Postnatal - Growth Charts

From Embryology
WHO report- child growth standards.jpg

Introduction

Length for age boys (birth to 2 years)

Part of the normal ongoing monitoring of the newborn infant development is the simple measurement of weight, length, height and simple motor skills compared to large data sets of clinically normal infants. The original standards differed between countries and the time when the control data was collected (some based on data from 1970s or earlier). This has recently changed with the release of WHO international child growth standards using entirely new data sets. New international WHO Child Growth Standards (2006)[1] for infants and young children released (27 Apr) by the World Health Organization (WHO) provide evidence and guidance for the first time about how every child in the world should grow.

"The new standards prove that differences in children's growth to age five are more influenced by nutrition, feeding practices, environment, and healthcare than genetics or ethnicity."

Earlier growth charts had been prepared independently for children of different countries and nationalities (see External Links) using large numbers of clinically normal children.

In Australia, following advice from National Health and Medical Research Council (NHMRC), the Australian Department of Health has determined that percentile charts from the U.S. National Centre for Health Statistics be used for Australian children (this may be updated to the new WHO standard). The percentiles on these charts are generally similar to the previous NHMRC Charts (1980) except that, above the age of 8 years, American children tend to be taller and heavier, this becoming more marked in the teenage years.


Postnatal Links: Introduction | Birth | Neonatal | Neonatal Diagnosis | Milk | Nutrition | Growth Charts | Disease School Exclusion | Vaccination | Puberty | Genital | original page

Some Recent Findings

  • Growth charts compared.[2]"Most growth references are single-country references, exemplified here by charts from the UK, the Netherlands and the USA. By contrast, the Euro-Growth reference and the WHO standard are based on multinational samples. Comparison of these five charts reveals surprisingly large differences that are for the most part unexplained. Differences between the WHO charts and other charts are only partially explained by the use of a prescriptive approach and by the data truncation employed. The large differences between charts probably are of merely trivial consequence when charts are used in monitoring individual children. When charts are used in health assessment of groups of children, the impact of the differences, however, is substantial."
  • Using the new UK-WHO growth charts.[3]"The new UK growth charts for children aged 0-4 years (designed using data from the new WHO standards) describe the optimal pattern of growth for all children, rather than the prevailing pattern in the UK (as with previous charts). The new charts are suitable for all ethnic groups and set breast feeding as the norm. UK children match the new charts well for length and height, but after age 6 months fewer children will be below the 2nd centile for weight or show weight faltering, and more will be above the 98th centile. The new charts look different: they have a separate preterm section, no lines between 0 and 2 weeks, and the 50th percentile is no longer emphasised. The charts give clear instructions on gestational correction, and there is a new chart for infants born before 32 weeks’ gestation. The instructions advise on when and how to measure and when a measurement or growth pattern is outside the normal range. The charts include a "look-up" tool for determining the body mass index centile from height and weight centiles without calculation and aid for predicting adult height."
  • Comparative use of WHO standards and French national reference curves[4]"The WHO curves published in 2006 reflect the exact growth of infants who are exclusively breast-fed for at least 4 months. These curves are universal but not widely used in France."
  • New intrauterine growth curves based on United States data[5] "The Lubchenco curves may not represent the current US population. The new intrauterine growth curves created and validated in this study, based on a contemporary, large, racially diverse US sample, provide clinicians with an updated tool for growth assessment in US NICUs. Research into the ability of the new definitions of small-for-gestational-age and large-for-gestational-age to identify high-risk infants in terms of short-term and long-term health outcomes is needed."
  • Growth of Belgian and Norwegian children compared to the WHO growth standards[6]"Generally, the number of Belgian and Norwegian children below -2 SD lines of the WHO standards was lower and >2 SD higher than expected. The largest differences were for head circumference (0.97% Belgian and 0.18% Norwegian children below -2 SD, 6.55% Belgian and 6.40% Norwegian children >2 SD) and the smallest for length/height (1.25% Belgian and 1.43% Norwegian children below -2 SD, 3.47% Belgian and 2.81% Norwegian children >2 SD). The growth pattern of breastfed children of non-smoking mothers was in both countries more alike the local national growth references than the WHO standards."
  • WHO Child Growth Standards: Methods and development Growth velocity based on weight, length and head circumference Geneva: World Health Organization, 2009.

