296 Ziegler^CDC Growth Charts: USA
The CDC charts [1] were created to replace the
widely used National Center for Health Statistics/
WHO charts of 1974 because of inadequacies
identified in the latter. The CDC charts are based
on a large number of nationally representative
data from several national surveys conducted be-
tween 1976 and 1994. The exception are data con-
cerning the first year of life, which, besides being
few in number, were obtained mostly from in-
fants representing lower socioeconomic strata.
Also data on subjects more than 6 years of age
from the survey in 1988–1994 were excluded be-
cause of the increased prevalence of high weight.
All data were cross-sectional. State-of-the-art
smoothing procedures were used to generate per-
centile curves. Charts on weight-for-age and (re-
cumbent) length-for-age are available for the age
period from birth to 3 years. For the age period
from 2 to 20 years, charts for weight-for-age,
height-for-age and BMI-for-age are available.
Euro Growth Charts
The Euro Growth Charts [2] were the result of a
multinational effort. Data for these charts were
gathered from birth to 5 years of age in children
who were born between 1990 and 1993 and lived
close to 22 measurement sites in 11 European
countries. The data were gathered longitudinally,
with 1,746 children being followed to the age of 1
year, and 1,071 to the age of 3 years. The data were
analyzed cross-sectionally, using state-of-the-art
smoothing techniques.CommentIn contradistinction to the WHO Growth Stan-
dards [3, 4] , the CDC and Euro Growth Charts
are growth references. They represent, with mi-
nor exceptions, the growth of healthy children
living in the respective geographic areas. Use of
references for the interpretation of growth mea-
surements thus indicates a child’s position in rela-
tion to other children living in the same area.
Growth standards, on the other hand, already in-
corporate an element of judgment, and their use
provides information on desirable (ideal) child
growth derived from predominantly breastfed in-
fants.
The importance of using proper measurement
techniques cannot be overemphasized, in partic-
ular with regard to measurement of recumbent
length. The latter requires two measurers using
appropriate equipment and techniques if repro-
ducible measurements are to be obtained. Mea-
surements of length must be interpreted using
charts for length, and measurements of height
must be interpreted using charts for height.References 1 Kuczmarski RJ, Ogden CL, Guo SS,
Grummer-Strawn LM, Flegal KM, Mei
Z, Wei R, Curtin LR, Roche AF, Johnson
CL: 2000 CDC Growth Charts for the
United States: methods and develop-
ment. Vital Health Stat 11 2002; 246:
1–190.
2 Haschke F, van’t Hof MA (eds): Euro-
Growth. J Ped Gastroenterol Nutr 2000;
31:suppl 1.3 WHO Multicentre Growth Reference
Study Group: WHO Child Growth Stan-
dards. Geneva, WHO, 2006. http://www.who.
int/childgrowth/en/.
4 WHO Multicentre Growth Reference
Study Group: WHO Child Growth Stan-
dards based on length/height, weight
and age. Acta Paediatr Suppl 2006; 450:
76–85.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