I’ve had this post in my drafts folder since May. It was started as a point of talking about growth curves and has been a bulleted and fragmented list of a post. When I started this topic was charged with EMOTIONS, and while still an emotional topic for me, time and change have lessened the raw feeling.
Have you seen the AT&T commercials with the kids sitting around a table being asked questions about which is better? The conclusions that 2 is better than one, and bigger is better, and I really really hate those commercials. Because why is bigger better? And is bigger always better?
We have this underlying value in our culture that bigger is better. That for boys stronger is better. That smarter is better. But we need to stop and ask – what do we mean by better? I spent 18 months stressed about Simon’s growth and eating habits and grappling with this, but in some ways I didn’t really step back to think about this until last spring.
In one of my classes I was talking about some research I’d been working on and some talks I’d attended at a conference. The topic was increasing executive function and information processing skills in pre-schoolers in order to improve academic outcomes later in school. The argument is that enhanced executive functioning is necessary (better) for success. Then my professor asked WHY? And that got me thinking. Because why do we find it necessary to train four and five year olds for academic success. Why not instead work with the individual to enhance their innate skills to become the best them they can be. (And rather than go into a long tangent of institutional schooling and how we teach our children I will stop here. Asking the question was enough to get me thinking.) Definition of success can vary.
So if “smarter” isn’t necessarily better – can the same argument apply to bigger and stronger? Let’s talk percentiles for the purposes of this post (FYI – I HATE PERCENTILES).* Simon was born 7 lbs. 8.5 oz (56%) and 21 inches long (97%). At 3 months he was in the 25% for weight I asked the ped. if I should be concerned that he’d dropped curves and was told that since he was gaining there was nothing to worry about.** I kept breastfeeding and life went on. At 4 months he was in the 15%, still dropping, but breastfeeding was working and he was still gaining. I wasn’t worried. Then we got to his 12 month appointment and I was told he was under weight (<3% according to CDC charts) and I needed to wean immediately so that he would start eating more solids and gain weight. Nothing else except to schedule the 15 month appointment.
So many things wrong with this. 1) on the WHO charts he was 8%, which is a drop but not alarming – or maybe it is because of the constant fall but not the percentile itself. 2) weaning is NOT the answer as breast milk has more calories per ounce than any solid food. 3) Simon just wasn’t all that interested in food until about 20 months, but I didn’t worry about it until this moment. 4) scheduling a follow-up three months later seems a little long if there actually is a problem.
I then spend 12 – 15 months stressed out about his size. About his eating habits. Second guessing myself and maybe I should have been supplementing with formula all along.*** So much anxiety. And neither of us were ready to wean. I trusted information from LLL Leaders and an IBCLC much more about infant nutrition. (I never supplemented and nursed to 26 months). Meeting other kids on the small side helped. At the 15 month appointment we went in to get weighed and I insisted the WHO chart be used. at 12% was told – nothing to worry about you’re fine. So WHY ALL THE FEAR. We switched to a ped. who is much more supportive and while not overly concerned agreed to keep an eye on weight gain and took my concern and questions seriously.
But it had started. The constant comparison to kids withing a few days or weeks of Simon in age and why is he so small. The doubting myself. The wondering WHY WON’T MY KID EAT? Because the “books” say at some meals your toddler may eat as much as you. I hate a lot of the parenting books. One that did help though was “Why Won’t My Child Eat” The to-scale picture of a baby’s stomach and a banana is awesome. And seeing the individual growth curves that are all over the place helped too. And remembering an article I read a couple of years ago where babies were measure daily that showed growth is not linear. It is in fits and starts so a lot depends on the day the doctors appointment happens to be.
The thing with percentiles is that they are based on a normal curve which means someone has to be at the ends. 10% of kids HAVE to be in the 10% percentile, that’s just how statistics work. But in this bigger is better culture we look at growth like grades where 90% is good and 10% is bad. It is NOT the same.
Simon didn’t love food, but we kept offering. We tried all kinds of tricks. I felt a lot of guilt. I don’t want Simon to be the smallest boy in his class. But so what if he is? Rob is 6’1″ and I am 5’6″; my mom’s family is very tall, most men 6’3″ or taller and all are bean poles. But my dad and brother and Rob’s dad and brother are all under 6 feet. And all are skinny (my dad and brother both wrestled in the 103 and below weight classes in high school) so smaller stature shouldn’t be surprising or worrisome as I think all of these men in my life are of normal size and success. But bigger is better right?