WHO Child Growth Standards

Girls Boys
WHO-XX length birth to 2 years.png WHO-XY length birth to 2 years.png
Girls length birth to 2 years Boys length birth to 2 years
WHO chart - girls head birth to 5 years.png WHO chart - boys head birth to 5 years.png
Chart PDF | WHO - Girls Chart PDF | WHO - Boys


Head growth and corresponding charts differ slightly for girls and boys. Given as head circumference-for-age Birth to: 13 weeks, 2 years, 5 years.

Links: Growth Charts | - Standard Head circumference-for-age | WHO Growth Standards


Until page is updated please use the external links to the WHO resources listed below. Standards are available for download as PDF documents in either English, French and Spanish (and other languages).

Main introduction page WHO Child Growth Standards, data is available as Charts, tables and Simplified Field tables. (The WHO Child Growth Standards English documents link page)

Links to the first set of the WHO child growth standards (0 - 60 months):

Study data set: "WHO Multicentre Growth Reference Study (MGRS) was undertaken between 1997 and 2003 to generate new growth curves for assessing the growth and development of infants and young children around the world. The MGRS collected primary growth data and related information from approximately 8500 children from widely different ethnic backgrounds and cultural settings (Brazil, Ghana, India, Norway, Oman and the USA)."


Links: ABC (Australia) News Item 28Apr06 | Nature News Item 11Aug04

UK-WHO Growth Charts

These UK growth charts are based upon the WHO charts, an associated paper describes "How to Use".[7]

The charts include a useful calculator of adult height from a child's current height, that can also be used for normal growth estimates.[8]

UK WHO Growth Charts: 0-4 Years - Boys | 0-4 Years - Girls | NICM Boys | NICM Girls


Links: UK WHO Growth Charts

Clinical Growth Measurements (USA)

CDC-XX length birth to 3 years.png CDC-XY length birth to 3 years.png
Girls length birth to 3 years Boys length birth to 3 years
  • Infants (birth to 24 months) must be measured for length, and the sex appropriate length-for-age or weight-for-length charts for infants from birth to 36 months must be used to plot the measurements.
  • At age 24 months and older, if children can stand unassisted and follow directions, stature should be measured and plotted on the stature-for-age chart for older children (2 to 20 years).
  • BMI-for-age charts are recommended to assess weight in relation to stature for older children (2 to 20 years). The weight-for-stature charts are available as an alternative to accommodate children ages 2-5 years who are not evaluated beyond the preschool years. However, all health care providers should consider using the BMI-for-age charts to be consistent with current recommendations.
  • Note- Body Mass Index (BMI), an evaluation of a person's weight status in relation to height, is the most commonly used approach to determine if adults are overweight or obese, and is now the recommended measure for assessing overweight in children.

Some text extracted from United States Clinical Growth Charts

Growth Charts

This link is to local PDF document of the 2001 CDC Growth charts. CDC Growth Charts - United States.pdf (16 pages 300 kb)

Data includes:

  • Weight-for-age percentiles Boys, birth to 36 months, Girls, birth to 36 months, Boys, 2 to 20 years, Girls, 2 to 20 years
  • Length-for-age percentiles Boys, birth to 36 months, Girls, birth to 36 months
  • Stature-for-age percentiles Boys, 2 to 20 years, Girls, 2 to 20 years
  • Head circumference-for-age percentiles Boys, birth to 36 months, Girls, birth to 36 months
  • Weight-for-length percentiles, Boys, birth to 36 months, Girls, birth to 36 months
  • Weight-for-stature percentiles, Boys, Girls
  • Body mass index-for-age percentiles Boys, 2 to 20 years Girls, 2 to 20 years

Chinese Growth Charts

Historic data is also available for ethnic Chinese girls and boys in Hong Kong from the early 1960s.[9] Environmental and nutritional factors may have altered these values over the last 40 years and more recent 2009 data is now available for height and weight[10] and body mass index.[11]

"Comparison with the new WHO growth charts and 2000 CDC growth charts for the United States, the results showed that there was some big difference in weight and height among the three growth charts. For boys under 15 years of age and girls under 13 years of age, the China curves are slightly higher than WHO and CDC curves, but after those ages, the China curves fall behind and the difference became larger as age progresses. At the age of 18 years, the Chinese children are 3.5 cm shorter in boys and 2.5 cm shorter in girls as compared with the U. S. children. The difference in weights are very large for the school children, especially in girls. The weight of Chinese boys was 5.9 kg less than that of the U. S. boys at 18 years, and the difference was much bigger in girls, the weight of U.S. girls between 8 to 18 years was 4.1-20.5 kg more than that of Chinese girls at the same age range."[10]

Newborn Head Circumference

Neural Exam - Newborn head circumference

Neural Exam - Newborn head circumference

Movie showing how to accurately measure the newborn head circumference.


