Multicentre Growth Reference Study Research Articles

Stunting is associated with blood lead concentration among Bangladeshi children aged 2-3 years.

BackgroundLead toxicity is of particular public health concern given its near ubiquitous distribution in nature and established neurotoxicant properties. Similar in its ubiquity and ability to inhibit neurodevelopment, early childhood stunting affects an estimated 34 % of children under 5 in low- and middle-income countries. Both lead and stunting have been shown to be associated with decreased neurodevelopment, although the relationship between these childhood burdens is underexplored. The association between lead exposure and stunting has been previously established, yet limited data are available on susceptibility windows.MethodsWhole blood lead samples were collected from rural Bangladeshi children at delivery (umbilical cord blood) and at age 20–40 months (fingerstick blood). Stunting was determined using the Child Growth Standards developed from the World Health Organization Multicentre Growth Reference Study. Children with height for age < -2 z-scores below the median of the WHO Child Growth Standards were classified as stunted in all analyses.ResultsMedian (IQR) umbilical cord and fingerstick blood lead levels were 3.1 (1.6–6.3) μg/dl and 4.2 (1.7–7.6) μg/dl, respectively. In adjusted multivariable regression models, the odds of stunting at 20–40 months increased by 1.12 per μg/dl increase in blood lead level (OR = 1.12, 95 % CI: 1.02–1.22). No association was found between cord blood lead level and risk of stunting (OR = 0.97, 95 % CI: 0.94–1.00).ConclusionsThere is a significant association between stunting and concurrent lead exposure at age 20–40 months. This association is slightly attenuated after controlling for study clinic site. Additional research including more precise timing of lead exposure during these critical 20–40 months is needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12940-016-0190-4) contains supplementary material, which is available to authorized users.

Linear growth of children attending public daycare centers in the municipality of Campina Grande, Paraíba, Brazil.

To identify variables predictors of linear growth in preschool children attending public child day care centers of Campina Grande, Paraíba. A cross-sectional study on a probabilistic sample of 335 children attending child day care centers. Were obtained information about socioeconomic, maternal and children's characteristics. The height/age (Z-score) was analyzed as continuous dependent variable. Anthropometric data were obtained in compliance with the recommendations of the World Health Organization. The Multicentre Growth Reference Study was used as the reference population. The data were subjected to multiple linear regression analysis using the hierarchical model. Children who slept in rooms with at least two people, households without garbage collection, households with no refrigerator, rural zone, illiterate mothers, mothers of short stature, low birth weight and stay in child day care center at part time were the conditions associated with worse height/age of children. There is a clear difference in linear growth with multicausal characteristic in which the low birth weight, as an expression of adverse history, and the socioeconomic conditions, as an expression of health inequities, profiling the genetic potential of growth.

Pleuritic chest pain due to migratory bullet

There has been a continuous effort to develop standard growth charts for neonates. Reference growth charts based on cross-sectional intrauterine data were developed from measurement of anthropometric parameters of neonates of different gestations at birth. Similarly postnatal charts for preterm neonates were developed based on longitudinal measurements of infant's parameters over intervals. Fetal–infant growth charts were devised by combining cross-sectional intrauterine data and postnatal infant's longitudinal parameters. Revised Fenton 2013 charts incorporating neonatal anthropometric data look to be most adequate for preterm infants of 22 weeks gestation till 50 weeks post-menstrual age. These growth references describe how infants grew in certain time in a defined population. There was a need of developing growth standard defining growth of healthy population in optimal conditions. WHO Multicentre Growth Reference Study charts were developed as growth standards describing the growth of healthy children from term gestation till 5 years of age. Intergrowth 21st growth chart is the new growth standards for preterm infants and looks promising in infants of gestation 33 weeks or more.

Web-Based Versus Conventional Training for Medical Students on Infant Gross Motor Screening.

