Sr11 246

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Sr11 246

  1. 1. Table 24 percentile column headings aligned correctly 6/30/2010 2000 CDC Growth Charts forMay 2002 the United States: Methods and DevelopmentSeries 11, Number 246
  2. 2. Copyright informationAll material appearing in this report is in the public domain and may bereproduced or copied without permission; citation as to source, however, isappreciated.Suggested CitationKuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC growth charts for theUnited States: Methods and development. National Center for Health Statistics.Vital Health Stat 11(246). 2002Library of Congress Cataloging-in-Publication Data2000 CDC growth charts for the United States: methods and development. p. cm. — (DHHS publication ; no. (PHS) 2002-1696) (Vital and healthstatistics. Series 11, Data from the National Health Survey ; no. 246) ‘‘May, 2002.’’ ISBN 0-8406-0575-7 1. Children—Anthropometry—United States—Statistics. 2. Children—United States—Growth—Statistics. 3. United States—Statistics, Vital.I. Series. II. Series: Vital and health statistics. Series 11, Data from theNational Health Survey ; no. 246GN63 .A225 2001305.230973021—dc21 2001051405For sale by the U.S. Government Printing OfficeSuperintendent of DocumentsMail Stop: SSOPWashington, DC 20402-9328Printed on acid-free paper.
  3. 3. Series 11, Number 2462000 CDC Growth Charts forthe United States: Methodsand DevelopmentData From the National HealthExamination Surveys and the NationalHealth and Nutrition ExaminationSurveysDEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health StatisticsHyattsville, MarylandMay 2002DHHS Publication No. (PHS) 2002-1696
  4. 4. National Center for Health StatisticsEdward J. Sondik, Ph.D., DirectorJack R. Anderson, Deputy DirectorJack R. Anderson, Acting Associate Director forInternational StatisticsJennifer H. Madans, Ph.D., Associate Director for ScienceLawrence H. Cox, Ph.D., Associate Director for Researchand MethodologyJennifer H. Madans, Ph.D., Acting Associate Director forAnalysis, Epidemiology, and Health PromotionEdward L. Hunter, Associate Director for Planning, Budget,and LegislationJennifer H. Madans, Ph.D., Acting Associate Director forVital and Health Statistics SystemsDouglas L. Zinn, Acting Associate Director forManagementCharles J. Rothwell, Associate Director for InformationTechnology and ServicesDivision of Health Examination StatisticsClifford L. Johnson, M.S.P.H., DirectorRosemarie Hirsch, M.D., M.P.H., Chief Analysis BranchCarolyn Petty-Martin, Acting Chief Operations BranchVicki L. Burt, Sc.M., R.N., Chief Planning BranchLewis Berman, M.S., Chief Information Management Branch
  5. 5. Acknowledgments John Chang Computer Information Systems and Support Services Nova Research CompanyW e wish to gratefully acknowledge the contributions Bethesda, MD of many individuals who had Chris Cronkvarious roles in the growth chart Center for Health Statisticsrevision process. These contributions State of Wisconsin Department ofinclude statistical and computer Health and Family Servicesprogramming expertise, data and Madison, WIsummary statistics, graphical support,and knowledge and experience in the William Davisareas of pediatric growth and growth Klemm Analysis Group, Inc.charts. We also wish to thank Thelma Washington, DCSanders and Zung Le for their editorial Catherine Duransupport. In addition to acknowledging National Center for Health Statisticsthe contributions of all individuals Centers for Disease Control andidentified in appendix I of this report, Preventionthe following persons are also Hyattsville, MDrecognized, with their affiliations at thetime of their contribution: Odell Eldridge Computer Information Systems andPhil Batty Support ServicesCenter for Health Information Nova Research Company Management and Epidemiology Bethesda, MDState of Missouri Department of HealthJefferson City, MO Stephen Sloan National Center for Health StatisticsFred Buhr Centers for Disease Control andCenter for Health Statistics PreventionState of Wisconsin Department of Hyattsville, MD Health and Family ServicesMadison, WI Christine Zeller Department of Community HealthMargaret Carroll Wright State UniversityNational Center for Health Statistics Yellow Springs, OHCenters for Disease Control and PreventionHyattsville, MD iii
  6. 6. ContentsAcknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iiiAbstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Concerns Surrounding the 1977 Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 The Revision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Data Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Data Exclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Statistical Curve Smoothing Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Observed and Smoothed Percentiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Evaluation of the Revised Growth Curves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Differences Between the 1977 NCHS and the 2000 CDC Growth Curves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Revision Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Growth Chart Workshops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Major Features of the 2000 CDC Growth Charts for the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Using the Revised Growth Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Specialized Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 General Growth Chart Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Appendix I. Description of Growth Chart Workshops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Workshop 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Workshop 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 Workshop 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 Workshop 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189Appendix TableI. Participants in the NCHS growth chart workshops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187Figures 1. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, birth to 36 months: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, birth to 36 months: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 3. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, birth to 36 months: Boys length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 4. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, birth to 36 months: Girls length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 v
