Growth Charts for Breastfeeding Babies

posted by Mama Hope | November 7th, 2008 in Growth & Development

When addressing concerns over weight gain in breastfed babies, it’s so important to use growth charts that accurately depict the curve of growth for breastfed babies. This information was not available until recently, but since 2006 growth charts by the World Health Organization have made possible a more accurate assessment of growth in breastfed babies.

WHO growth charts for breastfed babies

The WHO growth charts and standards are endorsed by the International Pediatric Association, the International Union of Nutrition Sciences (IUNS), and the United Nations Standing Committee on Nutrition (SCN).

Drawbacks to CDC Infant Growth Charts

Most U.S. health care providers currently use the CDC / Center for Health Statistics growth charts, based on a set of babies in the United States. However, at the time data for these charts were collected most children in the U.S. were not exclusively breastfed. According to the CDC:

The 2000 CDC Growth Chart reference population includes data for both formula-fed and breast-fed infants, proportional to the distribution of breast- and formula-fed infants in the population. During the past two decades, approximately one-half of all infants in the United States received some breast milk and approximately one-third were breast-fed for 3 months or more.

Note that the quote above indicates “some breast milk.” In fact, although breastfeeding has been increasing slowly since 1999, CDC national studies show that in the year 2003:

  • Only 30% of babies in the U.S. were exclusively breastfed through three months.
  • And only 10% of babies in the U.S. were exclusively breastfed through six months.

Currently the American Academy of Pediatrics, the American Academy of Family Physicians, and the U.S. Surgeon General all recommend exclusive breastfeeding until six months of age. Thus at the time the CDC data was collected, 90% of mothers were not feeding their babies in the optimal manner currently recommended.

Clearly this shows a weakness in the CDC charts. They are being used to measure optimal growth, but they are not based on optimal feeding practices!

WHO Breastfeeding Baby Growth Charts

world health orgnaization
Image via Wikimedia

In recognition of problems associated with use of the CDC charts, the World Health Organization, in partnership with the United Nations University, undertook a project to create a set of Growth Standards that would reflect optimal growth, and the recommended practice of breastfeeding as best for infant health and development.

Click on the links to download or print the following WHO growth charts for breastfed infants:

Never delay treatment as a result of any information you find online or on this website, and consult your qualified health provider before making any decisions as to your child’s health. If you’re interested in speaking to your health provider about how the WHO standards might be more effective in assessing the health of breastfed babies, more information is available on their site.

You may find the WHO paper on how to interpret growth standards useful in that regard. It includes detailed information on how to use the WHO growth charts to identify underweight and overweight children, versus children within the boundaries of normal development.

In contrast with the CDC charts, the WHO charts are:

  • Based upon breastfed children selected specifically for the study, “based on an optimal environment for proper growth: recommended infant and young child feeding practices, good healthcare, mothers who did not smoke, and other factors associated with good health outcomes.”
  • Prescriptive rather than simply descriptive. The WHO growth standards are designed specifically as a tool for diagnosis and detection of growth-related conditions such as under-nutrition and overweight, and obsesity.
  • Based on a large, diverse set of more than 8,000 children from around the world, including Brazil, Ghana, India, Norway, Oman, and the United States of America.
  • Include weight-for-length charts for infants, not simply weight-for-age and length-for-age, including clinical information on judging the three charts in combination to diagnose potential problems.

According to the World Health Organization:

Since the late 1970s, the National Center for Health Statistics / WHO growth reference has been in use to chart children’s growth. This reference was based on data from a limited sample of children from the United States. It contains a number of technical and biological drawbacks that make it less adequate to monitor the rapid and changing rate of early childhood growth. It describes only how children grow in a particular region and time, but does not provide a sound basis for evaluation against international standards and norms.

The new standards are based on the breastfed child as the norm for growth and development. This brings coherence for the first time between the tools used to assess growth, and national and international infant feeding guidelines which recommend breastfeeding as the optimal source of nutrition during infancy.

Unlike growth charts currently used in the U.S., the WHO standards do not simply presume the health of the included populace, but instead take specific steps to design a protocol that is based on optimal health. In contrasting the two, the World Health Organization also mentions their potential use in combating the current health epidemic of obesity:

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.

Differences in CDC vs. WHO Breastfeeding Charts

To illustrate the difference between the charts produced by the CDC and the WHO, the chart below shows both curves.

The above chart contrasts the median curve of the WHO growth standards with the 2000 growth charts produced by the United States CDC and the National Center for Health Statistics.

As doctors often use the direction of a child’s growth curve as an indicator of good health and nutrition, what’s important in the difference between the two charts is the arc of their growth curves. In contrast with the 2000 CDC charts, the WHO charts, based on babies breastfed according to health recommendations, show faster growth in the early months, followed by a slower growth rate beginning approximately the fourth month.

As a result of this differing curve, it’s possible that:

  • Breastfed babies whose growth rate slows in the 4-10 month range, may be mistakenly identified as suffering a nutrition problem when using the CDC charts.
  • Similarly, certain older babies and children who are predominantly artificially-fed could appear, when using the CDC charts, to be progressing optimally, when in fact they may be showing early signs of overweight.

The CDC and the National Center for Health Statistics is aware of these differences, and on their website state:

In general, exclusively breast-fed infants tend to gain weight more rapidly in the first 2 to 3 months. From 6 to 12 months breast-fed infants tend to weigh less than formula-fed infants.

As shown above, this difference can be as great as two pounds.

To address these issues, the WHO standards include not only growth charts but also guidelines for application of the standards, including innovative new growth indicators such as skinfold thicknessess, growth velocity standards and windows of achievement for six key motor development milestones.

