The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) recommend that health care providers in primary care settings
Use the WHO growth standard charts for children younger than aged 2 years regardless of type of feeding, to monitor growth in the United States.
Use the 2000 CDC growth reference charts for children aged 2 to 20 years to monitor growth in the United States.
Using the WHO growth standard for infants and children birth to aged 2 years has several advantages over the CDC growth reference for children of the same age including:
The WHO growth standard charts utilize growth of the breastfed infant as the norm for growth.
The WHO standards are based on high quality data collected for children younger than aged 2 years.
CDC's adapted versions of the WHO growth charts for children younger than aged 2 years are available with English units of measurement and percentiles at www.cdc.gov/growthcharts. The 4 available growth charts include:
Girls and boys, birth to 24 months: length-for-age and weight-for-age
Girls and boys, birth to 24 months: weight-for-length and head circumference-for-age.
The WHO growth charts as modified by CDC use the 2nd percentile and the 98th percentile as the outer most percentile cutoff values.
Using the WHO growth chart percentile cutoff values indicates a change in clinical protocol. Using the WHO growth charts, infants and young children with a
Weight-for-length less than the 2nd percentile are classified as low weight-for-length.
Length-for-age less than the 2nd percentile are classified as having short stature.
Weight-for-length greater than the 98th percentile are classified as high weight-for-length.
The use of BMI-for-age is not recommended for children younger than aged 2 years at this time.
When transitioning from the WHO growth standard charts to the CDC growth reference charts at aged 2 years, a change in growth classification may occur. During this transition, caution should be used in interpreting any changes in classification.
For the growth assessment to be an effective screening tool, accurate measurements are critical. A series of measurements will assist in appropriate interpretation of growth patterns.
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