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Published on: February 2, 2017
Worldwide practices in child growth monitoring
Mercedes de Onis1, Trudy M A Wijnhoven, Adelheid W Onyango
1Department of Nutrition, World Health Organization, 1211 Geneva 27, Switzerland. deonism@who.int
Insights
Child growth monitoring is universal, with most countries using weight-for-age charts. This global overview of child growth monitoring practices informs the development of a new international growth reference.
Area of Science:
- Pediatrics
- Global Health
- Child Development
Background:
- Child growth monitoring is crucial for assessing health and development.
- Existing growth references have limitations, necessitating a new international standard.
- Understanding current global practices is essential for implementing a new reference.
Purpose of the Study:
- To document worldwide child growth monitoring practices.
- To gather data for the creation and implementation of a new international growth reference.
- To identify challenges and variations in current growth monitoring systems.
Main Methods:
- A global survey was conducted using questionnaires sent to Ministries of Health.
- Information on national growth charts, reference populations, and classification systems was collected.
- Data from 178 countries, including 806 growth charts, were analyzed.
Main Results:
- Growth charts are utilized in all surveyed countries, primarily for preschool-aged children.
- Weight-for-age is the most common metric, often used exclusively.
- Percentiles are the most frequent classification method (63%), followed by z-scores (20%).
- Conceptual and practical challenges in growth monitoring were reported.
Conclusions:
- Child growth monitoring is a globally adopted practice in pediatric care.
- The findings provide critical insights for developing and applying a new international growth reference.
- Standardizing growth monitoring can improve early detection of growth faltering.
Objective:
To describe child growth monitoring practices worldwide in preparation for the construction and application of a new international growth reference.
Study Design:
A questionnaire was sent to Ministries of Health in 202 countries requesting information on growth charts used in national programs, reference populations, classification systems, problems encountered, and actions taken against growth faltering. Countries also provided hard copies of charts in current use. This information was entered and analyzed in Microsoft Access.
Results:
Responses were received from 178 (88%) countries, 154 of which included growth charts (n=806). Two thirds of the charts covered preschool age. All countries used weight-for-age, over half relying on this index alone. The reference most commonly used (68%) was the National Center for Health Statistics/World Health Organization population, with regional variations, where most European countries used local standards. Sixty-three percent of charts classified child growth on percentiles, whereas about one fifth used z scores. Problems reported were both conceptual (eg, interpreting growth trajectories) and practical (eg, lack of equipment).
Conclusions:
The survey demonstrates that growth charts are used universally in pediatric care. The information gathered on current use and interpretation of growth charts provides important guidance for constructing and applying the new reference.
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