Worldwide practices in child growth monitoring.
OBJECTIVE
To describe child growth monitoring practices worldwide in preparation for the construction and application of a new international growth reference.


METHODS
A questionnaire was sent to Ministries of Health in 202 countries requesting information on growth charts used in national programs, reference populations, classification systems, problems encountered, and actions taken against growth faltering. Countries also provided hard copies of charts in current use. This information was entered and analyzed in Microsoft Access.


RESULTS
Responses were received from 178 (88%) countries, 154 of which included growth charts (n=806). Two thirds of the charts covered preschool age. All countries used weight-for-age, over half relying on this index alone. The reference most commonly used (68%) was the National Center for Health Statistics/World Health Organization population, with regional variations, where most European countries used local standards. Sixty-three percent of charts classified child growth on percentiles, whereas about one fifth used z scores. Problems reported were both conceptual (eg, interpreting growth trajectories) and practical (eg, lack of equipment).


CONCLUSIONS
The survey demonstrates that growth charts are used universally in pediatric care. The information gathered on current use and interpretation of growth charts provides important guidance for constructing and applying the new reference.
de Onis
Mercedes
M
Department of Nutrition, World Health Organization, 1211 Geneva 27, Switzerland. deonism@who.int
Wijnhoven
Trudy M A
TM
Onyango
Adelheid W
AW
D000886:Anthropometry; D002648:Child; D002675:Child, Preschool; D014943:Global Health; D006128:Growth; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010372:Pediatrics / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012016:Reference Values; D011795:Surveys and Questionnaires