Q & A: Use of Revised NCHS Growth Charts for Children

[Joanne Ikeda]

The following information about the new growth charts was distributed by
Robert Kuczmarski,Dr.Ph.,RD., Nutrition Analyst for the National Center for
Health Statistics, Center for Disease Control, Hyattsville, MD, at the
recent American Dietetic Association meeting in Atlanta.  Since these are
questions many of you have asking, I thought I would share the "answers"
with you.  Best Wishes!...Joanne Ikeda


TOP QUESTIONS ASKED BY PRACTITIONERS ABOUT THE USE OF THE REVISED NCHS
GROWTH CHARTS

1.  WHEN WILL THE NEW GROWTH CHARTS BE AVAILABLE?
          The charts are scheduled for release in late 1998/early 1999.  
Dissemination of materials will be approximately 3-4 after the charts 
are released.  Information will be on the CDC Web page after it is 
released.

2.  DO WE USE THE SAME METHOD TO OBTAIN HEIGHTS AND WEIGHTS?
          Yes, the methods to obtain heights and weights will remain the 
same.  There are standard protocols used to collect reference population 
data (ex: PNSS/PedNSS).  You may want to check with the Coordinator of 
PNSS/PedNSS, Dept of Public Health, State WIC Office, or EPSDT agency to 
assure that you are following the most accurate methodology.

3.  HOW DOES USE OF BMI IMPACT THE DATA COLLECTED AS PART OF THE 
SURVEILLANCE SYSTEM WHICH I PARTICIAGE (EG CDC'S PNSS/PEDNSS)?
          It doesn't.  In your present surveillance system you submit 
heights and weights to CDC who analyzes the data; with the new system 
you will still submit the same data to CDC who will be able to analyze 
BMI or wt/ht for current or trend data based on request from states.

4.  DO WE USE THE SAME METHOD TO IDENTIFY AND CLASSIFY CHILDREM AS LOW 
LENGTH- OR STATURE FOR AGE; LOW WEIGHT-FOR-LENGTH, STATURE OR -AGE; OR 
HIGH WEIGHT-FOR AGE, -LENGTH OR -STATURE?
          There will be charts for length-, weight; and head 
circumference for age, and weight for length.  For ages 2-19 yr. there 
will be a BMI for age chart.  Still under consideration is a wt/ht chart 
for 2-5 yr. olds.

5.  I HEAR THAT THE NEW CHILD GROWTH CHARTS NOW COVER AGES UP THROUGH 
19?
          The new charts extend through 19.9 years of age, as there is 
data from five national surveys, which will now allow the charts to be 
extended up to age 19.9 years.

6.  HOW WILL A SERVICE PROVIDER QUICKLY CALCULATE BMI IN A CLINICAL OR 
PUBLIC HEALTH SETTING?
          CDC is testing three different methods to calculate (eg: 
table, slide rule, hand calculator).  Information will be forthcoming.

7.  WILL THERE BE SPECIAL CHARTS FOR DIVERSE POPULATIONS?
          No, current knowledge and expert opinion indicate that all 
children have a similar genetic potential for growth.  Observed 
racial/ethnic differences appear to be attributable primarily to 
environmental influences.

SPECIAL CONSIDERATIONS:

8.  WHAT CHARTS WILL BE RECOMMENDED TO PLOT PREMIES?
          Because almost all VLBW infants are preterm, separate preterm 
VLBW infants charts is recommended, as the growth of VLBW infants is 
markedly different from normal birth weight for term infants.  CDC is 
still evaluating the different existing charts.

9.  WHAT CHARTS WILL BE USED FOR KIDS WITH SPECIAL HEALTH CARE NEEDS?
          New growth charts for children with special health care needs 
have not been developed as part of the NCHS revision.  This area needs 
to be further researched.

10.  SHOULD WE USE ONLY CURRENT ANTHROPOMETRICS ON THE NEW CHARTS OR IS 
IT USEFUL TO USE PRIOR MEASUREMENTS FROM A DEFINED PERIOD (EX 3-6 
MONTHS) AS A MEANS OF COMPARISON OR TRANSITION?
          There is no extensive research on practitioner's use of these 
tools.  Information will be forthcoming after these studies have 
occurred.

11.  WILL THE KIDS FALL INTO THE SAME GROWTH PERCENTILES ON THE NEW 
CHARTS AS THE OLD?
          The answers to this question is not known at this time.  CDC 
will be conducting analysis of the old to the new charts.


