Off the Charts
Why pediatricians are abandoning percentiles.
by Jeanne Sager
May 26, 2008
"Failure to thrive."
With just three words, Christine Coan's pediatrician reduced the Philadelphia-area mom to tears. The doctor explained that in just the 7th percentile for weight, 12th for height, Alex — who breastfed until he was eight months old — was too small.
"I was devastated. I was embarrassed," Coan said. "I got this pit in my stomach like I was a failure."
Coan isn't crying any more. These days, the topic of her son Alex's height and weight leaves her spitting mad.
Yes, Alex was, in her words, a "shrimp," just like she herself was growing up (Coan today is just 5'2"). But his low weight was due in part to the fact that Alex had just begun walking, his body quickly burning through the Gerber Graduates he wolfed down at each meal.
And he was simply growing at his own rate.
There's a trend in the pediatric community away from quoting percentiles to parents.
Now almost four, Alex is neither the shortest nor the tallest kid in his class. Healthcare practitioners have since confirmed what Coan suspected: her doctor's interpretation of the percentile charts was dead wrong.
Sour experiences like this have led to a trend in the pediatric community away from quoting percentiles to parents. It's not that percentiles themselves are bad, just that improper reading can be unduly upsetting and that the charts used in the U.S. have certain limitations, especially for breastfed babies like Alex Coan.
According to the World Health Organization (WHO), the fatal flaw of the percentiles used by most U.S. pediatricians to chart growth is this: they compare children to other American children, and other American children are, well, big. Thanks to the U.S. obesity crisis, many of them are in fact way too big. And that leads some parents of smallish children to look at the charts and believe their kids are undernourished.
Instead of looking to the percentiles, we should consider a new kind of chart, says the WHO. By their metrics, we would judge children's progress in comparison not to each other, but to a fixed ideal. Advocates of the WHO model say that data developed in a study of children given the very best care and raised in the very best circumstances provides a standard less arbitrary than a percentile based on the growth of random children who may or may not be healthy.
But here in the United States, plenty of pediatricians still use the old percentiles, and the U.S. government approves. Introduced in the late 1970s by the National Center for Health Statistics (NCHS), the weight and height charts now fall under the umbrella of the Centers for Disease Control (CDC), which put out an update in 2000. The CDC says these new, detailed charts are optimal for tracking growth and preventing childhood obesity.
But health organizations worldwide have accused the CDC of failing to keep pace with the WHO, which put out its own revamped charts in 2006. The WHO study, which began in the late '90s and ran through 2003, looked at more than 8,000 children spread across the world, including kids in the United States, Brazil, Ghana, India and Norway. Researchers limited their study to families who fit "specific behaviors that are consistent with current health promotion recommendations (e.g., breastfeeding norms, standard pediatric care and non-smoking requirements)."
©2008 Jeanne Sager and Babble
About the Author
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Jeanne Sager is a freelance writer and photographer living in upstate New York with her husband and daughter, Jillian. She maintains a blog of her award-winning columns at jeannesager.blogspot.com. |
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