Interpreting CDC Growth Charts

Tracking Your Child's Weight

Plotting a child's BMI on the appropriate CDC growth chart is a useful tool for practitioners and caregivers to identify early signs of concern regarding undesirable weight changes, such as excessive weight gain or decrease (growth faltering). Monitoring a child's BMI percentile over time allows the practitioner to detect upward or downward trends (drifting) that can indicate potential health issues.  

For example, an 8-year-old girl weighing 62 pounds (28 kg), with a height of 50 inches (127 cm) tall, has a BMI of 17.5, placing her in the 77th percentile for her age. This is considered a healthy weight and her parents can expect her BMI-for-age to continue 'tracking' along the 77th percentile as she grows, provided her weight increases proportionally with her height. 

However, that same 77th percentile could be a 'red flag' for poor diet and/or physical activity habits if it reveals an upward drifting of her BMI%, perhaps from the 66th percentile at age 6 to the 77th at age 8. This 'early warning' enables parents to catch potentially unhealthy changes in a child's weight at an early age, when making changes in diet and exercise to correct the problem.

Growth Faltering

If there is a concern about faltering growth, the dietitian can take a detailed feeding/diet history. Patients who present with one atopic (allergic) diagnosis are at higher risk of having another atopic disease present. Evaluation of family history as well as a thorough diet history is important to determine if the patient needs to be referred to a specialist for evaluation. The more food allergies a patient has, the higher risk they have of growth faltering.

Based on the diet history, dietitians evaluate both nutrition and feeding practices that may impact dietary intake. Including:

• Mealtime arrangements and practices
• Types of food offered
• Food aversions and avoidance
• Parent/caregiver – child interactions, for example,  a parent/caregivers ability to recognize and respond to the child’s hunger/fullness cues
• Appetite
• Physical or developmental disorders that may impact feeding. Such as poor fine motor skills that restrict the child’s ability to feed themselves, or tongue-tie that may impact chewing and swallowing, etc.

Overweight/Obesity in Pediatric Patients

Patients who are overweight based on their growth charts interpretation should be assessment for malnutrition. Keep in mind malnutrition is defined as any deficiency, excess, or an imbalance of nutrients. The three broad categories of malnutrition are undernutrition, micronutrient-related malnutrition, and overweight/obesity and diet related noncommunicable diseases. Read more about this topic as presented by the World Health Organization. It is also important for the dietitian to consider the longterm implications of pediatric  overweight or obesity as they are at a higher risk of obesity concerns persisting into adulthood. (2)

References

1. 2 to 20 years:  Boys  Stature-for-age and Weight-for-age percentiles (CDC growth charts)  Accessed 6 September 2024.  Available at 2 to 20 years: Boys, Stature-for-age and Weight-for-age percentiles (cdc.gov)  
2. Use and Interpretation of the WHO and CDC growth charts for Children from Birth to 20 Years in the United States.  Accessed 6 September 2024.  Available at https://www.cdc.gov/nccdphp/dnpao/growthcharts/resources/growthchart-508.pdf. 
3. Faltering growth:  recognition and management of faltering growth in children.  National Institute for Health and Care Excellence (NICE). 2017.   Accessed 8 September 2024.  Available at https://www.nice.org.uk/guidance/ng75 
4. Balasundaram P, Krishna S. Obesity Effects on Child Health. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK570613/
5. Haas AM. Feeding disorders in food allergic children. Curr Allergy Asthma Rep. 2010 Jul;10(4):258-64. doi: 10.1007/s11882-010-0111-5. PMID: 20425004.