The WHO growth charts (babies from around the world fed according to WHO
recommendations of 4-6 months of exclusive bf followed by up to two years
and beyond of continued bf, plus appropriate solids) will be available in
2003.

Until then, the best charts to use remain the ROSS/WHO/CDC/NCHS charts,
which are all the same, and are based on a combination of breastfed and
bottlefed children from the US.  The CDC has made some revisions to their
charts, and those are availabe on the CDC web site.  There are lots of
archival posts about growth charts.

Remember that growth charts are *supposed* to be used to evaluate groups of
children, not individual children, and that how a child's growth charts on
the graph tells you almost nothing about its health and development.
Children do not necessarily stay at the same percentile across their
childhoods -- you can have children that start big and then 'catch down' or
that start small and then 'catch up'.  Some children have a growth spurt in
mid-childhood, from about 4-6 years, while others do not.  Some grow very
fast in the first year and then hardly at all from 1 to 3.  Others start out
very small and slow growing and then grow quickly as toddlers.  All sorts of
patterns are within the range of normal.  As health care professionals, you
should be evaluating not just growth in weight, but growth in length/height,
arm circumference, head circumference, motor/cognitive/language development,
temperament, and health.

Using "new and improved" growth charts, theoretically or actually based on
all breastfed children, instead of the old Ross/WHO/CDC/NCHS based on a
combination of breastfed and bottle-fed children, will not solve the problem
of misinterpreting the pattern of growth relative to the charts, or
over-reliance on a single measure (weight-for-age) in the assessment of
children's health.

Kathy Dettwyler
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