Academic journal article Central European Journal of Public Health

Growth of Czech Breastfed Infants in Comparison with the World Health Organization Standards

Academic journal article Central European Journal of Public Health

Growth of Czech Breastfed Infants in Comparison with the World Health Organization Standards

Article excerpt


Growth references are important for paediatric health monitoring. It is critical to understand differences in growth interpretation and potential consequences when using available growth references. This study compares the growth of Czech breastfed children with the current WHO growth standards 2006 and the Czech references 1991, 2001.

A total of 960 infant/parent pairs in the Czech Republic were recruited through paediatric practices. Anthropometric data were collected during infants' first 12 months of life and parent questionnaires were gathered during a preventive visit at 18 months.

Czech breastfed infants were longer with a greater head circumference at all percentiles compared to the WHO standards and were similar to the national references. The percentile weight-for-age and weight-for-length values of infants (≤6 months) were lower, and higher (6-12 months) compared to the WHO standards. The infant growth in the sample differed from both the WHO standards as well as the national references.

Our findings indicate that the growth of Czech breastfed children differs from the current national references. These discrepancies were smaller compared to the WHO standards. The results of the study were used for new growth assessment guidelines to optimize feeding recommendations for Czech infants. The adoption of the WHO standards in the Czech Republic is not recommended.

Key words: breastfeeding, Czech, growth standards, infants, national references, WHO standards


The World Health Organization (WHO) released new growth standards for children aged 0-5 years in 2006 (1). The new standards are based on the Multicentre Growth Reference Study (MGRS) that included a sample of 8,500 children aged 0 to 5 years from 6 countries including Brazil, U SA, Ghana, India, Norway, and Oman (2). The main goal of the study was to establish growth standards that could be utilized internationally and thus, serve as a universal assessment tool for growth and development comparisons of children globally (1,2). Growth standards define how children should ideally grow, as opposed to the pmpose of growth references that are meant to depict the actual growth of a given infant population. Since 2006, the new WHO standards have been successfully adopted by many countries and have been veiy useful for growth assessments, especially in nations that have not had appropriate local references available (3, 4). However, multiple countries are still in the process of considering the adoption of the new WHO standards and 30 countries have decided not to adopt these standards in their paediatric practice (3).

The Czech Republic is one of a few countries that have had the unique opportunity to utilize its own growth references over the last several decades. The Czech growth references have been constructed and periodically updated based on a long-term and systematic monitoring of the Czech paediatric population (5-7). While the first anthropometric characteristics were collected from 100,000 Czech children back in 1895 (9), the regular Nationwide Anthropological Survey (NAS), with anthropometric measurements from children and adolescents aged 0-18 years, has been conducted eveiy 10 years since 1951 (5-8). Due to the lack of funding in 2011, the NAS was not completed for the first time since 1951. Thus, the 6th NAS completed in 2001 represents the most recent survey of Czech children and adolescents and growth curves from this survey aie currently utilized in Czech paediatric practice (10), with the exception of weight-for-age, weight-forheight and BMI-for-age reference values that were derived from the 5th NAS (6).

Given the unique and long-tenu anthropometric data from the nationwide surveys, the Czech paediatric practice faced a challenging issue related to the adoption of the new WHO growth Standards dming the past few years. An expert group on growth monitoring, assessment and growth standards was established by the National Institute of Public Health in the Czech Republic after the release of the new WHO standards in 2006. …

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