Tuesday, March 27, 2012

CDC or WHO Growth Scales - Watch your baby not the scale

Watch your baby, not the scale
Watch your baby, not other babies
Watch your baby, not some blog :)

Really moms, please know that every baby is different. If you are worried about your baby's development, than likely most of this post doesn't apply to you. But for most of us, our babies are all individually developing on their own scale and to think of percentiles too much, especially when most pediatricians are using the extremely out-dated and (especially for breastfed babies) irrelevant scales created by the CDC.

My two "underweight" kids. Both thriving. Both breastfed. Both born of a short mom and a thin dad of East Asian descent. Because you know... genetics matter....

Why is this? Perhaps because even the CDC recommends using the WHO forms. They recommend this update because:
"Healthy breastfed infants typically gain weight faster than formula-fed infants in the first few months of life but then gain weight more slowly for the remainder of infancy (25,26). Therefore, in the first few months of life, WHO curves show a faster rate of weight gain than the CDC charts for boys and girls (Figures 2 and 3). Use of the WHO charts in the United States might lead to an increase in the misperception of poor growth at this age." (CDC)

So basically today's overweight (mostly) white Americans adults were the formula (fattened) babies we are comparing our (increasingly) breastfed babies, many of whom aren't white.

Simplified their reasoning includes:
  • The WHO standards establish growth of the breastfed infant as the norm for growth.
    Breastfeeding is the recommended standard for infant feeding. The WHO charts reflect growth patterns among children who were predominantly breastfed for at least 4 months and still breastfeeding at 12 months.
  • The WHO standards provide a better description of physiological growth in infancy.
    Clinicians often use the CDC growth charts as standards on how young children should grow. However the CDC growth charts are references; they identify how typical children in the US did grow during a specific time period. Typical growth patterns may not be ideal growth patterns. The WHO growth charts are standards; they identify how children should grow when provided optimal conditions.
  • The WHO standards are based on a high-quality study designed explicitly for creating growth charts.
    The WHO standards were constructed using longitudinal length and weight data measured at frequent intervals. For the CDC growth charts, weight data were not available between birth and 3 months of age and the sample sizes were small for sex and age groups during the first 6 months of age.

From the CDC: "The curves were anchored at birth using national birth weight data obtained from U.S. birth certificates from 1968--1980 and 1985--1994 and birth length data from Wisconsin and Missouri birth certificates (the only states with these data available on birth certificates) from 1989--1995"

Further, the WHO uses more standard deviations of normal/average. Thus, they have a line for 3 percent and 97 percent... rather than just "below 5th" percentile.

Next time you visit your pediatrician, ask if they're using the CDC or WHO scale for your breastfed baby. If they're using CDC, ask them why they haven't updated to what is relevant to your baby.

And if you are breastfeeding and your baby is thriving and keeping on a decent growth path (not crossing "two lines" on the correct scale... and your pediatrician asks you to supplement (or stop breastfeeding) ask these questions:

  • If my child was at the 95th (90th, basically opposite of the percentile they're indicating) would you recommend I put my infant on a diet?
  • Can I weigh baby pre and post feeding to see how much baby is getting?
  • (Especially in young babies) Can you check my baby for a tongue tie?
  • What percent of infants are breastfed to 6 and 12 months here (American Academy of Pediatrics recommendation)? 24 months (WHO recommendation)?
  • Do you mind if I breastfeed here?
  • Is there a reason you don't have a breastfeeding-friendly waiting area with an area for moms to breastfeed?
  • Do you enjoy causing mommy guilt and paranoia?
For the WHO and CDC growth charts directly, click here.

For free breastfeeding support, advice and possibly great friendships, find your local Le Leche League.

Women need support in breastfeeding, not criticism of what isn't working. Find that help and get to where you need to be so that you're comfortable with where you are in you and your baby/toddler/child's relationship.

Have confidence! According to a study in Sweden, 99 percent of women can successfully breastfeed. There are some medical conditions that can affect you, but reach out for support and know that you can give the wonderful gift of human milk to your baby/infant/toddler.

CDC= Centers for Disease Control
WHO= World Health Organization

 The Baby Book: 


JR911 said...

Love, love, love that photo. Good for you in breastfeeding.

Cheap Is The *New* Classy said...

Always talk to the doctor. Too many times are these charts and stats and things relied on when the fact of the matter is that everyone is different. Not everyone has to fit within a scale or chart to be healthy, and not everyone who does, is. Thanks for the great information.


Beth :: Our Front Porch View said...

This is SO true. I hate when I see mom's start supplementing because they are falling short of "some curve"... ugh!

Sharing this article with my childbirth students!

Kelley Johnsen said...

I think we should watch the baby! These guidelines are just that guidelines, not the RULE!

Sarah @ made in usa challenge said...

I don't trust these growth charts at all. My son was in the 5th percentile as an infant and is in the 15th now and he is the healthiest, active little boy. He is just naturally thin. I used to worry about this needlessly.