1. An Introduction to the new UK-WHO Growth Charts
Access to training materials of the Royal College of Paediatrics and Child Health [RCCPCH] is gratefully acknowledged

2. Why did the World Health Organisation think new growth charts were needed?
Differences in weight gain seen between breast fed and formula fed infants
Healthy breast fed infants show very similar growth patterns around the world
Decided to produce charts that set breast feeding as the norm for infant feeding

3. WHO Charts - development
15 year programme of planning, data collection and analysis
New study of the growth of breast fed infants of non-smoking non-deprived mothers in 6 countries (USA, Norway, India, Ghana, Brazil, Oman) birth to 5 years
Very similar growth patterns in all 6 centres
Charts are a description of optimal rather than average growth
Suitable for all children worldwide

5. UK-WHO Charts - development
SACN (Scientific Advisory Committee on Nutrition) recommended:
Adoption of WHO charts in UK from age 2 weeks to 4 years
Continue to use UK birth and preterm data as no WHO preterm data
Royal College of Paediatrics and Child Health [RCPCH] commissioned to design charts and produce educational materials
An Irish child health review group has adapted the training materials for application in the Irish health care setting- with kind permission from RCPCH.

6. UK-WHO Charts UK-WHO Growth Chart 0-4 years are used for:
Infants born at term (37 weeks gestation or later)
Healthy infants born preterm from 32 weeks and before 37 weeks gestation – use the Preterm section on the left of the chart
UK-WHO NICM Growth Chart 23 weeks gestation to 2 years corrected age are used for:
Infants of less than 32 weeks gestation
Any other infant requiring detailed assessment/ close monitoring
After 2 years corrected age UK-WHO 0-4 years charts can be used.

7. UK-WHO Charts - implementation
Launch date for charts plus supporting materials was set for January 2013
0-4yrs A4
PHR charts 0-4yrs A5 format ( 6 charts /3 pages)
Separate NICM for low birth weight chart 23 weeks gestation to 2 years
To be used for all new births
No need to re-plot for older children
Charts in current use to continue for those born prior to January 2013

8. Effect on patterns of growth caused by the change to the WHO standard
Weight
Charts now allow for neonatal weight loss
Average children no longer drop down chart between birth and 4 weeks
After first 6 months
Drop in % below lower centiles and % weight faltering
Rise in % above upper centiles for weight
Height
Very similar growth in height/length at all ages

9. Comparison of WHO and UK90 centiles
Downward shift of centile lines
Boys 1 3 5 7 9 11 13 15 26 39 52
Age in weeks
Weight
WHO black
UK 1990 red
By 12 months,
WHO 2 nd
centile
= UK th
Comparison of WHO and UK90 centiles
Downward shift of centile lines

10. How will the new charts be different?
Separate preterm section
Head circumference extended to 2 years
Length/height discontinuity at 2 years

12. Why no lines between birth and 2 weeks?
New charts use UK 1990 data at birth, then WHO data from 2 weeks
Birth weight charts do not naturally join infancy chart
Weight at 2 weeks of age not = birth weight at 42 weeks gestation
Between birth and 2 weeks most infants lose and regain weight and charts cannot allow for this
Gap emphasises importance of looking at weight gain relative to birth weight in first days, not centile position

13. De-empathised 50th centile
Avoids confusing messages to parents about perceived ‘need’ for all children to be on 50th centile
Centile labels at both ends of each curve
50th centile identifiable from location of curve label

14. Age labelling
Age errors are the most common source of plotting mistakes
Charts marked in both weeks and calendar months

15. Length – height discontinuity
Centile lines shift down slightly at age 2
New charts show length up to age 2 years and height from age 2 onwards
Due to spinal compression, when a child is measured standing they are slightly shorter than when lying down
Important not to let length to height transition cause worries for parents
What matters is whether the child continues to follow their new centile position after the transition

16. Personal Child Health [PHR] record charts
Fewer pages in total
Fold-out measurement recording page allows plotting while in view
Information aimed at parents developed via focus groups

17. Chart instructions Draws on available research evidence
Clear guidance on:
method of measuring and plotting
role of length and height measurements
measurement frequency
Defines range of normality and need for further assessment, but not what action to be taken
PHR information for parents

18. UK-WHO growth charts summary
Launched in January 2013 for all new births
New UK-WHO Charts are a description of optimal rather that average observed growth
New separate preterm birth weight for use from 32 weeks
All infants from 37 weeks gestation should be plotted at term (age 0)
De-emphasised 50th centile, but identifiable from location of curve label
A4 charts include detailed user instructions
PHR has information aimed at parents