21 February 2025, Carolina: A new study published in Advances in Nutrition critically examines the effectiveness of Growth Monitoring and Promotion (GMP) in diagnosing or screening for inadequate growth in children. GMP tracks children’s growth through regular measurements (usually weight) plotted on a growth chart. This information is used to support promotional activities, including personalized counseling sessions for parents. Conducted by researchers from the International Food Policy Research Institute (IFPRI) and the University of South Carolina, the study raises important questions about the current practice of GMP, which is widely implemented in low- and middle-income countries (LMICs).
Jef Leroy, lead author and senior research fellow at IFPRI, stated, “Our findings challenge long-held assumptions about GMP’s role in improving child nutrition outcomes through diagnosis or screening for growth faltering and highlight the need for a reassessment of how GMP is currently designed and implemented.” He added, “Importantly, our study does not question the need for timely diagnosis of children with acute malnutrition; neither does it undermine the importance of well-child care.”
Key findings:
Erratic growth patterns: The study reveals that healthy children’s growth is naturally erratic, with frequent accelerations and decelerations in weight and height growth. This contradicts the widely held assumption that growth curves can reliably distinguish between children with normal and inadequate growth.
Diagnostic limitations: GMP’s reliance on weight-for-age and weight gain assessments is problematic. These indices do not distinguish between acute malnutrition or wasting (being too thin) and stunting (being too short for age). GMP also does not effectively identify which children require urgent nutritional interventions for wasting.
Screening limitations: Analysis of data from multiple countries shows that commonly used GMP criteria, such as lack of weight gain from one month to the next, are poor predictors of future growth failure. There is no strong relationship between early weight or height measurements and later stunting or wasting. “Weight and height measurements alone are not sufficient to identify which children will grow inadequately in the future,” said Edward Frongillo, co-author and professor at the University of South Carolina.
Lack of treatment options: There is no treatment to return the child back to an adequate growth pattern, i.e., the kind of growth that would lead the health worker to conclude that the child is growing well.
Policy implications and the need to redesign GMP
Growing up in a poor environment can have significant, lasting adverse effects on health, development, and opportunities for both individuals and societies. The study highlights the need for a careful redesign of GMP so it can contribute to the nutrition, health, and development of young children. Key recommendations include:
Identifying specific and feasible objectives for GMP and determining necessary actions to meet these objectives.
Focusing individual assessments on critical aspects of the child’s wellbeing and what parents can reasonably change.
“A redesigned GMP could include growth assessment, not as a basis for making decisions, but to inform interested parents. It could also be used to generate an opportunity to engage parents in discussion about how to foster their child’s nutrition, health, and development. Individual assessments should not create unrealistic expectations with parents,” stressed Leroy.
The study calls for additional research and close engagement with key stakeholders, including international agencies, government agencies, in-country stakeholders, program implementers, parents, and researchers, to redesign GMP effectively.
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