MCHB Training Module -- Using the CDC Growth Charts : Identifying Poor Growth in Infants and Toddlers

1. Anthropometrics: Weight, length, and weight-for-length

With all these measures, monitoring a child's measurements over time provides the best information. Growth faltering, or slowed growth velocity, often indicates a problem. Cutoff values are also used to classify children's growth as normal or questionable. See Overview of Growth Charts for more information about guidelines for growth assessment.

Several guidelines have been established to identify poor growth. The most common cutoff point for concern is the fifth percentile, though other cutoffs are also used. The table below summarizes recommendations of several agencies and organizations. Criteria refer not only to weight but also to length and weight-for-length.

CRITERIA TO IDENTIFY POOR GROWTH
Source	Indices	Cutoff point	Reference
Institute of Medicine	Length-for-age, height-for-age, weight-for-length or weight-for-height	5th percentile	Institute of Medicine, 1996
WIC	Length-for-age, height-for-age, weight-for-length, body-mass-index-for-age	10th percentile	US Department of Agriculture
CDC	Body-mass-index-for-age	5th percentile	BMI Module
WHO	Height (or length)-for-age, weight-for-height, weight-for-age	2.3 percentile (-2 SD)*	WHO, 1995
Medical practice	Weight-for-age, weight-for-length, length-for-age	5th percentile	Kessler and Dawson, 1999
Medical Practice	Weight-for-age, length-for-age or height-for-age	Dropping downward across percentiles	Kessler and Dawson, 1999, page 22
* For more information about the use of standard deviations, click here

The Institute of Medicine made recommendations for the identification of children needing special nutrition services through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). WIC, with its preventive emphasis, recommends the tenth percentile weight-for-length as a point for intervention. The fifth percentile of weight-for-age is commonly used in medical settings. The World Health Organization (WHO) takes a worldwide perspective and emphasizes the needs of developing countries. The WHO cutoff, 2 standard deviations below the mean, is slightly lower than the 5th percentile used in the US.