1. Table 24 percentilecolumn headingsaligned correctly6/30/20102000 CDC Growth Charts forMay 2002the United States: Methodsand DevelopmentSeries 11, Number 246

2. Copyright informationAll material appearing in this report is in the public domain and may bereproduced or copied without permission; citation as to source, however, isappreciated.Suggested CitationKuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC growth charts for theUnited States: Methods and development. National Center for Health Statistics.Vital Health Stat 11(246). 2002Library of Congress Cataloging-in-Publication Data2000 CDC growth charts for the United States: methods and development. p. cm. (DHHS publication ; no. (PHS) 2002-1696) (Vital and healthstatistics. Series 11, Data from the National Health Survey ; no. 246) May, 2002. ISBN 0-8406-0575-7 1. ChildrenAnthropometryUnited StatesStatistics. 2. ChildrenUnited StatesGrowthStatistics. 3. United StatesStatistics, Vital.I. Series. II. Series: Vital and health statistics. Series 11, Data from theNational Health Survey ; no. 246GN63 .A225 2001305.230973021dc212001051405For sale by the U.S. Government Printing OfficeSuperintendent of DocumentsMail Stop: SSOPWashington, DC 20402-9328Printed on acid-free paper. 3. Series 11, Number 2462000 CDC Growth Charts forthe United States: Methodsand DevelopmentData From the National HealthExamination Surveys and the NationalHealth and Nutrition ExaminationSurveysDEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health StatisticsHyattsville, MarylandMay 2002DHHS Publication No. (PHS) 2002-1696 4. National Center for Health StatisticsEdward J. Sondik, Ph.D., DirectorJack R. Anderson, Deputy DirectorJack R. Anderson, Acting Associate Director forInternational StatisticsJennifer H. Madans, Ph.D., Associate Director for ScienceLawrence H. Cox, Ph.D., Associate Director for Researchand MethodologyJennifer H. Madans, Ph.D., Acting Associate Director forAnalysis, Epidemiology, and Health PromotionEdward L. Hunter, Associate Director for Planning, Budget,and LegislationJennifer H. Madans, Ph.D., Acting Associate Director forVital and Health Statistics SystemsDouglas L. Zinn, Acting Associate Director forManagementCharles J. Rothwell, Associate Director for InformationTechnology and ServicesDivision of Health Examination StatisticsClifford L. Johnson, M.S.P.H., DirectorRosemarie Hirsch, M.D., M.P.H., Chief Analysis BranchCarolyn Petty-Martin, Acting Chief Operations BranchVicki L. Burt, Sc.M., R.N., Chief Planning BranchLewis Berman, M.S., Chief Information Management Branch 5. AcknowledgmentsJohn Chang Computer Information Systems and Support Services Nova Research CompanyW e wish to gratefully acknowledge the contributions Bethesda, MD of many individuals who had Chris Cronkvarious roles in the growth chartCenter for Health Statisticsrevision process. These contributionsState of Wisconsin Department ofinclude statistical and computer Health and Family Servicesprogramming expertise, data andMadison, WIsummary statistics, graphical support,and knowledge and experience in theWilliam Davisareas of pediatric growth and growth Klemm Analysis Group, Inc.charts. We also wish to thank Thelma Washington, DCSanders and Zung Le for their editorialCatherine Duransupport. In addition to acknowledgingNational Center for Health Statisticsthe contributions of all individuals Centers for Disease Control andidentified in appendix I of this report, Preventionthe following persons are also Hyattsville, MDrecognized, with their affiliations at thetime of their contribution:Odell Eldridge Computer Information Systems andPhil Batty Support ServicesCenter for Health InformationNova Research Company Management and Epidemiology Bethesda, MDState of Missouri Department of HealthJefferson City, MO Stephen Sloan National Center for Health StatisticsFred BuhrCenters for Disease Control andCenter for Health Statistics PreventionState of Wisconsin Department of Hyattsville, MDHealth and Family ServicesMadison, WIChristine Zeller Department of Community HealthMargaret Carroll Wright State UniversityNational Center for Health StatisticsYellow Springs, OHCenters for Disease Control andPreventionHyattsville, MD iii 6. ContentsAcknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iiiAbstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Concerns Surrounding the 1977 Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 The Revision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Data Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Data Exclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Statistical Curve Smoothing Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Observed and Smoothed Percentiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Evaluation of the Revised Growth Curves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Differences Between the 1977 NCHS and the 2000 CDC Growth Curves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11Revision Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11Growth Chart Workshops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12Major Features of the 2000 CDC Growth Charts for the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12Using the Revised Growth Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Specialized Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13General Growth Chart Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Appendix I. Description of Growth Chart Workshops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .187Workshop 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187Workshop 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188Workshop 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189Workshop 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189Appendix TableI.Participants in the NCHS growth chart workshops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .187Figures 1.Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, birth to 36 months:Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, birth to 36 months:Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 3.Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, birth to 36 months:Boys length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 4.Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, birth to 36 months:Girls length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 v 7. 5. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, birth to 36 months: Boys weight-for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 6. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, birth to 36 months: Girls weight-for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 7. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, birth to 36 months: Boys head circumference-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 8. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, birth to 36 months: Girls head circumference-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 9. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, 2 to 20 years: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 10.Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, 2 to 20 years: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 11.Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, 2 to 20 years: Boys stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 12.Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, 2 to 20 years: Girls stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 13.Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th, 97th percentiles, 2 to 20 years: Boys body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 14.Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th, 97th percentiles, 2 to 20 years: Girls body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 15.Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th, 97th percentiles: Boys weight-for-stature . . . 33 16.Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th, 97th percentiles: Girls weight-for-stature . . .34 17.Clinical growth chart 5th, 10th, 25th, 50th, 75th, 90th, 95th percentiles, birth to 36 months: Boys length-for-age and weight-for-age percentiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 18.Clinical growth chart 5th, 10th, 25th, 50th, 75th, 90th, 95th percentiles, birth to 36 months: Girls length-for-age and weight-for-age percentiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 19.Clinical growth chart 5th, 10th, 25th, 50th, 75th, 90th, 95th percentiles, birth to 36 months: Boys head circumference-for-age and weight-for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 20.Clinical growth chart 5th, 10th, 25th, 50th, 75th, 90th, 95th percentiles, birth to 36 months: Girls head circumference-for-age and weight-for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 21.Clinical growth chart 5th, 10th, 25th, 50th, 75th, 90th, 95th percentiles, 2 to 20 years: Boys stature-for-age and weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 22.Clinical growth chart 5th, 10th, 25th, 50th, 75th, 90th, 95th percentiles, 2 to 20 years: Girls stature-for-age and weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40 23.Clinical growth chart 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th percentiles, 2 to 20 years: Boys body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 24.Clinical growth chart 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th percentiles, 2 to 20 years: Girls body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 25.Clinical growth chart 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th percentiles: Boys weight-for-stature . . . . . . . . . . . . .43 26.Clinical growth chart 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th percentiles: Girls weight-for-stature . . . . . . . . . . . . . 44 27.Smoothed percentile curves, 2239 months: Boys length-for-age and stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 28.Smoothed percentile curves, 2239 months: Girls length-for-age and stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 29.Smoothed percentile curves, 75106 cm: Boys weight-for-length and weight-for-stature . . . . . . . . . . . . . . . . . . . . . . . . .47 30.Smoothed percentile curves, 75106 cm: Girls weight-for-length and weight-for-stature . . . . . . . . . . . . . . . . . . . . . . . . . 48 31.Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, birth to 36 months: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 32.Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, birth to 36 months: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 33.Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, birth to 36 months: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51 34.Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, birth to 36 months: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52 35.Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, birth to 36 months: Boys recumbent length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 36.Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, birth to 36 months: Boys recumbent length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 37.Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, birth to 36 months: Girls recumbent length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55vi 8. 38. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, birth to 36 months: Girls recumbent length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5639. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 46102 cm: Boys weight-for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5740. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, 46102 cm: Boys weight-for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5841. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 46102 cm: Girls weight-for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5942. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, 46102 cm: Girls weight-for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6043. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, birth to 36 months: Boys head circumference-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6144. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, birth to 36 months: Boys head circumference-for-age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6245. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, birth to 36 months: Girls head circumference-for-age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6346. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, birth to 36 months: Girls head circumference-for-age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6447. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 78120 cm: Boys weight-for-stature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6548. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, 78120 cm: Boys weight-for-stature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6649. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 78120 cm: Girls weight-for-stature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6750. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, 78120 cm: Girls weight-for-stature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6851. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 24237 months: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6952. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, 24237 months: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7053. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 24237 months: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7154. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, 24237 months: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7255. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 24237 months: Boys stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7356. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, 24237 months: Boys stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7457. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 24237 months: Girls stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7558. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, 24237 months: Girls stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7659. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 24237 months: Boys body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7760. Comparison of smoothed 5th, 25th, 50th, 75th, 85th, 95th percentile curves to empirical data points, 24237 months: Boys body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7861. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 24237 months: Girls body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7962. Comparison of smoothed 5th, 25th, 50th, 75th, 85th, 95th percentile curves to empirical data points, 24237 months: Girls body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8063. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, birth to 33 months: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8164. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, birth to 33 months: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8265. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, birth to 33 months: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8366. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, birth to 33 months: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84 vii 9. 67. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, birth to 33 months: Boys length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8568. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, birth to 33 months: Boys length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8669. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, birth to 33 months: Girls length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8770. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, birth to 33 months: Girls length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8871. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 46103 cm: Boys weight for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8972. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, 46103 cm: Boys weight for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9073. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 46103 cm: Girls weight for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9174. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, 46103 cm: Girls weight for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9275. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, birth to 33 months: Boys head circumference-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9376. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, birth to 33 months: Boys head circumference-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9477. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, birth to 33 months: Girls head circumference-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9578. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, birth to 33 months: Girls head circumference-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9679. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 84122 cm: Boys weight for-stature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9780. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, 84122 cm: Boys weight for-stature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9881. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 84122 cm: Girls weight for-stature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9982. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, 84122 cm: Girls weight for-stature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10083. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 27237 months: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10184. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, 27237 months: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10285. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 27237 months: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10386. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, 27237 months: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10487. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 27237 months: Boys stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10588. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, 27237 months: Boys stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10689. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 27237 months: Girls stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10790. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, 27237 months: Girls stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10891. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 27237 months: Boys body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10992. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 85th, 95th percentile curves, 27237 months: Boys body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11093. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 27237 months: Girls body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11194. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 85th, 95th percentile curves, 27237 months: Girls body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11295. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, birth to 36 months: Boys weight-for-age . . . . . . . . 113viii 10. 96. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, birth to 36 months: Girls weight-for-age . . . . . . . . . 114 97. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles withNCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, birth to 36 months:Boys recumbent length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115 98. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles withNCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, birth to 36 months:Girls recumbent length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 99. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, 4994 cm: Boys weight-for-length. . . . . . . . . . . . . .117100. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, 4994 cm: Girls weight-for-length. . . . . . . . . . . . . . 118101. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles withNCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, birth to 36 months:Boys head circumference-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119102. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles withNCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, birth to 36 months:Girls head circumference-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120103. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, 91120 cm: Boys weight-for-stature . . . . . . . . . . . . 121104. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, 91120 cm: Girls weight-for-stature . . . . . . . . . . . .122105. Comparison of revised CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles withNCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, 24213 months:Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123106. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, 24213 months: Girls weight-for-age . . . . . . . . . . .124107. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, 24213 months: Boys stature-for-age . . . . . . . . . . .125108. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, 24213 months: Girls stature-for-age . . . . . . . . . . . 126Text TablesA. Charts included in the 1977 NCHS Growth Charts and the 2000 CDC Growth Charts . . . . . . . . . . . . . . . . . . . . . . . . . . 2B. Source of data for each growth chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3C. Primary and supplemental data sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4D. Summary of curve smoothing procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Detailed Tables 1.Unweighted sample sizes for weight-for-age chart by sex, age, and data source: Births to 36 months . . . . . . . . . . . . . . 127 2.Unweighted sample sizes for recumbent length-for-age chart by sex, age, and data source: Birth to 36 months . . . . . .128 3.Unweighted sample sizes for weight-for-recumbent length chart by sex, length interval, and data source:Birth to 36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 4.Unweighted sample sizes for head circumference-for-age chart by sex, age, and data source: Birth to 36 months . . . .130 5.Unweighted sample sizes for weight-for-stature chart by sex, stature interval, and data source: 77 to 121 cm . . . . . . . 131 6.Unweighted sample sizes for weight-for-age chart by sex, age, and data source: 2 to 20 years . . . . . . . . . . . . . . . . . . . 