Intended for healthcare professionals

Education And Debate

Do growth chart centiles need a face lift?

BMJ 1994; 308 doi: (Published 05 March 1994) Cite this as: BMJ 1994;308:641
  1. T J Cole
  1. MRC Dunn Nutrition Centre, Cambridge CB4 1XJ.
  • Accepted 29 December 1993

European height and weight growth charts commonly extend from the 3rd to the 97th centile, whereas in North America the extremes are usually the 5th and 95th centiles. There is no good reason for the difference, and neither chart is particularly useful for screening owing to the high false positive rate associated with a cut off based on the lowest centile. The World Health Organisation's international growth reference uses cut offs based on standard deviation scores rather than centiles, which are more suitable for the extremes of growth status seen in the developing world. This chart, however, is incompatible with charts based on centiles. Here a unified growth chart is proposed: it has nine rather than seven centiles, and they are spaced two thirds of a standard deviation score apart rather than the more usual unit spacing. This gives a set of curves very like the conventional 3rd to 97th centiles, but with additional curves at 2.67 standard deviation below and above the mean (roughly the 0.4th and 99.6th centiles). The 0.4th centile is a more practical cut off for screening purposes than the 3rd or 5th centile.

Growth charts are currently in the news. In Britain, the long awaited successor to the Tanner-Whitehouse charts is starting to appear, and elsewhere an expert committee of the World Health Organisation has recently met to report on physical status: the use and interpretation of anthropometry. The remit of this committee is to review the evidence for using anthropometric charts at different stages of life and, where the evidence supports …

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