  7. 7. 5. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, birth to 36 months: Boys weight-for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 6. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, birth to 36 months: Girls weight-for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 7. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, birth to 36 months: Boys head circumference-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 8. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, birth to 36 months: Girls head circumference-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 9. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, 2 to 20 years: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 10. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, 2 to 20 years: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 11. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, 2 to 20 years: Boys stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 12. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles, 2 to 20 years: Girls stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 13. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th, 97th percentiles, 2 to 20 years: Boys body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 14. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th, 97th percentiles, 2 to 20 years: Girls body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 15. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th, 97th percentiles: Boys weight-for-stature . . . 33 16. Individual growth chart 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th, 97th percentiles: Girls weight-for-stature . . . 34 17. Clinical growth chart 5th, 10th, 25th, 50th, 75th, 90th, 95th percentiles, birth to 36 months: Boys length-for-age and weight-for-age percentiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 18. Clinical growth chart 5th, 10th, 25th, 50th, 75th, 90th, 95th percentiles, birth to 36 months: Girls length-for-age and weight-for-age percentiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 19. Clinical growth chart 5th, 10th, 25th, 50th, 75th, 90th, 95th percentiles, birth to 36 months: Boys head circumference-for-age and weight-for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 20. Clinical growth chart 5th, 10th, 25th, 50th, 75th, 90th, 95th percentiles, birth to 36 months: Girls head circumference-for-age and weight-for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 21. Clinical growth chart 5th, 10th, 25th, 50th, 75th, 90th, 95th percentiles, 2 to 20 years: Boys stature-for-age and weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 22. Clinical growth chart 5th, 10th, 25th, 50th, 75th, 90th, 95th percentiles, 2 to 20 years: Girls stature-for-age and weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 23. Clinical growth chart 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th percentiles, 2 to 20 years: Boys body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 24. Clinical growth chart 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th percentiles, 2 to 20 years: Girls body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 25. Clinical growth chart 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th percentiles: Boys weight-for-stature . . . . . . . . . . . . . 43 26. Clinical growth chart 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th percentiles: Girls weight-for-stature . . . . . . . . . . . . . 44 27. Smoothed percentile curves, 22–39 months: Boys length-for-age and stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 28. Smoothed percentile curves, 22–39 months: Girls length-for-age and stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 29. Smoothed percentile curves, 75–106 cm: Boys weight-for-length and weight-for-stature . . . . . . . . . . . . . . . . . . . . . . . . . 47 30. Smoothed percentile curves, 75–106 cm: Girls weight-for-length and weight-for-stature . . . . . . . . . . . . . . . . . . . . . . . . . 48 31. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, birth to 36 months: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 32. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, birth to 36 months: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 33. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, birth to 36 months: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 34. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, birth to 36 months: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 35. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, birth to 36 months: Boys recumbent length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 36. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, birth to 36 months: Boys recumbent length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 37. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, birth to 36 months: Girls recumbent length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55vi
  8. 8. 38. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, birth to 36 months: Girls recumbent length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5639. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 46–102 cm: Boys weight-for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5740. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, 46–102 cm: Boys weight-for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5841. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 46–102 cm: Girls weight-for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5942. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, 46–102 cm: Girls weight-for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6043. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, birth to 36 months: Boys head circumference-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6144. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, birth to 36 months: Boys head circumference-for-age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6245. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, birth to 36 months: Girls head circumference-for-age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6346. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, birth to 36 months: Girls head circumference-for-age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6447. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 78–120 cm: Boys weight-for-stature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6548. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, 78–120 cm: Boys weight-for-stature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6649. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 78–120 cm: Girls weight-for-stature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6750. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, 78–120 cm: Girls weight-for-stature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6851. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 24–237 months: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6952. