State of the art of growth standards

Growth charts have become widely used, if not universal, tools for the assessment of the growth and health of children. In 2006, the WHO published a set of charts designed to represent standards to which all the world's children should aspire. They were produced in response to the apparent variability in the patterns of child growth documented worldwide, and with the aim of creating a prescriptive standard based on best feeding advice. Our modern understanding and use of growth references arose out of the application of technology, mathematics and charting to the biology of growth in the 19th century. As means of summarizing normal development, modern growth standards have replaced Renaissance conceptions of human form based on idealized proportions in harmony with the cosmos, and the simple reference to key developmental milestones first noted by the ancients. The WHO growth standards are the culmination of a search for a human ideal based on 20th century biology. However, while they may be the 'best' standards based on contemporary feeding advice, they are 'provisional' because all developmental processes in biology, including body growth, are plastic and permit a flexibility of life course trajectories in response to epigenetic, nutritional and other environmental conditions.