WHO - Breastfed Babies

The World Health Organization is revising pediatric growth charts to better reflect the growth of breast-fed babies. The revisions may take 5 years. In the meantime pediatricians should be aware that breastfed babies tend to gain 600-650 g less in their first year than formula-fed babies, with the most marked differences seen between ages 3 and 9 months, Kathryn C. Dewey, Ph.D., said at the annual meeting of the American Academy of Pediatrics. Pediatricians who are unaware of the differences tend to assume that breastfed babies lagging behind the growth charts are inadequately nourished. As a result, too many mothers are advised to begin supplementing earlier than necessary, she said. Existing growth charts for children aged 2-18 years were based on a nationally representative sample, but charts for those up to age 2 were based on a study since shown to have several limitations, said Dr. Dewey, associate director of the Program in International Nutrition and professor of nutrition at the University of California, Davis.

The sample was too homogeneous, growth measurements were made infrequently, and most babies were bottle-fed, she said.

Several studies have been conducted in the past several years to evaluate differences in growth patterns. One study that Dr. Dewey worked on--the Davis Area Research on Lactation, Infant Nutrition, and Growth study--found that breastfed babies generally weighed less in their first year because they voluntarily took in less milk than did formula-fed babies.

The breastfed babies met developmental milestones at similar ages to bottle-fed babies, they were just as active, and they were healthier. Bottle-fed babies had twice the incidence of diarrhea and 20% more cases of otitis media.

Most other studies found similar results, and this year WHO acted on its own 1994 report recommending that existing growth charts be revised. A multicountry study is underway, and in keeping with guidelines for infant care, the new chart will be based on babies breastfed for their first year, Dr. Dewey said.

Text extracted from Pediatric News 32(1): 1, 1998.


Links: Normal Development - Milk | WHO Publications

Growth Chart for Preterm Babies

Preterm fetal-infant growth chart.jpg

Fetal-infant growth chart for preterm infants.[12] Improved 2003 version of the Babson and Benda graph based upon literature review and intrauterine data.


Links: Birth - Preterm | UK Neonatal and Infant Close Monitoring charts- Boys | UK Neonatal and Infant Close Monitoring charts-Girls

Specialized Growth Charts

Trisomy 21 (Down Syndrome)

This paper describes an approach for generating subpopulation-specific growth charts meeting requirements for implementation into Electronic health record (EHR) systems, using as an example weights for children with Down syndrome. Gender-specific growth curves were generated from 2358 weight values obtained from 331 patients with Down syndrome from July 2001 until March 2005. The project generated printable curves and computable data tables formatted according to growth chart standards set forth by the Centers for Disease Control and Prevention to facilitate implementation into EHR systems.[13]

Growth curve for boys with Trisomy 21 (Down syndrome).jpg Growth curve for girls with Trisomy 21 (Down syndrome).jpg


Links: Trisomy 21

Prader-Willi Syndrome

Human idiogram-chromosome 15.jpg

Chromosome 15

Standardized growth curves for weight, length, head circumference, weight/length, and BMI for non-growth hormone-treated white infants (108 boys and 78 girls) with Prader-Willi syndrome (PWS) between 0 and 36 months of age. Five separate standardized growth curves (weight, length, head circumference, weight/length, and BMI) representing 7 percentile ranges were developed from 186 non-growth hormone-treated white male and female infants with PWS aged 0 to 36 months, and the normative 50th percentile was plotted on each standardized infant growth curve.[14]


Williams Syndrome

The following data is from a paper producing a growth reference for British children with Williams syndrome.[15]

Female Height chart | Weight chart | Head circumference chart

Male Height chart | Weight chart | Head circumference chart


Links: Williams Syndrome

Growth Charts Program

Important Note: this program is based upon USA Clinical Growth Charts (2000) not the new WHO Child Growth Standards (2006).

