Global assessment of childhood growth monitoring: cross-sectional survey of national policies and practices

Abstract

Background: Monitoring children's growth is crucial in paediatric care for early identification of health issues, with the World Health Organization (WHO) advocating for its practice throughout childhood. However, the focus and implementation of growth monitoring vary globally, reflecting different health priorities and practices. Methods: We conducted a global, cross-sectional, questionnaire-based survey, targeted at representatives of the ministry responsible for growth monitoring and promotion, and at representatives of national paediatric societies. Results: We obtained responses from 122 countries. Of these, 88% had national growth monitoring guidance, most often issued by the ministry of health. Weight was the most consistently measured early childhood growth monitoring indicator, recorded routinely in 98% of countries during growth monitoring visits for children aged <1 year. The WHO Child Growth Standards were used in 86% of countries. The most common follow-up action for growth faltering was provision of nutritional or health advice, cited by 91% of respondents for children aged <1 year, with advice frequency decreasing as child age increased. Conclusions: Childhood growth monitoring is widely adopted, but implemented with considerable variation across countries. Strengthening its impact will require standardising indicators, integrating evidence-based guidelines into primary care, and ensuring equitable, actionable use across age groups.