Introduction to the new UK-WHO Charts
On 11 May 2009, the start of National Breastfeeding Awareness Week, the new UK-WHO growth charts were introduced to England, providing accurate guidance on child growth.
From this date on, the new charts should be used for all new births and new referrals to healthcare professionals. The existing UK 1990 Growth Charts will continue to be used for children born before 11 May 2009 and for children over four years.
The new UK-WHO 2009 charts offer important reassurance for parents of breastfed babies, and will replace current charts that were based on predominantly formula fed babies. The new charts describe “how children should grow” and represent a standard, rather than a reference describing “how children are growing”. The new charts will help parents and healthcare professionals identify children at risk of obesity at an early age.
On the 1990 growth charts, there were cases where unnecessary concern was triggered by the appearance of growth faltering in the second half of the first year in breastfed babies. The new charts, based on the breastfed growth pattern should help to reassure the parents of healthy, breastfed babies that they are growing normally.
Professor Alan Lucas, a child nutrition expert at the Institute of Child Health, University College London, said: "The growth of breastfed babies is more ideal than the growth of babies fed on formula - it is better for babies to grow more slowly.” In the past everybody thought it was best to have big bonny babies, but interestingly, just about every other animal species shows disadvantages in terms of long-term health if the infants grow too fast." His research has shown that babies who grow quickly show signs of higher blood pressure, diabetes, obesity and higher cholesterol levels in later life.
Using the new charts, it will be easier to accurately assess, measure and evaluate breastfeeding and complementary feeding. It will also ensure that breastfeeding mothers are no longer given misleading advice about the weight of their babies.
Current weighing practice in the UK appears to focus simply on weight gain. In an era of increasing child obesity, with its life-long health consequences, the vital message of the new growth standard is that “optimum growth is not necessarily maximum growth”.
The development of the UK-WHO Charts
The Scientific Advisory Committee on Nutrition (SACN) studied the charts and looked at how UK children compared to them and, in 2007, recommended that they be adopted in the UK.
It was decided to adopt the new charts for babies from two weeks of age as this would allow continued use of the UK 1990 preterm and term birth data. The new charts will be used from two weeks to four years. There will then be a switch back to UK 1990 charts at age four to allow all school entry measures to be plotted on the same charts.
The Royal College of Paediatrics and Child Health (RCPCH) was commissioned to design the new charts and produce these supporting educational materials. The design and instructions were developed by an expert group and tested in focus groups of staff and parents.
The project group developed the new following UK-WHO charts for early years:
- A4 growth chart 0-4 years
- A5 growth charts for the Personal Child Health Record (PCHR)
- A4 growth chart for hospitalised low birth weight infants 0-2 years
The Department of Health in England recommends that from May 2009 the new charts should be used for all new births, but that there is no need to re-plot for older children where they already have charts. The UK 1990 charts should still be used for all children over age four years.
The charts are available on the RCPCH website to download here:
http://www.rcpch.ac.uk/Research/UK-WHO-Growth-Charts
The research behind the new charts
The new recommended charts are based on data from predominantly breastfed babies.
The research involved more than 8,000 children from six different countries; USA, Norway, Oman, Brazil, India and Ghana1.
The criteria for the study were:
- Non-deprived, term infants
- Not from a multiple births (singleton)
- Non-smoking mother
- Willing to breastfeed
- Exclusively breastfed or predominately breastfed for a minimum of four months and there was no complementary feeding before six months
Infants were followed up throughout the 0-2 year period, using the guideline recommendations for times of measuring. Weight, length, head circumference, arm and skinfold thickness were measured.
- 1743 infants were enrolled and within that number 882 (51%) kept breastfeeding, 400 was the target number which was met1
- Irrespective of maternal diet there was conformity between all countries of the growth in the infants1
The data from this research has been used to formulate new charts that indicate how children should grow; this allows healthcare professionals and parents to recognise optimal weight gain in children.
The study emphasises that the current system pitches target weights too high and acknowledges that babies fed on breast milk put on weight more slowly than formula fed babies. This is important with research being carried out linking breast milk to a lower risk of obesity later in life and lower blood pressure 2,3,4 ,although research is ongoing.
What’s new on the UK-WHO Growth Charts?
For a fact sheet from the RCPCH on the key new features of the UK-WHO Growth Charts, click here
http://www.rcpch.ac.uk/doc.aspx?id_Resource=4471
For a fact sheet from the RCPCH that outlines the essentials of measuring and plotting at all ages, click here. If you have never been formally taught, this fact sheet will introduce you to what you need to know.
http://www.rcpch.ac.uk/doc.aspx?id_Resource=4472
For a full list of the education and training resources from the RCPCH to support the UK-WHO Growth Charts, click here.
http://www.rcpch.ac.uk/Research/Growth_Charts_Education_Training_Resources