Growth Charts version 1.1 by David Hanauer is based upon USA Clinical growth charts. A copy of the program is included on the Embryology CD. It can also be found in the EXTRAS folder on the CD the file is called "Growth_Charts.dmg.sit" and requires stuffit to decompress.

"Growth Charts is a Macintosh OS X application that allows for tracking and charting of growth data for children/teens from birth through age 20 years. It can track weight, length/height, head circumference, and even body mass index (BMI). Using the program, data can be stored, edited, and subsequently plotted on growth charts. The growth charts come from the Centers for Disease Control (CDC) and are the same ones used by pediatricians throughout the United States to monitor for abnormal or concerning growth patterns. If you have ever been curious to follow the growth of your child (or yourself) the same way that the doctor does, this program will allow you to do that using the same charts that your doctor probably uses."

The original program can also be found at (http://www.supermagnus.com/mac/Growth_Charts) (Email: David Hanauer)

References

  1. WHO Multicentre Growth Reference Study Group WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl: 2006, 450;76-85 PubMed 16817681
  2. Ekhard E Ziegler, Steven E Nelson Growth charts compared. Nestle Nutr Workshop Ser Pediatr Program: 2010, 65;197-210; discussion 210-2 PubMed 20139683
  3. Charlotte M Wright, Anthony F Williams, David Elliman, Helen Bedford, Eileen Birks, Gary Butler, Magda Sachs, Robert J Moy, Timothy J Cole Using the new UK-WHO growth charts. BMJ: 2010, 340;c1140 PubMed 20231247
  4. C Bois, J Servolin, G Guillemot [Monitoring infant growth: comparative use of WHO standards and French national reference curves]. [Usage comparé des courbes de l'Organisation mondiale de la santé et des courbes françaises dans le suivi de la croissance pondérale des jeunes nourrissons.] Arch Pediatr: 2010, 17(7);1035-41 PubMed 20488685
  5. Irene E Olsen, Sue A Groveman, M Louise Lawson, Reese H Clark, Babette S Zemel New intrauterine growth curves based on United States data. Pediatrics: 2010, 125(2);e214-24 PubMed 20100760 | Pediatrics.
  6. P B Júlíusson, M Roelants, K Hoppenbrouwers, R Hauspie, R Bjerknes Growth of Belgian and Norwegian children compared to the WHO growth standards: prevalence below -2 and above +2 SD and the effect of breastfeeding. Arch. Dis. Child.: 2011, 96(10);916-21 PubMed 19948662
  7. Charlotte M Wright, Anthony F Williams, David Elliman, Helen Bedford, Eileen Birks, Gary Butler, Magda Sachs, Robert J Moy, Timothy J Cole Using the new UK-WHO growth charts. BMJ: 2010, 340;c1140 PubMed 20231247
  8. Tim J Cole, Charlotte M Wright A chart to predict adult height from a child's current height. Ann. Hum. Biol.: 2011, 38(6);662-8 PubMed 21767107
  9. K S CHANG, M M LEE, W D LOW, E KVAN HEIGHT AND WEIGHT OF SOUTHERN CHINESE CHILDREN. Am. J. Phys. Anthropol.: 1963, 21;497-509 PubMed 14185528
  10. 10.0 10.1 Hui Li, Cheng-Ye Ji, Xin-Nan Zong, Ya-Qin Zhang [Height and weight standardized growth charts for Chinese children and adolescents aged 0 to 18 years]. Zhonghua Er Ke Za Zhi: 2009, 47(7);487-92 PubMed 19951507
  11. Hui Li, Cheng-Ye Ji, Xin-Nan Zong, Ya-Qin Zhang [Body mass index growth curves for Chinese children and adolescents aged 0 to 18 years]. Zhonghua Er Ke Za Zhi: 2009, 47(7);493-8 PubMed 19951508
  12. Tanis R Fenton A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format. BMC Pediatr: 2003, 3;13 PubMed 14678563 | BMC Pediatr.
  13. Rosenbloom ST, McGregor TL, Chen Q, An AQ, Hsu S, Dupont WD. Specialized Pediatric Growth Charts For Electronic Health Record Systems: the example of Down syndrome. AMIA Annu Symp Proc. 2010 Nov 13;2010:687-91. PMID: 21347066 | PMC3041286
  14. Butler MG, Sturich J, Lee J, Myers SE, Whitman BY, Gold JA, Kimonis V, Scheimann A, Terrazas N, Driscoll DJ. Growth standards of infants with Prader-Willi syndrome Pediatrics. 2011 Apr;127(4):687-95. Epub 2011 Mar 14. PMID: 21402637 | Pediatrics
  15. N D T Martin, W R Smith, T J Cole, M A Preece New height, weight and head circumference charts for British children with Williams syndrome. Arch. Dis. Child.: 2007, 92(7);598-601 PubMed 17301110 | PMC2083767

