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: Growth Charts: Valid For All Children?
DEAR DR.PAUL:I believe that growth charts are misused,
and cause a great deal of stress. I think that particularly the
immigrant population is done a disservice through the routine
use of these charts. I would like to know the scientific evidence
that supports growth charts. Thanks.
PEDIATRICIAN DR.PAUL ANSWERS:I agree, in
part with your first remark, as growth charts(or curves) can
be potentially misused; However, when used appropriately, growth
charts are a very valuable tool in pediatrics. The currently
used charts have been scientifically developed based on a North
American population by the National Center for Health Statistics(NCHS),
in Maryland, USA. Working in a multicultural setting over the
last 15 years, I came to realize that the NCHS charts may not
be accurate for children from Asia or China who tend to be smaller
than North American children. As a result, a child of Asian
background may seem to always be below the "normal or average".
This is like comparing apples to oranges. However, I managed
to obtain a growth chart from China and that same child plots
normally on this curve. Now, this is comparing apples to apples!
Let me stress though, that the most important point is the trend
or rate of growth, regardless of the child's ethnic origin and
which growth chart we use. If there is a fall off in the rate
at which a child is growing, this is a problem, no matter which
curve one uses. As each child is unique, parents should not
compare one child to another. This is not the purpose of growth
charts who's role is to help us make sure that a child is growing
at a normal rate.
Interestingly, there are other conditions or situations that
are associated with different growth rates and patterns. For
example, breastfed children have different growth rates as compared
to non-breastfed children. Also, babies born prematurely and
children with chronic medical conditions display different growth
rates. As a result, specific growth charts are currently available
for children with specific situations such as for breast-fed
infants, premature babies and for children with Down's syndrome.
Importantly, during the first 4 months of life, the growth curves
are generally universal; If during this time, any baby, regardless
of ethnicity is not following the growth curve or is plotting
below the normal range (even on the NHCS chart), this is a problem
which cannot just be discounted as a result of ethnic background.
In response to a growing multicultural population and the recognition
that children with specific medical conditions or situations
have their own growth rates, we are now refining our approach
by developing and using growth curves which are either "culturally"
specific or "condition/situation" specific. In the meantime
the medical community is becoming increasingly aware of these
issues and is adapting in terms of its views and expectations
of the growth of children from non-North American backgrounds.
ADDENDUM: The United States Department of Health and
Human Services has released new growth charts derived from from
both breast-fed and formula-fed babies. They can be found at:
www.cdc.gov/growthcharts
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