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, 24–237 months: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7053. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 24–237 months: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7154. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, 24–237 months: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7255. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 24–237 months: Boys stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7356. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, 24–237 months: Boys stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7457. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 24–237 months: Girls stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7558. Comparison of smoothed 5th, 25th, 50th, 75th, 95th percentile curves to empirical data points, 24–237 months: Girls stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7659. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 24–237 months: Boys body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7760. Comparison of smoothed 5th, 25th, 50th, 75th, 85th, 95th percentile curves to empirical data points, 24–237 months: Boys body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7861. Comparison of smoothed 3rd, 10th, 50th, 90th, 97th percentile curves to empirical data points, 24–237 months: Girls body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7962. Comparison of smoothed 5th, 25th, 50th, 75th, 85th, 95th percentile curves to empirical data points, 24–237 months: Girls body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8063. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, birth to 33 months: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8164. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, birth to 33 months: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8265. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, birth to 33 months: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8366. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, birth to 33 months: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 vii
  9. 9. 67. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, birth to 33 months: Boys length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 68. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, birth to 33 months: Boys length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 69. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, birth to 33 months: Girls length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 70. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, birth to 33 months: Girls length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 71. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 46–103 cm: Boys weight­ for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 72. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, 46–103 cm: Boys weight­ for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 73. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 46–103 cm: Girls weight­ for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 74. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, 46–103 cm: Girls weight­ for-length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 75. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, birth to 33 months: Boys head circumference-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 76. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, birth to 33 months: Boys head circumference-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 77. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, birth to 33 months: Girls head circumference-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 78. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, birth to 33 months: Girls head circumference-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 79. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 84–122 cm: Boys weight­ for-stature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 80. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, 84–122 cm: Boys weight­ for-stature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 81. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 84–122 cm: Girls weight­ for-stature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 82. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, 84–122 cm: Girls weight­ for-stature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 83. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 27–237 months: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 84. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, 27–237 months: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 85. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 27–237 months: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 86. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, 27–237 months: Girls weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 87. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 27–237 months: Boys stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 88. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, 27–237 months: Boys stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 89. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 27–237 months: Girls stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 90. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 95th percentile curves, 27–237 months: Girls stature-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 91. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 27–237 months: Boys body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 92. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 85th, 95th percentile curves, 27–237 months: Boys body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 93. Percent of empirical data below smoothed 3rd, 10th, 50th, 90th, 97th percentile curves, 27–237 months: Girls body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 94. Percent of empirical data below smoothed 5th, 25th, 50th, 75th, 85th, 95th percentile curves, 27–237 months: Girls body mass index-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 95. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, birth to 36 months: Boys weight-for-age . . . . . . . . 113viii