Early detection of developmental abnormalities is important for early intervention. A simple screening method is needed for use by general practitioners, as is an effective and efficient training method. This study aims to evaluate the effectiveness, acceptability, and usability of Web-based training for medical students on a simple gross motor screening method in infants. Fifth-year medical students at University of Indonesia in Jakarta were randomized into two groups. A Web-based training group received online video modules, discussions, and assessments (at www.schoology.com ). A conventional training group received a 1-day live training using the same module. Both groups completed identical pre- and posttests and the User Satisfaction Questionnaire (USQ). The Web-based group also completed the System Usability Scale (SUS). The module was based on a gross motor screening method used in the World Health Organization Multicentre Growth Reference Study. There were 39 and 32 subjects in the Web-based and conventional groups, respectively. Mean pretest versus posttest scores (correct answers out of 20) were 9.05 versus 16.95 (p=0.0001) in the Web-based group and 9.31 versus 16.88 (p=0.0001) in the conventional group. Mean difference between pre- and posttest scores did not differ significantly between the Web-based and conventional groups (mean [standard deviation], 7.56 [3.252] versus 7.90 [5.170]; p=0.741]. Both training methods were acceptable based on USQ scores. Based on SUS scores, the Web-based training had good usability. Web-based training is an effective, efficient, and acceptable training method for medical students on simple infant gross motor screening and is as effective as conventional training.

Fetal, Neonatal, Infant, and Child International Growth Standards: An Unprecedented Opportunity for an Integrated Approach to Assess Growth and Development

The recent publication of fetal growth and gestational age–specific growth standards by the International Fetal and Newborn Growth Consortium for the 21st Century Project and the previous publication by the WHO of infant and young child growth standards based on the WHO Multicentre Growth Reference Study enable evaluations of growth from ∼9 wk gestation to 5 y. The most important features of these projects are the prescriptive approach used for subject selection and the rigorous testing of the assertion that growth is very similar among geographically and ethnically diverse nonisolated populations when health, nutrition, and other care needs are met and the environment imposes minimal constraints on growth. Both studies documented that with adequate controls, the principal source of variability in growth during gestation and early childhood resides among individuals. Study sites contributed much less to observed variability. The agreement between anthropometric measurements common to both studies also is noteworthy. Jointly, these studies provide for the first time, to my knowledge, a conceptually consistent basis for worldwide and localized assessments and comparisons of growth performance in early life. This is an important contribution to improving the health care of children across key periods of growth and development, especially given the appropriate interest in pursuing “optimal” health in the “first 1000 d,” i.e., the period covering fertilization/implantation, gestation, and postnatal life to 2 y of age.

What would it take to prevent stunted growth in children in sub-Saharan Africa?

There is increasing agreement among the nutrition community about the use of length/height-for-age as the indicator to monitor the long-term impact of chronic nutritional deficiencies. Stunting, an indicator of linear growth failure, has both long- and short-term consequences affecting growth and development and adult work potential. The number of stunted children in sub-Saharan Africa is expected to increase by 2025 if the current trends remain. Stunting among African children peaks during the complementary feeding period, which coincides with the period when children are no longer on exclusive breastfeeding and infections are frequent. Addressing stunting has become the focus of global efforts. The World Health Assembly in 2012 set a 40 % reduction in the number of stunted children by 2025. To effectively address the issues of stunting in sub-Saharan Africa is it appropriate to examine the issue of what it takes. The WHO Multicentre Growth Reference Study (MGRS) conducted in several regions of the world, including Africa has lessons on what it would take to prevent in African children. The children in the MGRS had good socioeconomic background characteristics reflected by years of maternal education and availability of basic amenities, such as potable water and sanitary conditions. The prescription of exclusive breastfeeding, high-quality diversified diets and attention to care were critical factors contributing to healthy growth for the African children. Preventing stunting in sub-Saharan Africa is possible. It requires governments to put in place policies that would create the conducive environment needed. The complex and multiple causes of stunting offer the opportunity to address stunting in a multisectoral and within a food systems approach. The global resolve to make food systems deliver on healthy diet requires all stakeholders to work together to achieve the global goal of reducing stunting. This review highlights the key elements contributing to adequate growth in the Africa cohort of the WHO-MGRS and how these provide lessons for addressing stunting in children in sub-Saharan Africa.

Nutritional status assessment of school children in Bellary district, Karnataka

Background: Malnutrition continues to be a primary cause of ill-health and morality among children in developing countries. It is a major public health problem and accounts about half of the deaths worldwide. About 150 million children in developing countries are still malnourished and more than half of underweight children live in South East Asia region. The high levels of under-nutrition in south Asia pose major challenge for child development. There are other factors that affect the nutritional status of children. Aims and Objectives: To assess the Nutritional Status of School Children in Bellary district. Materials and Methods: A total 27,544 students from 169 schools were enrolled for the study. Sample size was calculated by taking 20% of total enrolled school children in Bellary district. Statistical Analysis: The body mass index, Z score and World Health Organization Multicenter Growth Reference Study growth charts was used for analysis. Results: The study population of 27,544 students comprised of which 13,519 (49.1%) male and 14,025 (50.9%) female. On the analysis, 4447 (16.1%) found to be undernourished. More male students were found to be undernourished 2237 (16.9%), but obesity was common in females 1723 (12.3%). Conclusions: The nutritional status of the students in our study has been found better than other studies, but there are cases of undernourished that need attention and there is a need to deal with obesity and overweight in the school in order to prevent the epidemic of noncommunicable diseases.