132 7.Unweighted sample sizes for stature-for-age chart by sex, age, and data source: 2 to 20 years . . . . . . . . . . . . . . . . . . .134 8.Unweighted sample sizes for body mass index (BMI)-for-age chart by sex, age, and data source: 2 to 20 years . . . . .136 9.Observed mean, standard deviation, and selected percentiles for weight (in kilograms) by sex and age:Birth to 36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13810.Observed mean, standard deviation, and selected percentiles for recumbent length (in centimeters) by sex and age:Birth to 36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13911.Observed mean, standard deviation, and selected percentiles for weight (in kilograms) by sex and recumbent length:Birth to 36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14012.Observed mean, standard deviation, and selected percentiles for head circumference (in centimeters) by sex and age:Birth to 36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141ix 11. 13. Observed mean, standard deviation, and selected percentiles for weight (in kilograms) by sex and stature: 77 to 121 cm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14214. Observed mean, standard deviation, and selected percentiles for weight (in kilograms) by sex and age: 2 to 20 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14315. Observed mean, standard deviation, and selected percentiles for stature (in centimeters) by sex and age: 2 to 20 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14516. Observed mean, standard deviation, and selected percentiles for body mass index (kilograms/meter2) by sex and age: 2 to 20 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14717. L, M, and S parameters and selected smoothed percentiles for weight (in kilograms) by sex and age: Birth to 36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14918. L, M, and S parameters and selected smoothed percentiles for recumbent length (in centimeters) by sex and age: Birth to 36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15119. L, M, and S parameters and selected smoothed percentiles for weight (in kilograms) by sex and recumbent length (in centimeters): Birth to 36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15320. L, M, and S parameters and selected smoothed percentiles for head circumference (in centimeters) by sex and age: Birth to 36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15621. L, M, and S parameters and selected smoothed percentiles for weight (in kilograms) by sex and stature (in centimeters): 77 to 121 cm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15822. L, M, and S parameters and selected smoothed percentiles for weight (in kilograms) by sex and age: 2 to 20 years . . 16023. L, M, and S parameters and selected smoothed percentiles for stature (in centimeters) by sex and age: 2 to 20 years . 16924. L, M, and S parameters and selected smoothed percentiles for body mass index (BMI, kilograms/meter2) by sex and age: 2 to 20 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178x 12. ObjectivesThis report provides detailed2000 CDC Growth Charts forinformation on how the 2000 Centersfor Disease Control and Prevention(CDC) growth charts for the United the United States: Methods andStates were developed, expandingupon the report that accompanied the Developmentinitial release of the charts in 2000. Robert J. Kuczmarski, M.S.P.H., M.P.H., R.D., Dr.P.H., Division ofMethodsDigestive Diseases and Nutrition, National Institute of Diabetes and The growth charts were developedDigestive and Kidney Diseases, National Institutes of Health;with data from five national healthexamination surveys and limited Cynthia L. Ogden, M.R.P., Ph.D., Division of Health Examinationsupplemental data. SmoothedStatistics; Shumei S. Guo, M.S., Ph.D.,Center for Lifetime Healthpercentile curves were developed inResearch, School of Medicine, Wright State University; Laurence M.two stages. In the first stage, selected Grummer-Strawn, M.A., M.P.A., Ph.D., Division of Nutrition andempirical percentiles were smoothedwith a variety of parametric and Physical Activity, National Center for Chronic Disease Prevention andnonparametric procedures. In the Health Promotion; Katherine M. Flegal, M.S., M.P.H., Ph.D., Divisionsecond stage, parameters were createdof Health Examination Statistics; Zuguo Mei, M.P.H., M.D., Divisionto obtain the final curves, additionalpercentiles and z-scores. The revised of Nutrition and Physical Activity, National Center for Chroniccharts were evaluated using statisticalDisease Prevention and Health Promotion; Rong Wei, M.S., Ph.D.,and graphical measures.Office of Research and Methodology; Lester R. Curtin, Ph.D., Office of Research and Methodology; Alex F. Roche, M.D., Ph.D., D.Sc.,ResultsF.R.A.C.P., Center for Lifetime Health Research, School of Medicine, The 1977 National Center for Health Wright State University; Clifford L. Johnson, M.S.P.H., Division ofStatistics (NCHS) growth charts wererevised for infants (birth to 36 months) Health Examination Statisticsand older children (2 to 20 years). Newbody mass index-for-age (BMI-for-age)charts were created. Use of nationaldata improved the transition from the Introductionstature-for-age, and body mass index (BMI)-for-age curves. The BMI-for-ageinfant charts to those for older children. charts represent a new tool that can beThe evaluation of the charts found noused by health care providers for the Tlarge or systematic differences between he National Center for HealthStatistics (NCHS) growth chartsearly identification of children who arethe smoothed percentiles and thethat have been in use since 1977 at risk for becoming overweight at olderempirical data. have been