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Winter 1999

Revised Pediatric Growth Charts for the U.S. to Include New BMI Chart
By Robert J. Kuczmarski, Dr. P.H., NCHS/CDC

The National Center for Health Statistics (NCHS) growth charts for infants, children, and adolescents are undergoing major revisions for the first time since their development in 1977. The revision project, led by the NCHS of the Centers for Disease Control and Prevention (CDC), is designed to provide improved instruments for screening and evaluating the attained size and growth patterns of children in the United States.

The availability of advanced statistical procedures and additional national survey data, especially from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-94) beginning at 2 months of age, provided the opportunity to address issues and concerns that arose with widespread national and international applications of the charts.

The revised charts will have smoothed percentile curves for measures included in the 1977 charts, with one particularly notable change. Gender-specific body mass index-for-age charts for ages 2 through 19 years will replace the weight-for-stature charts for children and adolescents, which were limited to the evaluation of prepubescent children.

Basing the growth charts on body mass index (BMI; kg/m2) has the following advantages:

• BMI tracks over time, and the tracking increases with increasing age in the pediatric years. BMI-for-age growth charts can be used clinically beginning at 2 years of age, when an accurate stature can be obtained. An additional advantage is that BMI charts can now be used for children ages 2 years or older who were too short to plot on the 1977 weight-for-stature charts.
  
  
• BMI is predictive of body fatness. It can also be used throughout the range of values to rank individuals with their peers, and to characterize underweight or at risk of underweight, although no expert guidelines currently exist for the classification of underweight based on BMI. There is clearly a need for further research in this area.

• The BMI percentile charts, when properly applied, can be used to screen individuals in clinical settings. Primary care providers and public health programs will be able to assess and monitor overweight in youths. The charts can also be used in surveillance of populations and for the early identification of persons who might benefit either from secondary prevention or from various interventions targeted toward controlling body weight.

Further information on the revised growth charts can be obtained at the NCHS/CDC Internet website (www.cdc.gov/nchswww).