h

e
a
d
w
e
i
g
h
t
5.5
5
4.5
4
3.5
3
2.5
38 40
BOYS WEIGHT (kg)
9
9
.
6
t
h
9
8
t
h
9
1
s
t
t
h
9
9
.
6
t
h
9
8
t
h
9
1
s
t
7
5
t
h
5
0
t
h
2
5
t
h
9
t
h
2
n
d
0
.
4
t
h
42
66cm
50cm
49
48
47
46
45
44
43
42
41
40
39
38
37
36
35
34
33
32
31cm
In association with
h
e
a
d
t
14 16 18 20 22 24 26 28 30 32 34
Age in weeks/ month
3 4 5 6 7 8
9
9
.
6
t
h
9
8
t
h
9
1
s
t
7
5
t
h
5
0
t
h
2
5
t
h
9
t
h
2
n
d
0
.
4
t
h
GIRLS
0

1 year
7
5
l
e
n
g
h
s
W
e
i
g
h
t
(
k
g
)
H
e
a
d
C
i
r
c
u
m
f
e
r
e
n
c
e
(
c
m
)
5.5
5
4.5
4
3.5
3
2.5
2
1.5
1
2
1.5
1
40
34 36 38 40 34 36 38 40
Gestation in weeks Gestation in weeks
40
39
38
37
36
35
34
33
32
31
30
29
28
27
26
40
39
38
37
36
35
34
33
32
31
30
29
28
27
26
U
K
-
W
H
O
C
h
a
r
t
2
0
0
9

D
H
C
o
p
y
r
i
g
h
t
2
0
0
9
Preterm
BOYS HEAD
CIRCUMFERENCE (cm)
5
0
t
h
2
5
t
h
9
t
h
2
n
d
0
.
4
t
h
9
9
.
6
t
h
9
8
t
h
9
1
s
t
7
5
t
h
5
0
t
h
2
5
t
h
9
t
h
2
n
d
0
.
4
t
h
9
9
.
6
t
h
9
8
t
h
9
1
s
t
7
5
t
h
5
0
t
h
2
5
t
h
9
t
h
2
n
d
0
.
4
t
h
Actual age
Gestational age
(7 weeks preterm)
For preterm infants (less
than 37 weeks gestation),
plot on this chart until 2
weeks after expected date
of delivery (42 weeks). As
with term infants, some
weight loss is common in
the early days.
From 42 weeks, plot on the
0
-
1 year charts with
gestational correction.
Plot at actual age then
draw a line back the
number of weeks the infant
was preterm and mark spot
with arrow; this is the
gestationally corrected
centile.
42 32
42
42 32
Birth
Head Circumference
124cm
120
116
112
108
104
100
96
92
88
84cm
96cm
92
88
84
80
76
72
68
64
60cm
t
64
62
60
58
56
54
52
50
48
46
44cm
34 32 36 38 40 42
82cm
80
78
76
74
72
70
68
66
64
62
60
58cm
50cm
49
48
47
46
45
44
43
42
41
40cm
36 38 40 42 44 46 48 50
39
38
37
36
35
34
33
32
31
30
29
28
27
26
H
e
a
d
C
i
r
c
u
m
f
e
r
e
n
c
e
(
c
m
)
W
e
i
g
h
t
(
k
g
)
Gestation in weeks
5.5
5
4.5
4
3.5
3
2.5
2
1.5
1
Birth Weight
34 32 36 38 40 42
Gestation in weeks
8 9
9
10
10
11
11
Actual age
Gestational age
(7 weeks preterm)
36 38 40 42 44 46 48 50
9
9
.
6
t
h
9
8
t
h
9
1
s
t
7
5
t
h
5
0
t
h
2
5
t
h
9
t
h
2
n
d
0
.
4
t
h
9
9
.
6
t
h
9
8
t
h
9
1
s
t
7
5
t
h
5
0
t
h
2
5
t
h
9
t
h
2
n
d
0
.
4
t
h
9
9
.
6
t
h
9
8
t
h
9
1
s
t
7
5
t
h
5
0
t
h
2
5
t
h
9
t
h
2
n
d
0
.
4
t
h
99.6th
98th
91st
75th
50th
25th
9th
2nd
0.4th
9
9
.6
th
9
8
th
9
1
st
7
5
th
5
0
th
2
5
th
9
th
2
n
d
0
.4
th
9
9
.6
th
9
8
th
9
1
st
75th
5
0
th
25th
9th
2nd
0.4th
2nd
9th
25th
50th
75th
91st
98th
99.6th
0.4th
2nd
9th
0.4th
25th
50th
75th
91st
98th
99.6th
h
e
a
d
w
e
i
g
h
t
h
e
i
g
h
t
552cm
50
48
46
44
42
40cm
30kg
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5kg
1
1
/2
1
1
/2
2 2
1
/2
2
1
/2
3
3
3
1
/2
99.6th
98th
91st
75th
50th
25th
9th
2nd
0.4th
13 14 15 16 17
13 14 15 16 17
19 20 21 22 23
19 20 21 22 23
25 26 27 28 29
25 26 27 28 29
31 32 33 34 35
31 32 33 34 35
37 38 39 40
37 38 39 40 41 43 44 45 46 47
9
9
.
6
t
h
9
8
t
h
9
1
s
t
7
5
t
h
5
0
t
h
2
5
t
h
9
t
h
2
n
d
0
.4
th
l
e
n
g
t
h
2
9
9
.6
th
9
8
th
9
1
st
7
5
th
5
0
th
2
5
th
9
th
2nd
0.4th
9
9
.
6
t
h
9
8
t
h
9
1
s
t
7
5
th
5
0
th
2
5
th
9
th
2
n
d
0
.4
th
9
9
.6
t
h
9
8
t
h
9
1
s
t
7
5
t
h
5
0
th
25th
9th
2nd
0.4th
ft/in
5.11
5.10
5.9
5.8
5.7
5.6
5.5
5.4
5.3
5.2
5.1
5.0
4.11
180
175
170
165
160
155
150
99.6th
98th
91st
75th
50th
25th
9th
2nd
0.4th
cm
Adult Height
Prediction
Age in months/ years
Age in months/ years
Measure length until age 2; measure
height after age 2.
A childs height is usually slightly less
than their length.
Preterm
GIRLS
1

