Background and Rationale for Developing a New International Growth Standard for Infants and Young Children

The development of a new international growth standard was recommended by a Working Group on Infant Growth convened by the WHO in 1991. A prescriptive approach was adopted to describe how children should grow rather than the more usual approach of describing how children grow at a specific time and place. An international (Brazil, Ghana, India, Norway, Oman, and the United States), community–based sample was used to highlight the similarities in early child growth among diverse ethnic groups who live in distinct geographical regions of the globe and have health needs met. Rigorously standardized and quality controlled anthropometric and data management methods were used and state-of-the-art analytical methods were applied. The design was longitudinal for children < 2 years of age and cross sectional between 2 and 5 years. Gender specific length (height)-, weight-, BMI-, head circumference-, mid-arm circumference-, and triceps- and subscapular skinfold thickness-for age and weight/length (height) standards have been released for children from birth to 5 years-of-age. These were based on 882 and 6669 children who participated in the study's longitudinal and cross-sectional components, respectively. Upgrading international growth references to standards more adequately assists in monitoring and attaining a wide variety of international goals related to health and other aspects of social equity. In addition to the provision of scientifically robust tools, the new standards, based a global sample of children whose health needs are met, also provide a useful advocacy tool to those with interests in promoting child health and wellbeing.