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| EDITORIAL |
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| Year : 2011 | Volume
: 15
| Issue : 7 | Page : 154-155 |
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Growth charts
Vaman Khadilkar1, Sanjay Kalra2, Anuradha Khadilkar1
1 Department of Paediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Old building basement, Jehangir Hospital, 32, Sassoon Road, Pune, India
2 Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, India
| Date of Web Publication | 13-Sep-2011 |
Correspondence Address:
Vaman Khadilkar
Department of Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune - 411 001, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2230-8210.84848
How to cite this article:
Khadilkar V, Kalra S, Khadilkar A. Growth charts. Indian J Endocr Metab 2011;15, Suppl S3:154-5 |
Majority of pediatric endocrine disorders present with aberrations of growth. Therefore, assessment of growth by objective anthropometric methods of weight, length/height and body mass index (BMI) is perhaps the most important tool in the hands of clinicians while diagnosing a pediatric endocrine disorder. Anthropometry scores over all the available endocrine tests in the assessment of growth failure. Hence, it is of paramount importance that appropriate growth charts are used to assess anthropometric measures in children.
Plotting a child's growth must always be the starting point in the investigations of growth failure. Longitudinal data plotted over a period of time is far more useful than a single record of height and weight. Observation of growth pattern over a period of minimum 1 year is necessary before a child is subjected to rigorous endocrine evaluation. [1]
Reference data are central to growth monitoring, and anthropometric numbers in themselves do not have much importance if the normal values are not known..
Growth curves can be classified into two major types: growth standards and growth references. Growth standards are prescriptive and define how a population of children should grow, given optimal nutrition and optimal health. Growth reference, on the other hand, is descriptive and is prepared from a population which is thought to be growing in the best possible state of nutrition and health in a given community. World Health Organization (WHO) 2006 growth curves for children under the age of 5 years are an example of prescriptive standards. [2]
The pattern of growth of children changes with time, and hence it is recommended that references should be updated regularly. WHO published new growth standards for children under the age of 5 years in 2006, which are being adopted in many countries, including India, as a global single standard of childhood growth for the under five children. For children above the age of 5 years, however, no global prescriptive standard such as WHO Multicentre Growth Reference Study (MGRS) is available and each country is expected to update its own growth references.
India is in a phase of nutritional transition, and thus it is vital to update growth references in Indian children on a regular basis. The previously available growth reference curves in India were based on the data collected by Agarwal et al. in 1989, which were published in 1992 and 1994, and were then adopted by the Indian Academy of Pediatrics for growth monitoring in 2007. [3],[4],[5]
We performed a national study in 2007-2008 in all five zones of India. From the data obtained, new affluent Indian growth charts for children from 2 to 18 years were constructed for height, weight and BMI. These charts are are published in this issue. The secular trend when compared to 1989 data for height is mild, but taller boys and girls (children above 90 th percentile) have become further tall by almost 1 inch each. [6],[7] There is alarming rise in the prevalence of obesity. The rising trend of BMI in Indian children and adolescents observed in this multicentric study rings alarm bells in terms of possible adverse health consequences in adulthood.
The IJEM has focused on these aspects of pediatric health in the past. Editorials and reviews [8],[9] have highlighted the menace of childhood obesity and metabolic syndrome.
In this issue of IJEM, too, we have shown how affluent Indian children under 5 years perform on new WHO growth charts. Indian children under the age of 5 years still remain much shorter and lighter with a relative preservation of BMI, suggesting that they are symmetrically small. The applicability of these charts in Indian circumstances is also discussed along with which cutoffs from WHO charts may be used to define stunting and underweight in a developing country. [10]
Other issues of the IJEM, to be published this year, contain reviews on childhood obesity and hypertension, as well as the cardiovascular risk of these entities. [11],[12],[13] Along with the current charts published in this issue, [10] these articles serve as advocacy tools for the recognition, prevention, and management of pediatric endocrine and metabolic health issues. It is hoped that more attention will be paid by endocrinologists as well as other stake holders toward this aspect of endocrinology.
 References | |  |
| 1. | Buckler JM. Growth disorders in Children. 1 st ed. London: BMJ Publishing Group; 1994. 
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| 2. | World Health Organization. Training Course on Child Growth Assessment. Geneva: WHO; 2008.
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| 3. | Agarwal DK, Agarwal KN, Upadhyay SK, Mittal R, Prakash R, Rai S. Physical and sexual growth pattern of affluent Indian children from 5-18 years of age. Indian Pediatr 1992;29:1203-82.
[PUBMED] |
| 4. | Agarwal DK, Agarwal KN. Physical growth in Indian affluent children (Birth-6 years). Indian Pediatr 1994;31:377-413.
[PUBMED] |
| 5. | Khadilkar VV, Khadilkar AV, Choudhury P, Agarwal KN, Ugra D, Shah NK. IAP growth monitoring guidelines for children from birth to 18 years. Indian Pediatr 2007;44:187-97.
[PUBMED] [FULLTEXT] |
| 6. | Khadilkar VV, Khadilkar AV, Chiplonkar SA. Growth Performance of Affluent Indian Preschool Children: A Comparison with the New WHO Growth standard. Indian Pediatr 2010;47:869-72.
[PUBMED] |
| 7. | Khadilkar VV, Khadilkar AV, Cole TJ, Sayyad MG. Crosssectional growth curves for height, weight and body mass index for affluent Indian children, 2007. Indian Pediatr 2009;46:477-89.
[PUBMED] [FULLTEXT] |
| 8. | Qazi IA, Charoo BA, Sheikh MA. Childhood Obesity. Indian J Endocrinol Metab 2010;14:19-25.
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| 9. | Ganie MA. Metabolic syndrome in Indian children - An alarming rise. Indian J Endocrinol Metab 2010;14:1-2.
[PUBMED] [FULLTEXT] |
| 10. | Khaldilkar V, Khadilkar A. Growth charts: A diagnostic tool. Indian J Endocrinol Metab 2011;15:S166-71.
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| 11. | Nisha B. Pediatric Endocrine Hypertension. Indian J Endocrinol Metab 2011 [In Press].
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| 12. | Raj M. Essential hypertension in adolescents and children - Recent advances in causative mechanisms. Indian J Endocrinol Metab 2011 [In Press].
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| 13. | Raj M. Obesity and Cardiovascular Risk in Children. Indian J Endocrinol Metab 2011 [In Press].
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