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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