4 years
Plot childs
height centile on
the pink lines
above; the black
numbers show
average female
adult height for
this centile;
80% of children
will be within
6 cm of this
value.
52
52
14kg
13.5
0.5kg
Plotting preterm infants
Use the low birthweight
chart for infants less than 32
weeks gestation and any
other infants requiring
detailed assessment.
Use this section for infants
of less than 37 weeks
gestation. As with term
infants there may be some
weight loss in the early days.
From 42 weeks, plot on the
0

1 year chart with

gestational correction.
Gestational correction
Plot actual age then draw a
line back the number of
weeks the infant was preterm
and mark the spot with an
arrow; this is the gestationally
corrected centile.
11kg
10.5
w
e
i
g
h
Age in weeks/ months
1 2 3 4 5 6 7
2 4 6 8 10 12 14 16 18 20 24 26 28 30 32 34 22
9
9
.
6
t
h
9
8
t
h
9
1
s
t
7
5
t
h
5
0
t
h
2
5
t
h
9
t
h
2
n
d
0
.
4
t
h
99.6th
98th
91st
75th
50th
25th
9th
2nd
0.4th
0
10
9.5
9
8.5
8
7.5
7
6.5
6
5.5
5
4.5
4
3.5
3
13
12.5
12
11.5
11
10.5
10
9.5
9
8.5
8
7.5
7
6.5
6
5.5
5
4.5
4
3.5
3
2.5
2
1.5
1
2.5
2
1.5
1
0.5kg
U
K
-
W
H
O
C
h
a
r
t
2
0
0
9

