Pancakes in a jiffy Quick Bread Mix

Pancake mix can be made at home for less money and less packaging. The mix can be easily adapted to make other favorite quick breads like muffins and biscuits. Cornbread can be made if cornmeal is added.Jiffy Mixes are actually a line of Michigan baking products made in Chelsea, Michigan. (I love Jiffy Mixes but I cheat and make my own!)

This mix is not gluten free. It is based on a half and half mixture of white flour for more gluten content, to support a light airy baked good, combined with whole wheat flour and wheat germ to boost the natural nutrients found in the whole wheat berry.

My basic Quick Bread Mixcontains dry milk powder so that only water, oil, egg and sweetener will need to be added when making a speedy batch of pancakes, muffins or biscuits.

Basic Quick Bread Mix
(makes about 15 cups of dry Quick Bread Mix)

5 cups White Flour  (or any mixture of 10-12 cups flour)
5 cups Whole Wheat Flour
2 cups Wheat Germ (or 2 cups flour or very finely crushed dry cereal flakes)
4 Tablespoons Baking Powder
2 Tablespoons Salt
3 cups Dry Powdered Milk (optional – if liquid milk or milk substitute is to be used instead of water for baking.)

makes about 8-12 three inch diameter pancakes.

1 1/2 cups Quick Bread Mix
1 egg

Pancake batter is drippy but not watery.

1 Tablespoon Sugar (helps brown the surface)
1 Tablespoon Oil
1 cup water plus extra 1/8 cup water as needed – if batch is thick or if thinner pancakes are desired.

Pancake batter is fairly runny but will mound slightly and the back of the spoon may be used to spread out the pancake batter to an even thickness. Fresh or thawed blueberries or chocolate chips can be dropped in the dough in each individual pancake or mixed in the batter. The sticky sweetness can burn to the pan more.

Pancakes take about 2-3 minutes per side on a medium hot skillet or large pan. Watch the surface for air bubbles to begin bubbling to the top and flip them for the first time after the bubbles have started to pop but haven’t all stopped rising to the surface. The second side can take just 1-2 minutes. The skillet may need to pulled from the heat if the pancakes are burning but are still raw in the middle.

A pastry blender, Amazon

makes about 9 three inch square biscuits
(bake for about 30 minutes at 375-400F)

3 cups Quick Bread Mix
1 stick margarine or butter
– using two knives, your hands or a pastry blender crumble the mix and butter together until granular – like floury rice crumbles instead of obvious bits of butter.

1 cup water – add and mix together.

Dump the dough onto a lightly floured work surface to fold the mass onto itself, squish down, fold again, squish down, repeat.

Add a little extra water by sprinkling on a spoonful or two if the crumbles aren’t sticking together well.

Powder the cutting board or table before the folding process or during as needed. If a little too much water was added just add a little more sprinkling of the Quick Bread Mix over the dough.

Eventually form the dough into a rectangle roughly 6 inches by 12 inches and about 1/1/2 inches thick  and then cut into 9 to 12 pieces. Perfect rounds was never the goal – crunch and taste but a more moist dense biscuit can be expected when using part whole wheat flour.

Basic Muffins

Makes one dozen. (about 25-30 minutes at 375 F)

2 1/2 cups Quick Bread Mix
1/2 to 3/4 cup Sugar
2 Eggs
1/2 cup Oil or 1 stick melted Butter or Margarine
1 teaspoon (tsp) Vanilla Extract *** and/or other flavor combinations and add ins
1 cup Water
or 1 cup Applesauce plus 1/8 cup water if needed
or 1/2 cup cooked pumpkin or cooked pureed sweet potato plus 1/2-3/4 cup water *

*Possible substitutions for the liquid. When milk powder is in the mix many other liquids can take the place. Orange juice or other fruit juice concentrates can be used in the concentrate form as a substitute for the liquid in the recipe and for part of the sweetener – depending on the family’s sweet tooth.  (Milk protein does add stability to the chemical mixture. Split pea soup powder that was made with no onion or other savory seasonings is a protein substitute worth trying in baking.)

