The use of local reference growth charts for clinical use or a universal standard: a balanced appraisal

A much-debated topic is whether a growth chart should be local, national or international. On the one hand, if we consider that, by definition, a reference chart describes the anthropometry of a given population, we can conclude that we need as many reference charts as the number of different populations, no matter whether their anthropometric differences are ascribable to ethnic characteristics or to environmental, nutritional, socioeconomic and health conditions. On the other hand, if we believe that all healthy children under unrestricted conditions fully express their growth potential, and that growth potential varies between individuals but not between populations, then a unique standard should apply to all children.