D
H
C
o
p
y
r
i
g
h
t
2
0
0
9
24kg
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5kg
12
12 48
Data Recording
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Birth Measurement
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 2
Measurement 4
Measurement 6
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 8
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 10
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 3
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 5
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 7
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Measurement 9
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Recording Date
Weight
Head Circumference
Length/Height
Location
Health worker name
Using the new
UKWorld Health Organization
04 years growth charts
Information for healthcare professionals about
the use and interpretation of growth charts
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
24kg
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
3
Introduction 4
Weighing and measuring 6
Plotting measurements 8
Interpreting the new growth chart 11
Predicting adult height 15
Weightheight to BMI conversion chart 16
Training and education from the Royal
College of Paediatrics and Child Health 18
Notes 22
Contents
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
24kg
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
4
Introduction
New UKWorld Health Organization (WHO) 04 years growth
charts have been introduced in England for all new births from
May 2009. The charts, which have been developed for the
Department of Health by the Royal College of Paediatrics and
Child Health, are based on the growth of breastfed infants
and replace previous charts that were based on the growth of
predominantly formula-fed babies.
The new charts have been constructed using the WHO
standards for infants aged 2 weeks to 4 years. These used
data from healthy children from around the world with no
known health or environmental constraints to growth who
were breastfed exclusively for at least 4 months and partially
for one year. For the first time, they provide a description of
optimal growth which will help to establish breastfeeding as
the norm. The WHO found that infants worldwide have very
similar patterns of linear growth; and the new charts describe
the ideal patterns of growth that we should aspire to for all
UK children, whatever their ethnic origin and however they
are fed in infancy. These have been combined with birth data
for gestations 23 to 42 weeks from the UK 1990 growth
reference, as the WHO dataset did not include preterm infants.
The new charts will have an impact on the interpretation of
weight patterns in children. UK children match the charts well
for length and height at all ages and for weight in the early
weeks, but after the age of 6 months roughly twice as many
children will be above the 98th centile for weight compared
with the UK 1990 charts, and only about 1 in 200 children will
be below the 2nd centile.
This leaflet provides instructions particularly for users of the
personal child health record (PCHR) charts; a shorter version
of these instructions can also be found on the A4 chart.
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
24kg
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
5
Key new features of the new UKWHO
growth charts:
3 A separate preterm section for infants of 32 to 36
weeks gestation.
3 A new low birthweight chart available for preterm
infants born before 32 weeks gestation.
3 No centile lines between 0 and 2 weeks.
3 The 50th centile has been de-emphasised.

No lines between
birth and 2 weeks
Term birth measurements
plotted at age 0
Preterm births plotted on
preterm section
separate
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
24kg
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
6
Weighing and measuring
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
24kg
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
When to weigh and measure length
Babies should be weighed in the first week as part of the
assessment of feeding and thereafter as needed.
Length or height should be measured whenever there
are any worries about a childs weight gain, growth or
general health.
If parents wish, or if there is professional concern, babies
can be weighed at 68 weeks, 12 and 16 weeks. Babies
should usually be weighed at 1213 months at the time
of routine immunisations. Measurements need to be
interpreted in relation to length, growth potential and any
earlier measurements of the baby.
If there is concern, weigh more often; however, weights
measured too closely together are often misleading, so
babies should be weighed no more than:
once a month from 2 weeks to 6 months of age
once every two months from 6 to 12 months of age
once every three months over the age of 1 year.
However, most children do not need to be weighed this
often; families should be reassured that they can attend for
advice without having their baby weighed.
When to measure head circumference
Head circumference should be measured around birth, at
the 68 week check and at any time after that if there are
any worries about the childs head growth or development.
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
24kg
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
8
Plotting measurements
Plot each measurement on the relevant chart by
drawing a small dot in pencil where a vertical line
through the childs age crosses a horizontal line
through the measured value.
The lettering on the charts (weight, length, etc.) sits on
the 50th centile, providing orientation for ease of plotting
(see page 2).
For babies born at term (37 weeks or later)
Plot birthweight (and, if measured, length and head
circumference) at age 0 on the 01 year chart. The
coloured arrows at age 0 represent UK birthweight data
and show the childs birth centile.
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
24kg
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
9
Weight gain in the early days varies a lot from baby to
baby, so there are no lines on the chart between 0 and
2 weeks. Weight collected in this period should still be
plotted but for interpretation should be compared with
birth weight (see page 11).
For preterm infants
A separate low birthweight chart is available for infants of
less than 32 weeks gestation and any other hospitalised
neonate or infant requiring detailed assessment.
For healthy infants born after 32 weeks and before 37
weeks, plot all measurements in the preterm section
(to the left of the main 01 year chart) until 42 weeks
gestation, then plot on the 01 year chart using
gestational correction.
The preterm section can also be used to assess the relative
size of infants at the margin of term (e.g. 37 weeks
gestation), but these measurements should also be
plotted at age 0 on the 01 year chart.

