Growth Charts

Monday, Dec 05, 2016

The WHO Child Growth Standards were developed using data collected in the WHO Multicentre Growth Reference Study (MGRS)1.

International Growth Charts

WHO Child Growth Standards

The standards describe normal child growth from birth to 5 years under optimal environmental conditions and can be applied to all children everywhere, regardless of ethnicity, socioeconomic status and type of feeding2. It can alert healthcare professionals if there are any growth problems such as short stature, faltering growth or over/underweight.

The WHO Child Growth Standards include charts such as3:

  • Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age.
  • Head circumference-for-age, arm circumference-for-age, triceps skinfold-for-age and subscapular skinfold-for-age.
  • Growth velocity based on weight, length and head circumference.
  • Motor development milestones
  • The Standards can be found here:
    Link to website


For children over 5 years of age, please refer to the WHO Growth reference data for 5 to 19 years4:
Link to website
 

The research behind the charts

The recommended charts are based on data from predominantly breastfed babies. The research involved about 8500 children from six different countries; USA, Norway, Oman, Brazil, India and Ghana5.
 
The individual inclusion criteria for the study were5:

  • Absence of health or environmental constraints on growth
  • Absence of maternal smoking
  • Single term birth
  • Absence of significant morbidity
  • Adherence to MGRS feeding recommendations (Exclusively or predominantly breastfeed for at least 4 months, introduce complementary foods by the age of 6 months and partially breastfeed for at least 12 months)

Infants were followed up throughout the 0 to 2 year period, using the guideline recommendations for times of measuring.  Weight, length, head circumference, arm and skinfold thickness were measured5.   

The data from this research has been used to formulate new charts that indicate how children should grow; this allows healthcare professionals and parents to recognise optimal weight gain in children.
 
The study emphasises that the current system pitches target weights too high and acknowledges that babies fed on human milk put on weight more slowly than formula fed babies.  This is important with research being carried out linking human milk to a lower risk of obesity later in life6,7 although research is ongoing.

UK-WHO Growth Charts

The UK-WHO Growth Charts are based on the WHO Child Growth Standards. They describe the optimal growth for healthy breastfed children. While previous UK growth charts were based on data from studies on breast- and formula-fed children so do not reflect normal weight fluctuations of breast-fed infants in the first few weeks8.

The UK-WHO 0 to 4 years charts are for all new births and new referrals in England and Scotland. The existing UK 1990 Growth Charts can continue to be used for children over 4 years8.

The charts are available on the Royal College of Pediatrics and Child Health (RCPCH) website to download here:
Link to website
 

Local Growth Charts

The WHO Child Growth Standards can be applied to all children regardless of ethnicity, socioeconomic status and type of feeding. Local growth charts can provide additional information to monitor children's growth and development. Please find growth charts based on Hong Kong or Chinese children listed below.

2009 Growth Charts for Chinese Children 0 to 18 years

The growth charts were created from data originally came from two national representative cross-sectional surveys that were conducted in 20059.  The first was the National Growth Survey of Children under the age of 7, which was conducted in 9 cities of China.  The second was The Physical Fitness and Health Surveillance of Chinese School Students9.  

The growth charts of height and weight were based on a national survey data and therefore are recommended as the China national growth standards for use in pediatric clinics and public health service9

1993 Hong Kong Growth Survey

The 1993 Hong Kong Growth Survey covered 25,000 individuals from birth to the age of 18 years10. Subjects include students studying in 49 schools and infants attending 8 maternal and child health clinics, all randomly chosen to represent Hong Kong. There were 500 to 800 subjects per sex per year.

The following growth parameters were measured10:

  • Weight for age, height for age, weight for height;
  • Head circumference;
  • Sitting height;
  • Upper to lower segment ratio;
  • Menarcheal age;
  • Age of pubertal changes - breast development in girls and penile development in boys;
  • Triceps and subscapular skinfold thickness and body mass index.

For height and weight charts for boys and girls from 0 to 18 years
For length and weight for infants from 0 to 24 months

Please visit: Link to website

 

References

  1. WHO Child Growth Standards. Available at: http://www.who.int/childgrowth/en/. Accessed on 05 September 2013.
  2. Will the standards be applicable to all children? Available at: http://www.who.int/childgrowth/faqs/applicable/en/index.html. Accessed on: 05 Sep 2013.
  3. The WHO Child Growth Standards. Documentation. Available at: http://www.who.int/childgrowth/standards/en/. Accessed on: 05 Sep 2013.
  4. Growth reference data for 5-19 years. Available at: http://www.who.int/growthref/en/. Accessed on: 05 Sep 2013.
  5. de Onis M, Garza C, Victora CG, Onyango AW, Frongillo EA, Martines J. The WHO Multicentre Growth Reference Study: planning, study design, and methodology. Food Nutr Bull. 2004 Mar;25(1 Suppl):S15-26.
  6. Li R, Fein SB, Grummer-Strawn LM. Association of breastfeeding intensity and bottle-emptying behaviors at early infancy with infants' risk for excess weight at late infancy. Pediatrics. 2008 Oct;122 Suppl 2:S77-84.
  7. Palou A, Picó C. Leptin intake during lactation prevents obesity and affects food intake and food preferences in later life. Appetite. 2009 Feb;52(1):249-252.
  8. UK-WHO growth chart FAQs. Available at: http://www.rcpch.ac.uk/child-health/research-projects/uk-who-growth-charts/uk-who-growth-chart-faqs/uk-who-growth-chart-faq. Accessed on: 09 Sep 2013.
  9. Li H, Ji CY, Zong XN, Zhang YQ. [Height and weight standardized growth charts for Chinese children and adolescents aged 0 to 18 years]. Zhonghua Er Ke Za Zhi. 2009 Jul;47(7):487-492.
  10. Hong Kong Growth Survey 1993. Available at: http://www.cuhk.edu.hk/proj/growthstd/english/gs_surve.htm. Accessed on: 09 Sep 2013.

 

WYE-EM-003-JAN-15


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Growth Charts

The WHO Child Growth Standards were developed using data collected in the WHO Multicentre Growth Reference Study (MGRS)1.