Growth charts for babies

Wright1 questions a move to growth charts from the World Health
Organisation (WHO) based upon recently collected cohort data in several
countries around the world. We welcome this consideration since current
charts are not only outdated and of limited value in breast fed infants,
but may also not be applicable to ethnic populations. Charts reflecting
trends to obesity and malnutrition would be ethically insensitive and the
scientific community should refrain from ‘normalising’ these ‘disease’
states. Hence although the WHO datasets may only comprise 20% of the
population in certain areas, the stringent WHO criteria should be accepted
as a ‘gold standard’ for infants. One should also consider that different
ethnic groups may require individual growth charts, which is not
surprising in groups such as South Asians where definitions of obesity,
overweight and metabolic syndrome are already acceptably different from
the white European population. However, such growth charts will only be
derived from long-term cohort studies in ethnic groups, which are long
overdue in the developed world.

Kiran CR Patel, Specialist Registrar in Cardiology
University Hospital Birmingham

Rubin Minhas, General Practitioner
Kent and Medway PCT

Lord Naren Patel
F.R.C.O.G.

Conflict of interest: The authors are all members of the South Asian
Health Foundation

1. Wright CM. Growth charts for babies. BMJ 2005;330:1399-400

Competing interests:
The authors are all national board members of the South Asian Health Foundation

I read this article with interest, but I felt I had to respond to the
following comment from Magda Sachs: "UK mothers appear to pick up the idea
that their baby’s growth should follow a particular chart centile, and
even minor fluctuations are of concern". In my experience as a mother of
two who has breastfed both children, the impression I have been given is
that my baby's growth SHOULD follow its curve and that any variation from
this IS a cause for concern! (This is something I now know to be
incorrect, but at the time it did cause me much worry, many sleepless
nights and almost made me give up on the idea of breastfeeding)

With my first child I regularly attended the baby clinic, as caring
for my baby was a totally new experience for me (I was a post-doctoral
biochemist and medical writer with an extremely limited experience of
children and babies). Every 14 days I took her along to be weighted and
her weight was plotted on a growth chart. When she was several weeks old
she appeared to drop slightly below her line. At the time I did question
whether the growth curves were applicable to breastfed babies but this
idea was quickly dismissed. My daughter's weight in relation to the growth
curve did appear to be a 'cause for concern' and I was advised to eat
more, rest more, have her weighted each week and perhaps 'try and feed her
a little more often'. (Slightly difficult as she breastfed for about 30
minutes every 2 and a half to 3 hours throughout the day).

Each time I took her to be weighed I worried about whether she would
still be below her line ... was she getting enough food from me? Was
breastfeeding working? Was I starving my baby? Should I try some formula
instead??

At each session she was still below her line and I was asked about
her feeding, and it was even hinted that it might be worth trying a bottle
if things did not improve.

After several weeks of this (and lots of worry on my part) I
eventually saw one health visitor who looked at my baby, asked a few
questions about how she fed, and then told me that my daughter appeared
happy, alert, active and if she continued to dirty her nappies regularly
then she was obviously getting enough food and perhaps this was just the
way she was! This provided enough reassurance for me to continue
breastfeeding my daughter - something I could have easily given up on, but
which I managed to continue for a total of 8 months.

With my second child I have not had the chance to get him weighed as
often or even had the opportunity to worry as much about his weight gain.
From the few readings that have been taken he also appears to have dropped
below his line and at a similar timepoint to his sister. Perhaps this is
also because he is breastfed or perhaps this is something that just
happens to my children!

Several of my friends have recently had children (and before anyone
askes we all live in different geographical areas) and those that
breastfeed seem to have had / are having similar experiences to mine. I
don't think that we are an isolated few - the impression WE have been
given as mothers is that growth curves ARE important and your baby MUST
maintain its line. If these charts are not interpreted correctly then a
difficult job is made even harder by adding unecessary worry over the
baby's weight. As a mother I would have welcomed more support with
breastfeeding and less apparently misplaced emphasis on these growth
curves

Competing interests:
Mother who has breastfed 2 children (both of which dropped below their line)