WHO child growth standards: head circumference-for-age, arm circumference-for-age, triceps skin fold-for-age and sub scapular skin fold-for-age.

Abstract

The origin of the WHO Child Growth Standards dates back to the early 1990s and a meticulous evaluation of the NCHS growth reference, which had been recommended for international use since the late 1970s. The review documented the deficiencies of the reference and led to a plan for developing new growth charts that would depict how children should grow in all countries rather than merely describing how they grew at a particular time and place. The outcome of this plan was the WHO Multicentre Growth Reference Study (1997-2003), which applied rigorous methods of data collection and serves as a model of collaboration for conducting international research. The study provides a solid foundation for developing a standard because the sample is based on healthy children living under conditions likely to favor achievement of their full genetic growth potential. Furthermore, the mothers of the children selected for the construction of the standards engaged in fundamental health-promoting practices, namely breastfeeding and not smoking. Other important features of the study are that it included children from a diverse set of countries (Brazil, Ghana, India, Norway, Oman and USA) and explicitly identified breastfeeding as the biological norm and established the breastfed child as the normative model for growth and development. By replacing the NCHS reference, which is based on children from a single country, with one based on an international group of children, the new standards recognize that children the world over grow similarly when their health and care needs are met. The WHO Child Growth Standards provide a technically robust tool for assessing the well-being of infants and young children. The standards depict normal growth under optimal environmental conditions and can be used to assess children everywhere, regardless of ethnicity, socioeconomic status and type of feeding.