Growth Charts

    • Growth charts show the growth of a reference population and are used to assess individuals and groups of children.
    • Serial measurements of the child's growth are plotted on a growth chart to assess patterns of growth.
    • Single or 'one-off' measurements for individual children show only a child's size, not their growth. 

    Timeline of growth charts in Australia

    chart timeline

    Chart 1: Timeline of growth charts in Australia - Download (Doc)

     

    How were growth charts developed?

    The WHO growth charts are based on measurements of children from birth to 5 years of age, from 6 countries representing different regions of the world: Brazil, Ghana, India, Norway, Oman and the United States. The families met strict eligibility criteria including:

    • No health, environmental or economic constraints on growth 
    • Healthy, term baby (excluded preterm and very low birth weight infants)
    • Exclusive or predominant breastfeeding for at least 4 months
    • Introduction of solids by 6 months and continued breastfeeding until at least 1 year
    • Infants had optimal health care including immunisations and good routine paediatric care
    • Non-smoking mothers

    Children's growth was measured more than 20 times over 5 years.The WHO promotes these charts for children from all ethnic backgrounds, irrespective of the type of infant feeding. 

    Previous growth charts used in Australia (NCHS 1977 and CDC 2000) were based on health surveys of children in the US and included:

    • Mainly formula fed infants
    • Very few measurements of young infants
    • Tendency towards higher weights, especially in the older age groups
    • Increasing rates of obesity 

    Which charts should I use?

    Recommended charts for girls and boys at different ages are listed below: 

     

     

    Girls

    Boys

    Centiles

    0 - 24 months

    WHO (2006)

    Head circumference

    Weight for age

    Length for age

     

    Head circumference

    Weight for age

    Length for age

     

    3rd - 97th  

    3rd - 97th

    3rd - 97th

     

    2 - 18 years

    CDC (2000)

    Weight for age

    Height (stature) for age

    BMI for age

    Weight for age

    Height (stature) for age

    BMI for age

    3rd - 97th

    3rd - 97th

    3rd - 97th  

     

    WHO charts for Northern Territory

    Charts for Western Australia

     

     

     

    Table 2: Recommended growth charts for use in Australia

    Growth charts to download

    What are the advantages of using the WHO charts?

    The recommendation for adopting the WHO standards for children 0 - 2 years in Australia is based on several considerations. (NB: WA use WHO charts for children 0- 5 years; NT use WHO charts for children 0- 18 years)

    Breastfeeding:

    • The WHO growth charts recognise breastfeeding as the biological norm
    • WHO charts reflect growth of children who were exclusively or predominantly breastfed for at least 4 months and still breastfeeding at 12 months.

    This is consistent with the advice of the NHMRC Australian Dietary Guidelines (2013) which recommend exclusive breastfeeding until around six months and then continued breastfeeding while solid foods are introduced and until 12 months of age and beyond for as long as the mother and infant wish.

    Growth standard versus growth reference:

    Children in the WHO sample were raised under ideal circumstances and health conditions. The WHO describes these charts as growth standards; identifying how children should grow in optimal conditions. On the other hand, CDC charts show the growth of a sample population of children in the US, and included some children with poor growth (due to illness etc) and other children who were overweight.

    Longitudinal versus cross-sectional growth monitoring:

    Infants in the WHO growth study were measured 21 times between birth and 2 years. Frequent measures are better at showing the rapid and changing rate of growth in early infancy 

    The CDC charts were based on national survey data - the infants and children were each measured only once. Measurements from the first 2 -3 months of life were not available, so different data was incorporated into the charts. In summary, the CDC charts show the size of a group of infants, not the actual growth as shown in the WHO longitudinal charts.

    International sample population
    :

    The WHO charts are based on children from a range of ethnic groups and are considered relevant for all Australian children regardless of their cultural background.  

    For more information about the strengths and limitations of different growth charts refer to background reading.

    Cut-points on growth charts

    • The top and bottom lines on all charts are based on the population of children actually measured for the charts. They may or may not be related to health outcomes.
    • This means that population estimates of the prevalence of 'overweight' or 'underweight' change depending on the growth chart used. For example, the same child may be classified as overweight or not overweight, depending on the chart used to assess them.
    • Fewer infants aged 6 months to 2 years would be described as 'underweight' (i.e. dropping below the 3rd percentile) when using the WHO charts compared with the CDC charts.

    Key messages:

    Regardless of which charts are used, serial measurements of a child's weight and length / height plotted on a growth chart are needed to assess the child's growth. 

    Health practitioners need a broad understanding of the way different growth charts were constructed, and consider this when interpreting growth of individual children. For example, WHO infant charts are based on the growth of healthy breastfed infants living in ideal conditions; CDC charts are based on a snapshot of children's weight and heights living in the US.

     

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