> Can anyone point me toward some resources explaining how to use the new
> WHO growth charts.
This is the information that is still to come. In my opinion, this could be
the most interesting and valuable part of the charts -- if it challenges
people worldwide to change practice and deepen understanding of the
appropriate use of growth monitoring.
On a very
> simplistic level, how much will these charts change our usual guidelines
> on ounces-per- week-in-the-early-weeks, and for the later months?
I don't know what the usual practice is in the USA, but here in the UK,
where every mother is issued with our own country-specific charts (weight,
height, head circumference) which are used when routine and other measures
are done, and the weight both written down in ounces / grams (sometimes
both) AND plotted on the charts, there is much much less emphasis on the
'ounces per week' that was current when I had my children. If you look at
the chart, you notice that the rate at which growth is changing changes
(otherwise it growth 'curves' would be a straight line) -- so every week or
two, the average number or range of ounces one can expect a baby to gain,
also changes. And, in any case, a week is too short a timescale. I know of
no chart where the data is based on babies weighed so often -- they are
usually weighed once a fortnight at most, sometimes once a month (or, the
data is cross-sectional) -- so the two weights taken two weeks apart are
connected by a smooth line, which is an ASSUMPTION as to how the growth of
an individual occurs [or, at least an assumption adopted for the sake of
chart production] during the fortnight. The curves are smoothed.
The most interesting part of ounces per week is that (here in the UK) a
range was quoted for what was expected, but never a cut-off of 'if it is
less /more than this amount, you must act in such and such a way'. The
lower limit -- was that a danger limit? Never clear. And anyway, dnager of
what? A danger to health or a danger of being underweight?
The point of the chart is to make the curve visible and to show if the SHAPE
is roughly 'right', to take the focus away from absolute numbers of ounces.
Don't American babies each get issued with their own chart? (mind you I
have just been sent the chart from the Republic of Ireland, which is
thumbnail size -- no way you could plot on it!!). An interesting read on
the point of growth monitoring (which really only deals with weight) is:
Panpanich R & Garner P (1999). Growth Monitoring in Children (Cochrane
Review), Issue 4 ed. John Wiley & Sons, Ltd, Chichester.
One interesting feature of the WHO chart is that, unlike our UK chart or
many others I have seen, it depicts the initial weight loss/regain. This
used to be shown in books from the first half of the 20th century (which
just had one centile line in them!!!), but, due to fortnightly weighing
dissappeared from later charts.
I doubt this helps you much, but there have been no other replies, so I
thought I would chime in. I think the basic issue is that we should all be
clamouring for better initial training in weight monitoring of ALL babies,
and the sue of whatever materials WHO issue. Of course, I know that the UK
hardly likes to use international WHO documents and policies, considering it
(I think) somehow infra dig. I bet this holds to the nth degree in the USA,
but one can live in hope -- and each of us might try to take responsibility
for reminding the heirarchy in our country of the usefulness of this mammoth
piece fo work from WHO (once it is fully available).
Magda Sachs
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