  • Spiced Apple Muffin variation: 1 cup Applesauce instead of water. Flavoring: 1 teaspoon Vanilla plus 2 teaspoons Ginger powder, 1/2 tsp Cardamom powder and 1/2 tsp Nutmeg powder.
  • The Applesauce muffin flavor could be the simple vanilla – up to 1 Tablespoon of Vanilla could be used if that is the only flavor. 1/2 teaspoon to 1 teaspoon of cinnamon would be typical with applesauce.
  • Possible add-ins: 1/2 to 1 cup of raisins, currents or other chopped dried fruit – rehydrate for a few minutes with 1/4 cup very hot water; 1/2 to 1 cup chopped nuts; 1/2 to 1 cup finely grated carrot; a half package of chocolate chips; or a cup of blueberries fresh or thawed slightly; 1 cup finely diced raw apple or pear; – With additions the one dozen muffin cups get too full and a mini muffin pan can usually be filled in addition to the regular size muffin pan resulting in roughly 12 regular and 6-8 mini muffins / tart pan.

8 inch square pan – (bake for about 30 minutes at 375-400 F)

1 1/2 cups Quick Bread Mix
1 cup Cornmeal
1 teaspoon Baking Powder
1/4 to 1/2 cup Sugar
1/4 teaspoon Salt (a pinch)
1 stick Butter or Margarine – melted or Oil
2 Eggs
1 cup Water – add 1/8-1/4 cup extra if needed – let the pan stand for a few minutes out of the oven to allow moisture to hydrate the cornmeal and powdered milk granules. (the milk granules will remain visible.)

Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

Macroglossia, a polite word for rude baby disease

Of course I’;m joking – babies aren’t rude, they are just babies and if their tongue sticks out all of the time practically then there may be an underlying problem that might have treatment options. Human babies and young children don’t just leave their tongues hanging out for no reason. For canines and species with few sweat glands, sticking out the tongue is an important way to lose extra body heat. Dogs pant and hang their tongue out when they are too hot. Elephants lose excess heat by flapping their ears.

A baby with macroglossia and BWS [link]

[Macroglossia] – try searching the phrase “protruding tongue” and you’ll find that it is a significant symptom for some [genetic] and [deficiency problems]. (Wikipedia links)

Macroglossia is an enlarged tongue – a little swollen looking – edematous in fact – (puffy). When a baby sticks its tongue out most of the time and it doesn’t seem to have good muscle control then it is a sign of a weak muscle problem and there can be a few reasons for that. Feeding tips are great for the average baby but for that occasional baby whose tongue doesn’t seem to want to stay in its mouth, ever, then there might be an underlying nutrient deficiency or rare genetic syndrome – and treatments may exist that could help.

This link to an article on about what it might mean when your baby sticks its tongue out does not mention macroglossia but the last paragraph does mention excessive drooling and feeding troubles as something to discuss with the baby’s doctor. [, article, by Kelly Stevens] The infant in the picture is portraying a tongue with poor muscle tone, seen in the rounded pickle shape. The minimal eyebrows are also associated with hypothyroidism. The physical appearance clues suggest to me a need for iodine and selenium support or treatment with thyroid hormone. I would refer the infant to a physician for further testing. Life doesn’t come at us one diagnosis at a time whether a dietitian or physician happen to notice a certain pattern.

Having to get a physician involved for every dietary counseling tip seems quite disabling – in addition to the already disabling but standard dietitian’s rule “don’t diagnose anything – ever – period”.  I was trained to be very very careful about any diagnostic language in charting because of the fact that dietitians are not physicians and therefore don’t diagnose. But we are trained as specialists to recognize the symptoms and external appearance of nutrient deficiency and toxicity as well as interpreting the standard lab tests. We are also trained to check and adjust diet orders or formula feeding “recommendations” for the physician to consider and approve or modify. Training may include crossing fingers to hope that the physician agrees with the “recommendations.”

Dietitians and physicians need to know and look for symptoms of deficiency and toxicity and so do moms and dads and individual owners of a living body.

Coping with feeding issues and health discomforts are what dietitians are trained to do and consider – the feeding tips in the article are on target and helpful. Check it out and then move on to this [, article by Julie Christensen] just to compare tongues and children’s eyes. The first baby also looks hypothyroid to me because of the dull, flat, depressed look of apathy. The look of apathy was poetically described in the original work that was done for iodine nutrient guideline guidelines. Entire villages would be quiet without evidence of children playing or adults working, even pets weren’t seen running about. A year after providing the iodized salt (The original fortification level had been designed to provide 150 micrograms in ten grams of salt which at the time was effective. Our current nutrient guidelines for salt would limit us to around 3 grams which would only provide 50 micrograms of iodine at the standard level of fortification. The fortification level for iodine hasn’t been reexamined since those 1940’s villages which didn’t have doughnut shops and fast food on every other corner and so the villagers didn’t have as much bromide or fluoride competing with the iodine as we do in our modern diet.)