  10. 10. 96. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, birth to 36 months: Girls weight-for-age . . . . . . . . . 114 97. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, birth to 36 months: Boys recumbent length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 98. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, birth to 36 months: Girls recumbent length-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 99. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, 49–94 cm: Boys weight-for-length. . . . . . . . . . . . . . 117100. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, 49–94 cm: Girls weight-for-length. . . . . . . . . . . . . . 118101. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, birth to 36 months: Boys head circumference-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119102. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, birth to 36 months: Girls head circumference-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120103. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, 91–120 cm: Boys weight-for-stature . . . . . . . . . . . . 121104. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, 91–120 cm: Girls weight-for-stature . . . . . . . . . . . . 122105. Comparison of revised CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, 24–213 months: Boys weight-for-age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123106. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, 24–213 months: Girls weight-for-age . . . . . . . . . . . 124107. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, 24–213 months: Boys stature-for-age . . . . . . . . . . . 125108. Comparison of CDC 2000 smoothed 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th percentiles with NCHS 1977 smoothed 5th, 10th, 25th, 50th, 75th, 90th, 95th percentile curves, 24–213 months: Girls stature-for-age . . . . . . . . . . . 126Text TablesA. Charts included in the 1977 NCHS Growth Charts and the 2000 CDC Growth Charts . . . . . . . . . . . . . . . . . . . . . . . . . . 2B. Source of data for each growth chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3C. Primary and supplemental data sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4D. Summary of curve smoothing procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Detailed Tables 1. Unweighted sample sizes for weight-for-age chart by sex, age, and data source: Births to 36 months . . . . . . . . . . . . . . 127 2. Unweighted sample sizes for recumbent length-for-age chart by sex, age, and data source: Birth to 36 months . . . . . . 128 3. Unweighted sample sizes for weight-for-recumbent length chart by sex, length interval, and data source: Birth to 36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 4. Unweighted sample sizes for head circumference-for-age chart by sex, age, and data source: Birth to 36 months . . . . 130 5. Unweighted sample sizes for weight-for-stature chart by sex, stature interval, and data source: 77 to 121 cm . . . . . . . 131 6. Unweighted sample sizes for weight-for-age chart by sex, age, and data source: 2 to 20 years . . . . . . . . . . . . . . . . . . . 132 7. Unweighted sample sizes for stature-for-age chart by sex, age, and data source: 2 to 20 years . . . . . . . . . . . . . . . . . . . 134 8. Unweighted sample sizes for body mass index (BMI)-for-age chart by sex, age, and data source: 2 to 20 years . . . . . 136 9. Observed mean, standard deviation, and selected percentiles for weight (in kilograms) by sex and age: Birth to 36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13810. Observed mean, standard deviation, and selected percentiles for recumbent length (in centimeters) by sex and age: Birth to 36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13911. Observed mean, standard deviation, and selected percentiles for weight (in kilograms) by sex and recumbent length: Birth to 36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14012. Observed mean, standard deviation, and selected percentiles for head circumference (in centimeters) by sex and age: Birth to 36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 ix
  11. 11. 13. Observed mean, standard deviation, and selected percentiles for weight (in kilograms) by sex and stature: 77 to 121 cm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14214. Observed mean, standard deviation, and selected percentiles for weight (in kilograms) by sex and age: 2 to 20 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14315. Observed mean, standard deviation, and selected percentiles for stature (in centimeters) by sex and age: 2 to 20 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14516. Observed mean, standard deviation, and selected percentiles for body mass index (kilograms/meter2) by sex and age: 2 to 20 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14717. L, M, and S parameters and selected smoothed percentiles for weight (in kilograms) by sex and age: Birth to 36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14918. L, M, and S parameters and selected smoothed percentiles for recumbent length (in centimeters) by sex and age: Birth to 36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15119. L, M, and S parameters and selected smoothed percentiles for weight (in kilograms) by sex and recumbent length (in centimeters): Birth to 36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15320. L, M, and S parameters and selected smoothed percentiles for head circumference (in centimeters) by sex and age: Birth to 36 months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15621. L, M, and S parameters and selected smoothed percentiles for weight (in kilograms) by sex and stature (in centimeters): 77 to 121 cm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15822. L, M, and S parameters and selected smoothed percentiles for weight (in kilograms) by sex and age: 2 to 20 years . . 16023. L, M, and S parameters and selected smoothed percentiles for stature (in centimeters) by sex and age: 2 to 20 years . 16924. L, M, and S parameters and selected smoothed percentiles for body mass index (BMI, kilograms/meter2) by sex and age: 2 to 20 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178x
