Pediatric Nutrition in Practice

4 Annexes

Key Words

Growth assessment · Growth references ·

Anthropometry · Interpretation

Key Messages

• Growth charts are essential tools for the interpreta-
  tion of growth measurements in children


• The CDC and Euro Growth charts are growth refer-
  ences that describe the growth of populations of
  children as they exist at a given time in a given loca-
  tion


• Growth standards (e.g. WHO Child Growth Stan-
  dards) describe the growth of children who live in
  favorable circumstances, receive optimal nutrition
  and show desirable growth characteristics


• Anthropometric measurements need to use proper
  techniques. Measurements of recumbent length
  must be interpreted against charts of recumbent
  length, and measurements of standing height must
  be interpreted against charts of standing height
  © 2015 S. Karger AG, Basel

Introduction

Growth assessment is an integral part of child-
hood health monitoring. For interpretation,
growth measurements must be compared with
appropriate norms. Such norms are provided by
growth references which describe the growth of

children who are living in a defined geographic

area and are deemed healthy. The relative position

of a child undergoing assessment in comparison

with reference data determines whether the child’s

growth is judged normal or abnormal. Widely

used growth references are the CDC Growth

Charts [1] and the Euro Growth Charts [2]. Both

were released in 2000. These charts describe the

growth of children living in the USA and in Eu-

rope, respectively. The WHO Growth Standards

[3, 4] , on the other hand, describe the growth of

children worldwide; for these standards, data were

obtained in Norway, the USA, Brazil, Ghana,

Oman and India from children living under ‘ideal’

circumstances with nonsmoking mothers and

from infants receiving ‘optimal nutrition’ (pre-

dominantly breast milk for the first 6 months),

and thus they illustrate what ‘normal growth’ is

under optimal environmental conditions.

When growth has to be assessed on the basis

of a single measurement, its interpretation has to

rely solely on the relative position of the mea-

sured value on the growth reference chart. The

accuracy of growth assessment is greatly im-

proved if two or more measurements are per-

formed at different times. This not only mini-

mizes the impact of inherent measurement er-

rors, it also permits the assessment of time trends

and thus strengthens the assessment of a child’s

growth vis-à-vis the growth reference chart.

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 295–307
DOI: 10.1159/000360353

4.2 The CDC and Euro Growth Charts

Ekhard E. Ziegler

4