New WHO Child Growth Standards Catch On: Since 2006, When the World Health Organization Launched the New Child Growth Standards, over 140 Countries Have Adopted Them. Gozde Zorlu Talks to Dr Mercedes De Onis about Why These Represent a New Approach and Why They Are Useful
Zorlu, Gozde, Bulletin of the World Health Organization
Q: What are the WHO Child Growth Standards?
A: These charts are a simple tool to assess whether children are growing and developing as they should. They can also be used to see whether efforts to reduce child mortality and disease are effective. The new standards demonstrate for the first time ever that children born in different regions of the world, when given the optimum start in life, have the potential to grow and develop to within the same range of height and weight for their age. The WHO standards are being widely used in public health and medicine and by governmental and health organizations for monitoring the well-being of children. The standards are also used for detecting children not growing to full capacity or those who are under- or overweight on average.
Q: What was the method of measuring children's growth before?
A: Before the Child Growth Standards were developed, WHO had been recommending the use of the US National Center for Health Statistics growth references since the late 1970s.
Q: How does today's growth standard differ from the growth references used before?
A: The new standard establishes breastfeeding as the biological norm and the breastfed infant as the standard for growth and development. Previous reference charts were based largely on the growth of infants fed formula milk. The WHO Child Growth Standards are global and for all children, in contrast to the previous international reference based on children from a single country--the United States of America (USA).
Q: What is the difference between a growth standard and a reference?
A: A growth reference provides a basis for making comparisons but deviations from the pattern it describes are not necessarily evidence of abnormal growth. A standard, on the other hand, embraces the notion of a norm or desirable target, a level that ought to be met, and therefore is a more effective guide to, and evaluator of, interventions to improve healthy development and growth. In 1993, WHO undertook a comprehensive review of these growth references. It concluded that they had biological and technical drawbacks and recommended a novel approach: a standard rather than a reference.
Q: How were the WHO growth standards developed?
A: The WHO growth standards are based on data from the WHO Multicentre Growth Reference Study (1997-2003), which applied a rigorous method that serves as a model of collaboration for conducting international research. The study provided a solid foundation for developing a standard because the sample was based on healthy children raised in environments that do not constrain growth. Furthermore, the mothers of the children selected for the construction of the standards engaged in fundamental health-promoting practices, namely breastfeeding and not smoking. Rigorous methods of data collection and standardized procedures across the six study sites (Brazil, Ghana, India, Norway, Oman and the USA) yielded very high-quality data. The generation of the standards followed state-of-the-art statistical methods.
Q: What is the connection between the WHO growth standards and infant and young child feeding practices?
A: The growth of an infant is strongly linked to how he or she is fed. The nutritional, immunological and growth benefits of breastfeeding have been proven, and so the breastfed infant is the natural standard for physiological growth. The adequacy of human milk to support not only healthy growth but cognitive development and long-term health provided a clear rationale for basing the WHO growth standards on breastfed infants. With the new growth standards, not only do paediatricians have a better tool to monitor the growth of breastfed infants but also health policies and public support for appropriate infant feeding practices will be strengthened.
Q: How many countries have adopted the WHO growth standards since 2006?
A: Over 140 countries had adopted them [by early March 2011] and are at different stages of their implementation. …