Peer-reviewed article
Perspective: Can Growth Monitoring and Promotion Accurately Diagnose or Screen for Inadequate Growth of Individual Children? A Critical Review of the Epidemiologic Foundations.
Jef L Leroy, Rebecca L Brander, Edward A Frongillo, Leila M Larson, Marie T Ruel et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This peer-reviewed analysis questions whether growth monitoring and promotion (GMP)—the regular measurement of children's weight and height—can accurately identify children with inadequate growth or predict future growth problems. Using longitudinal data from multiple countries, the authors found that individual healthy children's growth does not follow a single growth curve, making it difficult to distinguish healthy from inadequate growth based on measurements alone. The study concludes that current GMP criteria are not accurate for diagnosis or screening, though the authors still support dedicated programs to identify wasting and well-child care services.
Key points
- Individual healthy children's growth does not track along a specific growth curve
- Commonly used GMP criteria do not provide meaningful diagnostic information
- GMP is not an accurate screening activity for predicting inadequate growth later in childhood
- Collecting individual children's weight and height measurements does not reliably identify who needs support
- The authors support reconsidering the current design of GMP in low- and middle-income countries
Limitations
This is a conceptual and methodological critique rather than an intervention evaluation, so it cannot tell us what alternative approaches to growth assessment might work better. The document does not provide data on the specific populations studied or detailed statistical methods, limiting assessment of the generalizability of findings.
Abstract
Growth monitoring and promotion (GMP), the process of periodic anthropometric measurements to assess the adequacy of individual child growth, is implemented across low-income and middle-income countries. The epidemiologic foundations of GMP (i.e., that GMP can accurately diagnose or screen for inadequate growth) have never been critically reviewed. We first assessed growth patterns of individual healthy children. Using longitudinal data from low-income, middle-income, and high-income countries, we evaluated whether commonly used GMP criteria can be used for diagnosis and screening; i.e., whether they accurately identify current, or predict subsequent, inadequate growth in individual children. The growth of individual healthy children does not track along a specific growth curve, which challenges the notion that growth measurements alone can be used to distinguish between healthy and inadequate growth. We demonstrated that GMP criteria do not provide meaningful diagnostic information and that GMP is not a meaningful screening activity: commonly used GMP criteria are inaccurate predictors of (inadequate) growth later in childhood, and collecting individual children's weight and height does not help to identify who needs support or who will benefit. Our results do not undermine the importance of dedicated programs to diagnose wasting in individual children nor do they challenge the need for well-child care to support parents and to ensure children's optimal nutrition, health, and development. Our findings, however, highlight the need to carefully reconsider the current design of GMP in low-income and middle-income countries.