Growth of Czech infants breastfed in the 1st year

(Growth charts of breastfed infants)

Riedlová J.1, Vignerová J.2, Paulová M.2

3rd Faculty of Medicine, Charles University, Prague1

National Institute of Public Health, Prague2

Grant IGA MZ ČR NS9974-4/2008-11

Growth charts

• Length/ height• Weight• Weight/height• Body mass index (BMI)• Head circumference

• Boys/girls• The part of the health

and vaccination record• Programme GrowthCZ

Goal of the survey (2008-11)

• Compare national growth charts with WHO standards

• Compare the growth of Czech excl. breastfed infants with Czech growth references

• Compare the growth of Czech excl. breastfed infants with WHO standards

• Elaborate guidelines for evaluation of growth of a breasfed child in collaboration with paediatric associations

Material and Methods

• Czech infants breastfed at least 4 months• Absence of health problems• Birth in term, singleton• Birth weight more than 2500 g• Mother – nonsmoker before and after birth• Mother – al least secondary school• Socioeconomic conditions does not constrain growth (conditions in accordance with the WHO sample)

• Measurements at preventive examinations in 18 months• Interview with mother + informed consent• Records of all measurements from birth – length, weight, head

circumference from Health and Vaccination Record of a child

Study design• Data collection from 43 pediatricians from March 2009 to May

2010, overall 1775 questionnaires

• Selection of infants according to WHO criteria 960 infants, 471 boys and 489 girls (11 measurements from

every child, i.e. overall 10727 measurements)• Percentile charts for particular parameters elaborated• Percentile charts of Czech breastfed infants compared with:

– WHO standards– Czech reference data from the Nation-wide Anthropological

Surveys: 2001 - length and head circumference 1991 – weight and weight/length

• Is higher in Czech infants compared to WHO sample

Czech reference more suitable for assessing Czech breastfed infants.

Length

Czech reference x Czech breastfed

Czech reference x WHO

• Is lower in Czech infants in first 6 months compared to WHO sample

• After 3 months relative deceleration of weight gain in BF infants. Take into account in order to prevent preliminary introduction of supplements.

Czech references (1991) can be used while considering this fact.

Czech reference x WHO

Czech reference x Czech breastfed infants

Weight

Weight for length• Cut-off for not thriving well = 3rd

percentile: higher values in the WHO sample = higher rate of infants not thriving when using WHO standard

• Up to cca 65 cm breastfed infants do not differ sign.from Czech reference.

• Then it is necessary to consider lower weight of BF infants, with lower values in the percentile chart.

Using Czech reference for assessing Czech breastfed infants

more suitable.

Czech reference x WHO

Czech reference x Czech breastfed infants

Head circumference• Is higher in Czech infants

compared to WHO sample• Differences between curves are

increasing with age• HC of BF infants corresponds to

Czech reference

Czech reference more suitable for Czech breastfed infants.

Czech reference x WHO

Czech reference x Czech breastfed infants

Conclusion

• The growth of a breastfed infant is specific. • Neither Czech reference charts nor WHO growth

standards can be used without individual interpretation in accordance with the clinical examination.

• Implementation of WHO standards to the pediatric practice would be very demanding (managament, financial, personal resources).

• Considering specific growth of a breastfed child (esp. development of weight) it is possible to use current Czech reference charts.

Information for lactation counsellors

Information for pediatricians via papers in professional journals.

Programme GrowthCZ and leaflet:http://www.szu.cz/publikace/data/rust-kojenych-deti

• Even growth• Arrest of growth• Acceleration of

growth

The possible course of growth related to percentile curves

Evaluation of weight in the percentile chart

Percentile range

Evaluation

97 < obese

90 – 97 overweight

75 – 90 robust

25 – 75adequate

weight

10 – 25 slim

3 – 10 low weight

< 3 thin1

3

5

7

9

11

13

0 1 2 3 4 5 6 7 8 9 10 11 12věk (měsíce)

kgHMOTNOST, dívky

Percentil

97

50

3

90

75

25

10

Decisions taken in other countries

• England: WHO standards might be used for age from 2 weeks to 24 months. Otherwise use English references.

• Belgium: WHO standards not adopted, growth of breastfed infants closer to national references.

• USA: WHO standards adopted for children 0-24 months.

• India: When using WHO standards there is a high proportion of malnourished infants – thus national references used.