Q & A: Use of Revised NCHS Growth Charts for Children
jikeda at socrates.berkeley.edu
Tue Nov 10 10:53:15 PST 1998
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
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
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
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
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
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
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
- 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
- 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
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
E-mail jikeda at socrates.berkeley.edu
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