  12. 12. Objectives This report provides detailed 2000 CDC Growth Charts forinformation on how the 2000 Centersfor Disease Control and Prevention(CDC) growth charts for the United the United States: Methods andStates were developed, expandingupon the report that accompanied the Developmentinitial release of the charts in 2000. Robert J. Kuczmarski, M.S.P.H., M.P.H., R.D., Dr.P.H., Division ofMethods Digestive Diseases and Nutrition, National Institute of Diabetes and The growth charts were developed Digestive and Kidney Diseases, National Institutes of Health;with data from five national healthexamination surveys and limited Cynthia L. Ogden, M.R.P., Ph.D., Division of Health Examinationsupplemental data. Smoothed Statistics; Shumei S. Guo, M.S., Ph.D.,Center for Lifetime Healthpercentile curves were developed in Research, School of Medicine, Wright State University; Laurence M.two stages. In the first stage, selected Grummer-Strawn, M.A., M.P.A., Ph.D., Division of Nutrition andempirical percentiles were smoothedwith a variety of parametric and Physical Activity, National Center for Chronic Disease Prevention andnonparametric procedures. In the Health Promotion; Katherine M. Flegal, M.S., M.P.H., Ph.D., Divisionsecond stage, parameters were created of Health Examination Statistics; Zuguo Mei, M.P.H., M.D., Divisionto obtain the final curves, additionalpercentiles and z-scores. The revised of Nutrition and Physical Activity, National Center for Chroniccharts were evaluated using statistical Disease Prevention and Health Promotion; Rong Wei, M.S., Ph.D.,and graphical measures. Office of Research and Methodology; Lester R. Curtin, Ph.D., Office of Research and Methodology; Alex F. Roche, M.D., Ph.D., D.Sc.,Results F.R.A.C.P., Center for Lifetime Health Research, School of Medicine, The 1977 National Center for Health Wright State University; Clifford L. Johnson, M.S.P.H., Division ofStatistics (NCHS) growth charts wererevised for infants (birth to 36 months) Health Examination Statisticsand older children (2 to 20 years). Newbody mass index-for-age (BMI-for-age)charts were created. Use of nationaldata improved the transition from the Introduction stature-for-age, and body mass index (BMI)-for-age curves. The BMI-for-ageinfant charts to those for older children. charts represent a new tool that can beThe evaluation of the charts found no used by health care providers for the Tlarge or systematic differences between he National Center for Health Statistics (NCHS) growth charts early identification of children who arethe smoothed percentiles and the that have been in use since 1977 at risk for becoming overweight at olderempirical data. have been revised. The revised version, ages. The 2000 CDC Growth Charts known as the Centers for Disease also include weight-for-stature charts forConclusion Control and Prevention (CDC) Growth statures ranging from 77 to 121 cm, The 2000 CDC growth charts were Charts: United States released in 2000, primarily intended for use amongdeveloped with improved data and is recommended for use in clinical children from ages 2 to 5 years. Astatistical procedures. Health careproviders now have an instrument for practice and research to assess size and listing of the 1977 NCHS charts and thegrowth screening that better represents growth in U.S. infants, children, and 2000 CDC charts is shown in table A.the racial-ethnic diversity and adolescents (1).combination of breast- and formula- The 2000 CDC Growth Charts Historical Backgroundfeeding in the United States. It is consist of a set of charts for infants,recommended that these charts replace birth to 36 months of age and a set of Anthropometric data are valuablethe 1977 NCHS charts when assessing objective indicators of attained size and charts for children and adolescents fromthe size and growth patterns of infants, physical growth in children. A variety of ages 2 to 20 years. The charts forchildren, and adolescents. growth references were developed and infants include sex-specific smoothed percentile curves for weight-for-age, used in the United States since the earlyKeywords: growth charts c height c recumbent length-for-age, head 1900s. Most of these earlier referenceslength c weight c body mass index c circumference-for-age, and weight-for­ have considerable limitations, includinghead circumference c NHANES recumbent length; the charts for children lack of coverage for infants and and adolescents include weight-for-age, preschool children and limited Page 1
  13. 13. Page 2 [ Series 11, No. 246representation of ethnic, genetic, Table A. Charts included in the 1977 NCHS Growth Charts and in the 2000 CDC Growth Chartssocioeconomic, environmental, andgeographic variability (2). From 1977 NCHS Growth Charts* 2000 CDC Growth Charts*1946–1976, the Stuart/Meredith Growth Weight-for-age Weight-for-ageCharts were widely used. These charts Birth to 36 months Birth to 36 monthswere derived from stature and weight 2 to 18 years 2 to 20 yearsmeasurements taken on white children Length-for-age Length-for-ageliving near Iowa City, Iowa, or in Birth to 36 months Birth to 36 monthsBoston, Massachusetts, from 1930 to Weight-for-length Weight-for-length1945 (3). The sample sizes were Birth to 36 months Birth to 36 months Boys (49 to 103 cm) Boys (45 to 103 cm)relatively small and the smoothed Girls (49 to 101 cm) Girls (45 to 103 cm)percentile lines were reportedly based Head circumference-for-age Head circumference-for-ageon mathematical approximations of Birth to 36 months Birth to 36 monthscurves smoothed by hand (4). Thus, the Stature-for-age Stature-for-agedata did not represent the diversity of 2 to 18 years 2 to 20 yearschildren residing in the United Statesand statistical curve-fitting procedures Weight-for-stature** Weight-for-stature** Boys (90 to 145 cm) Boys (77 to 121 cm)were not used. Girls (90 to 137 cm) Girls (77 to 121 cm) The impetus for the development of BMI-for-agethe 1977 NCHS Growth Charts began in 2 to 20 years1971, when a study group sponsored by *All charts are sex-specific.the American Academy of Pediatrics and **The 1977 charts are applicable to boys with stature from 90 to 145 cm and age under 11.5 years, and to girls with stature fromthe Maternal and Child Health Program 90 to 137 cm and under 10.0 years of age. They are not applicable for any child showing the earliest signs of pubescence. The revised charts have no similar age or pubescence restrictions. Although the revised charts were developed for children 2 to 5 yearsof the Bureau of Community Health of age, in practice they may accommodate some shorter children with chronologic ages 5.0 years and over.Services, U.S. Public Health Service,recommended new growth charts, based year. Therefore, the national survey data normalized charts was the ability toon data from the NCHS Health were supplemented with data from the describe the relative status of children atExamination Surveys, for the clinical longitudinal growth study of the Fels extremes of the distributions.assessment of infants and children (5). Research Institute in Yellow Springs, Although the normalized chartsSubsequently, in 1974, the Food and Ohio. To avoid pooling multiple diverse allowed users a means to better quantifyNutrition Board of the National data sets in the 1977 NCHS charts for growth at the extremes, normalizationAcademy of Sciences made similar birth to 3 years, the infant charts were does not refer to an improvedrecommendations, emphasizing the need based solely on the Fels data. The 14 instrument to qualify growth asfor new growth charts for infants and sex-specific growth charts developed for ‘‘normal’’ or as a ‘‘standard’’ for growth.children based on nationally infants