German height references for children aged 0 to under 18 years compared to national and international data

Objectives: The objective of the present study is to present height-for-age percentiles representative for infants, children and adolescents in Germany and to compare them with existing German height references by Kromeyer-Hauschild (KH) and with international growth charts from the Centers for Disease Control (CDC) as well as the growth standard and the growth reference of the World Health Organization (WHO). Methods: The reference population consists of a nationally representative sample of 17 079 children and adolescents aged 0–17 years (KiGGS study 2003–2006) with standardized height measurements. Height reference curves were created using Cole's LMS method. To compare KiGGS with other reference systems, KiGGS height values were transformed to SD-scores using the KH, WHO and CDC references. Results: Height-for-age percentiles in KiGGS increase until age 16 years in girls and until the end of the observed age range (17.98 years) for boys. The difference in height between boys and girls is negligible before puberty and reaches 13cm at age 17.98 years. KiGGS and KH percentiles overlap almost completely with only slight differences. However, there are substantial differences in SD-score levels between KiGGS and international data. Especially in the extreme percentiles, KiGGS percentiles are generally positioned above WHO and CDC. For example, the KiGGS 3rd height percentile corresponds to the 8th percentile according to CDC and WHO (5–18 years) and to the 6th percentile in the 0- to 5-year-olds in the WHO growth standard and the KiGGS 97th height percentile in boys and girls corresponds to the 99th percentile in CDC and WHO. Conclusions: The KiGGS height-for-age reference can be recommended as a national height reference for screening and monitoring growth in infants (starting from 4 months of age), children and adolescents in Germany. In German samples, the WHO and CDC references can be used for international comparisons.