Beyond the Charts: Why Inuit Kids Need Unique Growth Standard

Learn how following the WHO growth curves may misdiagnose Inuit children's head sizes, leading to health disparities.

Inuit children, who are Indigenous peoples of the Arctic and subarctic regions, may have different head size norms due to genetic and environmental factors. Relying on WHO growth curves can lead to overdiagnosis of macrocephaly (larger head size) and underdiagnosis of microcephaly (smaller head size) when using standards not personalized to specific populations.

Addressing this difference could lead to more accurate diagnoses and better health outcomes for these children. The study was published in the journal Canadian Medical Association Journal().

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‘Using the World Health Organization (#WHO) growth curves as a basis for assessing Inuit children can result in the overdiagnosis of #macrocephaly (larger head size) and the underdiagnosis of #microcephaly (smaller head size). #medindia’

According to pediatric neurologist Dr. Kristina Joyal, "Clinicians must be able to identify children with potential medical issues appropriately, without underdiagnosis or overdiagnosis at the extremes of head circumference measurements”.

Researchers used WHO head circumference charts and data on 1,960 children born between 2010 and 2013 to compare the head circumferences of Inuit children in Nunavut. Out of the 25 communities in the area, 18 were represented in the study population.

Head circumferences were significantly greater than the WHO comparators at all age stages, with the majority of data coming from children ages 0 to 36 months.

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“We observed larger median head circumference values, distinct patterns of growth curves, higher rates of children with head circumferences greater than the 97th percentile (macrocephaly) and lower rates of children with measurements below the 3rd percentile (microcephaly).”

A percentile is a statistical measure that indicates the relative standing of a value within a dataset.

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If a child’s head circumference is at the 97th percentile , that child has a larger head size than 97 out of 100 children in the reference group. Only 3 out of 100 children have a larger head circumference.

This can result in higher diagnoses of macrocephaly, with resulting travel, treatment, and other stressors in otherwise healthy children, and underdiagnosis of microcephaly, which can mean delayed attention to a medical condition.

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Variance from WHO reference charts has also been documented in other groups, including Turkish, South Asian, Australian Aboriginal, Canadian Cree, Japanese, and other populations.

“This unnecessary overinvestigation perpetuates a system that continues to bring harm to Inuit people, given the historical context of racism, mistreatment, and experimentation by settler health care workers,” write the authors.

They call for population-specific growth curves for Inuit children, developed in partnership with local communities.

“Our findings likely have implications for other Inuit populations in Canada and the circumpolar regions. The implementation of growth curves relevant to this population would necessitate ongoing discussion with Inuit organizations, health care professionals, and public health officials in these regions,” the authors conclude.

Reference:

Head circumference values among Inuit children in Nunavut, Canada: a retrospective cohort study - (https:www.cmaj.ca/content/196/35/E1189)

Source-Eurekalert