The tongue is a muscle that can be strong and is meant to move food around in the mouth and into position to swallow. The baby in the first blog has a little round shaped tongue and it does not look like the agile muscle that is possible. A tongue potentially can be quite strong. [, young baby feeding tips article, by Kelly Stevens]  The older child in this [ article, by Julie Christensen] on “Why do rude kids stick their tongues out?” shows a boy with sparkling eyes and no slight puffy paleness underlying the skin, his eyebrows look average and hair is shiny with health and his skin has a slightly pink undertone. The picture shows a normal tongue sticking out rudely or in fun. The shape is a little pointed and flattened, the muscle is being purposefully extended for the gesture. The picture doesn’t show a soft little pickle shape just lollygagging around.

The rude child article has some unrude advice about telling the difference between a rude gesture and one that was triggered by shyness,  or just for fun, or from other attention getting motivations. Recognizing the underlying motivation can then help with choosing a more effective discipline method. Ignoring naughtiness at home can sometimes be the most effective strategy to reducing attention getting behavior. Punishments may be necessary if the attention getting naughtiness progresses to rudeness to adults outside of the home. One of the references mentioned in the story was written by Barbara Colorosa, one of my favorite authors who wrote the parenting book, “Positive Discipline”. She suggests discipline be considered as moments for teaching more appropriate ways to behave rather than as penalties. Punishing a child for spilling milk doesn’t teach them how to pour more carefully or why cleaning up the sticky mess while it is fresh is easier than waiting until it dried up and hard to clean.

I care about macroglossia because I felt sorry for the mother who kept asking her doctors why her baby wouldn’t keep its tongue in its mouth. She was getting no answers and she kept trying to poke her baby’s tongue back in its mouth. It can’t have been very fun for the anxious mother or for the baby. I only saw her once. However the information that I had collected for her next appointment was useful a few year’s later when I worked with a mother and children who shared the genetic condition BWS. The first baby and mom were more likely to have had iodine issues. BWS has several unique symptoms not just macroglossia. Starting a newborn with thyroid hormone replacement promptly can help normalize some types of congenital hypothyroidism. Trying to reduce fluoride rather than just providing more iodine may be part of the problem [5].

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

  1. Kelly Stevens, “What Does A Baby Sticking Out Its Tongue Mean? (Aug. 11, 2011) []
  2. Julie Christensen, “The Rude Child’s Behavior of Sticking Out the Tongue” (Sept. 2, 2011) []
  3. Barbara Colorosa, “Kids Are Worth It!”, 2002 []
  4. by Zelda Doyle, et al, “Are Australian Children Iodine Deficient? Results of the National Iodine Nutrition Study” (MJA, Vol. 184, No. 4, 20 Feb. 2006) []  (or are they goitrogen excessive?) Excerpt: “Western Australian children had the largest glands /an early sign of goiter/, despite having the highest median UIE level of the five states. The explanation for this phenomenon is not clear. It may relate to factors other than iodine, such as dietary or environmental goitrogens.” /fluoride for example/
  5. Thyroid history, History of the Fluoride/Iodine Antagonism” [] *Fluoride inhibits hyperthyroidism. Fluoride in the air from pollution or in ground water naturally promotes enlargement of the thyroid gland and symptoms of hypothyroidism.
  6. From the same website, “Salt Facts / Fluoridated Salt FAQ”  – [] – It was thought to be a good idea to add fluoride to salt in addition to the iodine and at even greater levels – world wide, beginning around 1986-1994 – oops. It’s still being added.
  7. The paper mentioned in the above link on fluoridation of salt,  Milner T, Estupiñán-Day D, “Overview of Salt Fluoridation in the Region of the Americas: Part II. The Status of Salt Production, Quality & Marketing and the State of Technology Development for Salt Fluoridation,” Salt 2000, 8th World Salt Symposium, Volume 2, pg 1033-1038 (2000)  pdf []
  8. USDHHS, NIDDK, National Endocrine and Metabolic Diseases Information Service page on hypothyroidism:  []
  9. Thomas W. Heinrich and Garth Graham, Hypothyroidism Presenting as Psychosis: Myxedema Madness Revisited,  Prim Care Companion J Clin Psychiatry. 2003; 5(6): 260–266.  []
  10. (I’ve been looking for the reference to the 1940’s study but I haven’t found it yet.)

