Growth Charts for Breastfed Babies

The 2006 World Health Organization (WHO) international growth charts for children aged 0–59 months.

  • Similar to the CDC growth charts, these charts describe weight for age, length (or stature) for age, weight for length (or stature), and body mass index for age.
  • Whereas the WHO charts are growth standards, describing the growth of healthy children in optimal conditions, the CDC charts are a growth reference, describing how certain children grew in a particular place and time. However, in practice, clinicians use growth charts as standards rather than references.
  • CDC recommends that clinicians in the United States use the 2006 WHO international growth charts, rather than the CDC growth charts, for children younger than 24 months (available here).
  • The CDC growth charts should continue to be used for the assessment of growth in persons aged 2–19 years.

The recommendation to use the WHO international growth charts for children under 24 months is based on several considerations, including the recognition that breastfeeding is the recommended standard for infant feeding.35

  • In the WHO charts, the healthy breastfed infant is intended to be the standard against which all other infants are compared; 100% of the reference population of infants were breastfed for 12 months and were predominantly breastfed for at least 4 months.
  • When using the WHO growth charts to screen for possible abnormal or unhealthy growth, use of the 2.3rd and 97.7th percentiles (or ±2 standard deviations) are recommended, rather than the 5th and 95th percentiles.
  • Clinicians should be aware that fewer U.S. children will be identified as underweight using the WHO charts, slower growth among breastfed infants during ages 3–18 months is normal, and gaining weight more rapidly than is indicated on the WHO charts might signal early signs of overweight.

Growth Chart

The CDC website has links to the WHO growth charts to be used for infants and children from birth to 2 years old, as well as to CDC growth charts for use with children age 2 and older in the United States.

CDC Growth Chart

Growth patterns over time using multiple data points should be used in conjunction with other medical and family history to assess appropriate growth.35

“The estimated prevalences of low weight for age and high weight for length among U.S. children differ depending on whether the [old] CDC charts (using the 5th and 95th percentiles) or the WHO charts (using the 2.3rd and 97.7th percentiles) are used (Figure 6). A substantial difference exists in the prevalence of low weight for age, with the WHO standard showing a lower prevalence beginning at age 6 months. The [old] CDC reference identifies 7%–11% of children aged 6–23 months as having low weight for age, whereas the WHO standard identifies less than 3%. The WHO standard also identifies fewer infants (aged less than 12 months) as having high weight for length (5%–9%) than the [old] CDC reference (9%–13%). For children aged 18–23 months, the differences in high weight for length essentially disappear”.