Since his birthday, with that first “scare” Simon’s weight gain has remained in the 8-10% and his height in the 25%. As of October at 27 months we no longer have quarterly weight checks as part of our “well-child” schedule. This is a relief and one more step in my letting go of the worry and guilt that comes with my child’s size. Because Simon is an awesome kid who is at or ahead of every other developmental milestone (believe me I’ve run him on lots of them – a perk of the degree).
So the point of all this rambling is that kids grow and develop at their own pace and there isn’t an “ideal” size or weight.**** Bigger doesn’t always mean better. Really thinking about underlying cultural values and letting go of mom-guilt have been an education for me as a parent. I’ve become more confident about “eating issues” and things are much better. I plan on exclusively breastfeeding baby brother and letting him nurse as long as he wants.
Simon will be 2.5 on Thursday and he is perfect and exactly how he should be.
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*Growth curves are useful if you are using the WHO growth charts. Our first ped. was using the CDC charts and when I requested they use the WHO charts was told that it didn’t make a difference and they used the CDC charts. That should have been an indication to run not walk to someone else. The CDC recommends not using their charts and that the WHO charts are more accurate. All percentiles in this post are according to WHO, except when noted. Not all kids will follow a standard trajectory, percentiles and growth curves are a useful tool, but they are just one tool and other measures are also important when determining if there is a problem.
**This was actually the right advice in this case, he was gaining an appropriate amount per week, which is the most important thing.
***Let’s note that I donated 150 oz of breast milk because I pumped much more than Simon ever drank from a bottle. And since I was committed to reverse cycling, I don’t really think that he was deprived of as much breast milk as he wanted, even if he always hated the bottle.
****I am not a medical professional, I am working toward a PhD in Developmental Psychology, but I write this as mostly a parent. There are times when you should be legitimately concerned about weight gain and Failure to Thrive. Please discuss your concerns with a doctor you trust as each child is unique and should be assessed individually.
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I never realized how many of the difficulties I had with my first born were rooted in being insecure as a new mom and letting other opinions (esp doctor and nurses) affect me until I had baby #2. For instance I supplemented Ike from the beginning because of my fear of under nourishment at the urging of those around me. With Nate when nurses brought it up I smiled and ignored them and have amazingly been able to nurse for over five months. I know you will find the same strength with your second son too!
For me I think a lot is I no longer/won’t trust advice more than my gut. I am learning to ask so many more questions. For most things I was able to smile and ignore (even nursing a toddler. in PUBLIC!) but the weight and food issue was really hard. I’m glad to know the confidence really does increase with #2.
What an awesome post! I have so many friends who have worried about their kiddos in the 5-10%iles… but I kept thinking WHY is the doc not worried my kid is the 95%ile? Like you said, someone HAS to be on each end in order to have the range, and as long as they keep growing on their own curve, it’s gotta be okay, right?
Your doc isn’t worried because your kid is FINE 🙂
I have so many thoughts on this subject. I know a lot of mothers (mostly bloggers) whose kids are in the very low percentiles on some chart, which makes me feel like the whole idea is just BS. Plus, why do we want children to be huge until suddenly we switch to worrying about obesity in elementary school? Makes no sense.
Mira’s been in the third percentile for weight for about a year now (around 25th for height), and I think I’ve been luckier than most in being able to not internalize it for two reasons: (1) people who mattered, including the pediatrician, were calm about it; and (2) I was a teeny, tiny kid and am now an average size adult. Then there’s also the reason I’m a little ashamed of: Mira’s a girl. Two days ago, an older woman looked at my energetic, talkative little girl and asked how old she was. I said, “two” and braced myself for the “she’s so tiny” comment that everyone feels free to offer. Indeed, it came, followed by, “But it’s good for girls to be little.” Sigh. I am almost militant in my insistence that Mira’s body is working just fine and I’m not going to force anything on her, thankyouverymuch, but I sometimes wonder if I’d be as calm is she were a boy and societal pressure was that much stronger.
Still, the truth is that kids grow at different rates, as I know all too well from my own experience as a teeny, tiny kid. I really like Ellyn Satter’s book Child of Mine regarding good eating habits–her philosophy, soundly grounded, is that parents are responsible for what and when children eat, and children are responsible for whether and how much. I’m a believer in the idea that our bodies know what we need if we don’t override that with too much sugar, etc. Anyway, thanks for the thoughtful and thought-provoking post.
I love that your pediatrician is calm about it. I think had we just started where we are now I would have saved myself a LOT of anxiety. I was the opposite – I was the super tall kid who is now an average sized adult, so that might be a part of it, I hadn’t thought much about that. Knowing that all of his other development was withing the normal range (or even a ahead) is what kept me from going crazy. The girl / boy thing is huge culturally and I know I wouldn’t worry about his eventual size (even though there is no real way to know that now) if he were a girl. I’ve heard of this book, I’m going to check it out.