Regarding: Couple Accused Of Starving Infant Daughter

What is excessive force? excessive removal of a child from its parents? Starvation if even well intentioned “to reduce risk of high cholesterol and needing a bypass surgery” is neglecting to meet the hunger signals and body language shown by crying and fussing in a typical infant. If an infant is too malnourished however they will be listless and not fuss much at all. A loving parent might think things are okay because the baby is quiet. This blog discusses types of failure to thrive – reasons for no weight gain – my main question unanswered from the newspaper article is what happened with the infant’s head circumference and height/age and length/weight curves.

Couple Accused of Starving Baby,” the Assoc. Press,  New York Daily News (11-17-11) []

I recently wrote about occasionally having written nutrition assessment letters in support of a few “dinky” WIC children and their parents who were regularly offering a healthy variety of food.  In the article I suggested that the common problem with that segment of my caseload was undiagnosed congenital hypothyroidism. Now I knew the children and parents that I wrote about and I had worked with them monthly or quarterly and measured their dinky, adorable, thriving in their own tiny way, children.

The other common thing amongst the little tykes was their growth chart patterns. There are three types of growth charts to be aware of regarding young children:

1. The head circumference isn’t discussed much but it will be the last curve “to fall off the chart” due to failure to thrive. An infant’s head is bigger than the passage already, so nature designed it to catch up and grow a little more rapidly outside of mom the first two years of life and then hatsize changes very little into adulthood. The neborn head circumference average is roughly 12-14 inches, by 3-6 months it may be 16-18 inches around, by one to two years old 20-22 inches. adult’s may be 24 inches around. I didn’t use a tape measure but mine is roughly 23 inches (level ribbon or tape measure held about one inch above the ears at the wide spot of the forehead/back of head – biggest loop that you can slide up and down with stiff tape measure but heald a little taut, really loose adds a quarter to half inch.)

To get back to malnourishment – the body always sacrifices itself for the brain, and the heart and lungs are second most important (or just as maybe that’s a type of trinity of life). A child that is “failing to thrive” or not growing normally may be doing so for physical malfunction reasons – plenty of food is being offered and/or even going in but the child is still not growing (and may be throwing up all over the laundry). Organic failure to thrive is due to physical  problems with the stomach and reflux, or underlying genetic malfunction effecting metabolic pathways, or unidentified disease, or nutrient deficiency, or other reasons – known and unknown. Recording daily food being offered , amounts consumed and symptoms that occur and then tallying up all the intake nutrient values to see if it “should” be meeting average needs is a tool that I used when investigating non-growing / non-thriving children.

One of the children that probably would have died without my intervention needed communication assistance for organic failure to thrive due to malformed stomach and constant regurgitation. The parents were somewhat learning disabled, not necessarily by a definition but it can make it easy to make the wrong assumptions. I bought a dry erase board for them to make it easier to immediately record how big a bottle was made and how much was eaten – what was offered and what was consumed and then the info was copied later onto paper for me – the infant ended up needing surgery. Turned out that lots was going in and there was tons of dirty laundry but the couple wasn’t able to communicate that to the doctor.

That little boy did weigh his birth weight at two months but he looked starving. His head circumference was practically following a normal curve and his height was only beginning to drop off the chart – really long and skinny with a big head and sunken eyes. He looked very starving and the parents were working very, very hard to care for him for those two months of tons of laundry (the poor may smell bad because food stamps doesn’t pay for laundry soap or laundromats or gasoline to get there – did you want to give that baby a few bottles, burp the spitting up, screaming in stomach pain little tyke, Michele dear, the couple probably did occasionally hire a babysitter or swap labor (you watch my kid today and I’ll watch yours tomorrow.)

2. Back to growth charts- the height growth chart was mentioned above. It will be affected second, head circumference is most protected and weight can slip fairly quickly off the typical pattern.

