Academic journal article Bulletin of the World Health Organization

An Evaluation of Infant Growth: The Use and Interpretation of Anthropometry in Infants

Academic journal article Bulletin of the World Health Organization

An Evaluation of Infant Growth: The Use and Interpretation of Anthropometry in Infants

Article excerpt

In reviewing the growth of infants who live under favourable conditions and are fed according to WHO feeding recommendations, the Working Group found significant differences between the growth patterns of these infants and the patterns reflected in the NCHS-WHO international reference. Given the short- and long-term consequences of growth failure, and the dangers of both the premature introduction of complementary foods and their undue delay -- described as the "weanling's dilemma", the Working Group concluded that use of the current NCHS-WHO reference appears to accentuate the difficulty of avoiding these extremes rather than to help ensure optimal infant nutritional management.

The Working Group identified the following requirements: (a) a new reference which will enhance the nutritional management of infants; (b) the reference population should reflect current health recommendations because of the frequent use of such reference data as standards; (c) evaluation, in a broad range of settings, of the practical utility of using reference data based on infants for whom the WHO feeding recommendations are being followed; (d) close investigation of the effects of different complementary foods on the growth of infants who are being fed according to the WHO recommendations; (e) criteria for evaluating abnormal growth patterns; (f) research for identifying proxy measures for length; and (g) evaluation of reference data based on other anthropometric measurements, such as skinfold thickness and arm and head circumferences.


In the preparatory process for a WHO Expert Committee meeting in November 1993 on "Physical status: the use and interpretation of anthropometry" (1), a Working Group was established by the WHO Nutrition Unit to evaluate infant growth with regard to (a) the appropriate use and interpretation of anthropometry in infants (for individuals and populations); (b) the identification and/or development of reference data for anthropometric indicators, with guidelines on their use; and (c) other crucial issues and gaps in knowledge needing further study.

The Working Group considered the following to be the major purposes of anthropometric assessments of individuals during infancy:

-- detection of growth faltering, failure-to-thrive, and excessive growth;

-- assessment of the adequacy of the intake of human milk or human milk substitutes;

-- assessment of the appropriate age at which to introduce complementary foods;

-- evaluation of the adequacy of the weaning diet;

-- assessment of the impact of illness and response to treatment;

-- screening for high-risk individuals needing special services; and

-- assessment of the response to counselling on improvement of feeding and other health-related practices.

Applications in populations were given less emphasis than those identified for the individual.

It was therefore of great concern that the growth of breast-fed infants living under favourable conditions in various geographical areas has been reported to be less than expected on the basis of the current National Center for Health Statistics-World Health Organization (NCHS-WHO) growth reference (2)(3), especially during the latter half of the recommended exclusive breast-feeding period, i.e., after the age of 3 months. Slower growth is reported to persist during the ensuing period of mixed feeding with human milk and solid foods. The magnitude of the negative deviations in weight-for-age appears to be sufficient for health care workers to reach faulty decisions regarding the adequacy of growth in infants following current WHO feeding recommendations. This possibility is of special concern in developing countries where breast-feeding is a key to survival or, at the very least, to avoid severe infectious morbidity. Exclusive breast-feeding is recommended by WHO from birth to 4-6 months of age, after which the child should continue to be breast-fed, while receiving appropriate and adequate complementary foods for up to 2 years of age or beyond. …

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