birth to age 36 months and older Both the 1977 smoothed percentiles andrepresentative survey data, to be children from ages 2 to 18 years are the 1978 normalized growth curves aresupplemented with data collected from generally referred to as the 1977 NCHS growth references. They allow theinfants in the Fels Longitudinal Growth Growth Charts (2,8,9). growth status of a child, or a group ofStudy (6). These recommendations were In 1978 CDC produced a children, to be compared with that of afurther supported in 1975 by a study normalized version of the NCHS reference population. The 1978group sponsored by the National curves (10,11). The World Health normalized curves are similar to, but notInstitute of Child Health and Human Organization (WHO) subsequently identical with the 1977 smoothedDevelopment, National Institutes of recommended these normalized charts percentiles.Health (7). for international applications (12–14). Growth charts for the United States These normalized versions of the 1977were developed by NCHS when Concerns Surrounding the charts are thus sometimes referred to asnationally representative cross-sectional the NCHS/WHO, CDC/WHO, or 1977 Chartssurvey data became available for most NCHS/CDC/WHO growth charts.of the pediatric age range (8). Data from Since the development of the 1977 Following the recommendation of NCHS Growth Charts, a number ofthe National Health Examination Survey Waterlow, et al., this version enabled the(NHES) II (1963–65) for ages 6–11 concerns have been raised about various expression of body measurements in aspects of the charts and the proceduresyears, NHES III (1966–70) for ages terms of standard deviations from the12–17 years, and the first National used in their development (10,16–23). median or z-scores (15). Z-scores Most of these concerns centered on theHealth and Nutrition Examination facilitate comparisons across ages andSurvey (NHANES) I (1971–74) for ages infant charts and were largely associated allow the mean and standard deviation with characteristics of the Fels data. The1–17 years were used to develop these to be calculated for a group ofcharts. National survey data were not Fels data came from a single measures. Another advantage of the longitudinal study of mainly formula­available for the period from birth to 1
  14. 14. Series 11, No. 246 [ Page 3fed, white middle-class infants in a weight-for-stature references for present report is designed to expand onlimited geographic area of southwestern adolescents, and the inability to assess the content of the initial report andOhio, collected 1929–75. In addition to growth at ages 18 years and over (16). provide more detailed information onnot being from a nationally the development of the revised CDCrepresentative sample, the Fels The Revision growth charts for the United States,observations were made at birth and 1 including the process, the data sources,month, at 3-month intervals from 3 to The 1977 charts were revised in the statistical procedures that were12 months, and at 6-month intervals part because more recent and followed, and the results of statisticalfrom 12 to 36 months. These intervals comprehensive national data on body evaluations for the revised charts.may be inadequate to properly identify measurements in U.S. children weregrowth patterns during periods of rapid available. After the 1977 NCHS Growthchange. The Fels birthweights may not Charts were developed, additional Methodsmatch more recent national birthweight national survey data became availabledistributions, and differences between from the NHANES II (1976–80)recumbent length and stature may have beginning at 6 months of age, and from Data Sourcesbeen too large, suggesting limitations in the NHANES III (1988–94) beginningthe recumbent length data. Moreover, at 2 months of age (24,25). During the The source of data for each growthsize and growth patterns of Fels infants planning of NHANES III, increasing chart is shown in table B. The primarymay not adequately represent current awareness of the concerns surrounding and supplemental data sources aregrowth patterns of combined breast- and the 1977 NCHS Growth Charts summarized in table C. Detailed sampleformula-fed infants in the population influenced the decision to oversample sizes for the data used to create each(8,18,19,21,22). In addition, differences children ages 2 months to 6 years. chart, stratified by age, sex, and databetween the recumbent length The objective of the revision source, are shown in detailed tables 1–8.measurements for infants from the Fels process was to use improved statisticaldata and the stature measurements from smoothing procedures, in conjunction National Datathe NCHS data sets lead to inconsistent with more comprehensive national The revised growth curves for thepercentile estimates from the 1977 survey data, to provide a better United States were developed with datacharts when the transition is made from instrument for health care providers who collected by NCHS in five cross-recumbent length to stature between 24 evaluate the growth status of children in sectional, nationally representativeand 36 months of age. Other concerns the United States (16). The Advance health examination surveys (table C):included the limited ability to assess Data report summarizing the the NHES II (1963–65) and IIIsize and growth at extremes beyond the development of the revised growth (1966–70), and NHANES I (1971–74),5th and 95th percentiles, the absence of charts was issued in 2000 (1). TheTable B. Source of data for each growth chart Age (months) or Chart height (cm) range Primary data sources1 Supplemental data sourcesWeight-for-age Birth to 36 months National surveys 3–52 National birth certificate data from United States Vital Statistics2Length-for-age Birth to 36 months National surveys 3–52,3 Birth certificate data from Wisconsin and Missouri State vital statistics2,4; CDC Pediatric Nutrition Surveillance System data for 0.5, 1.5, 2.5, 3.5, and 4.5 months2Head circumference-for-age Birth to 36 months National surveys 3–52 Fels Longitudinal Study data2Weight-for-length 45 to 103 cm National surveys 3–52,5 Birth certificate data from Wisconsin and Missouri State vital statistics2Weight-for-stature 77 to 121 cm National surveys 3–55 NoneWeight-for-age 24 to 240 months National surveys 1–55 NoneStature-for-age 24 to 240 months National surveys 1–5 None 5BMI-for-age 24 to 240 months National surveys 1–5 None1 Survey 1 = NHES II, Survey 2 = NHES III, Survey 3 = NHANES I, Survey 4 = NHANES II, and Survey 5 = NHANES III.2 Excludes birthweight <1,500 gm.3 Excludes data from NHANES III for ages <3.5 months.4 Wisconsin and Missouri were the only states with available data from birth certificates.5 Excludes data from NHANES III for ages ≥72 months.
