Growth charts

Growth charts demonstrate the growth of a reference population and are used for assessment of individuals and groups of children.

Serial measurements of the child's growth are plotted on the growth chart to identify and assess patterns of growth. Single or 'one-off' measurements for individual children are usually less meaningful.

Growth charts for use in maternal and child health services

In September 2010, the US Centers for Disease Control and Prevention (CDC) recommended using WHO growth charts to monitor growth for all children less than two years of age, and to continue to use the CDC growth charts to monitor growth for children aged two years and over. For more information see:

My health and development record

In 2011 'My Health and Development Record' (a revised Child Health Record) was released. This record contains the WHO and CDC growth charts.

The Royal Children's Hospital Melbourne has a number of growth charts to download

Importance of growth monitoring

Growth monitoring is especially important during infancy for:

  • detection of growth faltering or excessive growth
  • assessment of the impact of illness and response to treatment
  • screening for high risk individuals.

For populations, single measures can be used for monitoring and surveillance of under or over nutrition, international comparison and evaluating effectiveness of nutrition programs.

Unusual or concerning patterns of weight gain and growth sometimes go unrecognised for various reasons:

  • Measurements taken incorrectly, plotted on a growth chart inaccurately, or not plotted at all, may lead to erroneous interpretation of growth patterns and missed or unnecessary referrals.
  • Growth assessment is not effective in improving child health unless what is revealed by the growth monitoring is discussed with the family. Information about adequate or inadequate changes in growth is used to reinforce or motivate positive nutritional and healthy lifestyle practices with the family.

Why the WHO charts are needed

The WHO charts are described as 'optimal' rather than 'average' growth and are based on:

  • healthy, term babies
  • exclusive breastfeeding at least four months
  • introduction of solids by six months and continued breastfeeding for a year
  • non-smoking mothers
  • not low socio-economic status
  • data collection from birth to five years
  • similar growth patterns in children from the six countries (USA, Norway, India, Ghana, Brazil, Oman).

WHO promotes these charts for children from all ethnic backgrounds, irrespective of the type of infant feeding.

The previous charts (CDC) were based on health surveys in the US between 1963 and 1994.Criticisms of these charts are:

  • less than half the mothers initiated breastfeeding
  • small sample size
  • skewed towards higher weight because of increasing rates of obesity.

These charts are now recommended for children aged two years and over.

Difference between CDC and WHO growth charts 0-2 years

Weight: Differences in weight for age curves are most marked in infancy. Children in the WHO charts grow faster and have higher mean weights than the CDC children in the first few months of infancy. At around six months the lines cross and children in the WHO study are on average lighter than the CDC children from 6-32 months after which the medians are similar to 60 months.

Length: Length or height for age show similar shaped curves. On average WHO children are slightly taller than the CDC children. The WHO curves have much tighter variability and slower growth rates would be higher for all age groups using the WHO charts.

Weight for length and weight for height The CDC children are on average heavier, so rates of overweight are higher when using the WHO standard, and rates of underweight are lower.

BMI The BMI curves are higher on the CDC charts compared with the WHO charts. This reflects the higher prevalence of overweight children in the CDC sample, compared with the WHO charts.