Yahoo Lifestyle Baby growth charts: Measuring up
As the parent of a precious bubba, you’ve probably got a few worries – the kind of general anxieties that many parents face as they nurture their new family member into the world. Is bub sleeping enough? Crying too much? Pooping properly? And the ever popular, is he growing right?
The first inkling that something might not be right with your littlie’s growth may come when his height and weight are plotted on the growth charts. If it turns out that your bub is on the lighter end of the scale, or even underweight, it’s not uncommon to think that you’re doing something wrong with him, says babycare author and lactation consultant Pinky McKay – who says that feeling like you aren’t feeding your baby enough for him to grow properly is the “scariest thing” for a parent to experience.
“There’s enough to worry about when you are responsible for a baby, particularly the first time around, so it’s really devastating for a mum to feel as through she’s been starving her child,” Pinky says. “I quite often see mothers who breastfeed babies, particularly in the second half of the first year, being told by health professionals that their baby is sliding off the healthy range in the charts and being very upset.”
This can lead to a situation where breastfeeding mums can be pressured into switching to formula-feeding in order to boost their baby’s weight gain. According to researchers Timothy Cole, Anand Paul and Roger Whitehead, this is a growing trend. “Parents and carers are happy to see the child grow well in the first few months, but thereafter, as weight appears to falter, they tend to become increasingly concerned,” they write in a paper published in the British Medical Journal. This, they say, can “put pressure on the mother to switch the child to formula or complementary food prematurely.”
On the surface, this approach might make sense to a lot of new parents. If your baby’s not gaining weight properly, then something needs to be done. However, if your cherub isn’t tracking well against your health nurse’s growth chart, take heart: the problem might not be with him, but with the chart.
Old data
The baby growth charts used in Australia, with the exception of those in use in the Northern Territory, are the 2000 Centers for Disease Control and Prevention (CDC) Growth Charts. These are based on US
data collected in five surveys between 1963 and 1994 – surveys that involved mainly formula-fed babies, says Kate Mortensen, manager of the Australian Breastfeeding Association’s Lactation Resource Centre.
The CDC charts, then, “are just not representative of how infants in general should grow,” she explains.
As a general rule, breastfed infants put on weight more rapidly than formula-fed babies in the first few months of life, before their rapid weight-gain plateaus. Conversely, formula-fed infants continue to put on
more weight as they get older. So because the CDC charts are based on formula-fed infant growth patterns, breastfed infants can appear to be not gaining enough weight according to the charts, even though they may be perfectly healthy.
It’s at this stage that a lot of parents are told to give their babies formula, despite the World Health Organization (WHO) guidelines recommending exclusive breastfeeding for infants up to six months of age (with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond).
A new standard
In 2006, WHO released new Child Growth Standards based on data from a study of solely or predominantly breastfed babies from an ethnically diverse sample from Brazil, Ghana, India, Norway, Oman and the US. The standards were endorsed by the United Nations Standing Committee on Nutrition,the International Union of Nutrition Sciences and the International Pediatric Association. Even the CDC now recommends their use for monitoring kids from birth to two years.
“We welcome the WHO growth standards – we have been waiting for them for years,” Kate says. “This is how children should grow. The old charts represent how children did grow. Introducing these charts [to Australia] should be a national priority.”
In Australia, the Northern Territory officially adopted the newer WHO charts in 2009 and remains the only state or territory to do so in Australia. The reason, according to the Territory’s Department of Health, is
because it saw the WHO charts as an appropriate standard of how children should grow, and because “breastfeeding is the optimal source of nutrition for babies” and the charts are in line with a policy that encourages a natural approach to feeding.
So why hasn’t the rest of Australia followed suit? A spokeswoman from the Federal Department of Health and Ageing says that in 2010, independent research was commissioned into the use of growth charts in Australia and, in particular, which growth chart (CDC or WHO) would offer the best information for Australian families. “The research suggested that neither chart is ideally suited to the Australian context and emphasised the need for the provision of education and explanatory materials to ensure that growth charts are interpreted correctly, regardless of which one is used,” she explains.
The spokeswoman says the findings of the research are being considered by governments with a view to forming a recommendation on the adoption of a single, standardised infant and children’s growth chart
in Australia.
Kate says this should happen sooner rather than later. She strongly supports introducing the WHO charts in all states and territories as a national priority, because the CDC charts can undermine breastfeeding and its benefits. “What we really want is everyone – from paediatricians and midwives to child health nurses and dietitians – on the same page.”
Formula-fed babies?
But where do the WHO charts, with their emphasis on breastfeeding, leave the large number of Australian babies who are formula-fed? Kate is convinced that the new charts will still be very helpful. “While we have a problem with under-nutrition, we also have a problem with over-nutrition,” she says.
The WHO charts should be able to help parents and carers identify overfeeding in formula-fed babies, which will provide a platform for helping to tackle the childhood obesity problem in Australia at its source. “Infant health is the start of it all,” Pinky says. “We are worried about obesity, and yet we are pushing these mothers to have their babies put on more weight.”
Childhood obesity is indeed a problem throughout Australia. Earlier this year, a study in the International Journal of Obesity looking at data concerning 200,000 Victorian preschoolers found that while the rate of obesity is falling slowly, 12.4 per cent of two-year-olds are still classified as obese.
The national figures, meanwhile,put overall childhood obesity figures closer to 25 per cent.
How to use charts
Charts are a useful guide to a baby’s development, Pinky says, but they need to be looked at in context. Aside from the question of whether your bub is breastfed or formula-fed, his overall appearance, behaviours and family background all offer important insight into his development.
“Appearing anywhere on the chart is okay – some parents think their baby has to be in the 50th percentile or above to prove they are good parents, but not every baby is going to be in that top range,” she says. “If a baby is failing to thrive, he’ll have a skinny little bottom and won’t have any chub on his legs. A healthy baby has clear eyes, is physically active and alert, and has good muscle tone and skin tone. You can’t ignore your health professional’s advice, but you can certainly take your baby for a second opinion.”
Kate agrees that a chart – regardless of which one it is – should not be the only tool relied upon for assessing an infant’s health. “People are going to use charts, and they’re interesting and they can help, but they shouldn’t be the whole story,” she says.
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