Research Impact


Redesigning children's growth charts

12 December 2014


Research at the UCL Institute of Child Health underpinned the update in 2009 of children's growth charts, which are now in universal use throughout the UK. Modified versions of the charts are also used in Ireland and New Zealand.

Growth charts play a fundamental role in assessing child health - from standard check-ups of all children, to the detailed monitoring of those with health problems. In the UK, growth charts are provided to all new parents as part of the Personal Child Health Record (PCHR) - known as the 'red book'. They are used in general practice, community paediatrics, general paediatrics and paediatric endocrinology.

These are the first growth charts to be designed with input from parents. - Professor Tim Cole

Growth charts used in the UK were previously based on the British 1990 reference. In 2006, the World Health Organization issued new growth standards, and the Department of Health Scientific Advisory Committee on Nutrition recommended that these be adapted for use in the UK. The Royal College of Paediatrics and Child Health commissioned a Growth Chart Expert Group to design the new charts. Members of this group from the UCL Institute of Child Health were Professors Tim Cole and Gary Butler, and Dr Helen Bedford.

The new growth charts were launched in the UK in 2009, and are now in universal use across the nations. The charts are available in two formats: A5 charts that are included in the personal child health record (PCHR) known as the 'red book', and A4 professional charts. All new mothers receive a copy of the PCHR - in 2012, for example, it was distributed to all parents of the 813,000 infants born in the four countries that year. The A4 professional charts are used in primary, secondary and tertiary care. They enable practitioners to recognise the range of normal development, and so assist in early recognition of growth disorders and risk factors for obesity.

The charts have also been adapted for use in other countries. In New Zealand they have been used since 2010, and in Ireland since 2013.

The guiding principles in the design of the new charts were that they should be evidence-based, useful and easy to use - and hence more likely to be effective. Parents often claim to understand growth charts, yet they show only limited comprehension when tested. The new charts have a better layout, clearer, more targeted instructions, and improved elements to assist interpretation. A new body mass index (BMI) look-up chart also makes it easier to plot the child's BMI centile over time. This helps to increase parental and professional awareness of a child's overweight, which parents are poor at recognising.

Funders included the Royal College of Paediatrics and Child Health and the MRC.

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