24
23
22
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20
19
18
17
16
15
14
13
12
11
10
9
8
24kg
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
10
Gestational correction
This should only be used for infants born before
37 weeks.
Plot measurements at the childs actual age and then
draw a line back the number of weeks the infant was
preterm. Mark the spot with an arrow (see diagram
below): this is the childs gestationally corrected centile.
Gestational correction should continue until at least 1 year
of age and until 2 years for infants born before 32 weeks.
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
24kg
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
11
Assessing weight loss after birth
Some degree of weight loss is common in the rst week
but 80% of infants will have regained this by 2 weeks
of age. Recovery of birthweight by 2 weeks suggests
that feeding is effective and that the child is well.
Fewer than 5% of babies lose more than 10% of their
weight at any stage, and only 1 in 50 are 10% or more
lighter than birthweight at 2 weeks. A weight loss of 10%
or more at any stage therefore needs careful assessment.
Percentage weight loss can be calculated as follows:
Weight loss = difference between current weight
and birthweight
Percentage weight loss =
weight loss birthweight x 100%
For example:
A child born at 3.500kg who drops to 3.150kg at
5 days has lost 350g or 10% (0.35 3.5 x 100).
In a baby born at 3.000kg, a 150g
loss is 5% (0.15 3.0 x 100).
Interpreting the new growth chart
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
24kg
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
12
What do the centiles mean?
The new charts indicate a childs size compared
with children of the same age and maturity
who have shown optimum growth. The chart
also shows how quickly a child is growing.
The centile lines on the chart show the expected range
of weights and heights (or lengths); each describes the
number of children expected to be below that line,
e.g. 50% below the 50th, 91% below the 91st.
Children come in all shapes and sizes, but 99 out of 100
children who are growing optimally will be between
the two outer lines (0.4th and 99.6th centiles); half
will lie between the 25th and 75th centile lines.
Being very small or very big can sometimes be associated
with underlying illness. There is no single threshold below
which a childs weight or height is denitely abnormal,
but only 4 out of 1000 children who are growing
optimally are below the 0.4th centile, so these children
should be assessed to exclude any problems. Those above
the 99.6th centile for height are almost always healthy.
If weight is above the 99.6th centile, calculate body
mass index (BMI) (see page 17). Also calculate the BMI
if the weight and height centiles appear very different.
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
24kg
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
13
What is a normal rate of weight gain
and growth?
Babies do not all grow at the same rate, so a babys
weight often does not follow a particular centile line,
especially in the rst year. Weight is most likely to
track within one centile space (the gap between two
centile lines see the diagram on page 10). In infancy,
acute illness can lead to sudden weight loss and a
weight centile fall, but on recovery the childs weight
usually returns to its normal centile within two to
three weeks. However, a sustained drop through two
or more weight centile spaces is unusual (fewer than
2% of infants) and should be carefully assessed by the
primary care team, including measuring length/height.
Because it is difcult to measure length and height
accurately in pre-school children, successive
measurements commonly show wide variation.
If there are worries about growth, it is useful to
measure length or height on a few occasions over
time; if there is a stable average position over
time this suggests that growth is normal.
Head circumference centiles usually track within a range
of one centile space. After the rst few weeks a drop or
rise through two or more centile spaces is unusual (fewer
than 1% of infants) and should be carefully assessed.
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
24kg
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
14
Why do the length/height
centiles change at 2 years?
The growth standards show length data up to 2 years
of age, and height from age 2 onwards. When a child
is measured standing up, the spine is squashed a little,
so their height is slightly less than their length; the
centile lines shift down slightly at age 2 to allow for
this. It is important that this difference does not worry
parents; what matters is whether the child continues
to follow the same centile after the transition.
24
23
22
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20
19
18
17
16
15
14
13
12
11
10
9
8
24kg
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
15
Parents like to know how tall their child will be as an adult.
The childs most recent height centile (aged 24 years)
gives a good idea of this for healthy children. Plot this
centile on the adult height predictor to the right of the
height chart to nd the average adult height for children
on this centile. Four out of ve children will have adult
heights that are within 6cm above or below this value.