The growth rate can be slowed down by malnourishment due to lack of food being provided, or lack of absorption of nutrients, or physical regurgitation/spitting up or projectile vomiting or the food, or too much fuel being burned up (common with a minor undiagnosed heart defect – saw one of those also , it took his parents a long time to get appropriate dx as well. Worms and early cancer also might increase calorie needs),

3. Weight gain rate growth is really only valuable if it is compared to the child’s height and to the own child’s previous growth rate. The dinky children that were relatively healthy and growing at an tiny barely plottable growth curve, were still growing and did have their own plottable growth curve (similar to each other BTW). They followed the normal curve but just weren’t on it. they chugged along in a few cases a half inch off the chart which would practically be 25% below “fifth” percentile.

To briefly review Bell curve and normal distribution (fromTarot blog recently) we expect f percent of children to look healthy and normal “oof the chart:” in either direction. Children of Asian descent are not common in Marquette but they always saw the dietitian because they never plotted on the growth chart for weight/height – narrow shoulders, narrow hips, narrow mom and dad. They all matched each other and were offering healthy food every two to three hours – no problems there except with the growth chart assumptions (that fifty percentile is a goal – no it is only a goal for fifty percent of children the other fifty percent would look too fat or too skinny at that weight for height).

4. I think I just started the weight for height growth chart so I thought I better put the number up.

Inorganic failure to thrive is due to parental/caregiver or stress/depression relationship type issues. Occasionally the baby really has no appetite and the parents are offering and offering and the infant isn’t accepting anything – starving itself – that is pretty rare and would take the careful recording of just exactly what is being offered versus what is being consumed (and the estimated amount that was kept down / not spit up). A family that is paranoid about cholesterol and excess weight gain may be offering too little and if stressful feeding interactions are also used the baby may give up rather than continue to fuss for food (too starved of an infant will get listless, apathetic, look a little depressed).

A dinky healthy child will have a bit of cush/moistness to the skin with a little bit of rounding over the muscles and bones, and a healthy glow of youth (moistness factor). A skinny child will be gangly with boniness and ribs showing but not up at the nipple / chest-bone area and dry skin and thin, wispy hair, possibly even falling out easily. A starving model will have chest-bone rib exposure while a thin model will have a bit of flesh rounding out the ribs at least a little. (Offer a skinny model a snack and if she says “No thanks, I’m not hungry” then zinc may be needed – too deficient and the appetite disappears – it can get uncomfortable to eat with too shrunken of a stomach; if she says “No thanks,  I’m not hungry right now but maybe later,” then I’m a little less worried about her.)

A too skinny child will have that body builder appearance where you can see the outline of their muscles very clearly through paper-thin skin (lack of subcutaneous fat was referred to in the Associated Press article). The patella or kneebone will be very knobby and sticking out – it is just floating over the front of the leg suspended by ligaments – stringy cords. Moistness within the joints helps prevent arthritis/joint pain problems and reduce accidents over time. Hydration helps many things and Dr. Batmanghelidj helped asthma patients with more water and sea salt – chemical structure of bleached table salt may be less helpful to the body possibly and it doesn’t taste as good to me at least definitely.

A “dinky” hypothyroid child that followed their own special growth curve two standard deviations off the chart on weight and height for age, might actually plot normally weight is compared to height and head circumference was usually on the grid or just a bit below the fifth percentile. Weight and height compared to their age group were the most “abnormal” and if only weight was looked at the rest of the pattern might be missed. The physical appearance included – if you pick up a dinky child you can still support their bottom in the palm of your hand – narrow bone structure with narrow hips. A straving child will be bony and gangly and achingly sore where all that delicate skin isn’t sqooshy enough to prevent bruising with little pressure. (Stuffed teddy bear with too little stuffing left.)

To sum up – I would need to see the child and ideally see the history of measurements for weight, height and head circumference. If it is a dinky child with parents who are concerned about cholesterol then they may feel comfortable with small size. The tests that were all normal would not have caught congenital hypothyroidism that was due to a thyroid gland that used bromide, fluoride or chloride instead of the iodine (malfunction undetected by a TSH – Thyroid Stimulating Hormone test). Goiter is not evident any longer as a sign of iodine deficiency because the thyroid gland has adapted.

Clues that congenital hypothyroidism might be a problem besides having a two and half year old so small that their bottom fits in the palm of your hand (hard to disguise that oddity and there isn’t a growth chart for it):

1. Mom has hypothyroidism or the symptoms of it but no diagnosis (I do not care what her lab tests say unless she has done a 24 urine collection and had it assessed for iodine content.)

