Children’s growth is determined using height and weight.
Growth curves are then used to determine whether a child is growing properly.
But what is healthy growth?
And is it the same all over the world?
Are height and weight on their own sufficient to determine this?
Hinke Haisma, demographer and nutritionist at the University of Groningen, thinks that the way that children’s growth is determined can be improved.
‘We should not only look at their height and weight, but also at where and how children grow up.’
‘Not long ago, the World Health Organization (WHO) developed new growth curves. They based them on data from children from six countries, from Oman to Norway, all from prosperous families. The problem with using these curves is that they set a standard – they dictate how children should be growing. But what is good? And is it the same everywhere? That’s the crucial question. In countries where there is not only malnutrition but also increasing obesity, for example Brazil, it should be questioned whether the children from wealthier families should be taken as the norm. And even within the Netherlands there are significant differences. In East Groningen children grow up under different circumstances than those in a multicultural neighbourhood in Rotterdam, and parents need to be advised in a different way.’
‘In order to be able to advise parents properly about their child’s growth, care providers need an instrument to chart that growth. That instrument should not only be based on height and weight, but also take into account the circumstances in which the child is growing up. Does the mother work? Can she breastfeed? When do parents consider someone to be obese? These are the kinds of question you have to take into account. Sometimes a care provider will discover that it’s better not to use the word “obese” in their advice because it simply means nothing to the parents. Better advice would be, for example, to eat together more often instead of everyone shoving their own pizza in the oven. If you phrase the advice differently, perhaps it will hit the target!’
‘Internationally, the problems are even more polarized. In Tanzania the birth weight of babies is good on average, but problems often arise as soon as the transition is made from breastfeeding to regular food. That’s when the children start to have problems with diarrhoea and other diseases because dirty water is used to prepare the food. There’s simply no point in just looking at the nutritional status. The advice must involve the availability of clean water.’
‘In India completely different problems rule. There many children are born underweight. If you only looked at the growth curves, you would advise parents to feed up their children so that they quickly get up to weight. But children with a low birth weight are in a sense “preprogrammed for food shortages”. Their metabolism is different to that of children with normal weight. If you give such children extra food, you significantly increase their chances of developing diabetes in later life. In this case, too, tailored advice is what’s needed.’
‘Because the current instrument to measure growth only looks at height and weight, care has become medicalized. You do parents and their children an injustice if you recommend weighing a baby before and after every feed, or encourage parents to give their child extra food if it falls just under the curve with breastfeeding. It’s highly likely that parents will lose confidence with this kind of advice. It’s not for nothing that young Dutch parents often call the ‘consultation bureaus’, the health centres that monitor child development, consternation bureaus. But it is possible to really support parents if care providers have a measurement instrument which they can use to look at the situation behind the growth curves as well.’
(1967) is assistant professor and Rosalind Franklin Fellow at the department of Demographics of the University of Groningen. After graduating in nutrition studies from Wageningen, she worked for the International Atomic Energy Agency (IAEA) in Vienna and for the World Health Organization (WHO) in Brazil. Haisma gained a PhD in 2004 with research on the link between socioeconomic status, breastfeeding and obesity in Brazil. Earlier this month NWO awarded her a prestigious VIDI grant for innovative, international research on how healthy growth can be determined differently by using more than just height and weight.
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