Frequently Asked Questions About the

2000 CDC Growth Charts

How can I get copies of the growth charts?
The clinical charts are available from the Clinical Growth Charts page and
can be downloaded and copied. PowerPoint files of the growth charts,
which can be modified with different logos, are also available on
the PowerPoint Presentations of the Clinical 2000 CDC Growth Charts
page. Growth charts formatted for the Women, Infants, and Children
(WIC) program are available from the WIC website . In addition, The
American Academy of Pediatrics (AAP) is selling copies of the growth
charts and some pharmaceutical companies are distributing them.


What is a percentile?
Percentiles are the most commonly used clinical indicator to assess the
size and growth patterns of individual children in the United States.
Percentiles rank the position of an individual by indicating what percent of
the reference population the individual would equal or exceed. For
example, on the weight-for-age growth charts, a 5-year-old girl whose
weight is at the 25th percentile, weighs the same or more than 25
percent of the reference population of 5-year-old girls, and weighs less
than 75 percent of the 5-year-old girls in the reference population.

What is a z-score?
A z-score is the deviation of the value for an individual from the mean
value of the reference population divided by the standard deviation for
the reference population. Because z-scores have a direct relationship with
percentiles, a conversion can occur in either direction using a standard
normal distribution table. Therefore, for every z-score there is a
corresponding percentile and vice versa.

My child is at the 5th percentile on a chart, what should I do?
If you are concerned about your childs growth, talk with your child's
health care provider.

What growth charts are appropriate to use with exclusively
breastfed babies?
In the United States, the WHO growth standard charts are recommended
to use with both breastfed and formula fed infants and children from birth
to 2 years of age (CDC, 2010). The WHO growth charts reflect growth
patterns among children who were predominantly breastfed for at least 4
months and still breastfeeding at 12 months. These charts describe the
growth of healthy children living in well-supported environments in sites
in six countries throughout the world including the United States. The
WHO growth charts show how infants and children should grow rather
than simply how they do grow in a certain time and place and are
therefore recommended for all infants (Dewey, 2004; WHO Multicentre
Growth Reference Study Group, 2006).
The WHO growth charts establish the growth of the breastfed infant as
the norm for growth. Healthy breastfed infants typically put on weight
more slowly than formula fed infants in the first year of life (Dewey,
1998). Formula fed infants gain weight more rapidly after about 3 months
of age. Differences in weight patterns continue even after complementary
foods are introduced (Dewey, 1998).

What charts should be used for special populations?
The CDC has not evaluated the use of the WHO growth charts in
premature or very low-birth weight infants. The 2000 CDC growth charts
for the United States include data on low birth weight infants but do not
include data on very low birth weight infants (VLBW; less than 1,500
grams). Alternate charts are available to assess the growth of VLBW
infants. The most recent charts are those developed from data collected
in the National Institute of Child Health and Human Development
Neonatal Research Network Centers (Ehrenkranz, 1999). These charts
extend to about 120 days uncorrected postnatal age or until a body
weight of 2,000 grams is reached. A specific growth reference available
for VLBW infants is the Infant Health and Development Program (IHDP)
reference (Guo, 1996; Guo, 1997; Roche, 1997). The IHDP growth charts
are an option for assessing the growth of VLBW infants from an age
corrected for gestation of 40 weeks to 36 months. However, a limitation
of the IHDP charts is that they are based on data collected in 1985,
before current medical and nutritional care practices were being used.
See the training module: Growth Charts for Children with Special Health
Care Needs for information on assessing growthof low birth weight and
premature infants.
A variety of health conditions affect growth status and there are
specialized charts that may be considered for use with children affected
by these conditions. See the training module:Growth Charts for Children
with Special Health Care Needs for a discussion of these charts. These
specialized growth charts provide useful growth references, but may have
some limitations. Generally, they were developed from relatively small
homogeneous samples and data used to develop the charts may have
been obtained from inconsistent measuring techniques. For example, in
some cases, chart reviews were used to collect data; in other cases, the
measurement techniques were not clearly defined. In most cases, Body
Mass Index (BMI)-for-age charts are not available for special conditions
and have not been validated to use with children whose body composition
might differ from that of typical children. For children aged 2 to 20 years,
the CDC BMI-for-age growth charts would provide a useful reference to
monitor weight in relation to stature.
References
Centers for Disease Control and Prevention. Use of the World Health
Organization and CDC growth charts for children aged 0-59 months in the
United States. MMWR Recomm Rep. 2010;59(RR-9);1-
15. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5909a1.htm.
Accessed November 26, 2012.
Dewey KG, Cohen RJ, Nommsen-Rivers LA, Heinig MJ, for the WHO Multicenter Growth Reference
Study Group. Implementation for the WHO Multicentre Growth Reference Study in the United
States. Food Nutr Bull. 2004;25(suppl1):S84-S89.
WHO Multicentre Growth Reference Study Group. Assessment of differences in linear growth
among populations in the WHO Multicentre Growth Reference Study. Acta
Paediatr Suppl.2006;450:56-65.
Dewey KG. Growth characteristics of breastfed compared to formula-fed infants. Biol
Neonate.1998;74(2):94-105.
Ehrenkranz RA, Younes N, Lemons JA, Fanaroff AA, Donovan EF, Wright LL, Katsikiotis V, Tyson JE,
Oh W, Shankaran S, Bauer CR, Korones SB, Stoll BJ, Stevenson DK, Papile L. Longitudinal growth
of hospitalized very low birth weight infants. Pediatrics. 1999;104:280-289.
Guo SS, Wholihan K, Roche AF, Chumlea WC, Casey PH. Weight-for-length reference data for
preterm, low birth weight infants. Arch Pediatr Adolesc Med. 1996;150:964-970.
Guo SS, Roche AF, Chumlea WC, Casey PH, Moore WM. Growth in weight, recumbent length, and
head circumference for preterm low-birthweight infants during the first three years of life using
gestation-adjusted ages. Early Hum Dev. 1997;47:305-325.
Roche AF, Guo SS, Wholihan K, Casey PH. Reference data for head circumference-for-length in
preterm low-birth-weight infants. Arch Pediatr Adolesc Med. 19