  15. 15. Page 4 [ Series 11, No. 246II (1976–80), and III (1988–94). The number of children in NHES II who had URL: http://www.cdc.gov and in thesurvey designs are based on stratified, their 12th birthday after the home NHANES III procedures manual (30).multistage probability samples of the interview and before the examination The procedures were consistent withcivilian, noninstitutionalized population and those who had their 18th birthday published recommendations forin the 48 contiguous States (NHES II, after the home interview and before the standardized anthropometricNHES III, NHANES I) or all 50 States examination in NHES III were also techniques (31). The NHANES III(NHANES II, NHANES III). All included. Although the revised growth measurement techniques for weight,surveys consisted of a home interview charts for older children were developed recumbent length, stature, and headand a standardized physical examination for ages from 2 to 20 years, additional circumference were based onconducted in a mobile examination NHANES data for individuals younger procedures used in the previous NHEScenter. Age was calculated as age at the than 2 years and older than 20 years and NHANES surveys, and either thetime of examination when the were included in the analysis to improve same or comparable measuringanthropometric data were recorded. estimates at the lower and upper equipment was used across theChildren ages 6–11 years from NHES boundaries (table C). Detailed surveys.II, 12–17 years from NHES III, 1–19 descriptions of these surveys have beenyears from NHANES I, six months–19 provided (25–29). Supplemental Datayears from NHANES II, and 2 Anthropometric proceduresmonths–19 years from NHANES III developed for NHANES III are For the infant charts, a limitedwere included in the revision. The small documented on videotape number of additional data pointsTable C. Primary and supplemental data sources Data set Years Data source Subject1 Sex Chart2 Primary data setsNHES II 1963–65 National survey Age (months): 72.0–145.9 M, F W, S, BMINHES III 1966–70 National survey Age (months): 144.0–217.9 M, F W, S, BMINHANES I 1971–74 National survey Age (months): 12.0–23.9 M, F L 12.0–35.9 M, F HC 12.0–281.9 M W 12.0–245.9 F W 18.0–305.9 M, F S, BMI Length (cm): 65–109 WL Stature (cm): 77–127 WSNHANES II 1976–80 National survey Age (months): 6.0–35.9 M, F L, HC 6.0–281.9 M W 6.0–245.9 F W 18.0–305.9 M, F S, BMI Length (cm): 65–109 WL Stature (cm): 77–127 WSNHANES III 1988–94 National survey Age (months): 3.0–35.9 M, F L 2.0–35.9 M, F HC 2.0–71.9 M, F W 18.0–305.93 M, F S 18.0–71.93 M, F BMI Length (cm): 65–109 WL Stature (cm): 77–127 WS Supplemental data setsUnited States Vital Statistics 1968–80; Birth certificates Age: birth M, F W 1985–94State of Wisconsin Vital Statistics 1989–94 Birth certificates Age: birth M, F L Birth length (cm): 45–52.9 WLState of Missouri Vital Statistics 1989–94 Birth certificates Age: birth M, F L Birth length (cm): 45–52.9 WLFels Longitudinal Study 1960–94 Hospital records4 Age: birth M, F HCPediatric Nutrition Surveillance 1975–95 Clinic records Age (months): 0.1–4.9 M, F L System51 Data from outside the 2 to 20-year range for the child/adolescent charts were used to improve estimates at the upper and lower age boundaries. Subject ages, shown for growth chart variables,reflect the endpoints of age ranges for data actually used to construct the smoothed percentile curves.2W = weight-for-age; S = stature-for-age; BMI = body mass index-for-age; L = length-for-age; HC = head circumference-for-age; WL = weight-for-length; WS = weight-for-stature.3Lengths at ages 18.0–23.99 months, and stature at all other ages.4Majority measured in hospital by Fels staff.5Selected clinics.