2. Mom has had several children and the baby is one of the youngest. (Mom may have started out with iodine stores but is running lower now because there really isn’t that much fortification or use of iodized table salt and really do we sprinkle on that vitamin D with a slat shaker or vitamin C?)

3. Baby was a twin or triplet . . . or was premature or small for gestational age – although a few of the dinkiest kind of started 7 pounds and just never took off with the more typical, rapid growth rate seen from birth to two and a little slower through preschool.

4. A congenital hypothyroid baby may look like an adorable little midget, pixie, elf child. Big eyes and biggish head compared to the dinky body but perfectly proportioned arms and legs to the body. A little person with other types of dwarfism may have the individual’s head and torso similar in size to that of a typical adult but their arms and legs may be proportionally much shorter than average. Hair on a congenital hypothyroid child may be fine, very soft and baby fine and possibly short with spikiness – nature’s little punk rockers.

5. The dinky child will have an appetite and eat quite normally without any odd quirks, but in vvery small bird like portions – matching their tiny body’s need when calculated based on body weight instead of looking at “recommended intakes” – recommended for the fifty children eating on the fiftieth percentile line perhaps.(autistic kids invariably had quirks in diet preferences or strong opinions.)

6. The iodine content of a urine collection for the child is also a useful indicator as to whether there is much iodine in the diet – lots going in will have more coming out – and a challenge loading dose of iodine can be given and the the urine again measured. The iodine deficient body will retain more of the excess loading dose and the urine will have more than in the first batch but no where near the total that was consumed for the day (I took the loading dose of 50 mg broken into AM and PM – with meals the stuff is a little icky on the stomach – patient forums seem to suggest that sea weed  is more comfortable – don’t know – I use Iodoral.) Fluoride, bromide and chloride levels being excreted can also be monitored – high levels of those reflect the exchange having been made by the malfunctioning thyroid hormone of the non iodine (any port in a storm) for the iodine from the massive influx of the loading dose. The metallic taste in the mouth that can occur during iodine supplementation is theorized to be the bromide / fluoride taste. Yellowish stuff has been reported to stain white clothing (ooze from the skin) – that could be the iodine too it is yellowish, I never checked what color bromide or fluoride are typically.

– there are probably a few more clues and reference links but – brief sum up – Need to see and measure the child – iodine content of the child’s urine would be more concrete in a court than “dinky” although the healthy dinky growth chart pattern would be evidence if all four growth charts were used – Ht/Age, Wt/Age, Ht as Length/Wt, and Head Circumference/Age.

Couple Accused of Starving Baby,” the Assoc. Press,  New York Daily News (11-17-11) []
growth chart info from the CDC website, [link]
Growth Reference Versus Growth Standard

The CDC and WHO growth charts differ in their overall conceptual approach to describing growth. The WHO charts are growth standards that describe how healthy children should grow under optimal environmental and health conditions. The curves were created based on data from selected communities worldwide, which were chosen according to specific inclusion and exclusion criteria. Deviation from the WHO growth standard should prompt clinicians to determine whether suboptimal environmental conditions exist, and if so, whether they can be corrected.

Whereas the WHO charts describe growth of healthy children in optimal conditions, the 2000 CDC growth charts are a growth reference, not a standard, and describe how certain children grew in a particular place and time. The CDC charts describe the growth of children in the United States during a span of approximately 30 years (1963–1994).

CDC   (***the charts that I used)

The CDC growth curves for children aged Table 1). The curves were anchored at birth using national birth weight data obtained from U.S. birth certificates from 1968–1980 and 1985–1994 and birth length data from Wisconsin and Missouri birth certificates (the only states with these data available on birth certificates) from 1989–1994 (5). Birth data were based on 82 million birth weight measurements and 445,000 birth length measurements.

Breastfeeding and Growth Patterns  (***The whole section because it is so important)

When the WHO growth curves were created, the difference in growth between primarily formula-fed infants and primarily breastfed infants was an important consideration (12). The WHO charts were based on the premise that the healthy breastfed infant is the standard against which all other infants should be compared. This is consistent with U.S. dietary reference intakes, in which norms for infant intakes of most nutrients are determined on the basis of the composition of human milk and the average volume of human milk intake (21).

