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WHO Growth Chart Training

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Using the WHO Growth Standard Charts

Infant Growth Patterns on the WHO and CDC Growth Charts

Growth patterns differ between breastfed and formula-fed infants. Beginning around 3 months of age weight gain is generally lower for breastfed infants than for that of the formula-fed infant.1-3 Linear growth generally follows a similar pattern for both breast- and formula-fed infants.4

  • For the first 3 months of age, the WHO growth charts show a somewhat faster rate of weight gain than the CDC growth charts.
  • After about 3 months of age, WHO growth charts show a slower rate of growth than the CDC growth charts.
    • Because formula-fed infants tend to gain weight more rapidly after age 3 months, they may be more likely to cross upward in percentiles on the WHO growth charts, perhaps becoming classified as overweight.5
    • Early recognition of a tendency toward overweight or obesity might appropriately trigger interventions to slow the rate of weight gain although no evidenced-based guidelines for treating overweight in infancy exist.
      • Studies suggest that higher weight gain during infancy is associated with increased risk of obesity in childhood.6-7
      • Consequently, lower weight gain during the first two years of life may be beneficial to health in the long term.6-7

References

1Kramer MS, Guo T, Platt RW,Vanilovich I, Sevkovskaya Z, Dzikovich I, Michaelsen KF, Dewey K for the Promotion of Breastfeeding Intervention Trials Study Group. Feeding effects on growth during infancy. J Pediatr 2004;145(5):600-5.

2Dewey KG. Growth characteristics of breast-fed compared to formula-fed infants. Biol Neonate 1998;74(2):94-105.

3Dewey KG. Growth patterns of breastfed infants and the current status of growth charts for infants. J Hum Lact 1998;14(2):89-92.

4American Academy of Pediatrics. Pediatric Nutrition Handbook, 6th edition. Kleinman RE (ed). Elk Grove Village, IL. American Academy of Pediatrics 2009.

5Grummer-Strawn LM, Reinold C, Krebs NF; Centers for Disease Control and Prevention (CDC). Use of the World Health Organization and CDC growth charts for children aged 0-59 months in the United States. Recommendations and Reports. MMWR Recomm Rep 2010; 59(RR-9);1-15.

6Baird J, Fisher D, Lucas P, Kleijnen J, Roberts H, Law C. Being big or growing fast: systematic review of size and growth in infancy and later obesity. BMJ 2005;331(7522):929.

7Ong KK and Loos RJ. Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions. Acta Paediatr 2006;95(8):904-8.

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