My 4 yr old went to the peditrician for a healthy check-up, and she’s concerned because he’s 10 pounds under weight. That translates into being in one of the lowest percentiles (whatever that means). Now, by that textbook description, you’d think I have an emasciated skeleton of a child who is so letharic and failing to thrive.
My son is a happy-go-lucky boy with a baby-fat belly and yes, you can see his ribs, but in a healthy way. Don’t the doctors know skinny when they see it? Is skinny now deemed unhealthy, too? Maybe the rest of the country is just so fat, now all the charts totally f’d up!?! For goodness sake, my boy is JUST FINE!
Who defines what is normal? Did the AMA get an affidavit from the Almighty Himself? Maybe the doctors don’t even know a healthy child when they see one, and now my wife is all worked up over this BS. Next, they’ll be saying he’s too fat, right? (F’ing doctors, imho! …Forgive me.) :mad:
What’s the SD on these growth charts? Who defines “normal”, and maybe one day, they can define it for me, I am sure…without any exceptions.
The CDC creates growth charts in the US and they were last updated in 2000. Data from five national health examination surveys collected from 1963 to 1994 and five supplementary data sources were combined to create them.
Being in the 10th percentile for weight just means that 90% of boys in the US are heavier than your child at this age. 10 pounds under weight just means that he is light for his height.
The thing that alerts doctors is usually if there is a change – my eldest child is at the 50th percentile for height (in the US; in Holland he is short) and has been since birth. He is under the 50th percentile for weight and has been since about 9 months old. If he came in at the 10th percentile or the 90th next year then we would want to look at why that might be because it is a change. My youngest child was always on the low end of the chart for height and weight, but at his 4 year old checkup he fell off the chart for weight. It was concluded that he was doing things rather than eating, and that he could use some more calories to burn off so we put him on full fat milk and yogurt and cheese and gave him nuts for snacks and so on to raise his calorie intake. His nutrition profile was fine but he needed more calories to maintain his weight given his activity level.
That said, it is a matter of common wisdom that no child is normal according to the growth charts, they are all too big or too small or too thin or too fat. It can indeed become annoying. But it really is no big thing. It probably has less to do with the position on the growth chart and more to do with the low weight for height plus the position on the growth chart. The doctor is not criticising your child, your family, or your eating patterns. The doctor is trying to keep an eye on things to see to it that your child remains healthy. Really.
The percentiles mean that x percent of children are above and below that. So, for example, a 4 year old boy who weighs 26 pounds weighs less than 97% (and probably less than 99%) of all his peers.
Weight is correlated with stature (height) so a very short child may have normal weight for stature but overall be small for his age.
The growth chart percentiles are literally that: statistical averages gathered by tallying up all comers.
I’m not a pediatrician and have no advice about your baby. It’s not clear to me why you feel the pediatrician is taking an arrogant position. It is true that someone has to be in the top and bottom percentiles when these sorts of averages are created. Many pediatricians follow trends in growth as carefully as isolated point measurements.
This. My middle kid is 50th percentile height/weight, but he doesn’t eat much, which had me concerned, since my other two are “off the charts” in height and weight (though not obese at all, just big kids for their ages). But he’s always been 50th percentile and that’s stable, so the Dr. says relax.
Well, no, I gathered that because the OP indicates the doctor said two things: that the child was 10 pounds under weight and that he is below the 10th percentile for weight. So I concluded that the doctor was trying to illustrate in two different ways why she was concerned.
I also gather that the message did not quite get through so I could of course be wrong, maybe the doctor really said that the child is 10 pounds under weight for his age (not for his height) because he is low on the growth charts for weight. If so then I agree with the OP, that strikes me as very near to a meaning-free statement.
Jinx, what is your son’s precise height? What is his precise weight? What is his precise age? If you want an answer to your question, you might start by giving us enough information to be able to make any comments.
I don’t think you should take it so personally. There are good reasons doctors use growth charts and monitor children’s gains in height and weight. Sudden changes or uneven growth can indicate various problems.
I think it’s good you are aware of this. Your kid is probably absolutely fine, but it’s not going to hurt him if you are aware he’s much skinnier than average and take care to get even more nutritious food into him.
I was an average-sized baby and toddler and suddenly fell to the bottom of the weight chart at around your son’s age, to the concern of my parents and doctor. Nothing was wrong with me, I haven’t been above the 5th percentile since, and I’m 24 now and quite hearty. It’s true that some people are just skinny, and I do think doctors are seeing less of them these days.
Just stepped back in here to express an anxiety about either reassuring Jinx or worrying him. As WW comments, it’s hard to be specific without the exact data points. Beyond that, though, growth charts are used for a reason, and the reason is that some kids do need further, and more aggressive, evaluation. While it’s true most do not, some do. Certainly one consideration is where the child falls on the growth chart (if the baby listed in the OP really is only 48 months and really is 10 lbs under “average” it’s well below the 3rd percentile if I read the chart correctly, and that is a completely different ballgame from the 5th percentile…) but many other factors such as the pediatrician’s evaluation of the child’s environment come into play. Those are not evaluable over the internet, and it’s my personal suggestion to not get into specifics for this particular child.
Jinx: please do not infer anything from this. I am literally saying we should not have an opinion which worries you or reassures you.
Common wisdom is mathematically impossible in this case. The growth charts are based on percentiles; by definition a large majority of children are normal according to the growth charts.
It can find growth disorders or a Thyroid problem by tracking your child’s height and weight. They can now give a small stature child hormones during puberty to stimulate growth. 10 lbs is not a big amount to an adult but in a 4 year old it might be a sign that there is a problem with growth. 10 lbs underweight does not sound right for a 4 year old.
