Evolution of growth charts in India

  • Vaman Khadilkar Senior Paediatric Endocrinologist, Jehangir Hospital, Pune, India; Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
  • Chirantap Oza Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
  • Anuradha Khadilkar Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India; Hirabai Cowasji Jehangir Medical Research Institute, Pune, India https://orcid.org/0000-0002-3399-3235
Keywords: anthropometry, Indian growth charts, growth references, growth standards, synthetic growth charts


Growth charts are graphical representations of centile or standard deviation curves prepared from population-based studies. Growth charts are derived from large numbers of children either cross-sectionally or longitudinally. The variation in anthropometric measures amongst individuals of different ethnicities requires specific charts also for Indian children and need to be updated to reflect secular trends. Growth charts in India have come a long way from the development of first ones in the mid-1940s by National Institute of Nutrition (NIN) to Paediatrician Friendly IAP growth charts with mid-parental height and BMI tool. Indian BMI charts recommend overweight and obesity cut-offs for children to the adult equivalents of 23 and 27kg/m2 to prevent the under-diagnosis of obesity. Indian growth charts have been published for upper:lower segment ratios, Turner syndrome, waist circumference, height velocity and sitting height.


Agarwal, D. K./Agarwal, K. N./Upadhyay, S. K./Mittal, R./Prakash, R./Rai, S. (1992). Physical and sexual growth pattern of affluent Indian children from 5 to 18 years of age. Indian Pediatrics 29 (10), 1203–1282.

Agarwal, R./Sankhyan, N./Jain, V. (2015). Normal growth and its disorders, in: GHAI Essential Paediatrics. CBS, Delhi.

Bogin, B. (2021). Social-Economic-Political-Emotional (SEPE) factors regulate human growth. Human Biology and Public Health 1. https://doi.org/10.52905/hbph.v1.10

Borghi, E./de Onis, M./Garza, C./Van den Broeck, J./Frongillo, E. A./Grummer-Strawn, L./Van Buuren, S./Pan, H./Molinari, L./Martorell, R./Onyango, A. W./Martines, J. C./WHO Multicentre Growth Reference Study Group (2006). Construction of the World Health Organization child growth standards: selection of methods for attained growth curves. Statistics in Medicine 25 (2), 247–265. https://doi.org/10.1002/sim.2227

Box, G. E. P./Cox, D. R. (1964). An analysis of transformations. Journal of the Royal Statistical Society: Series B (Methodological) 26 (2), 211–243. https://doi.org/10.1111/j.2517-6161.1964.tb00553.x

Cole, T.J., 2012. The development of growth references and growth charts. Annals of Human Biology 39 (5), 382–394. https://doi.org/10.3109/03014460.2012.694475

Cole, T. J. (1994). Do growth chart centiles need a face lift? The BMJ Clinical research 308 (6929), 641–642. https://doi.org/10.1136/bmj.308.6929.641

Cole, T. J./Green, P. J. (1992). Smoothing reference centile curves: the LMS method and penalized likelihood. Statistics in Medicine 11 (10), 1305–1319. https://doi.org/10.1002/sim.4780111005

de Onis, M., Garza, C., Victora, C.G., Onyango, A.W., Frongillo, E.A., Martines, J., 2004. The WHO Multicentre Growth Reference Study: planning, study design, and methodology. Food and Nutrition Bulletin 25 (1 Suppl), S15-26. https://doi.org/10.1177/15648265040251S103

Hermanussen, M./Scheffler, C. (2022). Nutrition, size, and tempo. Human Biology and Public Health 3. https://doi.org/10.52905/hbph2022.3.37

Hermanussen, M./Stec, K./Aßmann, C./Meigen, C./Van Buuren, S. (2016). Synthetic growth reference charts. American Journal of Human Biology 28 (1), 98–111. https://doi.org/10.1002/ajhb.22759

Indian Academy of Pediatrics (2020). Paediatrician friendly IAP Growth Charts for 0-18 years. Available online at https://iapindia.org/iap-growth-charts/ (accessed 2/20/23).

Indian Academy of Pediatrics Growth Charts Committee, Khadilkar/V./Yadav, S./Agrawal, K. K./Tamboli, S./Banerjee, M./Cherian, A./Goyal, J. P./Khadilkar, A./Kumaravel, V./Mohan, V./Narayanappa, D./Ray, I./Yewale, V. (2015). Revised IAP growth charts for height, weight and body mass index for 5- to 18-year-old Indian children. Indian Pediatrics 52 (1), 47–55. https://doi.org/10.1007/s13312-015-0566-5

International Institute for Population Sciences, 2017. India National Family Health Survey NFHS-4 2015-16. Mumbai, India. https://dhsprogram.com/publications/publication-fr339-dhs-final-reports.cfm (accessed 9/12/22).

