Published 8 May 2009, doi:10.1136/bmj.b1892
Cite this as: BMJ 2009;338:b1892 

News
UK adopts growth charts based on data from breastfed babies
Rebecca Coombes 

All newborn babies and children up to 4 years old in the United Kingdom will
have their growth measurements plotted on new charts from this week, which 
will
lead to more infants classed as overweight or obese. 

The UK is the first in Europe to adopt the new standards, based on World 
Health
Organization data collected for breastfed babies. The charts replace those 
in
use for nearly 20 years and which used measures based predominately on 
babies
fed with formula milk. 

All children, regardless of whether they are breast or bottle fed, will be
plotted against the new standards. As breastfed babies grow at a slightly 
slower
rate, the average weight of infants at the age of 1 year in the WHO chart is 
1
kg less than in the old charts. As a result, the Department of Health 
expects
the number of children classified as overweight at the age of 1 to double to 
6%. 

The new measurements are based on the results of a 15 year programme of data
collection and analysis by WHO in six countries—the United States, Brazil,
Ghana, India, Norway, and Oman. The 8500 children measured were all breast 
fed,
on good diets, and with non-smoking mothers. All countries studied had 
similar
growth rates, regardless of race and culture. 

Charlotte Wright, from the Royal College of Paediatrics and Child Health, 
who
helped develop the UK charts for the Department of Health, said, "This is a
description of optimum growth that sets the breastfed infant as the norm.
British babies grow at a very similar rate to the WHO standards. 

"The only difference is that by the age of 1, British babies are plumper. 
They
are rising away in terms of weight, rather than height. The likeliest answer 
to
this is that very few UK infants are breast fed throughout their first year. 
So
babies are getting an early introduction to high energy feeding that may be
pushing infants to over consumption, leading [them] to become overweight." 

She hoped it would also take the pressure off breastfeeding women to give 
their
babies formula. "Parents of small babies who breast feed have come under
pressure to supplement feeding. This gives parents a more realistic take on
where the child is." 

On the other hand, she said, children who are in danger of becoming fat 
might
have been rated as normal on the old charts, and now might be pushed into 
the
overweight or obese areas of the chart. "It might make parents think before
giving their child another yoghurt," she said. 

The UK has adopted the charts as part of its drive to raise breastfeeding 
rates
in the UK. In England 78% of mothers start breast feeding but rates tail off
rapidly, with only 22% breast feeding at 6 months. Initiation rates are much
higher in many other European countries; Norway, Denmark, Sweden, 
Switzerland,
Austria, and Italy have rates of more than 90%. 

Sheela Reddy, principal nutritionist at the Department of Health, said, 
"Breast
feeding is recommended for the first 6 months, but there is a rapid drop-off 
in
rates soon after birth. These charts set out a standard to aspire to for all
babies. It should help establish breast feeding as the normal way of feeding 
all
infants. And will help us to identify rates of obesity and overweight early 
on." 

In other changes, babies will now not be tracked on the chart until they are
more than 2 weeks old, reflecting the fact that most babies lose weight 
after
birth. The charts also de-emphasis the 50th centile because research found 
that
parents often became fixated on keeping their child's weight to be on or 
near
centre. For the first time, the charts include a chart to convert body mass
index and a predictor of adult height. Separate charts will be issued for
preterm babies. 

Cite this as: BMJ 2009;338:b1892 

and letter in response: 

http://www.bmj.com/cgi/eletters/338/may08_1/b1892#213494 

Introduction of UK-WHO Growth Charts-Training 11 May 2009 

Charlotte Wright,
Professor of Community Child Health
University of Glasgow, G3 8SJ,
Tony Williams, Tim Cole, Rob Moy, Helen Bedford, Eileen Birks, David 
Elliman, Magda Sachs 

Re: Introduction of UK-WHO Growth Charts-Training 

New UK-WHO growth charts are being launched in England this month using the 
new
World Health Organization (WHO) standard; the culmination of an ambitious
worldwide programme which for the first time sets the breastfed infant as 
the
norm. The Department of Health funded re-design has made it possible to 
rethink
the way charts are used, produce supporting educational materials and make 
all
freely available at www.growthcharts.RCPCH.ac.uk. We have all been 
collaborating
on this project for the past year and are proud of the results. 

Since the WHO charts were produced as a tool to support and promote breast
feeding, we were surprised to hear that Wyeth / SMA, a manufacturer of 
infant
formula, plans to `launch' the UK-WHO charts via a series of educational
seminars, with the help of the Child Growth Foundation (CGF). None of the 
design
team will be taking part in the series and we all deplore this attempt to 
use
the WHO charts to promote formula milk. For those seeking education 
independent
of commercial sponsorship, we will be running a series of RCPCH (Royal 
College
of Paediatrics and Child Health) and CPHVA (Community Practitioner and 
Health
Visitors Association) endorsed training sessions starting in June. 

Competing interests: None declared
 ------
Magda Sachs
UK-WHO Grwoth Chart Group, UK 

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