What’s the problem?
All parents know that dreaded moment too well - when you’re sitting in your pediatrician’s office, your child having been just weighed and measured, and it’s time to hear the verdict. How have all your efforts turned out this year? Making sure he gets enough sleep, getting enough healthy foods in him, playing outside enough, hiding all the junk food, and on and on and on. All the “no”s were uttered so you could hear the right words on this day from the doctor: “Your child is a normal weight and growing well.”
Parents tend to put an immense amount of pressure on themselves to make sure their child turns out “right.” When it comes to health, it feels like we get messages from every direction about what to do and not to do. We know that kids are growing so rapidly, they need all the best nutrition and to do all the right things so they can “grow normally”, so they can “follow their curve” and not be “abnormal” for the rest of their lives.
What if I told you, most of the time these efforts are entirely an unnecessary stress overload? What if I told you - your child’s growth chart is not your parent report card!
If you see an unexpected dip or a frightful spike in your child’s growth chart, does your heart jump a bit? Do you think, “Should I have been more strict?” And if your doctor suggests a nutrition drink or a vitamin supplement or, even worse, a diet - does your self-worth as a parent sink beneath the floor?
As a kids’ dietitian who looks at growth charts every day, I see those looks in parents’ eyes. I hear those questions bubble up - “Is that normal?” “Should I be worried?” “Should I stop giving him milk?” And the objections - “He’s always been so skinny, but no matter how many nutrition drinks he gets, his weight stays the same!” “He’s always been big, our whole family is big, maybe it’s just the way we are.” So much concern, self-doubt, and worry caught up in those words.
We - parents and health professionals alike - put so much meaning into what those wavy lines tell us. But would it surprise you to know that dips and rises in growth can be perfectly normal? That a child who is in the extreme percentiles (5th%ile or 95th%ile) is likely to stay there, or their growth may suddenly even out without any warning?
What we know
We are still learning about what information we can reliably gather from growth charts. After all, growth charts have been around for less than 50 years. We have never had so many data points to deal with before. Though it’s not what we’d like to believe, growth is not an exact science, and there is not enough research on it or any reliable measure of how it changes over time. Growth charts are a tool, just like a stethoscope or a thermometer - and should be treated with the same value. It should be used along with many other markers to assess your child’s overall health and changes in growth. The CDC itself says this about growth charts: “Growth charts are not intended to be used as a sole diagnostic instrument. Instead, growth charts are tools that contribute to forming an overall clinical impression for the child being measured.”
Here are a things we’ve learned from the research over the last couple decades:
Growth in height from birth to 2 years happens in very short periods - there might be a lot of growth within a day and then a period of no growth for awhile
A child’s weight and height gain in the first year is twice that of the gains in the 2nd year
Growth which stays at one extreme of the growth curve - so really low or really high - and stay consistently there is likely normal
Lots of movement on growth charts can be completely normal
Clear weight loss in kids is always something we need to address
When should I be concerned?
Most true growth concerns will have more signs than just a change in the growth chart, because they will typically be tied to an underlying issue. Your child might be sick, feeling or acting differently, have low energy, or have physical signs on their body. Consider some of these markers that you may want to look into:
Your child accepts fewer than 10-20 foods for longer than 2 months
Your child is consistently and noticeably distressed around foods or mealtime
Your child seems to have problems with the oral-motor skills of eating
Your child’s body fat percentage has significantly decreased
Your child’s weight has clearly changed in a short amount of time
Your child has other medical symptoms
When in doubt, consult a health professional you trust and don’t be afraid to ask plenty of questions. You deserve to feel comfortable and confident about your child’s health and wellbeing, and it is the job of health professionals to help you get those answers or refer you to someone who can help.
More questions or concerns about your child’s growth and nutrition?
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