Forget preschool entrance exams. The first stressful tests for a family can be those administered by a pediatrician with a tape measure and scale.
On the parenting website babble.com, Philadelphia-area mom Christine Coan recently told writer Jeanne Sager about her experience with a baby whose measurements didn't match up to the majority of children.
She was given the disheartening classification of "failure to thrive" for her son Alex, who was deemed small for his age.
"I was devastated. I was embarrassed," Ms. Coan said. "I got this pit in my stomach like I was a failure."
Alex, now 4, turned out to be a healthy, normal boy. But cases such as this highlight a growing scrutiny of seemingly neutral growth charts. While they are a standard tool for detecting potentially serious dips in a child's development, they don't always capture the whole picture. This is especially true of breast-fed infants, who can be leaner than formula-fed babies, especially in the six- to nine-month age range.
Now, a number of Canadian public health organizations representing doctors, nurses and dietitians are poised to adopt the 2006 World Health Organization international growth charts in place of the U.S.-based growth charts that were created by the Centers for Disease Control and Prevention.
In addition to recognizing the growth patterns of breast-fed babies, the WHO charts are also likely to reclassify those whom the CDC charts may have termed normal as overweight or obese.
"The WHO is the newest kid on the block in evaluating growth," says Calgary pediatrician Ted Prince, adding that with the U.S. charts, weight has been steadily climbing, and the WHO standards "have been more constant."
The Canadian Paediatric Society's nutrition and gastroenterology committee, led by Valérie Marchand, a pediatric gastroenterologist at St. Justine's Hospital in Montreal, is one of the groups looking at updating measurement policy. Dr. Marchand expects the committee to release the new policy by the end of the year.
The CDC charts are based on data gathered in five nationally representative surveys conducted between 1963 and 1994 in the United States. The 2000 charts are based on a representative sample of breast-fed and formula-fed children.
The recent WHO charts are based on a sample of 8,500 children between 1997 and 2003 in Brazil, Ghana, India, Norway, Oman and the United States.
Only breast-fed children in healthy environments - non-smoking households, for instance - are included in the sample. Measurements were taken 21 times between birth and the age of 5.
"The WHO charts are excellent because they are based on how a child in the best condition should grow," Dr. Marchand says. She and her colleagues will recommend the adoption of the organization's weight, height, BMI (body mass index) and head circumference measurements, based on age.
By conducting an international study, the WHO found there is actually little difference between children from different races or continents, Dr. Prince says. "Even across different socioeconomic populations, the growth is pretty constant."
It may also be a relief for parents of breast-fed children. The growth of those babies often slows for a few months at around the age of six months.
The CDC charts can create doubt in a mother's mind, Dr. Marchand says.
"You'll think, well, my child is not growing properly," she says. "Maybe I don't have enough milk, maybe I'm doing something wrong. Using growth charts that are for breast-fed babies will help those mothers feel more secure about their breastfeeding.
"Now that we are promoting breastfeeding, we really want to have a growth chart to reflect that to avoid misconceptions about growth and breast-fed infants."
Over all, the weight-for-height and BMI figures are a little lower on the WHO charts compared with the CDC's. As excess weight and obesity have grown in the United States, the heavier weights have been normalized.
"On the WHO chart, you'll see more patients labelled as overweight and less patients labelled as wasted," Dr. Marchand says. "Sometimes unnecessary worries can be avoided and justified worries can be better addressed."
The new charts will therefore help normalize the lean child and single out the overweight or obese child a little more, Dr. Prince says. What a difference a few percentage points make.
Children who are currently considered at the very top of the normal weight range for their age will be bumped into obese territory with the WHO charts, he says.
Until the new growth charts get their wide release, though, Dr. Prince says he and his colleagues need to be sensitive about sending parents away with rankings in their heads.
"It may happen that parents go away disheartened," he says. "That would be unfortunate. Physicians need to be mindful of what they say. But growth charts can be a sign that things aren't quite what they should be."