Nikki mentions an article in Breastfeeding Review that is critical of the
WHO growth standards.  I haven't read it, but some of the criticism she
recounts is familiar.  I take issue here with the comment from critics that
since children in their patch, be it the US or Malaysia or western Norway,
do not eat 'ideally', the way the data collection sample in the WHO growth
study did, the standards are inapplicable where they work.  

For decades we have used growth charts obtained by measuring an unselected
population of people at different ages, not even necessarily the SAME
unselected people as they each grew, just an unselected group at various
ages, and then plotting all the weight values for a given age on a two-axis
coordinate graph, and seeing where all the points fall.  Then they drew
lines that divide the data points into percentiles and the unrelenting
tyranny of averageness was cemented.  These charts have enabled us ONLY to
see where the growth of a given individual child lands in relation to an
unselected population of children, about whose feeding we know nothing other
than that the child was alive at the time of the measurement.

Nonetheless, these charts have uniformly been used as though they were
STANDARDS and as though being exactly average is better than being even
slightly heavier or lighter than average.  Thus a breastfed child who
deviated very much from the 50th percentile might be at risk, either for
supplementation or meaningless, impossible-to-follow advice to feed the
child less while still continuing to breastfeed. 

With the advent of the WHO standards, we finally have curves that actually
do show how children ought to grow, curves that can reveal underlying
nutritional problems in a community, both under- and overnutrition.  And now
the same professional groups who have been misusing the old curves all
along, are bellyaching because the new STANDARDS are revealing the
nutritional problems in their communities.  It really points up what Magda
knows, that the purpose of weighing children as part of health status
monitoring is poorly understood, and the interpretation of the weight by use
of a graph is at least as poorly understood as the purpose of weighing them
at all.  And don't even get me started on How to Weigh a Baby, a topic not
even covered in most professional training curricula here.

Until practitioners in health surveillance functions understand what this is
all about, (until they understand how much they don't know!) what graph they
are using is irrelevant.  I've found it is much easier to teach parents how
to use the WHO standards, than to teach experienced practioners.

Rachel Myr
Kristiansand, Norway

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