Reclassification of Stunting in 0–5-Year-Olds Using WHO and Indian Charts

A study published in the Indian Journal of Pediatrics aimed to classify children under five into four height categories—standard, short, severely short, and tall—using the WHO 2006 and the Indian 2019 synthetic growth charts. It also compared how the proportion of stunted children varied depending on the chart.

The study included 1,557 healthy children (795 boys) aged 0–5 years who attended outpatient clinics for routine vaccinations. Z-scores were calculated using both sets of charts to classify the children into height categories.

According to WHO charts, 73.5% of children were classified as normal, compared to 85.4% in the Indian 2019 synthetic charts.
The mean height-for-age Z-score was -0.85 (±1.62) with WHO charts and -0.37 (±1.38) with Indian synthetic charts.
The prevalence of short stature was 15.03%, and severe short stature was 7.51%, using WHO charts, which reduced to 7.77% and 2.38%, respectively, when using the Indian synthetic charts.
WHO charts identified 22.54% of children as stunted (short + severely short), while Indian synthetic charts identified 10.15%, indicating a 12.4% overdiagnosis by WHO standards.

The study showed that WHO growth charts may overestimate the prevalence of stunting in a normal population of under-five children. Using regional growth charts could help reduce unnecessary evaluations in healthy children.

(Source: Indian J Pediatr (2025). https://doi.org/10.1007/s12098-025-05437-6)

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