://www.who.int/childgrowth/standards/technical_report/en/index.html.