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Note. Height-weight-age tables for children

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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and those requiring medical attention should be superseded by a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.
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