How to use: nutritional assessment in children

One-fifth of children in hospitals are undernourished. Ignorance of undernourishment results in poorer outcomes for those children: longer hospital stays, complications and readmission.1 Nutritional assessment ought, therefore, to be a...

The INTERGROWTH-21st project and the multicenter growth reference study: enhanced opportunities for monitoring growth from early pregnancy to 5 years of age.

Breastfeeding MedicineVol. 9, No. 7 Breastfeeding Research and Program DataThe INTERGROWTH-21st Project and the Multicenter Growth Reference Study: Enhanced Opportunities for Monitoring Growth from Early Pregnancy to 5 Years of AgeCutberto GarzaCutberto GarzaUniversity Professor, Boston College, Chestnut Hill, Massachusetts.Visiting Professor, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.Visiting Professor, George Washington University Milken Institute School of Public Health, Washington, D.C.Search for more papers by this authorPublished Online:11 Sep 2014https://doi.org/10.1089/bfm.2014.0106AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited ByGrowth Abnormalities as a Risk Factor of Adverse Neonatal Outcome in Hypertensive Pregnancies—A Single-Center Retrospective Cohort Study19 June 2021 | Children, Vol. 8, No. 6Working group reports: evaluation of the evidence to support practice guidelines for nutritional care of preterm infants—the Pre-B Project1–420 January 2016 | The American Journal of Clinical Nutrition, Vol. 103, No. 2 Volume 9Issue 7Sep 2014 InformationCopyright 2014, Mary Ann Liebert, Inc.To cite this article:Cutberto Garza.The INTERGROWTH-21st Project and the Multicenter Growth Reference Study: Enhanced Opportunities for Monitoring Growth from Early Pregnancy to 5 Years of Age.Breastfeeding Medicine.Sep 2014.341-344.http://doi.org/10.1089/bfm.2014.0106Published in Volume: 9 Issue 7: September 11, 2014PDF download

KAJIAN PERBEDAAN PREVALENSI BALITA KURUS DAN PENDEK MENURUT STANDAR WHO 2005 DIBANDING NCHS: Analisis Data SKRT 2004

THE DIFFERENCE IN THE PREVALENCE OF WASTING AND STUNTING IN CHLIDREN AGE 0-59 MONTHS BY USING NCHS AND NEW WHO ANTHROPOMETRIC STANDARD: Re-analysis of Indonesian Household Health Survey 2004 WHO introduced new Child Growth Standard for children 0 – 60 months of age in the early 2006 based on Multi-Centre Growth Reference Study (MGRS) in 6 countries: Brazil, Ghana, India, Norway, Oman and the United States of America involving healthy children living in healthy environment that provide possibility for them to grow according to their genetic potential. WHO recommended that the standard be used as a new anthropometric reference replacing the existing NCHS-WHO child growth reference. However, some experts demand to evaluate the standard, before Indonesia adopts it in the nutrition program. This paper tries to compare the consequence of adopting new WHO standard to the magnitude of stunting and wasting. The main objective of the paper is to re-analyze the existing anthropometric data on children aged 0-59 months by using both NCHS-WHO reference and new WHO standard on the prevalence of wasting (W/L or W/H) and stunting (H/A). This re-analysis is based on anthropometric data of 3,316 children age below 5 years old from Household Health Survey 2004. Child weight and length/height were converted into z-scores of W/H and H/A by using both NCHS and new WHO Growth Standard, and compared the prevalence of wasting and stunting. The results showed that the prevalence stunting is higher by using new WHO Growth Standard (28.6%) compared to that by using NCHS growth references (24.1%). The difference in the prevalence varied between sex from 4.5-4.7% and across age groups from 1.3-9.2%. Similar results also found for the prevalence of wasting. The prevalence of wasting by using WHO Growth Standard and NCHS growth references was 15.1% and 13.8% respectively. The difference in the prevalence varied between sex from 0.8-2.1% and across age groups which varied fourfold (21.0% and 5.6%) for children age below 6 month old and only 1.7% for children age 48-59 month old. Keywords : anthropometric standard, stunted, wasted, height for age, weight for height

