Growth Monitoring of Children Under Five Years Using National Reference Charts Versus International Growth Standards, 2007–2023: A Systematic Review

Abstract

Background Growth charts are commonly used for monitoring attained size at a specified age relative to a population average considered to represent expected growth. Objectives To evaluate the impact of the application of international growth charts for children under five on common growth metrics when compared to national reference charts. Search Strategy We conducted a systematic literature search across five electronic databases: CINAHL Complete (EBSCOhost), EMBASE (Ovid), MEDLINE (PubMed), Scopus, and Web of Science. Selection Criteria Studies published in English between 2007 and 2023 that made comparisons between national reference charts and either INTERGROWTH‐21st (IG‐21st) or WHO Child Growth (WHO CGS) charts. Data Collection and Analysis Common growth metrics were compared using either z‐scores or centiles. The prevalence of small‐ and large‐for‐gestational age, stunting, wasting, underweight, overweight, and obesity was compared when calculated using international standards versus national charts. Main Results We identified 1556 records, of which 314 were excluded as they were duplicates, 1069 after reading the title and abstract, 90 after reading the full texts, and 7 we could not retrieve the full texts. Z‐score or centile values of local references were more often reported to be higher than values of WHO CGS when evaluating weight‐, length‐, or head circumference‐ for‐ age. Seven of 11 studies reported higher rates of small‐for‐gestational age, while four of five studies reported lower rates of large‐for‐gestational age using local references compared to IG‐21st standards. Conclusions Meaningful differences exist in growth assessment between national and international charts that have implications for identifying at‐risk infants.