revised. The revised version, ages. The 2000 CDC Growth Charts known as the Centers for Diseasealso include weight-for-stature charts forConclusion Control and Prevention (CDC) Growth statures ranging from 77 to 121 cm, The 2000 CDC growth charts were Charts: United States released in 2000, primarily intended for use amongdeveloped with improved data and is recommended for use in clinicalchildren from ages 2 to 5 years. Astatistical procedures. Health careproviders now have an instrument for practice and research to assess size andlisting of the 1977 NCHS charts and thegrowth screening that better representsgrowth in U.S. infants, children, and 2000 CDC charts is shown in table A.the racial-ethnic diversity andadolescents (1).combination of breast- and formula- The 2000 CDC Growth Charts Historical Backgroundfeeding in the United States. It isconsist of a set of charts for infants,recommended that these charts replacebirth to 36 months of age and a set ofAnthropometric data are valuablethe 1977 NCHS charts when assessingobjective indicators of attained size and charts for children and adolescents fromthe size and growth patterns of infants, physical growth in children. A variety of ages 2 to 20 years. The charts forchildren, and adolescents. growth references were developed and infants include sex-specific smoothed percentile curves for weight-for-age, used in the United States since the earlyKeywords: growth charts c height c recumbent length-for-age, head1900s. Most of these earlier referenceslength c weight c body mass index c circumference-for-age, and weight-forhave considerable limitations, includinghead circumference c NHANES recumbent length; the charts for children lack of coverage for infants and and adolescents include weight-for-age, preschool children and limited Page 1 13. Page 2 [ Series 11, No. 246representation of ethnic, genetic,Table A. Charts included in the 1977 NCHS Growth Charts and in the 2000 CDC GrowthChartssocioeconomic, environmental, andgeographic variability (2). From1977 NCHS Growth Charts* 2000 CDC Growth Charts*19461976, the Stuart/Meredith GrowthWeight-for-age Weight-for-ageCharts were widely used. These chartsBirth to 36 months Birth to 36 monthswere derived from stature and weight 2 to 18 years2 to 20 yearsmeasurements taken on white childrenLength-for-age Length-for-ageliving near Iowa City, Iowa, or inBirth to 36 months Birth to 36 monthsBoston, Massachusetts, from 1930 to Weight-for-lengthWeight-for-length1945 (3). The sample sizes wereBirth to 36 months Birth to 36 monthsBoys (49 to 103 cm)Boys (45 to 103 cm)relatively small and the smoothed Girls (49 to 101 cm) Girls (45 to 103 cm)percentile lines were reportedly basedHead circumference-for-age Head circumference-for-ageon mathematical approximations ofBirth to 36 months Birth to 36 monthscurves smoothed by hand (4). Thus, theStature-for-ageStature-for-agedata did not represent the diversity of 2 to 18 years2 to 20 yearschildren residing in the United Statesand statistical curve-fitting proceduresWeight-for-stature** Weight-for-stature** Boys (90 to 145 cm)Boys (77 to 121 cm)were not used. Girls (90 to 137 cm) Girls (77 to 121 cm) The impetus for the development of BMI-for-agethe 1977 NCHS Growth Charts began in2 to 20 years1971, when a study group sponsored by*All charts are sex-specific.the American Academy of Pediatrics and**The 1977 charts are applicable to boys with stature from 90 to 145 cm and age under 11.5 years, and to girls with stature fromthe Maternal and Child Health Program 90 to 137 cm and under 10.0 years of age. They are not applicable for any child showing the earliest signs of pubescence. Therevised charts have no similar age or pubescence restrictions. Although the revised charts were developed for children 2 to 5 yearsof the Bureau of Community Health of age, in practice they may accommodate some shorter children with chronologic ages 5.0 years and over.Services, U.S. Public Health Service,recommended new growth charts, basedyear. Therefore, the national survey data normalized charts was the ability toon data from the NCHS Healthwere supplemented with data from thedescribe the relative status of children atExamination Surveys, for the clinicallongitudinal growth study of the Fels extremes of the distributions.assessment of infants and children (5).Research Institute in Yellow Springs,Although the normalized chartsSubsequently, in 1974, the Food andOhio. To avoid pooling multiple diverse allowed users a means to better quantifyNutrition Board of the Nationaldata sets in the 1977 NCHS charts for growth at the extremes, normalizationAcademy of Sciences made similarbirth to 3 years, the infant charts weredoes not refer to an improvedrecommendations, emphasizing the need based solely on the Fels data. The 14 instrument to qualify growth asfor new growth charts for infants and sex-specific growth charts developed fornormal or as a standard for growth.children based on nationallyinfants birth to age 36 months and olderBoth the 1977 smoothed percentiles andrepresentative survey data, to be children from ages 2 to 18 years arethe 1978 normalized growth curves aresupplemented with data collected from generally referred to as the 1977 NCHSgrowth references. They allow theinfants in the Fels Longitudinal Growth Growth Charts (2,8,9).growth status of a child, or a group ofStudy (6). These recommendations wereIn 1978 CDC produced a children, to be compared with that of afurther supported in 1975 by a studynormalized version of the NCHSreference population. The 1978group sponsored by the National curves (10,11). The World Healthnormalized curves are similar to, but notInstitute of Child Health and Human Organization (WHO) subsequently