The likeness of fetal growth and newborn size across non-isolated populations in the INTERGROWTH-21st Project: the Fetal Growth Longitudinal Study and Newborn Cross-Sectional Study

Large differences exist in size at birth and in rates of impaired fetal growth worldwide. The relative effects of nutrition, disease, the environment, and genetics on these differences are often debated. In clinical practice, various references are often used to assess fetal growth and newborn size across populations and ethnic origins, whereas international standards for assessing growth in infants and children have been established. In the INTERGROWTH-21(st) Project, our aim was to assess fetal growth and newborn size in eight geographically defined urban populations in which the health and nutrition needs of mothers were met and adequate antenatal care was provided. For this study, fetal growth and newborn size were measured in two INTERGROWTH-21(st) component studies using prespecified markers and the same methods, equipment, and selection criteria. In the Fetal Growth Longitudinal Study (FGLS), we studied educated, affluent, healthy women, with adequate nutritional status who were at low risk of intrauterine growth restriction. The primary markers of fetal growth were ultrasound measurements of fetal crown-rump length at less than 14 weeks and 0 days of gestation and fetal head circumference from 14 weeks and 0 days to 40 weeks and 0 days of gestation, and birthlength for newborn size. In the concomitant, population-based Newborn Cross-Sectional Study (NCSS), we measured birthlength in all newborn babies from the eight geographically defined urban populations with the same methods, instruments, and staff as in FGLS. From this large NCSS cohort, we selected an FGLS-like subpopulation to match FGLS with the same eligibility criteria. Between May 14, 2009, and Aug 2, 2013, we enrolled 4607 women in FGLS and 59 137 women in NCSS. From NCSS, 20 486 (34·6%) women met the FGLS eligibility criteria, and constituted the FGLS-like subpopulation. With variance component analysis, only between 1·9% and 3·5% of the total variability in crown-rump length, fetal head circumference, and newborn birthlength could be attributed to between-site differences. With standardised site effect analysis in 16 gestational age windows from 9 weeks and 0 days of gestation to birth for the three measures (128 comparisons), only one was marginally higher than 0·5 SD of the standardised site difference range. Sensitivity analyses, excluding individual populations in turn from the pooling of all-site centiles across gestational ages, showed no noticeable effect on the 3rd, 50th, and 97th centiles derived from the remaining populations. Our populations were consistent at birth with those in the WHO Multicentre Growth Reference Study (MGRS). The mean birthlength for term newborn babies in that study was 49·5 cm (SD 1·9), which was very similar to that in the FGLS cohort (49·4 cm [1·9]) and the NCSS derived FGLS-like subpopulation (49·3 cm [1·8]). Fetal growth and newborn length are similar across diverse geographical settings when mothers' nutritional and health needs are met, and environmental constraints on growth are low. The findings for birthlength are in strong agreement with those of the WHO MGRS. These results provide the conceptual frame to create international standards for growth from conception to newborn baby, which will extend the present infant to childhood WHO MGRS standards. Bill & Melinda Gates Foundation.

Nutritional deficit in children in a major city of the interior of the state of Bahia, Brazil

The study sought to analyze the nutritional deficit of children and associated environmental factors and maternal and infant characteristics in a major city in the interior of the state of Bahia. Information from mother/child-under-four duos of a birth cohort was assessed. Malnutrition was defined by the height-for-age (H/A) anthropometric index, at a cutoff of -1 z-score relative to the benchmark of the 2006 Multicentre Growth Reference Study. The variables studied were: the characteristics of children (birth weight and multiple births) and mothers (age at the time of birth, education level, parity and performing prenatal exams) and environmental factors (floor and roof material of residence, source of water consumed, indoor plumbing, water used for consumption and ownership of a refrigerator). Logistic regression was used to identify factors associated with nutritional deficit. Nutritional deficit occurred in 24.6% of children. Underweight at birth, inadequate prenatal care, precarious nature of the floor of the home and no indoor plumbing were predictors of malnutrition among children in the study. Factors associated with malnutrition confirm the contribution of social issues in the genesis of malnutrition.

Trends in stunting and overweight in Peruvian pre-schoolers from 1991 to 2011: findings from the Demographic and Health Surveys.

