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Growth Monitoring of Children Under Five Years Using National Reference Charts Versus International Growth Standards,

Bancy Ngatia1, Linda Vesel2, Eric O Ohuma1

  • 1Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.

BJOG : an International Journal of Obstetrics and Gynaecology
|November 6, 2025
PubMed

Insights

International growth charts significantly alter growth metrics for children under five compared to national references. These differences impact the identification of at-risk infants, highlighting the need for careful chart selection in pediatric care.

Area of Science:

  • Pediatric Growth Monitoring
  • Public Health Surveillance
  • Comparative Growth Analysis

Background:

  • Growth charts are essential tools for monitoring child development against population averages.
  • Accurate growth assessment is critical for identifying potential health issues in early childhood.

Purpose of the Study:

  • To evaluate how international growth charts (INTERGROWTH-21st and WHO Child Growth) affect growth metrics in children under five when compared to national charts.
  • To understand the implications of using different growth chart standards on the classification of pediatric growth parameters.

Main Methods:

  • A systematic literature search was conducted across major databases (CINAHL, EMBASE, MEDLINE, Scopus, Web of Science).
  • Studies published between 2007-2023 comparing national charts with INTERGROWTH-21st or WHO Child Growth charts were included.
  • Growth metrics like z-scores and centiles were analyzed to compare prevalence rates of SGA, LGA, stunting, wasting, underweight, overweight, and obesity.

Main Results:

  • Local reference charts often reported higher z-scores/centiles for weight, length, and head circumference compared to WHO Child Growth standards.
  • Seven out of 11 studies found higher rates of small-for-gestational age (SGA) using local references versus international standards.
  • Four out of five studies indicated lower rates of large-for-gestational age (LGA) when using local references compared to INTERGROWTH-21st standards.

Conclusions:

  • Significant discrepancies exist between national and international growth assessment standards.
  • These differences have critical implications for accurately identifying infants and children at risk due to growth deviations.
  • The choice of growth chart significantly influences clinical decisions and public health interventions related to child growth.
Abstract

Keywords:
INTERGROWTH‐21st standardsWHO child growth standardsgestational agegrowth chartsgrowth monitoringnutritional statuspublic health

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