Parents' estimation of their children's body size compared to classification of children's nutritional status using the international growth reference

While debates abound about the appropriateness of using an international growth reference in low-income countries and the use of cut-off points as diagnostics for malnutrition, there is little discussion about the relevance of anthropometric assessment of children for the population of concern. While the issue of cultural appropriateness may appear to be an arcane anthropological question, it does have wider applied significance in the field in terms of involving parents in growth monitoring programs and community nutrition surveillance. In a sample of 283 parents (mostly mothers) participating in a child health and nutrition study in peri-urban Kathmandu, Nepal, a majority of parents (68.4%) whose children were classified by NCHS standards as moderately-to-severely malnourished (i.e. below the -2SD cut-off for ht/age and wt/age) deemed them to be small in size. When children were divided into age groups, it was found that parents were very accurate at labelling their children as "small" when their children were under 36 months of age and much less accurate when they were between 36 and 60 months of age. Parents' perception of smallness of their children based on 'ranking' is sensitive and reasonably correlated with objective growth measures. Parents' opinions regarding the nutritional and health status of their children should be taken seriously and be incorporated into growth monitoring and community surveillance programs.