Issues in Implementing the New Growth Standards

The WHO growth standards offer an improved rationale and technical excellence. The role of the public health practitioner is to provide leadership in the programmatic introduction of improved materials so as to best support their use and purpose. Proper transition to the new standards necessitates at least three significant public health activities. 1) Development of the public health – medico - political decision and mandate to introduce the standards is ongoing in many countries, including the US. 2) Education and training of all public health, healthcare and nutrition personnel in the proper use and appropriate interpretation will require public mandate and support; since the new charts may lead to misinterpretations of increases or decreases in under- or over-nutrition in a population. Under optimal conditions, this would proceed simultaneously with the introduction. 3) Skills development to ensure adequate support for breastfeeding arguably should be in place before the new standards are introduced. As the new standards are based on the growth of breastfed children whose mother received breastfeeding support for exclusive breastfeeding, we may not see this same growth without lactation support. One outcome to be avoided is misinterpretation of children's growth that could be associated with inappropriate counseling and care. Benefits of the new standards warrant worldwide acceptance. It is the responsibility of the public health community to ensure an action agenda to create proper breastfeeding support skills and data interpretation. Suggested approaches to 2 and 3 will be presented, including the possibility of employing easy to use job-aids, and skills-based algorithms.