Ask Dr. Gwenn

Q) Dear Dr. Gwenn:

My children dance and do karate and the instructor noticed my kids looked "underweight" compared to other kids.  She suggested I add more fat to their diet. Should I? Their doctor has never said anything about it.  I’m not sure what to do.

I have always being an over-weight person, even as a child, so I am very interested in my children’s diets.  I’m currently 5'5" and weight 230 lbs.  My husband was short and average growing up but is now 6’ and 200lbs.  I have three kids:

LG is (female) Age 4:  3'2" and 34 lbs. (would like to eat constantly)

IG is (male) Age 6 3'8" and 44 lbs. (is the picky eater)

AG is (female) Age 8  4'2" and 48 lbs. (is a good eater)

I try to serve healthy meals and my children enjoy a lot of healthy things that their peers won’t eat.  We consume low fat dairy and slim milk, eat and snack on a variety of cheeses (like brie etc.)  They all enjoy yogurt and even ice cream sometimes too. I serve fish twice a week, beans and beef weekly and we eat a lot of veggies, and chicken.

I have noticed that AG is smaller then everyone her age but I figured she'll blossom soon.  It's a challenge as AG can't find clothes to fit as size 6 it too short and just right around the waist.  IG is starting to become that way too.  He can't wear most size 5 yet because of the wide waist.  From photos for our families there is nobody who I would call as skinny as my oldest daughter. It may help to know that my niece has been buying slims for years and is now 12 and starting to fill out. 

Thank you for your help.

DG

A) Dear DG:

Thanks for your question. You are smart to pay attention to your kids eating based on your history.  Your kids' karate instructor is certainly well meaning but is basing her advice purely on observation and not medical training or concrete data. Before you change your kids diets, let's first tease out if any of your kids have a weight problem at all.

Kids come in all sizes and shapes and some may look overweight or underweight but be fine when you look at standard growth curves and BMI. When I looked at the growth curves for your kids, they clearly have no problems in weight. In fact, they are all very appropriate heights for weights. 

For example, if you look at this growth curve and plot IG's data he is 50%ile for weight and just over 25%ile for height.

Similarly, here's the curve to plot LG and AG's data. LG is just under 50%ile for weight and just under 25%ile for height. AG is between the 10th and 25%ile for weight and just under 50%ile for height.

BMI's for your kids are similarly reassuring:

(Click here for the BMI chart for females and here for the male chart)

LG has a BMI of 16 which is approximately the 75%ile for age

IG has a BMI of 16 which is approximately 50-75%ile for age

AG has a BMI of 13.5 which is below the 5th%ile for age

So, on paper, none of your kids are truly over weight or underweight. If anything, you’ll want to watch LG and IG over time to make sure that BMI dues not creep up. For AG, review her diet and make sure she is getting enough of a balance. She may not be underweight at all but could easily gain a few pounds without concern.

I’d suggest a few things to help you feel comfortable about your kids' growth and nutrition:

1. Call your pediatrician and review your concerns and growth parameters with him or her. While I can give you a perspective of today I can not provide you with the trend based on past growth.
2. Your karate instructor was certainly well-intended but I believe out of line to mention any medical concerns to you. Perhaps in the future just smile and don’t  pay much attention to comments that don’t fit what your pediatrician has told you.
3. You and your husband could become outstanding role models for your kids by trying to loose weight. I know this is easier said than done especially since you’ve been struggling with this your entire life. Studies do support that kids learn from their parents. If you are open and honest with your kids about your struggles they won’t internalize the wrong message. Please know I’m not implying they have received the wrong message, just pointing out a potential pitfall.
4. Shop at stores that carry adjustable waist pants such as Old Navy, LL Bean or the Gap. As you'll see, there are many kids that need slim clothing - especially before puberty.

This is a good example of how well meaning people can ratched up the worry alarm for us as parents. If you ever find yourself second guessing yourself or searching on-line for answers, call your pediatrician for a realith, and sanity, check.  Of all the roles that we pediatricians serve for families, that is likely the most important – and what  we are here for!