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Growth assessment in infants and toddlers using three different reference charts
Andrea Nash1, Mary Corey, Kelly Sherwood
1Department of Newborn and Developmental Paediatrics, Sunnybrook and Women's College Health Science Centre, 76 Grenville Street, Toronto, Canada.
Insights
The Centers for Disease Control and Prevention (CDC) growth charts identify more young children at risk of undernutrition compared to NCHS or Tanner charts. Conversely, fewer children are flagged for overnutrition risk using CDC charts, impacting nutritional assessments.
Area of Science:
- Pediatric Nutrition
- Growth Monitoring
- Public Health
Background:
- Accurate assessment of nutritional status in children is crucial for early intervention.
- Different growth references may lead to varying classifications of nutritional risk.
- Tertiary care settings require reliable tools for identifying children at risk of undernutrition or overnutrition.
Purpose of the Study:
- To compare the proportion of children under 24 months identified as at risk of undernutrition or overnutrition using different growth references.
- To evaluate the impact of using Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), and Tanner-Whitehouse (Tanner) growth charts.
Main Methods:
- A cohort of 548 infants and toddlers (aged ≤24 months) in a tertiary care facility was assessed.
- Weight-for-age and length-for-age percentiles, and percent ideal body weight were calculated using CDC, NCHS, and Tanner growth charts.
- Electronic computation of growth parameters was performed.
Main Results:
- The CDC growth charts identified a higher proportion of children at risk of undernutrition (weight-for-age <3rd percentile) compared to NCHS and Tanner charts.
- Using CDC charts, more children were classified with percent ideal body weight <90 (risk of undernutrition).
- Conversely, fewer children were classified at risk of overnutrition (percent ideal body weight ≥110%) with CDC charts compared to NCHS and Tanner charts.
Conclusions:
- Implementation of CDC growth charts in tertiary care is likely to increase the number of children identified with undernutrition risk.
- A decrease in the identification of overnutrition risk is expected with the use of CDC charts.
- Growth charts serve as references for screening and should not be used in isolation for comprehensive nutritional status assessment.
Objective:
To determine if the proportion of children < or =24 months old in a tertiary care facility defined as at risk of undernutrition or overnutrition differs according to different references used for assessment: the Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS) or Tanner-Whitehouse (Tanner) growth charts for weight-for-age and length-for-age.
Methods:
Lengths and weights were measured on infants (207 female, 341 male) aged < or =24 months admitted from or attending clinics in the General Pediatric or Respiratory Medicine Programs at The Hospital for Sick Children, Toronto. Weight-for-age and length-for-age percentiles and percent ideal body weight were electronically computed.
Results:
The proportion of all children whose weight-for-age was <3rd percentile (at risk of undernutrition) was greatest using the CDC growth charts (22.5%) compared with the NCHS (15.9%) or Tanner (19.2%) growth charts. Likewise, the proportion of all infants/toddlers with percent ideal body weight <90 (at risk of undernutrition) was greatest using the CDC (32.3%) compared with the NCHS (22.1%) or Tanner (25.9%) growth charts. In contrast, the percentage of children whose percent ideal body weight was > or =110% (at risk of overnutrition) was least using the CDC (18.1%) compared with the NCHS (26.1%) or Tanner (22.4%) growth charts.
Conclusion:
More children aged < or =24 months will be defined as at risk of undernutrition and fewer at risk of overnutrition when using weight-for-age or percent ideal body weight and the CDC growth charts compared with the NCHS or Tanner growth charts. As a result, requests for a more detailed nutritional assessment for undernutrition will likely follow implementation of the CDC growth charts in a tertiary care setting. As the CDC, NCHS and Tanner growth charts are growth "references" rather than "standards," other than for screening purposes, they should not be used in isolation when assessing growth and nutritional status.
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