  16. 16. Series 11, No. 246 [ Page 5obtained from other sources were Longitudinal Study who were born Statistical Curveincorporated at birth and during the first between the years 1960 and 1994,few months of life where national data corresponding to the national surveys. Smoothing Procedureswere either not available or were Most of these data were recorded in Data from the national surveys wereinsufficient (table C). The infant hospitals by the Fels staff. The Fels pooled because no single survey in theweight-for-age curves included national Longitudinal Study began in 1929 with NHANES series has enoughbirthweight distributions taken from a major goal of following physical observations to construct growth charts.birth certificates for more than 83 growth and development in a cohort of Sample sizes from 400 to 500 aremillion infants born in the United States 1,000 people from birth throughout their required to achieve precision of thebetween 1968–80 and 1985–94, entire life cycle (32). Data at birth, empirical percentiles at the specific agescorresponding to years in which infants including head circumference at birth, selected for the curve fitting (33). Thisin the national surveys were born. Birth obtained since 1975, come from is particularly important for outlyinglength data were only available from relatives of the early cohorts. percentiles that are used in research andtwo States, Wisconsin and Missouri. clinical practice. Pooling enhances theThese States recorded this information Data Exclusions number of subjects at each age, therebyon birth certificates for 890,000 infants increasing the stability of the outlyingborn between 1989 and 1994. These Several exclusions were made prior percentile estimates.data were used in the development of to curve smoothing. First, data for all Statistical sample weights werethe length-for-age and weight-for-length very low birthweight (VLBW) infants available for each national survey. Thesecurves. Additionally, a limited amount (<1,500 grams) were excluded from the sample weights take into account theof data from the CDC Pediatric infant growth charts, primarily because unequal probabilities of selectionNutrition Surveillance System (PedNSS) the growth of VLBW infants is known resulting from the complex samplingwas used in the length-for-age charts. to be markedly different from that of cluster design, planned oversampling ofThe majority of infant data in the higher birthweight, full-term infants. For selected subgroups, nonresponse, andPedNSS system come from clinical NHANES I and II, if a reported noncoverage. These survey-specificrecords of the Special Supplemental birthweight from the interview sample weights were applied to theNutrition Program for Women, Infants questionnaire was not available, an national survey data resulting in eachand Children (WIC) (20). Because the exclusion was not applied. As part of survey representing the U.S. populationPedNSS data are not nationally the NHANES III protocol, birth at the time the survey was conducted.representative, a subset of the PedNSS certificates were obtained from the All statistics were calculated with thedata collected from 1975 to 1995 was States for children born in the United original survey sample weights.used. Clinics were selected for inclusion States. For NHANES III, if a reported Sampling weights were not available forbased on three specific conditions. First, birthweight was missing from the survey the supplemental data.the mean lengths and weights had to be interview data, birthweight from the Statistical procedures were appliedwithin ±0.5 cm and ±0.5 kg of the mean child’s birth certificate was used to to the observed data in two stages, firstfrom NHANES II and III combined for determine possible exclusion, and, if to generate initial smoothed curves foreach single month of age from age 3 to neither were available, an exclusion was selected major percentiles and second to11 months. Second, the clinics had to not made. Second, data from NHANES generate the parameters that were usedhave a SD within ±0.2 cm and ±0.2 kg III for children greater than or equal to to construct the final smoothed curvesof the SDs in the combined NHANES II 6 years of age were excluded from the and additional percentiles. The firstand III. Finally, the skewness in weight charts for weight-for-age, weight-for­ stage is referred to as the curvedistribution of the selected clinics’ stature, and BMI-for-age. Inclusion of smoothing stage, and the second stagepopulation had to be within ±0.3 kg of these data would have led to the as the transformation stage. In the firstthe skewness of weight in the combined underclassification of overweight, stage, selected empirical percentilesNHANES II and III. A total of 213 because overweight cutoff criteria based were smoothed with a variety ofPedNSS clinics were selected, resulting on weight- and BMI-for-age percentiles parametric and nonparametric regressionin a sample of 14,846 observations at would have been shifted upward. Third, procedures. In the transformation stage,0.5 months, 8,825 at 1.5 months, 5,240 11 infants whose recumbent length and the smoothed curves were approximatedat 2.5 months, 1,640 at 3.5 months, and stature differed by greater than or equal using a modified LMS estimation2,258 at 4.5 months. All the matching to 5 cm were excluded from the procedure to provide the transformationprocedures excluded subjects with length-for-age, weight-for-length, parameters, lambda, mu, and sigmabirthweights <1,500 grams. stature-for-age, weight-for-stature, and (LMS). This resulted in final percentile Head circumference at birth was not BMI-for-age charts. Fourth, two outlier curves that closely matched theavailable from the national surveys or values, one for head circumference of an percentile curves smoothed in the firstfrom birth certificates. Consequently, the infant girl, and one for recumbent length stage and allowed computation ofhead circumference-for-age curves of an infant boy, were excluded because additional percentiles and z-scores. Theincluded data for head circumference at the measurement values and the procedures for each stage are describedbirth from 362 infants in the Fels sampling weights were extreme.

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