Adapting the new WHO Growth Charts for use in the United Kingdom

The World Health Organisation brought out new growth charts for children 0-5 years old in 2006. These charts are based on breastfed children.

The UK Department of Health decided that that these charts would be used in the UK. They asked the Royal College of Paediatrics and Child Health to design a chart using the WHO data for use in the UK. They brought together a group so experts to do this.

Like many European countries, the UK had its own growth chart, based on UK babies. This chart included preterm data, so the decision was made to use the UK preterm data and the WHO chart from 2 weeks – which is why we now have a ‘UK-WHO chart’.

I was asked to join the expert group – my expertise comes from 20+ years as a Breastfeeding Mother Supporter and because I did my PhD work on breastfeeding mothers and routine weighing of babies. One of the things I did as part of the chart group was to lead focus groups of parents and of professionals. We asked parents about their understanding of the chart and what information they need, and we asked professionals to do plotting exercises on the old and new charts and tell us how they found the new design.

One of the most important ways the new UK-WHO chart *looks* different from our old UK chart is that the 50th centile (the line which shows the place where 50% of children are above and 50% are below in weight / height / head circumference) was a big thick line on the old chart. On the new chart it is a dotted line. This is because parents in the first focus group told us “We know our babies should grow on the big line in the middle of the chart”. This was causing many parents to worry about their baby if they were not on that line and to give them formula to try and get them in the ‘right’ place.

The new charts show that babies should grow well in the first weeks – the WHO centile lines are *higher* than on our old UK chart! But by the end of the first year, the lines are lower, showing that babies do not need to keep growing so fast. This means that children whose mothers were told ‘you really need to stop breastfeeding now your baby is 5 / 6 / 9 / 12 months because they are not growing fast enough – give them a bottle!’ are less likely to have this pressure. I have done the weights from a little girl like this and shown it to lots of health visitors and they agree that it looks different on the new chart and they would not be worried about this little girl (healthy, breastfed girl!) if they saw the weights on the UK-WHO chart.

There is so much to say about this! It was an exciting project. I think it was important that a breastfeeding supporter was included and that parents’ voices helped to shape the chart design! We did lots of educational material for training in the UK, and we also wrote notes for parents to have in their child health record book with their growth charts. You can see all our material online. The parents’ information is called ‘A5 foldout’ and there is an extra fact sheet for parents. You can find the charts at: http://www.rcpch.ac.uk/Research/UK-WHO-Growth-Charts -- there is a link to the training materials, too.

You can also read some of my research results in this paper which is free online.

I don’t know if you will have the chance to do something like this in Sweden, but I hope you find it interesting to know something about our work. Thank you!

Gästbloggare: Magda Sachs
Breastfeeding Supporter, The Breastfeeding Network, UK
UK-WHO Growth Chart Group