Last week I had the pleasure of attending the UK Baby Friendly conference 
and hearing Tim Cole speak about the new WHO growth charts.  Tim Cole is the 
medical statistician who constructed the UK’s own country-specific growth 
charts, which are currently advised for use in the UK (called the UK90).  He 
is also a member of the WHO working group which has constructed the WHO 
growth charts. 

Some information he gave is readily available in published papers, but 
useful to repeat.  As you know, the WHO chart is a standard and not a 
reference, TC is of the opinion that we can no longer construct reference 
charts which will be useful anywhere in the world, due to the increase in 
childhood obesity which would skew the charts. 

Our UK90 is a nine-centile chart with centils2/3rds of a standard deviation 
apart – and this is also how the WHO chart is constructed.  One of the most 
interesting parts of the talk was TC’s comparison of the WHO and UK90.  I 
know this is of little use to many of you who will never have used the UK 
chart, however it was interesting to hear that all of the centiles on the UK 
chart fall within the centiles on the WHO chart.  So many babies referred 
cos they were below the 0.4th centile would no longer be referred. 

TC revealed that the ‘dip; on the @WHO chart (which I own has been puzzling 
me for some time) was drawn in and does not reflect the data they collected. 
So, while presumably they had a basis for drawing the dip, it does not 
represent real data.  A really interesting comment he made was that he would 
say that NO chart should be used in the first four weeks of life – I presume 
this is due to the amount of centile crossing which makes this so confusing 
to interpret, but I have to admit I did not make a good note if he said 
exactly why. 

TC said he had recommended to the UK govt working party that the UK should 
adopt the WHO chart from 0-2 years and keep our UK90 charts thereafter.  He 
did not elaborate.  We will hear soon-ish what the recommendation is to be.  
One of the audience questions was how soon any adoption would take place and 
TC suggested that it would take on the order of ten years – which is how 
long it has taken for the UK90 to replace the previous (Tanner Whitehouse) 
charts. 

Thrive lines – an acetate overlay to measure the moment when two major 
centiles are crossed and a referral should be suggested, will be useable 
with the WHO chart (these exist here in the UK, but many health visitors do 
not know about them and certainly have received no training: I would suspect 
many paediatricians are also somewhat unfamiliar with them).  Overall TC 
foresees fewer referrals using the WHO charts, because they account for more 
variability of the population.  Also, due to the data being collected in 6 
countries (originally it was to have been 7), there should be no need for 
separate charts for babies of different ethnicity.  (This is a perennial UK 
query).  Of course, this relies on people understanding the chart and not 
worrying if the baby is in the bottom quarter, which is currently apt to 
happen. 

TC’s final emphasised point was that the introduction of the new chart in 
the UK context will require careful training.  Since we are a developed 
country, this may well hold true in all developed country settings. 

Sorry to post at such length, but thought this info might be of interest to 
share.  I am indebted to the trustees of BfN who paid my conference fee and 
travel, and to Rachel Myr who shared her hotel room so that I could be sure 
not to miss a minute of the day. 

Magda Sachs, PhD
Breastfeeding Supporter, BfN (The Breastfeeding Network), UK 

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