Abstract

Criteria used in growth-monitoring programmes in developing countries were applied to three-month weight-gain data for children 12-24 months old in three populations: in Berkeley, California; Guatemala; and Tamil Nadu. A significant proportion of the Berkeley children showed growth faltering: 18% had at least one period in which they failed to gain any weight, and 37% had at least one in which they gained less than 300 g in three months. The frequency of faltering, however, was appreciably greater in Guatemala (45% and 82% respectively) and Tamil Nadu (42% and 74% respectively). These data raise concerns that growth-monitoring criteria, as used in most settings, identify too many children for special attention, perhaps more than can be handled by most programmes. Adjusting the criteria to select fewer children necessarily means departure from the simplest guidelines about focusing on the growth trajectory (i.e., up, flat, or down) to those that specify rates of weight gain by age. This may make growth monitoring impractical in many settings.