WHO Child Growth

Standards 0-5 years

GROWTH CHARTS
Consist of a series of percentile curves that illustrate the distribution of selected body measurements in the study population

Used to track the growth of children from infancy thru adolescence Indicates the state of the child's health, nutrition and well being

z-score= (observed value) – (median reference value) z-score of reference population

Sam, 96.1 cm tall and 2 years and 4 month old. - Median ref: 90.4 cm - z-score ref: 3.3 96.1 – 90.4 = 1.73 3.3 Sam’s z-score for height-for age is 1.73, or above 1.

Height-for-age BOYS
2 to 5 years (z-scores)

Need for Growth Charts Individual level Monitoring & documenting growth Comparison with references std To detect growth faltering Monitoring health status Performance of programs Comparison over time Identification of problem areas National/international comparisons Community level National level Scientists Research tool .

Community level Early identification of children’s growth failure for detection of malnutrition and taking appropriate interventions Early identification-overweight/obesity Sensitize health workers Educate parents and allay their anxiety by showing normal growth in chart .

What needs to be monitored at community level • • • • Length/age Weight/age Weight /height or BMI Head circumference/age • Height/age • Weight/age • BMI/age First 2 years 2 –10 years >10 years Above in relation to pubertal development .

Why should we adopt new charts? The new Child Growth Standards is a crucial development in improving infant and young child nutrition globally. as human milk supports not only healthy growth. but also optimal cognitive development and long-term health. Unlike the old growth charts." (2) establish breastfeeding as the biological "norm. ." and (3) provide international standards for all healthy children. the new standards (1) describe how children "should grow.

WHO Working Group on Infant growth 1991-1993 Comprehensive review shows growth patterns of healthy breastfed infants differ from the current NCHS/WHO international reference A new growth reference is needed to improve infant health management The reference population should reflect health recommendations in view of the frequent use of references as “standards” .

1993 WHO Expert Committee • Recommends development of a new international growth reference • Based on an international sample of “healthy” infants WHA resolution (WHA 47.5) 1994 • Endorses need for new reference • Requests it to be based on breastfed infants .

which was implemented between 1997 and 2003 ► designed to produce a standard rather than a reference.WHO Multicentre Growth Reference Study (MGRS). Children from a diverse set of countries: Brazil. Ghana. Norway. India. Oman and the USA They include windows of achievement for six gross motor development milestones .

WHO Growth Reference Study Prescriptive Approach Optimal Nutrition • Breastfed infants • Appropriate complementary feeding Optimal Environment • No microbiological contamination • No smoking Optimal Growth Optimal Health Care • Immunization • Pediatric routines .

age Head circumference-for-age Growth velocity • Weight • Length/height • Head circumference • Arm circumference .WHO Child Growth Standards Attained growth         Weight-for-age Length/height-for-age Weight-for-length/height Body mass index-for-age Mid-upper arm circumference-for-age Triceps skinfold-for-age Subscapular skinfold-for.

MGRS study design Longitudinal (0-24 months) year 1 year 2 year 3 Cross-sectional (18-71 mo) .

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Assessment of linear growth differences among populations in the WHO Multicentre Growth Reference Study.450:56-65. . Acta Paediatr Suppl 2006.Mean length from birth to 24 months for the six MGRS sites Brazil Ghana India Norway Oman USA Mean of Length (cm) 50 0 60 70 80 200 400 Age (days) 600 WHO Multicentre Growth Reference Study Group.

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If perents of normal height have a child who is excessively tall fot his or her age) A Child whose weight-for-age falls in this range may have a growth problem. 3. Refer a child in this range for assessment if you suspect an endocrine disorder (e. A trent toward the 2 z-score line show definite risk It is possibke for a stunded or severely stunded child to become overweight . 2. 4. A child in this range is very tall. Tanness is rarely a problem. unless it is so excessive that it may indicate endocrine such as a growth-hormone-producing tumor.g. A plotted point above 1 shows possible risk. but this is better assessed from weightlength/heoght or BMI-for Age.INTERPRETING GROWTH INDICATORS Notes: 1.

for the WHO Multicentre Growth Reference Study Group. Public Health Nutrition 2006. Garza C. Borghi E.9:942-947. Onyango AW. Comparison of the WHO Child Growth Standards and the NCHS growth reference: implications for child health programs. . Yang H.Prevalence of stunting (below -2 SD length/height-for-age) by age based on the WHO standards and the NCHS reference in Bangladesh NCHS 80 70 60 50 WHO % 40 30 20 10 0 0-5 6-11 12-23 24-35 Age (months) 36-47 48-60 0-60 Source: de Onis M.

Comparison of the WHO Child Growth Standards and the NCHS growth reference: implications for child health programs. Onyango AW. Garza C. Borghi E. for the WHO Multicentre Growth Reference Study Group.Prevalence of underweight (below -2 SD weight-for-age) by age based on the WHO standards and the NCHS reference in Bangladesh NCHS 80 70 60 50 % WHO 40 30 20 10 0 0-5 6-11 12-23 24-35 Age (months) 36-47 48-60 0-60 Source: de Onis M. Public Health Nutrition 2006.9:942-947. . Yang H.

CDC and WHO curves Mean weight-for-age z-score 0.4 -0.8 0 1 2 3 4 5 6 7 8 9 10 11 12 Age (months) .4 0 -0.8 CDC NCHS MGRS 0.Mean weight-for-age z-scores of healthy breastfed infants relative to the NCHS.

healthy children & practices. mixed feeding.Comparison of existing growth charts Data charact Source Study period Population NCHS Multiple different studies 1929-1975 US. white. breastfed Birth-5yrs Age-group Birth-20 yrs Birth-20 yrs . bottle fed CDC Multiple different studies WHO Primary data 1963-1994 US. no racial/ethnic diff 1997-2003 6 Countries pooled data.

WHO Reference 5-19 years .

using the original sample (a non-obese sample with expected heights). WHO proceeded to reconstruct the 1977 NCHS/WHO growth reference from 5 to 19 years.An expert group meeting in January 2006 to evaluate the feasibility of developing a single international growth reference for school aged children and adolescents. supplemented with data from the WHO Child Growth Standards .

from which only data from the 1 to 24 years age range were used.The core sample used for the reconstruction of the reference for school-aged children and adolescents (5–19 years) was the same as that used for the construction of the original NCHS charts. . The third data set was from the Health and Nutrition Examination Survey (HANES) Cycle I (birth to 74 years). pooling three data sets The first and second data sets were from the Health Examination Survey (HES) Cycle II (6–11 years) and Cycle III (12–17 years).

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Is it possible to achieve? Who shall use the growth charts? Pediatricians? Physicians? Provider? Family? Kader? Nutritional Status Endocrinologist: Mid Parental Height Health .Some Questions? Individual growth monitoring in children in Indonesia.

Some Questions? Capacity Building: • Training of different level of workers/volunteers • Systematic Changes/strengthening How do we introduce the new charts in the existing program? .

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