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South Med J. 2013 Sep;106(9):495-9. doi: 10.1097/SMJ.0b013e3182a5efe6.

WHO growth chart awareness among clinicians in Kentucky.

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From the College of Medicine and the Applied Statistics Laboratory, University of Kentucky, Lexington, USA.



To examine children's growth chart use among clinicians and explore awareness of the Centers for Disease Control and Prevention's (CDC) recommendations for the use of World Health Organization (WHO) growth charts.


A cross-sectional survey of pediatricians and family practitioners in Kentucky.


Only 29% of clinicians reported using WHO growth charts, with board-certified urban pediatricians more likely to be aware of the WHO growth charts and to recognize that CDC growth charts led them to overdiagnose infants as being underweight. Approximately one-fourth of respondents did not know the source of growth charts for their practice. Only 13% of clinicians discussed body mass index and other vital parameters with parents and provided copies of growth charts at the end of patient visits. Clinicians who provided copies of growth charts to parents were more likely to be nonacademic, board-certified pediatricians in urban areas with more than 10 years' experience.


More than 6 months after the CDC's recommendation to use WHO growth charts for children younger than 2 years old, few clinicians were familiar with and used the WHO charts. Increased awareness and training, increased availability of WHO growth charts, and adherence to the recommendations will result in more accurate growth calculations and avoid underidentification of infants at risk for overweight and obesity.

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