If they rule out a growth disorder it is probably just normal for your child to be that weight.
Based on the information you’ve provided, I’m not sure you should be.
I think you should sit down and talk with your pediatrician about how you feel about what you think she said, because it seems likely that you and your doctor are operating with very different understandings of the situation and very different definitions of terms. I am sure your doctor would appreciate the opportunity to clear up any misunderstanding, and you (and your wife) would greatly benefit from clearer communication with the pediatrician.
It might be helpful to discuss with your doctor what she thinks it means that he plots at a lower percentile. Does she think your son is emaciated, failing to thrive, or unhealthy? It may be that she thinks your happy skinny child with a baby-fat belly is just fine, as you do.
Don’t get hung up on the word “normal” with regard to growth charts (in fact, the charts themselves use percentiles, not a normal/abnormal distinction). The idea isn’t to label someone’s kid as abnormal, but just to see if he’s growing as expected based on how other kids grow on average. The charts are a helpful tool, but they provide only part of the evaluation of child development.
Please talk you your doctor about this. In my experience, pediatricians regard telephone calls about parent concerns as part of the job and would welcome the opportunity to alleviate any miscommunication.
One of my sons never even got on the chart as far as weight. One of his teachers commented on how skinny he was, but his pediatrician looked at his father, looked at me, and said, “Don’t worry about it.”
When I met my husband he was 27 years old, 6’3" and weighed 140. I was 5’5" and weighed 100. It’s genes.
I do see a lot more pudgy kids than I used to, though. Could be your ped is just used to seeing heftier kids, so yours seems skinnier by comparison.
Our doc did tell us not to let the kid have anything to drink until after eating his meals. And of course to feed him lots of veggies. Like he was going to eat that.
Don’t forget that muscle and bone density count towards weight. If a kid looks normal but is under weight, the doctor might be slightly worried about bone density and muscle mass. Doesn’t mean he wants the kid to start eating Twinkies.
My grandson was 5% in weight (about ten days premature) and has remained there. He is 40% in height. As he comes up on 2, he is perfectly normal in activity, speech and in every other way. The pediatrician is not concerned in the slightest. He eats very well, incidentally, and is also still being breast fed once a day, but that is as much for my daughter as for him at this stage.
Pediatrician here and I of course cannot make any intelligent comment on this particular child, but I can give some SD on growth curves.
Yup the height and weight curves are from the CDC and monitoring how a child does, over time, on those curves gives us many heads up. (As CP notes - the trends.) “Normal” is statistical but in usual actual usage we are going to note a child in the top or lowest 5% - not declare a problem, but at least note and consider for a second. We will note a significant change from the child’s usual curves. And note significant differences in the height and weight percentiles, especially if one is changing and the other isn’t. And if a child’s curves really don’t fit for where they would be expected to be on the basis of the child’s parents’ height and builds. All can be normal for a particular child in a particular family (and usually are) but all need a quick think-about if nothing else.
Nowadays many of us are also following the body mass index (BMI) curves and there also how someone is doing as followed over time means much more than any static number. These percentiles btw do not reflect current population norms but instead what was normal 20 or so years ago. Childhood obesity is defined as being in the top 5%ile on those curves and 15% of kids today are in that top 5% of the historic norms. Most kids hit a leanest point (in an absolute number sense) on those BMI curves somewhere around 4-5 years old and get more solid again - it’s called “adiposity rebound”. Kids who hit that rebound early are at a much greater long term risk of obesity than those who hit it later, even if the former’s BMI percentage is still below 80 and the latter’s is over 95. Again, the trend matters more than the static point in time.
IF jinx’s kid is falling off of his own weight curve and is dropping down BMI curves then a pediatrician should be concerned, protruberant belly or not. Lots of kids with serious problems have bellies that stick out even as they lose muscle mass. Or a doc might be a doofus looking at a kid who tracks skinny and declaring under 5%ile as abnormal and “a concern” by definition. Don’t know which if either. The curves and their defined “normal” are a tool; not an assurance that the tool will be used intelligently.
Our two sons have always been tall for their age and we have been told, repeatedly, at check-ups that the “weight for age” charts are of limited value at best for the tall kids and the small kids. Weight for height is much more interesting. Even then, somebody has to be in the lowest 10%, that’s just how statistics work. So where is your son on the weight for height chart, Jinx? Has he been there all along, or has he been dropping down the percentiles?
Okay, I don’t understand one thing here - why does the CDC even give Pediatricians the updated statistics curve? I can understand the value of the Doctors telling the CDC the actual measurements, and the CDC putting them all into one table - if we are talking about the increase of obesity, we need data first.
I also understand why BMI charts - which I was given to understand are adapted for age in addition to gender - are very useful: you need to know if on a health standpoint the child is underweight or not.
But what purpose is the comparision to other child in that age group currently worth, esp. if obesity is rising, so that many children will be overweight? Telling the parents: “for his age, he is a bit underweight (because he’s running around too much and not eating enough), so give him more calories” or “for her age, she is overweight, so give her water instead of juice to drink and lay off the high-calorie mushes” is useful and important. Telling the parents “Well, 90% of his age group are heavier, but he’s not actually underweight, the other kids are obese” - what use is that?
I can’t say I understand the question, especially in light of my past posts in this thread. But I’ll do my best to answer what I think you are asking.
We need to what is normal in order to know what is abnormal. Things that are abnormal deserve to be looked at a bit more closely in case they are abnormal for a reason of concern, or in case the abnormality would cause a problem presently or avoidably in the future. Knowing what is abnormal is more than exclusively looking at a single point on a chart. It requires understanding context, within the child’s life and growth pattern, and within our society and our time.