Reviews

L T Weaver How did babies grow 100 years ago? Eur J Clin Nutr: 2011, 65(1);3-9 PubMed 21119695

| Eur J Clin Nutr.

Harold Siden, Rose Steele, Rollin Brant, Susan Cadell, Betty Davies, Lynn Straatman, Kimberley Widger, Gail S Andrews Designing and implementing a longitudinal study of children with neurological, genetic or metabolic conditions: charting the territory. BMC Pediatr: 2010, 10;67 PubMed 20854664

Anastasios Papadimitriou, Polyxeni Nicolaidou, Andreas Fretzayas, George P Chrousos Clinical review: Constitutional advancement of growth, a.k.a. early growth acceleration, predicts early puberty and childhood obesity. J. Clin. Endocrinol. Metab.: 2010, 95(10);4535-41 PubMed 20610589


Articles

Mareike Diekmann, Orsolya Genzel-Boroviczény, Luciano Zoppelli, Martina von Poblotzki Postnatal growth curves for extremely low birth weight infants with early enteral nutrition. Eur. J. Pediatr.: 2005, 164(12);714-23 PubMed 16151792

Maureen Hack, Mark Schluchter, Lydia Cartar, Mahboob Rahman, Leona Cuttler, Elaine Borawski Growth of very low birth weight infants to age 20 years. Pediatrics: 2003, 112(1 Pt 1);e30-8 PubMed 12837903

R A Ehrenkranz, N Younes, J A Lemons, A A Fanaroff, E F Donovan, L L Wright, V Katsikiotis, J E Tyson, W Oh, S Shankaran, C R Bauer, S B Korones, B J Stoll, D K Stevenson, L A Papile Longitudinal growth of hospitalized very low birth weight infants. Pediatrics: 1999, 104(2 Pt 1);280-9 PubMed 10429008


PMID 21286295 | PMC2865939

Search Pubmed

July 2011 "child growth chart" - All (1304) Review (82) Free Full Text (256)

Search Pubmed Now: child growth chart

Terms

  • AGA - Appropriate for Gestational Age, term describing birth Height (Ht), weight (Wt), occipital-frontal circumference (OFC) at birth postnatal growth patterns.
  • breast-fed infants - fed by maternal milk. These infants tend to gain weight more rapidly in the first 2 to 3 months, from 6 to 12 months breast-fed infants tend to weigh less than formula-fed infants.
  • Percentiles - statistical term, rank the position of an individual by indicating what percent of the reference population the individual would equal or exceed. For example, on the weight-for-age growth charts, a 5-year-old girl whose weight is at the 25th percentile, weighs the same or more than 25 percent of the reference population of 5-year-old girls, and weighs less than 75 percent of the 5-year-old girls in the reference population.
  • SGA - Small for Gestational Age, term describing birth Height (Ht), weight (Wt), occipital-frontal circumference (OFC) at birth postnatal growth patterns.
  • z-score - statistical term, for the deviation of the value for an individual from the mean value of the reference population divided by the standard deviation for the reference population. Because z-scores have a direct relationship with percentiles, a conversion can occur in either direction using a standard normal distribution table. Therefore, for every z-score there is a corresponding percentile and vice versa.


(some text modified from CDC Growthchart FAQ)

External Links

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Cite this page: Hill, M.A. 2017 Embryology Postnatal - Growth Charts. Retrieved September 25, 2017, from https://embryology.med.unsw.edu.au/embryology/index.php/Postnatal_-_Growth_Charts

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