Ecological considerations in the creation and the use of child growth standards

There is no proper substitute for a country, especially a developing country, having its own child growth standards or norms for clinical use, based on a representative sample of the population. Separate standards may be derived for subgroups of the population, but the application to the whole population of standards based on an economically privileged group is inappropriate, as is the use of an international standard. The screening or clinical use of growth standards should be sharply distinguished from the use of growth measurements to compare disadvantaged with privileged groups or populations. In particular, the use of growth standards to screen individual children should not divert attention from the need to change existing differences between disadvantaged and privileged groups.