Growth Charts for Infants and Toddlers

Introduction to Growth Charts

The American Academy of Pediatrics, in collaboration with the National Institutes of Health and the Centers for Disease Control and Prevention, recommends using the WHO growth charts from birth until 24 months of age, then transitioning to CDC growth charts from 24 months through 19 years of age, as this represents the current standard of care in the United States for establishing growth trends in young children 1

The World Health Organization growth standards should be used for all children under 24 months of age, as they are based on healthy breastfed infants and represent optimal growth under ideal conditions, functioning as true standards rather than references 1
The Centers for Disease Control and Prevention charts should be used from 24 months through 19 years of age, as they extend through age 20 years, allowing continuous monitoring throughout childhood and adolescence without further chart changes, and the methods used to create WHO and CDC charts are similar after 24 months, making this an appropriate transition point 2

For children under 24 months using WHO charts, the 2.3rd and 97.7th percentiles (±2 standard deviations) should be used to identify potentially abnormal growth, rather than the traditional 5th and 95th percentiles 1
For children 24 months and older using CDC charts, the 5th and 95th percentiles are typically used as cutoff points 2

Breastfed infants typically show slower weight gain between 3-18 months compared to formula-fed infants, and this is normal on WHO charts, while formula-fed infants tend to gain weight more rapidly after approximately 3 months and may cross upward in percentiles 1, 2
The transition from WHO to CDC charts at age 2 years can create a slight discontinuity in how a child's growth is classified, potentially leading to overidentification of slow weight gain 4
Growth patterns over time using multiple serial measurements should be used in conjunction with medical and family history to assess appropriate growth, as single data points are insufficient 4

Healthcare providers require training on accurate measurement techniques, interpretation of growth standards versus references, and understanding the characteristics of the WHO cohort to properly apply these charts 4, 5