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Designing the new UK–WHO growth charts to enhance assessment of growth around birth
  1. Tim J Cole1,
  2. Charlotte M Wright2,
  3. Anthony F Williams3,
  4. ; RCPCH Growth Chart Expert Group
  1. 1MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, University College London, London, UK
  2. 2College of MVLS, University of Glasgow, Glasgow, UK
  3. 3Department of Child Health, St George's Hospital Medical School, University of London, London, UK
  1. Correspondence to Professor Tim Cole, MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK; tim.cole{at}


The decision to adopt the new WHO standard in the UK necessitated substantial changes to the neonatal section of the chart, including separation of the preterm UK birth weight reference from the WHO standard. The evidence-based design process has led to several novel features that could be generally applied in other chart designs, and revealed uncertainties leading to inconsistencies in charting. Failing to plot the birth weight of term infants at age 0 can lead to spurious centile crossing in the early weeks of life, particularly among infants at the extreme of gestation. Users will need training to use the charts, but this should improve overall understanding and the use of charts.

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  • Funding This UK–WHO early years growth chart project was funded by a grant from the English Department of Health to the RCPCH. TJC is funded by Medical Research Council grant G0700961, based at GOSH/UCL Institute of Child Health, which received a proportion of funding from the Department of Health's NIHR Biomedical Research Centres funding scheme. The Gateshead Millennium Baby Study was funded by grants from the Henry Smith Charity and Sport Aiding Research in Kids (SPARKS). None of the funders had any influence on the writing of the paper.

  • Competing interests All authors were members of the Growth Chart Expert Group. TJC and CMW have acted as advisers on certain elements of the WHO Multicentre Growth Reference Study. TJC receives royalties from his LMSchartmaker software used to construct the UK birth for gestation charts.

  • Ethics approval This study was conducted with the approval of the Gateshead local research ethics committee.

  • All authors collaborated in writing this article. TJC drafted it, and the other authors commented on each draft. TJC will act as guarantor of the paper.

  • Provenance and peer review Not commissioned; externally peer reviewed.