TIPS FOR NUTRITION SERVICE PRACTITIONERS & ADMINISTRATORS TO DEVELOP 
SYSTEMS FOR TECHNICAL ASSISTANCE AND TRAINING

1.  HOW WILL THE REVISED CHARTS BE DISSEMINATED?  Educational CDC will 
disseminate an educational packet, which will contain background 
information, camera ready charts, BMI table and a mathematical formula 
for calculating BMI.  CDC Web page is also available.

2.  WHAT ARE SOME SUGGESTIONS FOR STATES TO GEAR UP FOR THE NEW SYSTEM?
          Set up an internal or statewide working group; Collaborate 
with other providers including partners from both the public and 
private sector (see suggestions in #3); Provide technical assistance and 
training.

3.  WHO MIGHT BE PARTNERS IN PROVIDING TECHNICAL ASSISTANCE AND 
TRAINING?  Partners in the public sector:  Dept of Public Health (WIC, 
PrimaryCare, special needs, Early Intervention); Head Start; Dept. of 
Education, Cooperative Extension. 
          Private sector partners:  tertiary or community hospitals with 
pediatric dept, Nutrition Chapter of the American Academy of Pediatrics, 
State Dietetic Association, Pediatricians, and Formula Companies

4.  WILL THE REVISED GROWTH CHARTS BE MANDATORY OR GUIDELINES?  Neither, 
as the information provided by CDC is a promotional and educational 
piece to educate clinicians on changes in the revised chart.

5.  WHAT MIGHT BE SOME SUGGESTED FORUMS TO PROVIDE TRAINING?  Whatever 
you do market it creatively.  Think integration with ongoing activities 
such as:  regularly scheduled staff meetings/trainings (ex: invite 
internal and statewide partners to a 2-4 hr training on a subject such 
as data quality reimbursement, ADA protocols.  Add a component on the 
growth charts.
          - Identify target audiences; develop a plan and timeline.  
Train the trainer and expand from there.
          - Provide incentives (eg: snacks, ceu's, camera ready charts; 
resource person for ongoing assistance
          - Other suggestions adding a workshop as part of a 
state/regional dietetic or; practice groups meeting; or other major 
state/regional meetings such as head start, special needs, early 
intervention).
         - integrate into orientation for all staff

6.  WHO MIGHT BE WILLING TO FUND AN INSERVICE ON USE OF THE NEW GROWTH 
GRIDS?  Inkind assistance or funding may be from PNSS/PedNSS; home 
visiting programs; primary care, WIC, or special needs programs.  
Formula companies, pediatric facilities, state dietetic associations.

7.  WHO COULD PROVIDE OF TRAINING WITHIN MY STATE ON THE GROWTH CHARTS?  
Collaborate with the Dept of Public Health, WIC, PNSS/PedNSS staff, Dept 
of Nutrition of pediatric hospitals; state pediatric experts.  Discuss 
target groups, share workload.  Train multiple trainers.

8.  HOW CAN I EXPLAIN BMI TO PARENTS OR "THE AVERAGE PERSON" ON THE 
STREET?  BODY MASS INDEX is defined as weight in Kg divided by the 
square of height in meters which is more highly correlated with body 
fatness than weight-for-height in older children.  A more complete 
definition will be included in the educational packet disseminated by 
CDC.

References:
Briefel R (1996): Nutrition Monitoring in the U.S. Chapter 52 in: 
Present Knowledge in Nutrition, 7th edition.  EE Ziegler and LLJ Filer, 
Jr., Eds.  ILSI Press, Washington, DC.

Kuczmarski, RJ. Revised Growth Charts Due in Late '98.  American Academy 
of Pediatrics News vol. 14, Sept. 1998.

Centers for Disease Control and Prevention.  Pregnancy Nutrition 
Surveillance, 1996 Full Report USADHHS CDCP, 1998.

Centers for Disease Control and Prevention Pediatric Nutrition 
Surveillance system-US, 1980-1991 and Pregnancy Nutrition Surveillance 
System US 1979-1990.  November 27, 1992:  MMWR 1992; 41: (No.22-7).

Distributed by Joanne P. Ikeda,MA,RD, Cooperative Extension Nutrition
Education Specialist, Department of Nutritional Sciences at the University
of California, Berkeley, CA, as a public service to health professionals. 
Joanne P. Ikeda,MA,RD
Cooperative Extension Nutrition Education Specialist
Department of Nutritional Sciences
University of California, Berkeley
CA 94720-3104

Phone (510)642-2790
FAX (510)642-0535
E-mail  jikeda at socrates.berkeley.edu