Oh yikes. So much wrong with that woman’s statement, right? But yeah– it’s definitely the boy thing :/ I too was a tiny, small child and am a short but relatively normal-sized adult. But I do worry about my son being “too small” in a way I know I wouldn’t if he were a girl. Blah. Stupid effing gender stereotypes.
As ridiculous as this sounds, I have tears in my eyes reading this, my girls are both petite, and I worry and stress and trot off to the gi dr trying to figure out why. My oldest at 5 is my biggest concern, but is plugging along on the 5% and I of course think she is perfect. But it is exhausting that every person we meet has to comment on her petite size and thinks she is younger. Very valid point above, we applaud the 95th percentile but then have changed how we teach all kids due to the obesity epidemic. I’m going to think about that further. Such a refreshing post to see I am not alone with my growth chart dislike and sweet tiny kiddos.
I had no idea this post would bring out so many feeling in so many people. Sometimes I think hurtful comments are just because kids weight and size is part of cultural “small talk” and it really shouldn’t be. Thanks for reading and commenting.
I know many women who were tall in elementary school and then stopped growing and became average height or even short. My own growth trajectory (I was extremely short until high school, when I suddenly grew) was more like the boys I knew. Boys’ growth spurts are often later than girls’–hence the funny middle school scene of little boys and their larger female classmates. 🙂
We’ve talked about the incredible similarities between my S and yours, right? The 9 months of visits to the nutritionist and pediatric GI when he dipped below the 3rd percentile? Thankfully his drs never requester or required that I weaned, but the endless worry over his eating, the fear that I should have supplemented with formula and that I’ve shortchanged him by insisting on exclusive breast feeding, the battles at mealtime. It sucks so badly. Thankfully, while still small, he’s no longer falling on the curve but is maintaining around 3-5% (he’s also around 30% for height).
Can you e-mail me some tips about handling mealtime? I think we need a better system.
Yeah, I think the doctor who brought up the concern could have handled it so much better and saved me a lot of stress and worry. But now that we’ve maintained a curve for 18 months I’m pretty zen about it all. The fact that he does eat now helps a lot. I sent you a very long email. Let me know if you want more detail on any of the points. Lots of trial and error and hard work at staying calm at the table.
I have really struggled to comment on this, not just because of time, but because it really brings back a lot of anxious feelings I had about HGB’s weight. BFing was tough in the beginning, and “they” got on my a lot about supply and 100g here, 100g there… very stressful. I very much believe this informed my relationship with HGB and food, and his relationship with food in turn. Many, many food battles were fought…then again, knowing him now, I see it was a big part of his temperament. Ah! Such a complicated soup!
We were fortunate enough to have a paediatrician who did NOT put pressure on us at ALL about his weight. In fact, she even mentioned at one visit that their office used the WHO curves rather than the CDC curves (Health Canada doesn’t have any, apparently) because they were more diverse, had a larger n, and were more reliable overall. All that being said, HGB was and continues to be 5%ile… he has 4lbs on MJB. Yeah.
From about 12-20 months, Brad STRESSED about his weight. Like, tried to cram as much fat into everything possible. I believe HGB responded to this stress by shutting down and fighting more. I *knew* in my gut, that everything was fine, but I felt blamed by Brad that H wasn’t gaining. Brad didn’t/doesn’t want HGB to be “skinny” like him. (I found this REALLY eye-opening because I thought I had dodged a bullet in not having to deal with body image issues raising a boy…wrong!) Moreover, other bloggers with similarly aged kids (or younger!) were bigger than HGB and I just started feeling really shitty about the whole thing. Meanwhile, he grew normally, stayed on HIS curve, met all his milestones and has the vocabulary of a 5 year old. And I worry that his 24mo pants fall down. It’s that little niggle of guilt or something I can’t quite name that I have difficulty letting go of. Maybe it was all those platitudes I was fed along the way.
Part of what made me so angry with the ped is that he WASN’T falling so much on the WHO charts, he did, but not nearly so dramatic. But we’ve been settled at 8% for 18 months now. I have to be really careful about not asking parents what their kids weigh, especially when they are younger. My nephew will be 1 next month is only one size down from Simon. I’m really really glad we live in a different state because I think the constant comparison from family would put me over the edge. It’s that little niggle that still gets to me. But mostly I’ve let it all go. Most of the time.