Considering Your Baby’s Growth

If you breastfeed your baby, it’s good to know that infant growth charts are finally available that reflect the special patterns of breastfed versus formula-fed babies. Personally, I’ve had issues of weight gain crop up, and discovering the WHO children’s growth charts has been a great relief.

Keep nursing!


Mama Hope

Disclaimer: The above content is for informational purposes only and is not intended to give medical advice. This content not intended as a substitute for professional advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Never disregard professional advice or delay in seeking it because of content found on this site.

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15 Responses to “Growth Charts for Breastfeeding Babies”

  1. Great info! Most doctors use the CDC ones because they’re most available, so it’s important for breastfeeding moms to have this kind of info before needless worry over their babes not fitting the growth standard. :)

    Summers last blog post..Unpacking Memories

  2. Thanks so much for this. Great information. It is rather frustrating to be told your b/f kids are too skinny based on the old growth charts. Or when my b/f kids are compared to other kids and I’m told “oh they’re so little” grr.

    chandlerfuls last blog post..Election Confession (Yes I (finally) Did)

  3. thank you. i’ve been looking for an article that explains the differences concisely.

    thanks for taking the time to post this.

  4. Summer,
    Thanks! In reading your comment I realized that in my post I implied that doctors might be currently switching to the WHO charts, but I’ve seen no evidence that this is the case. As you stated, most still use the CDC charts. I updated my post, thanks!

    Chandlerful and Pantrygirl,
    Thanks so much for commenting. Glad to know I can help! I’m definitely in the ballpark of moms needing these WHO charts to reduce worries. I’ll post my personal story soon. Good to be reminded I’m not the only one!

  5. I see women so distressed over their ped telling them their breastfed baby isn’t gaining enough! I always tell them to make sure their doctor is using the breastfed charts, of course almost no doctors do. These have been out for a while now but people just don’t know about them!

    Jeskas last blog post..Today sucked

  6. Wow, I knew the CDC charts were slighted in favor of formula fed babies, but I had no idea the exclusively breastfed sample was so tiny. The CDC charts are practically useless for breastfed babies. Thank you so much for such a comprehensive collection of this data. My son is 8.5 months and has gone from the 78th percentile to the 35th since our last check up. The drop off according to the WHO chart is far less dramatic. I was getting anxious about our upcoming 9 month check up. We’re seeing a different pediatrician since my current one (who wholeheartedly supports extended breastfeeding) is on maternity leave. I can now go in there with this info just in case. You’ve helped calm this mama’s nerves. I’m bookmarking your wonderful site.

  7. Thanks so much Rachel for sharing your story and your kind words!

    We mamas are so concerned about the health of our young ones that it makes us vulnerable to self doubt, which can then be so unhealthy when what you need as a breastfeeding mom is to believe in yourself and to nurture your child instinctively and intuitively!

    I’m so glad that my efforts have helped calm your nerves and given you some straightforward information to defend your practices if necessary. Hopefully you won’t need to. If you haven’t had it yet, I hope your 9 month checkup goes well. We can all be grateful, too, for the World Health Organization’s efforts in putting together their vital resource for mothers around the world!

    Be well,

    (Mama) Hope

    hopealsos last blog post..Fighting The Blues — A Challenge

  8. I have a breastfed 23month old girl who has had weight and height issues since 9 months. I am presently still nursing and we continue to struggle with her growth. Her present weight and height are 7.92kg and 33 in. Her head circ. is 43. I was wondering if you could recommend someone i could consult with regarding this situation. My present pediatrician feels my nursing is the problem.

  9. Hi Kary,

    If you also suspect your breastfeeding may be related to weight issues, you can get support through either:
    - La Leche League International, or
    - The International Board of Lactation Consultant Examiners

    If you are able to find a local breastfeeding support group or consultant through either of these resources, you could also ask about local references for doctors. If your measurements are correct, I can understand your interest in a second medical opinion on your child’s health. It’s perfectly reasonable to visit a second doctor for an alternate diagnosis. It’s also reasonable to visit with your own doctor to be sure that your own health is not impacting your milk supply.

    Here are some other resources that might be helpful:
    - The WHO guide to interpreting growth standards. You can chart your baby’s height and weight with the charts provided in my original article above, and use the information on page 14 and pages 31-36 of the WHO guide to accompany the information and guidance you receive from your doctor. You might also consider bringing these pages with you when you visit your doctor.
    - KellyMom.com is an online guide to breastfeeding and nutrition.
    - Common Sense Breastfeeding, Keeping Breastfeeding Going is a comprehensive list of articles on continued breastfeeding by a board certified lactation consultant.
    - WholesomeToddlerFood.com has information and resources on recommended calorie intakes and nutrition for toddlers.

    (Roll over and click all of the above resource names for hyperlinks.)

    I hope this information is helpful to you and I wish you and your child the best of health.

  10. Thank you so much for this post!

    The growth charts you posted above have since been removed from the WHO site - until about a month ago there was a separate set of links to them (called something like infants breastfed for at least one year). The only growth standards available at the WHO web site are ones that look much more like the 2000 CDC charts.

    One pediatrician diagnosed my breastfed (and I’m convinced completely healthy) baby with “failure to thrive” at the nine-month visit and tried to get us to do kidney function exam. (We changed doctors.) I’ve been trying to find the growth charts for babies breastfed for a year for the new doctor because she did not have them. I’m really glad you posted the pdfs instead of the links that aren’t there anymore.

    Do you also have the percentile charts?

    kata´s last blog post..I cried

  11. Actually - sorry, they ARE the same charts, I managed to confuse myself with the Z-scores.

    kata´s last blog post..I cried

  12. i want to know more about growth charts


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