[Monitoring infant growth: comparative use of WHO standards and French national reference curves]
Related Experiment Video
Updated: Jun 12, 2026
Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts
Published on: January 29, 2018
C Bois1, J Servolin, G Guillemot
1Service départemental de protection maternelle et infantile (PMI), conseil général des Hauts-de-Seine, 2-16 boulevard Soufflot, Nanterre, Hauts-de-Seine, France. cbois1@cg92.fr
Insights
The World Health Organization (WHO) infant growth curves, unlike French Personal Child Health Record curves, provide a more accurate assessment for all infants. Using WHO curves optimizes infant care by preventing misinterpretations of weight gain.
Area of Science:
- Pediatrics
- Public Health
- Growth Monitoring
Background:
- The World Health Organization (WHO) growth curves (2006) are designed for exclusively breast-fed infants but are underutilized in France.
- French Personal Child Health Record (PHCR) curves differ significantly from WHO curves, particularly in the 2-3 month range.
- Discrepancies between growth curve interpretations can impact infant care and feeding recommendations.
Purpose of the Study:
- To evaluate if the choice of growth curve (WHO vs. PHCR) influences the interpretation of infant growth and subsequent advice.
- To assess the applicability of WHO curves for all infant feeding types in the French context.
- To compare the concordance of interpretations between WHO and PHCR curves.
Main Methods:
- Retrospective analysis of weight gain curves (WHO and PHCR) for 20 exclusively breast-fed infants by 22 physicians.
- Prospective analysis of WHO curves for 151 infants (0-3 months) monitored in a consultation setting.
- Statistical analysis using weighted kappa to measure inter-observer agreement for curve interpretations.
Main Results:
- Significant discordance was observed between interpretations of French PHCR and WHO curves at 2 months (weighted kappa = -0.26).
- Satisfactory concordance was found for interpretations within the WHO curves (weighted kappa = 0.71) and PHCR curves (weighted kappa = 0.58) independently.
- French PHCR curves overestimated weight gain in one-third of infants, potentially leading to inappropriate feeding restrictions or overlooked concerns.
Conclusions:
- The WHO growth curves offer a more reliable and consistent assessment of infant weight gain compared to French PHCR curves.
- The WHO curves are applicable to a broader infant population, including non-breast-fed infants (excluding premature babies), for growth monitoring.
- Wider adoption of WHO curves in France is recommended to enhance the accuracy of infant growth assessment and optimize clinical care.
Abstract:
The WHO curves published in 2006 reflect the exact growth of infants who are exclusively breast-fed for at least 4 months. These curves are universal but not widely used in France. At 2-3 months, they have a much higher level than the curves of the Personal Child Health Record. The aim of our study was to evaluate whether the choice of the type of curve influenced the interpretation of infant growth and the advice given, and whether WHO curves could be used for all infants. Initially, 22 physicians retrospectively interpreted the WHO and Personal Child Health Record weight gain curves of 20 infants who were exclusively breast-fed. All of the curves were interpreted twice. In a second step, we drew the WHO curves from 0 to 3 months for the 151 infants monitored by the consultation. At 2 months, there is a very clear discordance in the interpretations of the French and WHO curves (weighted kappa = -0.26 CI 95% [-0.62; 0.18]), contrasting with the satisfactory concordance of the WHO interpretations (weighted kappa = 0.71 CI 95% [0.25; 0.89]) and Personal Child Health Record (weighted kappa = 0.58 CI 95% [0.09; 0.81]) curves. By overestimating the weight gain during the first weeks, in one-third of the infants use of the French curves leads to either inappropriate suggestions of restrictions or their insufficient weight not being taken into account. Moreover, the weight gain at 2-3 months for 151 infants of all categories is within the limits of the WHO curves, without going below the percentile lines for the non-breast-fed infants, except premature babies. Broader use of the WHO curves could be proposed in order to optimize the care of infants, regardless of how they are fed.
Related Concept Videos
01:27Microbial Growth Measurement: Indirect Methods
01:23Microbial Growth Measurement: Direct Methods
01:19Guidelines For Measuring Vital Signs
Before taking a patient's vital signs, a nurse would consider and assess the patient's comfort level and ensure appropriate equipment is available.
01:29Drug Dosing: Infants and Children
01:26Derivatives: Problem Solving
01:29Oxygen Requirements and Growth Patterns