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Growth Assessment and
Surveillance
Growth is an essential expression
of health and a way to measure efforts designed to reduce child mortality and
disease. Basic growth assessment involves measuring a child’s weight and
length or height and comparing these measurements to growth standards. The
purpose is to determine whether a child is growing normally or has a growth
problem or trend towards a growth problem that should be addressed. Growth
assessments that are not supported by appropriate response programmes are not effective in improving child health.
Given the importance of normal
growth as a summary indicator for health, WHO established a working group to
examine issues related to anthropometry in 1990. The working group concluded
that the National Center for Health Statistics (NCHS) references and its
variations being used in countries around the globe were fraught with
numerous technical inadequacies. These technical fallacies were pinned down
to the following:
 The
data for development of these standards was collected from pre-dominantly
formula-fed infants who resided in a restricted geographic area in USA and
were of relatively high socio-economic background. This approach was widely
inconsistent with the multiple health benefits associated with breastfeeding.
The
measurements from the sample were taken only once in three months and the
analytical methods available at the time were inadequate for the task and
were likely to depict inappropriately the pattern of growth and variability
of normal growth. The measurements at three monthly intervals are inadequate
to capture the dynamic pattern of growth in the first six months of life.
These shortcomings caused
mischaracterization of the shape of the curve particularly during the first
six months.
In response to these findings and
recommendations, WHO convened a group in 1995 to develop new growth references. The new WHO Growth standards were officially
launched on 27th April, 2006.
The new WHO Growth Standards
differed from any existing growth charts in a number of innovative ways.
The curves are drawn from a sample of
children residing in six different countries around the globe, allowing the
development of a truly international standard which is in contrast to the
previously used international references based on children residing in one
particular country.
A
key characteristic of the new standard is that it establishes breastfeeding
as the biological norm and the breastfed infant as the standard for measuring
healthy growth. Previous reference charts were based on the growth of random
mixture of breast fed and artificially fed children.
For
the first time, they describe “how children should grow”, which is a
prescriptive approach, not just descriptive. These charts show that all
children across all regions can attain a similar standard of height and
weight and development with correct feeding practices, good health care and a
healthy environment. It is a more pro-active way of measuring and evaluating
child growth, setting out normative conditions and evaluating children and
populations against standards.
The
development for the first time of standardized BMI charts for infants to five
years pf age is a major innovation in assessing healthy weights of children.
Additionally
the development of “Windows of Achievements” for six key motor development
milestones will provide a unique link between physical growth and mental
development.
There
are separate charts available for boys and girls
As per the available National
Family Health Survey data (2005-’06), 42.5% under five children in India are
under weight (weight for age), 48%
children under five years of age are stunted in the country (height for age)
while 19.8% children in the same age group are wasted (weight for height).
Useful links
 Headquarters Website
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