Promoting optimal monitoring of child growth in Canada: using the new WHO growth charts.

Growth monitoring and promotion of optimal growth are essential components of primary health care for infants and children. Serial measurements of weight, height/ length for all children, and head circumference for infants and toddlers, compared with the growth of a large sample population of children depicted on a selected growth chart It also allows early identification of potential nutritional or health problems and enables prompt action before a charts have described the growth of their sample population regardless of whether that growth is ideal or not. The release of new, improved growth charts from the World Health Organization (WHO) has prompted a reexamination of existing recommendations for assessing the growth of Canadian children. The optimal growth displayed in the WHO Growth Standards for infants and preschool children represents the prescribed gold growth charts for older children have also been updated and improved to reflect optimal growth. The 2006 WHO Child Growth Standards for children (birth to five years) and the WHO Growth Reference 2007 (for children and adolescents (5 -19 years) are now recommended for the assessment of growth of Canadian children based on this review by Dietitians of Canada, Canadian Paediatric Society, The College of Family Physicians of Canada and Community Health Nurses of Canada. This statement presents recommendations and the rationale for implementation of both sets of the WHO growth charts for monitoring the growth of individual children. It is intended for use as a practice guideline to assist medical practitioners and allied health professionals to provide evidence-informed, consistent care. RÉSUMÉ La surveillance de la croissance et la promotion d optimale constituent des éléments essentiels des soins de santé primaires pour les nourrissons et les enfants. La comparaison des mesures sérielles de poids et de taille/longueur chez tous les enfants et du perimeter de la tête chez tous les nourrissons et toutpetits à une courbe de croissance choisie qui illustre la croissance à Une telle comparaison permet également de dépister de manière précoce des problèmes de santé ou des problèmes nutritionnels courbes de croissance décrivaient la croissance de leur groupe échantillon, peu idéal ou non. Or, la publication de nouvelles courbes de croissance améliorées par de la Santé (OMS) a entraîné une révision des recommandations existantes des enfants canadiens. En effet, la croissance optimale présentée dans les normes OMS de croissance pour les nourrissons et pour constitue la norme or en matière de croissance des enfants. Par ailleurs, les courbes de croissance pour les enfants plus âgés, qui avaient été conçues récemment, ont également été mises à jour et améliorées afin de refléter la croissance optimale. Les diététistes du Canada, la Société canadienne de pédiatrie, le Collège des médecins de famille du Canada et les Infirmières et infirmiers en santé communautaire du Canada ont procédé à une revue de la littérature, et les normes 2006 pour les enfants (de la naissance et à 5 ans) et les références OMS de croissance 2007 (pour les enfants et adolescents de 5 à 19 ans) sont maintenant recommandées pour évaluer la croissance des enfants canadiens. La présente déclaration décrit les recommandations et de croissance OMS pour surveiller la croissance des enfants sur une base individuelle. Cette déclaration devrait être utilisée à médecins praticiens et le personnel paramédical à fournir des soins cohérents et fondés sur des données probantes. Using the New WHO Growth Charts www.dietitians.ca www.dietetistes.ca © Dietitians of Canada and Canadian Paediatric Society. 2010. All rights reserved. PAGE 2 ISSUES STATEMENT Growth monitoring is the single most useful tool for defining health and nutritional status in children at both the individual and population level. This is because disturbances in health and nutrition, regardless of their aetiology, almost always affect growth. When disturbances in growth are caught early, small changes in behaviour that are within the means of many families, are likely to be effective in reversing the trend. However, abnormal patterns of weight gain and growth often go unrecognized and undiagnosed for several reasons, namely: Some infants and children are not routinely weighed and measured at their regular health care visits, while others see a health professional only for acute care and may not be measured at all. Measurements taken incorrectly, plotted on a growth chart inaccurately, or not plotted at all, may lead to erroneous interpretation of growth patterns and missed or unnecessary referrals. More recent growth charts have reflected the increasing prevalence of unhealthy weights, raising the growth curves, leading to under-identification of overweight individuals and over-identification of individuals with failure-to-thrive. Furthermore, regular assessment of growth is not effective in improving child health unless what is revealed by the growth monitoring is discussed with the family, and information about adequate or inadequate changes in growth is used to reinforce or motivate positive nutritional and healthy lifestyle practices. 2 Canada does not have a national paediatric surveillance system for collecting anthropometric and nutritional data; therefore, national growth charts do not exist for Canadian children. Growth references have been developed from small populations of Canadian children that were not nationally representative. Over the last three decades there has been substantial discussion on which reference population to use in assessing adequacy of childhood growth. In 2004, Dietitians of Canada, Canadian Paediatric Society, The College of Family Physicians of Canada and Community Health Nurses of Canada published recommendations for use of the 2000 American growth charts from the Centers for Disease Control and Prevention. At the time, there was evidence that growth patterns of well-fed healthy preschool children from diverse ethnic backgrounds were comparable thus supporting the use of a single international growth reference based on healthy, well-nourished children from different geographic and genetic origins who had fully met their growth potential. However, until recently, no such international growth charts existed. In 2006, the World Health Organization (WHO), in others, released new international growth charts depicting the growth of children from birth to age five years, who had been raised in six different countries (Brazil, Ghana, India, Norway, Oman, USA) according to recommended nutritional and health practices, including exclusive breastfeeding for the first four to six months of life.a In 2007, the WHO also released charts for monitoring the growth of older children and adolescents that had been updated and improved to take into account the growing epidemic of childhood obesity. Availability of these new charts from the WHO has again raised the question of which are the most desirable growth charts to use for Canadian children. This statement focuses on growth monitoring and the use of growth charts for individual assessment of growth.