Breastfeeding, growth and growth standards: Performance of the WHO growth standards for monitoring growth of Belgian children

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Abstract
Background: In 2006, the World Health Organization published universal growth standards for all children from birth to 5 years of age, based on a sample of breastfed children. Aims: The present study documented breastfeeding prevalence in the Flemish Growth Survey 2004, and compared growth of exclusively breastfed children in Flanders with local reference charts and WHO growth standards. Subjects and methods: A subset of 3287 children 0–3 years of age from the Flemish reference population was studied. Prevalence and duration of breastfeeding were estimated with the status quo method. SD scores (SDS) of length/height, weight, BMI, and head circumference were plotted by age. Results: Breastfeeding is initiated for 68.2% of children, and approximately 25% were exclusively breastfed until at least 6 months of age. Breastfed children grow according to a typical pattern that deviates from the local reference curve. The average length of breastfed children is reasonably close to the WHO growth standard, but this does not hold for weight, BMI, or head circumference. In Flanders, breastfed children are more comparable to the local reference than to the WHO growth standards. Conclusions: Growth of breastfed children is similar to the WHO standards for length, but not for other traits. In Flanders, the use of the recent local growth reference is advised for both breastfed and formula-fed children.