WHO, IAP, and ICDS Growth Charts — Are They the Same?

Overview

1. WHO Growth Standards (2006)

• Based on the Multicentre Growth Reference Study (MGRS) — children from 6 countries raised under optimal conditions (breastfed, non-smoking households, good socioeconomic status).
• Describes how children should grow, not just how they do grow.
• Parameters: weight-for-age, height-for-age, weight-for-length/height, BMI-for-age, head circumference, arm circumference, subscapular and triceps skinfolds.
• Uses Z-scores (SD scores) and percentiles.
• Adopted by India's NHP and RBSK programs for under-5 children.

2. IAP Growth Charts (2015 Revised)

• Developed specifically for Indian children aged 0–18 years.
• Based on data from urban, affluent Indian children — considered the closest to achieving genetic growth potential in India.
• Parameters: weight-for-age, height-for-age, BMI-for-age.
• Uses percentile curves (3rd, 10th, 25th, 50th, 75th, 90th, 97th).
• Recommended for use in clinical settings (OPD, private practice) in India.
• Key change in 2015: adopted WHO standards for 0–5 years and IAP-specific data for 5–18 years.
• For adolescents, IAP charts are particularly valuable as WHO data is less representative of Indian teens.

3. ICDS Growth Charts (Tri-color Card / Road-to-Health Card)

• Used at Anganwadi centers under the ICDS program for children 0–6 years.
• Primarily a weight-for-age chart — simpler, designed for use by Anganwadi workers (AWWs) with minimal training.
• Uses a tri-color system: Green (normal), Yellow (moderately underweight), Red (severely underweight).
• Earlier versions were based on NCHS (National Center for Health Statistics) reference; updated versions incorporate WHO 2006 standards.
• Focused on community screening and monitoring at grassroots level, not clinical diagnosis.
• Does not include height/BMI parameters — less comprehensive than WHO or IAP charts.

Key Differences at a Glance

Practical Bottom Line

• For under-5 children in India, WHO 2006 standards and IAP 2015 charts largely align (IAP adopted WHO standards for 0–5 yrs in 2015).
• For 5–18 years, IAP charts are preferred in Indian clinical practice as they reflect Indian children better than WHO reference data.
• ICDS charts are the simplest and used only for community-level surveillance — they are not interchangeable with WHO or IAP charts for clinical diagnosis.
• Using WHO charts in Indian adolescents may overestimate growth faltering since Indian children are genetically shorter/lighter than the multicountry WHO reference.

WHO Growth Chart: Names, History, and Standards

Is WHO Growth Chart the Same as "Road to Health / Field / Batson Growth Chart"?

Historical Evolution of Growth Charts

1. Harvard (Stuart-Meredith) Standard — 1940s

• Developed by Harold Stuart and Howard Meredith at Harvard.
• Based on data from white, affluent American children (Boston area).
• Used as the early reference standard globally.
• Limitation: Not representative of non-Western or mixed populations.

2. Gomez Classification — 1956

• Used Harvard standards as the reference (median weight-for-age).
• Defined malnutrition grades (I, II, III) based on % of expected weight.
• The Harvard standard was the backbone of early malnutrition classification systems.

3. "Road to Health" Card (Morley's Chart) — 1960s

• Developed by Dr. David Morley (UK) for use in Africa (Nigeria).
• A simple weight-for-age chart using the Harvard/Boston standard as reference.
• Called "Road to Health" because the growth curve visually represented the "road" a child should follow.
• Designed for use by community health workers — hence also called a "field" chart.
• Batson's chart is a variant/adaptation of Morley's Road to Health card, used in parts of Africa.
• These charts were not WHO charts — they predated the formal WHO growth reference. However, WHO later endorsed and adapted the Road to Health concept for its own cards.

4. NCHS/WHO Growth Reference — 1977/1978

• The National Center for Health Statistics (NCHS) developed a growth reference based on US children (from the Fels Research Institute).
• WHO adopted the NCHS reference in 1978 as an international reference.
• This became known as the WHO/NCHS reference (not the same as the 2006 WHO standards).
• Based on: Predominantly formula-fed US children — criticized for not reflecting optimal growth of breastfed children worldwide.

5. WHO 2006 Growth Standards (MGRS-based) — The Current WHO Chart

• Based on the Multicentre Growth Reference Study (MGRS), conducted 1997–2003.
• Six countries: Brazil, Ghana, India, Norway, Oman, USA.
• Children raised under optimal conditions: breastfed, non-smoking environments, good healthcare.
• Prescriptive standard (how children should grow) vs. the older NCHS reference which was merely descriptive.
• This is the current "WHO growth chart/standard" in use today.
• Covers ages 0–5 years.

6. WHO 2007 Growth Reference (5–19 years)

• Based on re-analyzed NCHS data (not MGRS) — a reference, not a standard.
• Less robust than the 0–5 year MGRS-based standards.

Summary Table

Direct Answers

No. The Road to Health, Field, and Batson charts were earlier community-level tools based on the Harvard standard, developed in the 1960s–70s — they predate the current WHO chart. While WHO later incorporated the "road to health" concept into its child health cards, these are historically and methodologically distinct charts.

The current WHO 2006 growth standards are based on the MGRS (Multicentre Growth Reference Study) — not the Harvard standard. The Harvard standard underpinned older tools like Morley's Road to Health card and the Gomez classification, and was partly the basis for the older 1978 WHO/NCHS reference. The 2006 MGRS-based standard superseded all of these.