To examine trends in stunting and overweight in Peruvian children, using 2006 WHO Multicentre Growth Reference Study criteria. Trend analyses using nationally representative cross-sectional surveys from Demographic and Health Surveys (1991-2011). We performed logistic regression analyses of stunting and overweight trends in sociodemographic groups (sex, age, urban-rural residence, region, maternal education and household wealth), adjusted for sampling design effects (strata, clusters and sampling weights). Peru. Children aged 0-59 months surveyed in 1991-92 (n 7999), 1996 (n 14 877), 2000 (n 11 754), 2007-08 (n 8232) and 2011 (n 8186). Child stunting declined (F(1, 5149) = 174·8, P ≤ 0·00) and child overweight was stable in the period 1991-2011 (F(1, 5147) = 0·4, P ≤ 0·54). Over the study period, levels of stunting were highest in rural compared with urban areas, the Andean and Amazon regions compared with the Coast, among children of low-educated mothers and among children living in households in the poorest wealth quintile. The trend in overweight rose among males in coastal areas (F(1, 2250) = 4·779, P ≤ 0·029) and among males in the richest wealth quintile (F(1, 1730) = 5·458, P ≤ 0·020). The 2011 levels of stunting and overweight were eight times and three and a half times higher, respectively, than the expected levels from the 2006 WHO growth standards. The trend over the study period in stunting declined in most sociodemographic subgroups. The trend in overweight was stable in most sociodemographic subgroups.

Growth parameters of Sri Lankan children during infancy: A comparison with world health organization multicentre growth reference study

Objectives: growth monitoring (GM) is an important intervention ensuring wellbeing of children. If GM to be meaningful it is essential to have reference standards appropriate for that population. In Sri Lanka growth charts based on WHO multi centre growth reference study (MGRS) are used for GM. This study was carried out to ascertain the appropriateness of MGRS charts for GM in Sri Lankan children. Methods: out of a birth cohort of 2215 children, 250 from each sex were invited fora followed up. Children were examined at 2, 4, 6, 9 and 12 months, to measure weight and length. Statistical characteristics of weight and length for each sex were calculated and compared with MGR data. Results: out of babies invited to participate in the study 244 boys and 241 girls responded initially. Out of this 85% of boys and 86% of girls completed the follow up. Weight and length of both sexes deviated significantly at all ages from MGRS data. Conclusion: MGRS data seems to be inappropriate for monitoring growth of Sri Lankan children

Crescimento humano: parâmetros e reflexões acerca de referenciais

The research “Growth parameter of Sri Lankan children during infancy: a comparison with world health organization multicentre growth reference study “, by P.J. Perera et al.1, published in this issue of the journal is basically whether the WHO reference 20062 is appropriate for the Sri Lanka, due to the results presented, it necessarily causes some reflections on the growth of children, the determinants and implications, both for the primary care of children and adolescents in general, as for the use of growth as an indicator of welfare of the population groups. First of all we need to consider that such research, in its methodological aspects, was performed in a proper and careful manner, which confers robustness to their results, sine qua non characteristics to perform any considerations. The first consideration is related to the extreme care that must be taken when evaluating growth based on results obtained from the use of a reference (curve) of growth. Whatever the reference used, the results must be carefully analyzed3, even when resorting to a reference done with the best methodological cares, as proposed by the WHO reference in 2006. We must always remember that this is only a reference; therefore it is more a descriptor of the growth trend than a standard that must be achieved by all in an absolute manner. The authors reflection about possible negative repercussions for breastfeeding in their country is a good example1, even assuming that the exchange of reference cannot be considered the only solution to such difficulties. A critically use, and not a purely mechanical analysis, when comparing the values obtained with the reference would probably be a better solution, including the educational aspects that would then arise. In this sense, the results of the study, interpreted from another angle of view, the collective, produce an estimation that 85% or more of the children from Sri Lanka in the first year of life are lower than the median of the reference or, what is even worse, that 50% of the total is below the 15th percentile of the reference length of WHO 2006, which indicates a very high prevalence of stunting. This induces a second thought: however it is known that the growth is a result of the interaction between genetics and environment4,5, it is not possible to consider that such growth deficit is due mainly to ethnic characteristics, therefore genetic, of the population of Sri Lanka, even accepting what the authors say about the sample, i.e. a population relatively well situated within the socio-economic scenario of the country. It is not always possible to achieve an optimal growth pattern (if it exists). It is often important to try to understand whether a particular child (or a group of children) is having a growth that is compatible with the expression of their potential in the environment they live in, because if they are under, not in the referential, but the best possible under the circumstances, it will require for us to comprehend the reasons in order to produce some consistent way of intervention to optimize the growth in that particular environment. As a result, a third reflection becomes necessary considering the demographic, epidemiological and, especially, the nutritional6 transitions. Popkin believes that the nutrition transition is composed of several stages, among which there is one in which coexist a population with absence of severe protein-energy malnutrition, the presence of stunting (possible sequel of chronic malnutrition in the first years of life) and a gradually increase of the prevalence of overweight and obesity that progressively ends up also extending towards the layers of lower socioeconomic status. In addition, Journal of Human Growth and Development 2014; 24(1): 7-10 EDITORIAL

