What Growth Charts Are Recommended for Use?

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 World Health Organization (WHO) growth standard charts for infants and children aged birth to 2 years to monitor growth in the United States (Grummer-Strawn, Reinold, Krebs, 2010). The WHO growth charts are available at https://www.cdc.gov/growthcharts/who_charts.htm.
  • Use the 2000 CDC growth charts to monitor growth in children aged to 20 years in the United States (Grummer-Strawn, Reinold, Krebs, 2010).
  • Use the 2022 CDC Extended Body Mass Index (BMI)-for-age growth charts for children with very high BMI (above the 97th percentile). These growth charts are optimized for children with a BMI above the 97th%.

Training on the WHO growth charts to assess growth among infants and children aged birth to 2 years is available at https://www.cdc.gov/nccdphp/dnpao/growthcharts/who/index.htm.

2000 CDC Growth Charts

This training course focuses on the CDC clinical growth charts for children and teens aged 2 to 20 years. The four sex- and age-specific CDC clinical charts included in this training are:

2022 CDC Extended BMI-for-Age Growth Charts:

  • Children 2 to 20 years: Boys EXTENDED BMI-for-age pdf (available from NCHS on 12/15/22)
  • Children 2 to 20 years: Girls EXTENDED BMI-for-age pdf (available from NCHS on 12/15/22)

2000 CDC Growth Charts

The 2000 CDC growth charts, released in May 2000, consist of revised versions of the growth charts, originally developed by the National Center for Health Statistics (NCHS) based on reference data from 1963 through 1994, extended to age 20 years and with the addition of the Body Mass Index (BMI)-for-age charts. Body Mass Index (BMI)-for-age charts. BMI is a calculated measure using weight and height that is defined as body weight in kilograms divided by height in meters squared (Keys et al., 1972).

The 2000 CDC growth charts include the weight-for-age, stature-for-age, and the BMI-for-age charts for boys and girls aged 2 to 20 years. CDC recommends that the BMI-for-age charts be used to screen for underweight, healthy weight, overweight, and obesity for all children and teens aged 2 to 20 years. The weight-for-age and stature-for-age charts are used to determine the pattern of weight and stature separately to aid in understanding the growth pattern observed on the BMI-for-age chart.

2022 CDC Extended BMI-for-age Growth Charts

The 2000 CDC BMI-for-age growth charts were based on a very small sample of children with severe obesity leading to compressed percentiles and less accurate underlying statistics for children with very high BMIs.

Because of this, in 2022, CDC expanded the BMI-for-age growth charts based on an updated reference population that includes children with obesity from 1999 – 2016 and uses updated statistical methods to calculate percentiles for children with very high BMIs.

The 2022 CDC Extended BMI-for-Age Growth Charts include four additional percentile curves above the 95th percentile (i.e., 98th, 99th, 99.9th, and 99.99th percentiles), can plot BMI up to 60 kg/m2, and differ by age and gender. Clinicians can use these charts to track BMI for children aged 2 to 20 years with very high BMIs above the 97th percentile. The 2000 CDC Growth Charts and their recommended use for children and adolescents without obesity have not changed.

For more information on the 2000 CDC growth charts overall see https://www.cdc.gov/growthcharts/cdc_charts.htm

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