Growth assessment in infants and toddlers using three different reference charts.
OBJECTIVE
To determine if the proportion of children < or =24 months old in a tertiary care facility defined as at risk of undernutrition or overnutrition differs according to different references used for assessment: the Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS) or Tanner-Whitehouse (Tanner) growth charts for weight-for-age and length-for-age.


METHODS
Lengths and weights were measured on infants (207 female, 341 male) aged < or =24 months admitted from or attending clinics in the General Pediatric or Respiratory Medicine Programs at The Hospital for Sick Children, Toronto. Weight-for-age and length-for-age percentiles and percent ideal body weight were electronically computed.


RESULTS
The proportion of all children whose weight-for-age was <3rd percentile (at risk of undernutrition) was greatest using the CDC growth charts (22.5%) compared with the NCHS (15.9%) or Tanner (19.2%) growth charts. Likewise, the proportion of all infants/toddlers with percent ideal body weight <90 (at risk of undernutrition) was greatest using the CDC (32.3%) compared with the NCHS (22.1%) or Tanner (25.9%) growth charts. In contrast, the percentage of children whose percent ideal body weight was > or =110% (at risk of overnutrition) was least using the CDC (18.1%) compared with the NCHS (26.1%) or Tanner (22.4%) growth charts.


CONCLUSIONS
More children aged < or =24 months will be defined as at risk of undernutrition and fewer at risk of overnutrition when using weight-for-age or percent ideal body weight and the CDC growth charts compared with the NCHS or Tanner growth charts. As a result, requests for a more detailed nutritional assessment for undernutrition will likely follow implementation of the CDC growth charts in a tertiary care setting. As the CDC, NCHS and Tanner growth charts are growth "references" rather than "standards," other than for screening purposes, they should not be used in isolation when assessing growth and nutritional status.
Nash
Andrea
A
Department of Newborn and Developmental Paediatrics, Sunnybrook and Women's College Health Science Centre, 76 Grenville Street, Toronto, Canada.
Corey
Mary
M
Sherwood
Kelly
K
Secker
Donna
D
Saab
Joanne
J
O'Connor
Deborah L
DL
D000367:Age Factors; D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D002487:Centers for Disease Control and Prevention, U.S. / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006128:Growth; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008297:Male; D009309:National Center for Health Statistics, U.S.; D015596:Nutrition Assessment; D009752:Nutritional Status; D009864:Ontario / Q000453:epidemiology; D012015:Reference Standards; D012016:Reference Values; D014481:United States