280 de Onis^of tables and charts is presented on the WHO
website (www.who.int/childgrowth/en), together
with tools such as software and training materi-
als that facilitate their clinical application. The
d i s j u n c t i o n o b s e r v e d a t 2 4 m o nt h s i n t h e l e n g t h - /
height-based charts represents the change from
measuring recumbent length to standing height.
Standards for other anthropometric variables
(i.e. mid-upper-arm circumference, and triceps
and subscapular skinfolds) are also available on
the website.
Implications of Adopting the WHO Child
Growth Standards
The scrutiny that the WHO Standards have un-
dergone is without precedent in the history of de-
veloping and applying growth assessment tools.
Governments set up committees to scrutinize the
new standards before deciding to adopt them,
and professional groups conducted thorough ex-
aminations of the standards. The detailed evalua-
tion allowed assessing the impact of the new stan-
dards and documenting their robustness and
benefits for child health programs. Since their re-
lease in 2006, the WHO Growth Standards have
been widely implemented globally [8]. Reasons
for adoption include: (1) providing a more reli-
able tool for assessing growth that is consistent
with the Global Strategy for Infant and Young
Child Feeding; (2) protecting and promoting
breastfeeding; (3) allowing monitoring of malnu-
trition’s double burden, i.e. stunting and over-
weight; (4) promoting healthy growth and pro-
tecting the right of children to reach their full ge-
netic potential; and (5) harmonizing national
growth assessment systems. In adopting the
WHO Growth Standards, countries have harmo-
nized best practices in child growth assessment
and established the breastfed infant as the norm
against which to assess compliance with chil-
dren’s right to achieve their full genetic growth
potential.
The detailed examination of the WHO
Growth Standards by technical and scientific
groups has provided a unique opportunity to val-
idate their robustness and to improve our under-
standing of their broad benefits:- The WHO Standards identify more children
as severely wasted [9] ; besides being more ac-
curate in predicting mortality risk [10–12] , use
of the WHO Standards results in shorter dura-
tion of treatment, higher rates of recovery and
fewer deaths, and it reduced loss to follow-up
or the need for inpatient care [13] - The WHO Standards confirm the dissimilar
growth patterns of breastfed and formula-fed
infants, and provide an improved tool for cor-
rectly assessing adequacy of growth in breast-
fed infants [14–16] ; they thereby considerably
reduce the risk of unnecessary supplementa-
tion or cessation of breastfeeding, which are
major sources of morbidity and mortality in
poor-hygiene settings - In addition to confirming the importance of
the first 2 years of life as a window of opportu-
nity for promoting growth, the WHO Stan-
dards demonstrate that intrauterine retarda-
tion in linear growth is more prevalent than
previously thought [17] , making a strong case
for the need for interventions to start early in
pregnancy and before - Another important feature of the WHO Stan-
dards is that they demonstrate that undernu-
trition during the first 6 months of life is a con-
siderably more serious problem than previ-
ously detected [16–18] , thereby reconciling
the rates of undernutrition observed for young
infants and the prevalence of low birth weight
and early abandonment of exclusive breast-
feeding - The WHO Standards also improve early de-
tection of excess weight gain among infants
and young children [19, 20] , showing that
obesity often begins in early childhood, as
should measures to tackle this global ‘time
bomb’
Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 278–294
DOI: 10.1159/000360352