Who growth charts question from client (names omitted)

[Guest guest]

I received this email from a client and she asked me to post it for your

opinion...

To the Breastfeeding specialists at the American Academy of Pediatrics:

I am writing to you to discuss how the AAP's endorsement of the

CDC growth charts likely lower the rates of breastfeeding, contributes to

childhood obesity, and generally undermines public health.

I am the nursing mother of a 16 month old baby girl of South

Asian descent who was born full term at 4lbs 6oz. After her birth, I followed

the recommendations of the AAP precisely, breastfeeding exclusively for 6

months, then adding rice cereal, fruits and vegetables at 6 months, and then

adding meats at 9 months. My pediatrician uses the standard growth chart

published by the Center of Disease Control. According to this growth chart, my

daughter was born around the 2nd percentile, shot up to the 25th percentile at 3

months, and then started falling down to the 15th, the 10th, and 5th percentile.

Finally, at 12 months, she was below the 5th percentile. My pediatrician said

that my daughter's height and head circumference were normal but was concerned

that she was very much underweight. Also, my daughter was underwent some blood

tests and was confirmed not to have celiac disease or any thyroid issues

Here is that CDC chart:

http://www.cdc.gov/nchs/data/nhanes/growthcharts/set1clinical/cj41l018.pdf

I began to think it was a mistake for me to breastfeed my

daughter for a whole year because I read that formula fed babies were heavier. I

thought that, because my daughter was low birth weight, she " needed formula " to

help her weight catch up with the other babies her age. At this point, I visited

my local lactation consultant telling her that I thought it was a mistake for me

to follow the advice of the lactation community since it had resulted in my

daughter being very much underweight at 12 months. My lactation consultant

introduced me to the World Health Organization chart which is internationalized

to reflect the growth of babies from 7 continents, including India the country

where my family is from. These babies were breastfed exclusively for 6 months

and then had solids added at 6 months and were breastfed for a total of 2 years.

Fortunately, my daughter's growth was more consistent with this

chart and closely tracked the 3rd percentile curve. Here is the WHO chart:

http://www.who.int/childgrowth/standards/cht_wfa_girls_z_0_2.pdf

When I showed my pediatrician the WHO chart, she dismissed it

and continued to use the CDC chart because this is the chart officially approved

by the AAP.

However, the CDC openly admits that this chart does not track

the growth of breastfed babies.

Specifically, the CDC states:

The new reference represents the combined growth pattern of

breast and formula fed infants in the U.S. About 50 percent of the infants were

reported to breastfeed with about 33 percent breastfeeding for 3 months or

longer. Because the patterns of growth for exclusively breastfed and formula fed

infants differ, caution must be used when interpreting growth of exclusively

breastfed infants.

See:

http://www.cdc.gov/nccdphp/dnpa/growthcharts/training/modules/module2/text/page5\

a.htm

This link also lists the ethnic composition of the babies in the

chart--only 2% are Asian and Pacific Islander...which means fewer than 2% are

South Asian. Thus, this chart compares my breastfed South Asian baby to

primarily white formula fed babies of European descent. The CDC chart is

racially-biased and should not be used to evaluate the growth patterns of

minorities. I suspect my daughter's weight is a result of her genetics because

her father and most everyone on his side of the family is thin.

It is shocking to me that most pediatricians can claim that they

support breastfeeding for at least 1 year but yet rely on a growth chart in

which 85% of the babies are NOT breastfed for a year and the majority of them

were formula fed after 3 months. It is also disturbing that some pediatricians

don't bother to notify nursing mothers that their charts were not designed for

exclusively breastfed infants.

By using the CDC chart, the pediatric establishment is tacitly

supporting formula feeding over breastfeeding and, therefore, undermining public

health. Use of the CDC chart sets up the growth pattern of formula fed children

as the ideal. Pediatricians look at the CDC chart and are effectively saying

" This is how healthy babies grow. " when, in fact, the CDC chart reflects an

unnatural growth pattern primarily based on artificial formula feed. The WHO, on

the other hand, chart reflects the natural growth for babies because it is

based on the natural food for babies--breast milk.

According to my lactation consultant, breastfed babies actually

gain weight faster than their formula-fed counterparts during the first 3 months

of life but after that their weight gains becomes slower than that of formula

fed infants.

In fact, I've heard of nursing mothers who weaned before 6

months because, after their babies " fell off their curves " on the CDC chart

after 3 months, they were convinced that they had " insufficient milk " . Odds are,

there was nothing wrong with their milk supply and the babies were likely still

tracking their WHO curves. The problem is that the CDC chart takes into account

that nearly 67% of babies are formula fed after 3 months. That's the real

reason the breastfed babies " fell off their curves " on the CDC. Thus, the use of

the CDC chart quite likely lowers breastfeeding rates, discouraging nursing

mothers by making them falsely believe there is a problem with their milk

supply.

There was an article published on the AAP's own website which

indicates that the WHO chart is a better tool to use to screen for obesity. In

other words, babies whose weight appears " normal " on the CDC chart may very well

be trending towards obesity. See:

http://pediatrics.aappublications.org/cgi/content/abstract/123/1/102?rss=1

Given the rising rates of obesity among U.S. children, one would

think that the pediatric establishment would rush to embrace the WHO chart.

My cousin's wife is a pediatrician and she said that the CDC is

about to approve the WHO chart for breastfed babies and that pediatric residents

are just starting to use it. In the meantime, the vast majority of pediatricians

continue to use the CDC chart.

Can you please confirm that the AAP is about to approve the WHO

growth charts for breastfed babies? If so, can you tell me when? I'm very

disappointed that my pediatricians continue to use the CDC chart to evaluate my

breastfed South Asian daughter and I would like to show them some documentation

that indicates that the AAP will approve the WHO charts in the future. If that

is not the case, I would like to know why the AAP is not approving the WHO

chart.

Best Regards,