The World Health Organization has, after more than 25 years, corrected a serious anomaly in the child growth reference chart. “… This [earlier] reference was based on data from a limited sample of children from the United States. It contains a number of technical and biological drawbacks that makes it less adequate to monitor the rapid and changing rate of early childhood growth,” WHO press release stated.
The growth reference that the press release refers to was prepared in the late 1970s for infants and children less than five years of age based on a limited sample from just one country. To make it worse, the growth reference was based on children who were mostly formula-fed. It is well known that the growth patterns of formula-fed infants deviate substantially from those of breastfed infants. The reason being, formula-fed infants gain more weight compared with breastfed infants. And the result – breastfed infants would appear to be underweight.
It is not a question of breastfed infants’ growth just falling short of the ‘ideal’ as indicated in the growth reference, but the physiological factor that may push many a parent to change over to breast milk substitutes. That in effect would be denying infants the immense health benefits that come from being breastfed.
Though belated, WHO has now corrected the anomaly. The new ‘International child growth standard,’ released by WHO recently, is based on a study involving nearly 8,500 exclusively breastfed children from six countries – India, Brazil, Oman, Ghana, Norway and the United States. Unlike the currently followed outdated growth reference, which describes how children in different regions grow, the new standard describes how children “should grow” when all their needs are met.
The new standard would be universally applicable as it was derived from a large sample of exclusive breastfed children representing both the developed and developing countries. And that is what makes the standard superior to the earlier reference.
Nutrition, not genetics
The release also underlines the fact that children’s growth up to age five is dictated, among other things, by nutrition and feeding practices rather than genetics or ethnicity. “The new standards are based on the breastfed child as the norm for growth and development,” the release stressed. WHO reiterates that breastfed infants should be the standard for measuring healthy growth. This is not the first time that the world body has highlighted the benefits of exclusive breastfeeding.
That breastfed children enjoy not just healthy growth in terms of physical attributes but also better cognitive development has been well established. The importance attached to breastfeeding by the standard should serve as a fillip to those championing the cause of breastfeeding. It is worth noting that the Indian Government has been a staunch supporter of breastfeeding and had enacted legislation in 1993 to regulate the production, supply and distribution of infant milk substitutes, feeding bottles and infant foods.
Breastfeeding has, in the recent past, gained much attention for many reasons. While it is known that children fed on breast milk substitutes gain weight quickly compared with breastfed babies, such bonny babies face many health problems at a later stage. There is an increasing trend of children becoming overweight and obese in many developed countries. Developing countries too face this problem, though to a lesser degree. Several studies have shown overweight and obese children growing to become obese adults.
Breastfed children are less likely to become obese adults though certain food habits and sedentary lifestyle at a later stage can greatly offset the advantages gained by having been breastfed. Many diseases, including diabetes and cardio vascular disease, have been linked to obesity. And feeding children with breast milk substitutes is seen as one of the earliest contributors to obesity.
The standard has taken this into consideration and has for the first time included body mass index (BMI), which helps to know the total body fatness, for children. This will help parents, doctors and care givers to know if children are over or under-nourished. It has again for the first time included motor development milestones – sitting, standing and walking, with and without assistance, in the standard.