Johnson, N. L. (1949). Systems of frequency curves generated by methods of translation. Biometrika 36 (1-2), 149–176. https://doi.org/10.1093/biomet/36.1-2.149

Khadikar, V./Khadilkar, A. V./Lohiya, N. N./Karguppikar, M. B. (2021). Extended growth charts for Indian children. Journal of pediatric endocrinology & metabolism 34 (3), 357–362. https://doi.org/10.1515/jpem-2020-0573

Khadilkar, A./Ekbote, V./Chiplonkar, S./Khadilkar, V./Kajale, N./Kulkarni, S./Parthasarathy, L./Arya, A./Bhattacharya, A./Agarwal, S. (2014). Waist circumference percentiles in 2-18 year old Indian children. The Journal of Pediatrics 164 (6), 1358-1362.e2. https://doi.org/10.1016/j.jpeds.2014.02.018

Khadilkar, A./Ekbote, V./Kajale, N./Chiplonkar, S./Prasad, H./Agarwal, S./Singh, N./Patwardhan, V./Lubree, H./Ladkat, D./Mandlik, R./Vispute, S./Palande, S./Patel, P./Lohiya, N./Khadilkar, V. (2019). Sitting height percentiles in 3-17-year-old Indian children: a multicentre study. Annals of Human Biology 46 (3), 267–271. https://doi.org/10.1080/03014460.2019.1637936

Khadilkar, V./Chiplonkar, S./Ekbote, V./Kajale, N./Mandlik, R./Khadilkar, A. (2018). Reference centile curves for wrist circumference for Indian children aged 3-18 years. Journal of pediatric endocrinology & metabolism 31 (2), 185–190. https://doi.org/10.1515/jpem-2017-0161

Khadilkar, V./Khadilkar, A./Arya, A./Ekbote, V./Kajale, N./Parthasarathy, L./Patwardhan, V./Phanse, S./Chiplonkar, S. (2019). Height velocity percentiles in Indian children aged 5-17 years. Indian Pediatrics 56 (1), 23–28.

Khadilkar, V. V./Karguppikar, M. B./Ekbote, V. H./Khadilkar, A. V. (2020). Turner syndrome growth charts: A Western India experience. Indian Journal of Endocrinology and Metabolism 24 (4), 333–337. https://doi.org/10.4103/ijem.IJEM_123_20

Khadilkar, V. V./Khadilkar, A. V./Borade, A. B./Chiplonkar, S. A. (2012). Body mass index cut-offs for screening for childhood overweight and obesity in Indian children. Indian Pediatrics 49 (1), 29–34. https://doi.org/10.1007/s13312-012-0011-y

Khadilkar, V. V./Khadilkar, A. V./Cole, T. J./Sayyad, M. G. (2009). Crosssectional growth curves for height, weight and body mass index for affluent Indian children, 2007. Indian Pediatrics 46 (6), 477–489.

Kondpalle, S./Lote-Oke, R./Patel, P./Khadilkar, V./Khadilkar, A. V. (2019). Upper and lower body segment ratios from birth to 18 years in children from Western Maharashtra. Indian Journal of Pediatrics 86 (6), 503–507. https://doi.org/10.1007/s12098-019-02883-x

Nummi, T./Mesue, N. (2013). Testing of growth curves with cubic smoothing splines. Springer Proceedings in Mathematics and Statistics 46, 49–59.

Özkoçak, V. (2019). Antropometric techniques used for determining aesthetic anatomical and anthropological structure. Eurasian Academy of Sciences Eurasian Art & Humanities Journal 9, 30–38.

Parekh, B. J./Khadilkar, V. (2020). Pediatrician-friendly IAP growth charts for children aged 0-18 Years. Indian Pediatrics 57 (11), 997–998.

Royston, P./Wright, E. M. (1998). A method for estimating age-specific reference intervals (`normal ranges’) based on fractional polynomials and exponential transformation. Journal of the Royal Statistical Society. Series A (Statistics in Society) 161 (1), 79–101.

Wei, Y./Pere, A./Koenker, R./He, X. (2006). Quantile regression methods for reference growth charts. Statistics in Medicine 25 (8), 1369–1382. https://doi.org/10.1002/sim.2271

WHO (2009). The WHO child growth standards. Available online at https://www.who.int/toolkits/child-growth-standards/standards (accessed 2.20.23).

WHO (2006). WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Available online at https://www.who.int/publications/i/item/924154693X (accessed 12.9.22).

WHO (n.d.). WHO Multicentre Growth Reference Study (MGRS). Available online at https://www.who.int/tools/child-growth-standards/who-multicentre-growth-reference-study (accessed 12.9.22).

How to Cite
Khadilkar, V., Oza, C., & Khadilkar, A. (2023). Evolution of growth charts in India. Human Biology and Public Health, 3. https://doi.org/10.52905/hbph2022.3.54