NOTE Height-Weight-Age Tables for Children. A very serviceable article on this subject, deserving t o be quoted in full, appears in no. 5, CI, July 29, 1933, Journal of American Medical Association. It is as follows : The relationship of weight at given ages and heights t o nutrition, and its significance as an index of the general health of the child, have long been of interest to medical investigators. Public health workers have made extensive use of height-weight tables as a screening method to detect at least most severe grades of undernourishment. The common use of the height-weight tables has so popularized weight that an industry of no mean proportions has developed in the weighing of human beings. It is reported that the largest return on any investment at the Century of Progress Exposition is that of the “guess your weight” scales. The erroneous impression expressed in the current phrase “your weight indicates your health” is evidence of the extent to which this idea has been established with the public. Actually, normal weight does not necessarily mean good health; nor do deviations from the average or mean always indicate poor health. While much basic work had been done earlier, the first impetus was given to the use of height-weight relationships in 1910 by Wood,l who published the tables bearing his name, which with various modifications have been widely used in health teaching and in textbooks and other publications. Four years later, Baldwin2 published a review of almost 200 studies of height-weight relationships, and in 1920 appeared Emerson and Manny’sS study of weight and height in relation to malnutrition. Emerson held that the 10 per cent underweight standard commonly employed to distinguish between normal children and those requiring medical attention should be superseded by a 7 per cent underweight criterion, and that a zone rather than a definite line of demarcation should be established. He recognized that, while this zone would exclude on the one hand the definitely undernourished and on the other the manifestly obese, it would include a considerable number who for one reason or another would Wood, T. D. : Health examinations. Ninth Yearbook of the National Society for the Study of Education, University of Chicago Press, 1910, part L, pp. 34-35. ’Baldwin, B. T.: Physical growth and progress ( a review of nearly 200 studies). Bull. 10, G . S. Bureau of Education, 1914. *Emerson, W. R. P., and F. A. Manny: Weight and height in relation to malnutrition. Arch. Pediat. XXXVII: 468 (Aug.) 1920. 155 AMERICAN JOURNAL O F PHYSICAL ANTHXOPOU)GI, VOL. YTIII, NO. J IILY-SEPTEMBEB, 1933 1 156 NOTE require individual diagnosis. The use of height and weight tables, however, went on apparently undeterred in numerous school and public health systems. Also in 1920, Bardeen' published his review of the work of numerous observers with respect not only to 'height-weight-age relationships, but also to volumetric, surface area, girth, sitting height and other measurements, emphasizing that the height-weight index is altered by physiologic age, by sexual peculiarities of structure, by inherited individual or racial peculiarities and by peculiarities of structure due to habits of living or environment. In 1921, Dublin,6 working with children of foreign parentage, warned against the too literal interpretation of an individual child's height-weight-age relationship to group averages. In 1922, Clark, Sydenstricker and Collinss published height-weight tables f o r children in the southern part of the United States and suggested that such tables would be more useful in that part of the country than the composite tables commonly used in which weights of children representing different racial and environmental backgrounds were all merged in a common average. The same authors' in 1923 pointed out a rough but by no means invariable relationship between underweight and malnutrition and emphasized that underweight might not mean malnutrition nor, on the other hand, overweight always be evidence of good nutrition. Also in 1923 the American Child Health Association published revised tables by Baldwin, Wood and Woodbury.* Clark, Sydenstricker and Collins" found that these new tables classed only 16 per cent of a given group of children as 10 per cent o r more underweight, whereas, according to the original Wood tables, 20 per cent would have been so classed. ' Bardeen, C. R. : The height-weight index of build in relation to linear and volumetric proportion and surface area of the body during postnatal development. Contributions to Embryology IX, no. 46, Carnegie Institute of Washington, 1920. Dublin, L. I. : Height and weight standards in nutrition work among childreii of foreign parentage, read before New Pork Nutrition Council in March, 1921. *Clark, Taliaferro, Edgar Sydenstricker, and S. D. Collins: Heights and weights of school children. Pub. Health Rep. XXXVII: 1185 (May 19) 1922. 'Clark, Taliaferro, Edgar Sydenstricker, and S. D. Collins: Weight and height a8 an index of nutrition. Pub. Health Rep. XXXVIII: 39 (Jan. 12) 1923. 'Baldwin, B. T., T. D. Wood, and R. M. Woodbury: Weight-height-age tables. New Pork, American Child Health Association, 1923. * Clark, Taliaferro, Edgar Sydenstricker, and S. D. Collins: The new BaldwinWood weight-height-age tables as an index of nutrition. Pub. Health Rep. XXXIX: 518 (March 14) 1924. NOTE 157 In 1924, Dublin and GebhartlO showed definitely that no great reliance can be placed on a height and weight table as an instrument for identifying the undernourished. In 1929, Franzen'l published a monograph describing the measurements made on groups of children whose height, weight and certain skeletal measurements were taken. He concluded that height and weight comparisons with group averages were not significant and emphasized skeletal measurements and estimates of subcutaneous tissue development. The formulas developed from these studies have been valuable scientific contributions but have not proved practicable for everyday use. Recently, Courtisl* has developed a series of curves, by which he proposed to predict growth in terms of percentage of maturity, judged in terms of the individual's own growth curves, not of group averages. The Joint Committee on Health Problems in Education of the National Education Association and the American Medical Association" definitely advises teachers weighing and measuring children to' interpret heights and weights in terms of growth over a period of time rather than by comparison with an average and has omitted all tables from its report, as has Wood,'+ their original proponent, in a leaflet published by the New Pork Health Department. Thus the consideration of height and weight as an index of nutritional health has progressed through a number of interesting phases. Height and weight tables still have definite uses. In the hands of the physician, and associated with a competent physical examination, they are still valuable. They may no longer, however, be accepted as sole measures, or even as satisfactory gross indexes, of the state of nutrition of a given child at a given time. Growth in terms of individual progress, not comparison with averages, is a better index. A good physical examination remains a basic necessity for the diagnosis of malnutrition as of any other disease. "Dublin, L. I., and J. C. Gebhart: Do height and weight tables identify undernourished children I New Pork Association for Improving the Condition of the Poor, 1924. 1l Franzen, Raymond : Physical measures of growth and nutrition. School Health Research Monographs 11, New Pork, American Child Health Association, 1929. 1l Courtis, S . A.: The prediction of growth. J. Educ. Research, March, 1933 ; Growth and development, read before the seventh health education conference. American Child Health Association, Ann Arbor, Mich., in June, 1933. =Health inspection of school children. Report of the Joint Committee on Health Problems in Education of the National Education Association and the American Medical Association, 1933. Wood, T. D. : Watch your child's growth. City of New Pork, Department of health and Department of Education.