Promoting optimal monitoring of child growth in Canada: Using the new World Health Organization growth charts Flashcards
What is the population from which the new WHO growth charts are derived from?
Children birth to age 5yo raised in Brazil, Ghana, India, Norway, Oman, and USA with exclusive breastfeeding for the first 4-6mo
What are the recommendations regarding monitoring growth in Canada?
- Growth of all full term infants and preschoolers should be evaluated using the WHO Child Growth Standards (0-5yo)
- Growth of all school-aged children and adolescents should be evaluated using the WHO Growth Reference 2007 (5-19yo)
- All infants, children and adolescents should have length, weight, and HC at all health care visits, incld. acute illness visits if not attending well child visits
- Weight and height should be obtained using calibrated, well-maintained quality equipment and standardized measurement techniques and plotted on the child’s personal growth record
- Corrected age should be used until 24-36mo when plotting antropometric measurements of premature infants
- Growth of preterm infants discharged from NICU and children with special health care needs should be monitored using the WHO Child Growth Standards and WHO Growth Reference 2007
- BMI for age should be used to assess weight relative to height and to screen for thinness, wasting, overweight, and obesity in all >2yo
- Weight for length or percent ideal body weight can be used <2yo
- Interpretation of plotted measurements should consider their centile rank, the relationship of weight, length/height, and BMI to each other, recommend cut-off values, parental heights (for stature measurements) and trend relative to previous centile ranks to identify major shifts in growth patterns
- HCP should teach children and their caregivers how to interpret their growth and to involve them in any management of growth abnormalities
- To ensure knowledge translation and uptake by key organizations, training on the use and interpretation of the 2006 WHO Child Growth Standards and the WHO Growth Reference 2007 charts should be provided to all health professionals involved in measuring and assessing the growth of Canadian children. This includes training in understanding the differences a practitioner can expect to see when using the WHO versus CDC growth charts, and how to explain them to parents or caregivers.
- While the recommendations in this collaborative statement pertain specifically to adoption of the WHO Child Growth Standards and Reference 2007 for individual children, it is suggested that these standards and reference charts should also be considered for the purposes of population health surveillance, so that children classified as underweight, overweight or obese at the individual level are captured in a consistent manner in population surveys.
- Development of a Canadian Paediatric Nutrition Surveillance System is recommended for the organized and ongoing collection of anthropometric measurements to follow the growth and nutritional status of Canadian children and describe trends in key indicators of their nutritional status. Data could be used for program planning, development and evaluation of health and nutrition interventions such as breastfeeding promotion programs, as well as monitoring progress toward health objectives for Canada. Collaboration with key stakeholders in the community health or population health sector is needed.
- Research is required in the following areas:
a) validation of using BMI for age to assess nutritional status in the first two years of life, with emphasis on identifying associations between BMI and subsequent health outcomes;
b) validation of using BMI for age to assess underweight in children of all ages; and
c) evaluation in all age groups of the predictive power of proposed BMI cut-offs for overweight and obesity with respect to adverse short- and long-term health outcomes.
What are the cut off points for different growth status in birth to 2yo?
Underweight = Weight for age <3rd centile
Severe underweight = Weight for age <0.1st centile
Stunting = length for age <3rd centile
Severe stunting = length for age <0.1st centile
Wasting = weight for length <3rd centile
Severe wasting = weight for lenght <0.1st centile
Risk of overweight = weight for length >85th centile
Overweight = weight for length >97th centile
Obesity = weight for length >99th centile
What are the cut off points for different growth status in 2-5yo?
Underweight = Weight for age <3rd centile
Severe underweight = Weight for age <0.1st centile
Stunting = height for age <3rd centile
Severe stunting = height for age <0.1st centile
Wasting = BMI for age <3rd centile
Severe wasting = BMI for age <0.1st centile
Risk of overweight = BMI for age >85th centile
Overweight = BMI for age >97th centile
Obesity = BMI for age >99.9th centile
What are the cut off points for different growth status in 5-19yo?
Underweight = Weight for age <3rd centile*
Severe underweight = Weight for age <0.1st centile*
Stunting = height for age <3rd centile
Severe stunting = height for age <0.1st centile
Wasting = BMI for age <3rd centile
Severe wasting = BMI for age <0.1st centile
Risk of overweight = N/A
Overweight = BMI for age >85th centile
Obesity = BMI for age >97th centile
Severe obesity = BMI for age >99.9th centile
- Weight for age not recommended for children >10yo, recommend BMI for age instead
What are the implications of these new growth curves for HCP?
- easily accessible training for busy practitioners on
a) performing accurate and reliable anthropometric measurements using precise equipment,
b) different features of the WHO charts compared with the CDC charts,
c) using and interpreting the new WHO growth charts including differences between growth on these charts and the CDC charts, as well as the significance of the new WHO cut-off points,
d) effective nutrition-negotiation skills with parents and caregivers to effect positive changes in nutrition and health, - leadership at the national and/or provincial/territorial levels to create multimedia training tools and resources for individuals and organizations across Canada,
- accessibility to resources, including portable, accurate measuring equipment, and
- a call for collective advocacy for a Canadian Paediatric Nutrition Surveillance System to monitor breastfeeding rates and growth and nutritional status of our children.