identical with the 1977 smoothedDevelopment, National Institutes of recommended these normalized charts percentiles.Health (7). for international applications (1214). Growth charts for the United StatesThese normalized versions of the 1977were developed by NCHS when Concerns Surrounding thecharts are thus sometimes referred to asnationally representative cross-sectional the NCHS/WHO, CDC/WHO, or 1977 Chartssurvey data became available for most NCHS/CDC/WHO growth charts.of the pediatric age range (8). Data from Since the development of the 1977Following the recommendation of NCHS Growth Charts, a number ofthe National Health Examination SurveyWaterlow, et al., this version enabled the(NHES) II (196365) for ages 611 concerns have been raised about variousexpression of body measurements inaspects of the charts and the proceduresyears, NHES III (196670) for agesterms of standard deviations from the1217 years, and the first National used in their development (10,1623).median or z-scores (15). Z-scores Most of these concerns centered on theHealth and Nutrition Examinationfacilitate comparisons across ages andSurvey (NHANES) I (197174) for agesinfant charts and were largely associatedallow the mean and standard deviation with characteristics of the Fels data. The117 years were used to develop these to be calculated for a group ofcharts. National survey data were not Fels data came from a singlemeasures. Another advantage of thelongitudinal study of mainly formulaavailable for the period from birth to 1 14. Series 11, No. 246 [ Page 3fed, white middle-class infants in aweight-for-stature references for present report is designed to expand onlimited geographic area of southwestern adolescents, and the inability to assessthe content of the initial report andOhio, collected 192975. In addition to growth at ages 18 years and over (16).provide more detailed information onnot being from a nationally the development of the revised CDCrepresentative sample, the Fels The Revisiongrowth charts for the United States,observations were made at birth and 1 including the process, the data sources,month, at 3-month intervals from 3 toThe 1977 charts were revised inthe statistical procedures that were12 months, and at 6-month intervals part because more recent andfollowed, and the results of statisticalfrom 12 to 36 months. These intervals comprehensive national data on body evaluations for the revised charts.may be inadequate to properly identifymeasurements in U.S. children weregrowth patterns during periods of rapid available. After the 1977 NCHS Growthchange. The Fels birthweights may not Charts were developed, additional Methodsmatch more recent national birthweightnational survey data became availabledistributions, and differences betweenfrom the NHANES II (197680)recumbent length and stature may have beginning at 6 months of age, and fromData Sourcesbeen too large, suggesting limitations in the NHANES III (198894) beginningthe recumbent length data. Moreover,at 2 months of age (24,25). During the The source of data for each growthsize and growth patterns of Fels infantsplanning of NHANES III, increasingchart is shown in table B. The primarymay not adequately represent currentawareness of the concerns surrounding and supplemental data sources aregrowth patterns of combined breast- and the 1977 NCHS Growth Charts summarized in table C. Detailed sampleformula-fed infants in the population influenced the decision to oversample sizes for the data used to create each(8,18,19,21,22). In addition, differences children ages 2 months to 6 years.chart, stratified by age, sex, and databetween the recumbent length The objective of the revisionsource, are shown in detailed tables 18.measurements for infants from the Felsprocess was to use improved statisticaldata and the stature measurements fromsmoothing procedures, in conjunctionNational Datathe NCHS data sets lead to inconsistent with more comprehensive national The revised growth curves for thepercentile estimates from the 1977survey data, to provide a betterUnited States were developed with datacharts when the transition is made from instrument for health care providers whocollected by NCHS in five cross-recumbent length to stature between 24evaluate the growth status of children in sectional, nationally representativeand 36 months of age. Other concernsthe United States (16). The Advance health examination surveys (table C):included the limited ability to assessData report summarizing the the NHES II (196365) and IIIsize and growth at extremes beyond thedevelopment of the revised growth (196670), and NHANES I (197174),5th and 95th percentiles, the absence ofcharts was issued in 2000 (1). TheTable B. Source of data for each growth chartAge (months) orChartheight (cm) range Primary data sources1 Supplemental data sourcesWeight-for-age Birth to 36 monthsNational surveys 352National birth certificate data fromUnited States Vital Statistics2Length-for-age Birth to 36 monthsNational surveys 352,3Birth certificate data from Wisconsinand Missouri State vital statistics2,4;CDC Pediatric Nutrition SurveillanceSystem data for 0.5, 1.5, 2.5, 3.5, and4.5 months2Head circumference-for-age Birth to 36 monthsNational surveys 352Fels Longitudinal Study data2Weight-for-length45 to 103 cmNational surveys 352,5Birth certificate data from Wisconsinand Missouri State vital statistics2Weight-for-stature 77 to 121 cmNational surveys 355NoneWeight-for-age 24 to 240 monthsNational surveys 155NoneStature-for-age24 to 240 monthsNational surveys 15 None5BMI-for-age24 to 240 monthsNational surveys 15 None1 Survey 1 = NHES II, Survey 2 = NHES III, Survey 3 = NHANES I, Survey 4 = NHANES II, and Survey 5 = NHANES III.2 Excludes birthweight