For example: if this boy is on
the 75th centile for height, the
adult height predictor suggests that
he may reach an adult height of
181cm +/ 6cm
Predicting adult height
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Weightheight to BMI
conversion chart
BMI indicates how heavy a child is relative to their height
and is the simplest measure of thinness and fatness from the
age of 2, when height can be measured fairly accurately.
In a child over 2 years of age, the BMI centile is a better
indicator of overweight or underweight than the weight
centile. The chart on page 18 provides an approximate BMI
centile, accurate to a quarter of a centile space.
Instructions for use of the weightheight
to BMI conversion chart
1. Read off the weight and height centiles from the
growth chart.
2. Plot the weight centile (left axis) against the height
centile (bottom axis) on the chart.
3. If between centiles, read across in this position.
4. Read off the corresponding BMI centile from the
slanting lines.
5. Record the centile with the date and the childs age
in the data box.
BMI = weight in kg (height in m x height in m)
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Interpretation
A child whose weight is average for their height will have
a BMI between the 25th and 75th centiles, whatever their
height centile.
BMI above the 91st centile suggests that the child
is overweight; a child above the 98th centile is very
overweight (clinically obese).
BMI below the 2nd centile is unusual and may reflect
under-nutrition.
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Training and education
from the Royal College of
Paediatrics and Child Health
The Department of Health and the Royal College of
Paediatrics and Child Health recommend the following:
Anyone who measures a child or plots or interprets charts
should be suitably trained or be supervised by someone
qualified to do so.
All users need training with the new UKWHO growth
charts in order to familiarise themselves with the changes:
Health professionals who occasionally use the new
charts will need to complete an introductory training
session of 3060 minutes.
Those who use the new charts regularly will be required
to complete a further two to three hours of training.
The growth chart educational materials can be
downloaded from the Royal College of Paediatrics and
Child Health website at: www.growthcharts.rcpch.ac.uk.
They include PowerPoint

slides, video clips, notes for

tutors and growth chart plotting exercises.
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Useful websites
www.growthcharts.rcpch.ac.uk
www.sacn.gov.uk/reports_position_statements/index.html
www.who.int/childgrowth/en
Further reading
Cole TJ (1997). Growth monitoring with the British 1990
growth reference. Archives of Disease in Childhood
76:4749
Cole TJ (2007). A chart to link child centiles of body mass
index, weight and height. Eur J Clin Nutr 56:119499
Cole TJ, Freeman JV, Preece MA (1998). British 1990 growth
reference centiles for weight, height, body mass index and
head circumference fitted by maximum penalized likelihood.
Stat Med 174:40729
De Onis M, Garza C, Victora CG et al. (2004). The WHO
Multicentre Growth Reference Study: planning, study design
and methodology. Food Nutr Bull 25(1):S15S26
Macdonald PD, Ross SR, Grant Let al. 2003. Neonatal
weight loss in breast and formula fed infants. Arch Dis Child
Fetal Neonatal Ed 88(6):F472F476
McKie A, Young D, Macdonald PD (2006). Does monitoring
newborn weight discourage breast feeding? Arch Dis Child
91(1):4446
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Scientific Advisory Committee on Nutrition and The Royal
College of Paediatrics and Child Health (2007). Application
of WHO Growth Standards in the UK. London: The
Stationery Office
WHO Multicentre Growth Reference Study Group
(2006). Assessment of differences in linear growth among
populations in the WHO Multicentre Growth Reference
Study. Acta Paediatr Suppl 450:5665
Wright CM, Waterston A, Matthews JNS et al. (1994).
What is the normal rate of weight gain in infancy? Acta
Paediatrica 83:35156
Wright C, Avery A, Epstein M et al. (1998). New chart to
evaluate weight faltering. Arch Dis Child 78(1):4043
Wright C, Lakshman R, Emmett P, Ong KK. 2008.
Implications of adopting the WHO 2006 Child Growth
Standard in the UK: two prospective cohort studies. Arch Dis
Child 93(7):56669
Wright CM, Parkinson KN (2004). Postnatal weight loss in
term infants: what is normal and do growth charts allow
for it? Arch Dis Child Fetal Neonatal Ed 89(3):F254F257
Crown copyright 2009
294502 2p 50K Nov 09 (ESP)
Gateway reference number 12892
Produced by COI for the Department of Health
If you require further copies of this title visit www.orderline.dh.gov.uk
and quote: Using the new UKWorld Health Organization 04 years
growth charts
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Using the new UKWorld Health Organization 04 years growth
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