The New WHO Growth Reference in the First 6 Months of Life and Breastfeeding

Abstract

The regular monitoring of growth ranks with immunisation as the most frequently used paediatric intervention. The new WHO growth reference (WHO, 2006) was developed to replace the growth reference in widespread use around the world, the CDC 2000 growth reference. The old reference was thought not to reflect optimal growth rates, as the sample used contained a high proportion of formula-fed infants. It was thought that a new growth reference would be lighter than the existing one. When the new WHO 2006 growth reference was developed it was heavier than the existing reference for the first 6 months of life. After 6 months the weight-for-age curve is lighter than existing references as was expected. However, if the new WHO 2006 growth reference is used under the age of 6 months an increased proportion of infants will be classified as underweight. This may lead to the early introduction of complementary foods and even the cessation of breastfeeding. Before a new growth reference is introduced it should be the subject of a randomised controlled trial to ensure that such an important monitoring toll does not have an unexpected impact on breastfeeding. Until the situation can be resolved the WHO 2006 growth reference should not be used under 6 months of life.