In the WHO charts, 100% of the reference population of infants were breastfed for 12 months and were predominantly breastfed for at least 4 months. In contrast, approximately 50% of the infants in the CDC data set had ever been breastfed, and 33% were still breastfeeding when they reached age 3 months, rates that are lower than those for infant cohorts born today. Data from the CDC National Immunization Survey indicate that in 2007 in the United States, 75% of infants had ever been breastfed, and 58% had been breastfed for at least 3 months (22). In addition, the composition of infant formula has changed considerably during the preceding 35 years (23). Therefore, the current growth of U.S. infants might not be the same as the growth of infants used in the creation of the CDC growth curves.

The expert panel universally agreed that breastfeeding is the optimal form of infant feeding and recognized that the growth of breastfed infants differs from that of formula-fed infants. The panel also recognized that AAP has stated the breastfed infant “is the reference or normative model against which all alternative feeding methods must be measured with regard to growth, health, development, and all other short- and long-term outcomes” (24).

Some U.S. clinicians who are currently using the CDC charts might be unaware of or not understand the growth pattern of exclusively breastfed infants, which differs from that of formula-fed infants. These clinicians might inappropriately recommend that mothers supplement breastfeeding with formula or advise them to wean their infants from breastfeeding completely.

The WHO and CDC charts show different growth patterns that might lead clinicians to different conclusions about variations in growth. Healthy breastfed infants typically gain weight faster than formula-fed infants in the first few months of life but then gain weight more slowly for the remainder of infancy (25,26). Therefore, in the first few months of life, WHO curves show a faster rate of weight gain than the CDC charts for boys and girls (Figures 2 and 3). Use of the WHO charts in the United States might lead to an increase in the misperception of poor growth at this age.

Beginning at approximately age 3 months, WHO curves show a slower rate of weight gain than the CDC charts, both in weight for age and weight for length. Because WHO curves are derived from infants who breastfeed through 12 months, infants who are still breastfeeding at approximately age 3 months are more likely to maintain their percentages on the WHO growth charts but to decrease in percentages on the CDC charts. In contrast, if WHO charts are used to assess the growth of formula-fed infants, these infants might be identified as growing too slowly during the first few months of life but then be identified as gaining weight too quickly after approximately 3 months.

Use of WHO Growth Charts for Children Aged 0-24 Months

Use of the 2006 WHO international growth standard for the assessment of growth among all children aged 0 to24 months, regardless of type of feeding, is recommended. (The charts are available at [].) When using the WHO growth charts, values of 2 standard deviations above and below the median, or the 2.3rd and 97.7th percentiles (labeled as the 2nd and 98th percentiles on the growth charts), are recommended for identification of children whose growth might be indicative of adverse health conditions. The rationale for use of the WHO growth charts for this age group includes the following: 1) the recognition that breastfeeding is the recommended standard for infant feeding and, unlike the CDC charts, the WHO charts reflect growth patterns among children who were predominantly breastfed for at least 4 months and still breastfeeding at age 12 months; 2) clinicians already use growth charts as a standard for normal growth; and 3) the WHO charts are based on a high-quality study, the MGRS.

Continued Use of CDC Growth Charts for Children Aged 24–59 Months

Use of the CDC growth charts for children aged 24–59 months is recommended. The CDC charts also should be used for older children because the charts extend up to age 20 years, whereas the WHO standards described in this report apply only to children aged 0–59 months. The rationale for continuing to use CDC growth charts includes the following: 1) the methods used to create the WHO and CDC charts are similar after age 24 months, 2) the CDC charts can be used continuously through age 19 years, and 3) transitioning at age 24 months is most feasible because measurements switch from recumbent length to standing height at the this age, necessitating use of new printed charts.


The estimated prevalence of low weight for age and high weight for length among U.S. children differ depending on whether the CDC charts (using the 5th and 95th percentiles) or the WHO charts (using the 2.3rd and 97.7th percentiles) are used (Figure 6). A substantial difference exists in the prevalence of low weight for age, with the WHO standard showing a lower prevalence beginning at age 6 months. The CDC reference identifies 7%–11% of children aged 6–23 months as having low weight for age, whereas the WHO standard identifies <3%. The WHO standard also identifies fewer infants (aged


the end of the article is several more long paragraphs – to sum up – The U.S. clinics have not all started using the newer growth charts and recommendations, improved education in their use is recommended as well as a call for more research into what cut-offs / criteria are indicative of poor growth outcomes (just being on or under the 5 or 95th percentile was never assessed for health in either set of grids. Both sets were simply plotting a bunch of children’s measurements using different types of children.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.