Booby Traps Series: Which growth charts is your pediatrician using?

This is the 49th post in a series on Booby Traps,™ made possible by the generous support of Motherlove Herbal Company.

My son was born in 2003.  His pediatrician gave us a copy of his early growth chart, which I put in his baby book to commemorate his chunkiness.

At the time I didn’t think too deeply about what the chart meant.  But now when I look at it I notice two things:

  1. It has formula logos running up the right hand side, and
  2. It was based on a sample of babies who weren’t being fed the way he was.

This was three years before the World Health Organization released growth charts which changed our understanding of how babies – breastfed and formula fed – grow.

Not sure what the WHO growth charts are?  Here’s the story of infant growth charts, featuring the extraordinary influence of babies born in Ohio.

Until recently the growth charts used by pediatricians were based on a sample of formula-fed, Caucasian babies born between 1929 and 1975 in Ohio.  These babies also often started solid foods before four months.  These charts were used around the world to chart babies’ growth.  More recently, in 2000, the CDC released a chart using a mixed sample of breastfed and formula-fed infants.  It yielded similar problems.

Research from the early 1990’s demonstrated that breastfed and formula-fed babies have different growth patterns.  The most significant difference is that breastfed babies grow faster than formula-fed babies in the first few months, and then “lean out” compared to formula-fed babies between 3 and 12 months.

So, if you try to chart a breastfed baby’s growth using the formula-fed charts, you might see a baby who is falling off of the curve after the first 2 months.  This sometimes resulted in recommendations that mothers supplement with formula.  It also meant that formula-fed babies who were experiencing excessive weight gain in later months – and at risk of later overweight and obesity – were viewed as normal and no interventions were recommended.

The new WHO charts use a sample of nearly 9,000 babies who were exclusively or nearly exclusively breastfed for the first six months.  The study methodology is described in detail here.  To me, the most interesting finding is that, when factors like malnutrition, socio-economic status, and maternal smoking are controlled for, growth of children around the world is quite similar.

The WHO is clear that these charts are not intended to apply just to breastfed babies.  They can serve as an important early warning to doctors if a formula-fed baby is experiencing excessive weight gain – a particular concern because formula-fed babies are at risk for overweight and obesity.  The WHO states, “Arguably, the current obesity epidemic in many developed countries would have been detectable earlier if a prescriptive international standard had been available 20 years ago.”

Since 2010 these charts have been recommended by the CDC and the American Academy of Pediatrics.  The CDC even has a tutorial for pediatricians on how to use them.  WIC will begin using them later this year.  They were adopted for use in the U.K. in 2009.

So the question is:  Have pediatricians and family practice physicians begun using them yet?  I don’t know of any data on this, but I know that practices can be slow to change.

Not using the WHO charts perpetuates a Booby Trap that has taken years to dismantle. If your providers aren’t using them, it may be time to bring in the AAP Breastfeeding Policy, which clearly states that these charts are more accurate and more supportive of infant health.

Is your pediatrician using the WHO charts?  Do you think that the difference in charts has affected the kind of breastfeeding care you’ve received?

*Some content in this post originally appeared on the Motherwear Breastfeeding Blog.


3 thoughts on “Booby Traps Series: Which growth charts is your pediatrician using?

  1. My son was born long and lean, and at nearly 5 years old that is still his body type. He was EBF, and for the first several months of his life his pediatrician was always concerned about his weight gain and wanted me to bring him in for weight checks and frequently suggested formula “just to be sure he’s gaining enough weight.” However I knew my supply was fine and my son was gaining and having plenty of wet diapers, so I never caved. However, I can definitely see that if my doctor had pushed harder or used scare tactics, it might have been more difficult to stick to my guns. Most of the moms I know who gave up breastfeeding before they’d personally planned did so because their ped told them their babies weren’t gaining enough and recommended supplementation with no mention of milk supply, and eventually mom’s supply tanked while baby plumped up so she figured, “Hey, the doc was right, I don’t make enough milk, look how big s/he’s growing now!” and quit nursing altogether. It’s unfortunate.


  2. Thank you so much for posting this! I have been looking for the WHO growth charts! My kids have been so different in how they grow. All were EBF for at least 6 months then we introduced solids after that point in time. Sometimes as late as 9 months. My ped has often freaked me out by saying that they aren’t gaining quick enough or gaining enough period. So frustrating…but knowing they use the CDC’s charts which are owned by formula makers it makes sense now. Seeing the WHO charts and comparing them to the CDC’s makes you really wonder.


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