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WHO Canadian Growth Charts

Download WHO Growth Charts for Canada

With the August 2009 edition of the Rourke Baby Record, there is a change in the growth charts that accompany the RBR.  We are now recommending the use of the World Health Organization (WHO) Child Growth Standards.  The WHO Child Growth Standards were released in April 2006 and were developed using data collected in the WHO Multicentre Growth Reference Study. http://www.who.int/childgrowth/en/  This study followed more than 8,000 children from six countries (Brazil, Ghana, India, Norway, Oman, USA) who were raised under optimal health conditions (exclusive or predominantly breastfed for more than four months, complementary foods by six months, continuation of breastfeeding until at least 12 months, immunized, receiving healthcare, nonsmoking environment).  Under these optimal conditions there were only 3% intersite differences, and thus the WHO Child Growth Charts may be used in children of different racial backgrounds.  As these WHO growth charts are based on optimal health conditions, they are called growth standards.

In past versions of the RBR, the growth charts used were from the United States Centers for Disease Control and Prevention (CDC).  http://www.cdc.gov/nchs/about/major/nhanes/growthcharts/clinical_charts.htm These CDC growth charts are based on the growth of American children without controlling for optimal health conditions and are better called growth references rather than growth standards.

Changing from CDC to WHO growth charts will result in different prevalence of underweight, overweight and obesity:

  • 0 - 6 months: WHO charts reflect a heavier sample - due to faster initial rate of weight gain in breastfed compared to formula fed infants
    • Higher rates of under-nutrition
    • Lower rates of overweight and obesity
  • Over 6 months: WHO charts reflect a taller lighter sample- due to slower rate of weight gain in breastfed and ideally nourished children
    • Lower rates of under-nutrition
    • Higher rates of overweight and obesity

The recent release of the WHO Growth Standards and Growth References has prompted a re-evaluation of which growth charts are appropriate for monitoring and assessing the growth of Canadian children. Promoting Optimal Monitoring of Child Growth in Canada: Using the New WHO Growth Charts, a practice guideline for health professionals, was developed collaboratively by Dietitians of Canada, Canadian Paediatric Society, The College of Family Physicians of Canada and Community Health Nurses of Canada. The project includes the full report, executive summary, health professionals’ guide, questions and answers for health professionals and for parents, and set of WHO Growth Charts adapted for the primary health setting for Canada. http://www.cps.ca/english/publications/CPS10-01.htm OR http://www.dietitians.ca/growthcharts

 

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