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WHO Growth Chart Training

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Summary

baby being weighed

  • The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) recommend that health care providers in primary care settings
    • Use the WHO growth standard charts for children younger than aged 2 years regardless of type of feeding, to monitor growth in the United States. 
    • Use the 2000 CDC growth reference charts for children aged 2 to 20 years to monitor growth in the United States.
  • Using the WHO growth standard for infants and children birth to aged 2 years has several advantages over the CDC growth reference for children of the same age including:
    • The WHO growth standard charts utilize growth of the breastfed infant as the norm for growth.
    • The WHO standards are based on high quality data collected for children younger than aged 2 years. 
  • CDC's adapted versions of the WHO growth charts for children younger than aged 2 years are available with English units of measurement and percentiles at www.cdc.gov/growthcharts. The 4 available growth charts include:
    • Girls and boys, birth to 24 months: length-for-age and weight-for-age
    • Girls and boys, birth to 24 months: weight-for-length and head circumference-for-age.
  • The WHO growth charts as modified by CDC use the 2nd percentile and the 98th percentile as the outer most percentile cutoff values.
  • Using the WHO growth chart percentile cutoff values indicates a change in clinical protocol. Using the WHO growth charts, infants and young children with a
    • Weight-for-length less than the 2nd percentile are classified as low weight-for-length.
    • Length-for-age less than the 2nd percentile are classified as having short stature.
    • Weight-for-length greater than the 98th percentile are classified as high weight-for-length.
  • The use of BMI-for-age is not recommended for children younger than aged 2 years at this time.
  • When transitioning from the WHO growth standard charts to the CDC growth reference charts at aged 2 years, a change in growth classification may occur. During this transition, caution should be used in interpreting any changes in classification.
  • For the growth assessment to be an effective screening tool, accurate measurements are critical. A series of measurements will assist in appropriate interpretation of growth patterns.
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