Worldwide variation in human growth and the World Health Organization growth standards: a systematic review

ObjectiveThe World Health Organization (WHO) has established a set of growth curves for use as international standards in children up to age 5. The WHO's position is that all economically...

The growing controversy about growth charts: WHO or regional?

Since production of WHO Multicenter Growth Reference Study (MGRS) growth standards in 2006, many countries have adopted the WHO charts for under five children [1]. In UK, WHO growth charts are used until 4 years [2] and in US only up to 2 years of age. Over-diagnosis of stunting and underweight in Asian children is likely with the use of these standards as Asian children are still thinner and lighter.

Promoting healthy growth and preventing childhood stunting: a global challenge

This compendium of reflections on a wide range of issues should feed a constructive dialogue on how best to pool efforts and address effectively the ‘wicked problem’ (Conklin 2005) of childhood stunting. Development agencies and the nutrition community are challenged to translate the existing high-level political and financial commitments into effective synergistic actions coordinated among multiple actors to reduce the global burden of stunting. Through this supplement and other initiatives the Healthy Growth Project hopes to make positive contributions to meeting that challenge. (Excerpt)

Parental height and child growth from birth to 2 years in the WHO Multicentre Growth Reference Study.

Linear growth from birth to 2 years of children enrolled in the World Health Organization Multicentre Growth Reference Study was similar despite substantial parental height differences among the six study sites. Within-site variability in child length attributable to parental height was estimated by repeated measures analysis of variance using generalized linear models. This approach was also used to examine relationships among selected traits (e.g. breastfeeding duration and child morbidity) and linear growth between 6 and 24 months of age. Differences in intergenerational adult heights were evaluated within sites by comparing mid-parental heights (average of the mother's and father's heights) to the children's predicted adult height. Mid-parental height consistently accounted for greater proportions of observed variability in attained child length than did either paternal or maternal height alone. The proportion of variability explained by mid-parental height ranged from 11% in Ghana to 21% in India. The average proportion of between-child variability accounted for by mid-parental height was 16% and the analogous within-child estimate was 6%. In the Norwegian and US samples, no significant differences were observed between mid-parental and children's predicted adult heights. For the other sites, predicted adult heights exceeded mid-parental heights by 6.2-7.8 cm. To the extent that adult height is predicted by height at age 2 years, these results support the expectation that significant community-wide advances in stature are attainable within one generation when care and nutrition approximate international recommendations, notwithstanding adverse conditions likely experienced by the previous generation.

Growth monitoring: a survey of current practices of primary care paediatricians in Europe.

ObjectiveWe aimed to study current practices in growth monitoring by European primary care paediatricians and to explore their perceived needs in this field.MethodsWe developed a cross-sectional, anonymous on-line survey and contacted primary care paediatricians listed in national directories in the 18 European countries with a confederation of primary care paediatricians. Paediatricians participated in the survey between April and September 2011.ResultsOf the 1,198 paediatricians from 11 European countries (response rate 13%) who participated, 29% used the 2006 World Health Organization Multicentre Growth Reference Study growth charts, 69% used national growth charts; 61% used software to draw growth charts and 79% did not use a formal algorithm to detect abnormal growth on growth charts. Among the 21% of paediatricians who used algorithms, many used non-algorithmic simple thresholds for height and weight and none used the algorithms published in the international literature. In all, 69% of paediatricians declared that a validated algorithm to monitor growth would be useful in daily practice. We found important between-country variations.ConclusionThe varied growth-monitoring practices declared by primary care paediatricians reveals the need for standardization and evidence-based algorithms to define abnormal growth and the development of software that would use such algorithms.