33 Growth Standards for Children

Dr. Mallikarjunar Rao

Learning outcome

• After studying this module the participant should be able to:
• Know what is growth and development
• What is meant by growth standards?
• Various standards available and about WHO Child Growth Standards

Growth is a physical maturation of the body that means increase in body size and proportions, while, development means functional maturation that is acquisition of skills. Growth and development go hand in hand with increase in age. The changes with age in size and differentiation of the human body have been studied so intensively that they can be described today in considerable detail. The study of growth is largely concerned with variation that is with the differences between individuals. One should know whether a child grows within normal range of variation for his age and currently growing at an acceptable speed. This information, of course, can only be obtained by studying large and carefully selected samples of normal children who are representative of the population. The creation in this way the growth standards is fundamental importance to those responsible for monitoring the health and well-being of children and advising on the effectiveness of measures to improve their nutrition or free from disease. The monitoring of growth in this point of view is particularly important in developing countries. Repeated studies for interval of 5 or 10 years to study changes in growth pattern of children form important index in the general well-being of the population. If the growth rates of children belonging to different racial, social, economic or geographical groups are compared, one can make inferences about the importance of these variables in regulating the growth.

Standard reflects an optimal level of Growth suggesting that, all children have the potential to achieve that level. Anthropometric measurements obtained on well-to-do children of the elite parents are usually treated as” standards”. World Health Organization (WHO1983) suggested the following criteria:

1. Measurements should relate to a well nourished population.
2. The sample should include at least 200 children in each age and sex group.
3. The study should be a cross sectional in nature.
4. Measurements should be carefully taken with trained person using standard methods and equipment.

Till recently the National Centre for Health Statistics (NCHS) reference data based on the anthropometric measurements of American children (Hamill et al., 1979) were recommended for use by the WHO (1983).

WHO Multicentre Growth Reference Study (MGRS-2006)

In the year 2006,WHO released New International Child Growth Standards for infants and young children by age and gender compiled in Multicentre Growth Reference Study, which is a community based multi country project, involving more than eight thousand children from Brazil, Ghana, India, Norway and United states of America. The children in the study were selected based on optimal environment for proper growth, such as predominantly exclusive breast feeding up to six months, recommended infant and young child feeding practices, good health care, mothers who did not smoke, and other factors associated with good health outcomes.

The standards are derived from data collected regularly on a cohort of new borns up to the age of 18 months and on cross sectional data on children in the age group of 18-60 months. The New WHO Child Growth Standards confirm that children born anywhere in the world and given the optimum start in life have the potential to develop to within the same range height and weight. Naturally there are individual differences among children, but across large populations, regionally or globally, the average growth is remarkably similar.

The new standards prove that differences in children’s growth to age five are more influenced by nutrition, feeding practices, environment and health care, than genetics and ethnicity. Based on the new growth standards of <5 year children WHO has also brought out reference values for older children in the age group of 5-18 years, by modifying NCHS reference values. The standards can be downloaded from the WHO website (www.who.int/childgrowth/en).

WHO – NEW CHILD GROWTH STANDARDS (2006)

Weight for age