Wednesday, January 12, 2011

Weighty Stuff

This is a recent picture of our daughter, A, over the Christmas holidays. Look closely at this image. Study all the details you can. Because I have some serious questions for you to answer.

Does this child look sick to you? Malnourished in any way? Suffering from a strange disease called my-mother-doesn't-feed-me-well?

No? Well then why, when I go to visit our family doctor for A's shots, do I get told that there are issues with her weight? This is how the situation usually unfolds:

1. Mom and A are led into examination room. Mom attempts to distract A with the doctor's wheely chair
2. Nurse enters with scale and measuring tape. A is undressed and sumitted to growth tests
3. Mom axiously looks at the scale, and sees that A has not gained the right amount of weight.
4. Nurse leaves. A is now naked, running around the examination room, pulling open drawers labelled "pap smears."
5. Mom and A wait...and wait....and wait
6. Doctor enters the room. All serious-like. Sits down, and says "now, there's a couple of things we need to talk about. We're concerned about A's weight."
7. Mom groans inwardly
8. A screams in glee, and begins pulling all objects out of Moms' purse and throwing them onto the floor.

By the end of these visits, I'm exhausted from dealing with A and trying to talk seriously to the doctor at the same time (we all know how hard it is to carry on a conversation while trying to make sure your child doesn't do something to harm him/herself).

To give the doctor credit, he first asked me what I thought might be wrong, and also asked me whether I believed something should be done about it. I stated the argument that I use frequently: she looks healthy and I think those growth charts are rubbish (I don't think I used this language, but you get the idea).

The growth chart that is used by most doctors here in Canada was first developed for testing with inner-city children in the U.S. The data was derived from the growth of Caucasian children in Boston between 1930 and 1956. This data has since been updated, and the WHO has come up with its own references for growth charts. However:

"Concern has been expressed in the literature that breast-fed infants, living under favourable conditions, were growing less well than expected when compared to the [WHO] growth reference." (WHO website, 2011)

Breast-fed babies have been found to grow less rapidly than formula-fed babies, and therefore end up deviating away from the reference data, i.e., they fall of the charts.

So A is now off the chart in terms of weight, and the doctor is recommending we go back to see a specialist, and find out whether it could be related to a gastrointestinal problem. We have been through this before, when we were sent for a second opinion about A's reflux.

My gut feeling is that everything is fine, and that seeing a specialist will yield nothing more than the standard report of "let's wait and see." But the doctor's worry is that if A were to contract a stomach virus, she would lose enough weight to make things really serious.

I'm blogging about this because I'm concerned about how obsessive we've become over our children's weight. We don't live in a developing country; we have clean water, an abundance of food, and good quality medical care. We have such an abundance of food that in recent years, the government has launched a national campaign to curtail childhood obesity. 8-year-olds are being told by their family doctor that they need to lose weight.

Could our money and resources not be put to better use? How about a national campaign to foster a love of the outdoors? Get kids into canoes, on snowshoes and hiking our many beautiful parks. What about doing more to reduce the influence of food industry giants such as Kraft and Nestle? How about supporting lower income families in learning how to cook homemade meals that rival the taste and cost of a McDonald's Happy Meal? And most importantly, working to find the causes (and solutions) for the unprecedented number of children struggling with mental health issues (depression, anxiety, low self-esteem, bullying...these are all linked to our society's general mental health)

I know that some parents like growth charts. They like to brag about their child's height falling into the 95 percentile. Either that, or they're anxiously polling all the parents at playgroup about whether the 5th percentile in weight is a serious problem. It's a cause for a lot of comparison and worry, but can also be a source of comfort for those who like things that are clean-cut and measurable.

This is all fine and good for our babies, but serious issues can arise with an older child who is told that they're not measuring well compared to other children. In fact, this type of conversation can even lead to disordered eating behaviours and distorted body image. Eating disorders can develop, and then you've got a child falling off the other end of the charts.

I'm making a suggestion to you all. Let's put away the measuring tapes for a while. As parents, get rid of your scales. Try to avoid placing an emphasis on weight and body size in your family. What's more important is how you are all feeling. Do you feel strong and resilient, or weak and walked-all-over? Do you take time every day to dance in your bare feet? Do you stop to sniff the snow? (there are no roses out right now, so snow will have to do) Have you all experienced the rush of an early summer dip in the lake? Do you make big messes in your kitchen, and allow your children to concoct their own recipes?

Bravo to you if you do, and good luck to those who wish to start. Let me know how it goes!

(p.s. I promise to get back to some music-related posts soon. Life experiences require me to rant)


  1. An excerpt from a recent article on the "Rourke Baby Record", the most commonly used tool by health care practitioners for monitoring infants' growth and development:

    "The World Health Organization (WHO) Child Growth Standards were released in 2006 based on the WHO Multicentre Growth Reference Study, a 6-year study of approximately 8500 children in 6 countries with optimal nutrition and health care followed longitudinally from birth to 5 years of age. A February 2010 Canadian collaborative statement from the Dietitians of Canada, the CFPC, the CPS, and Community Health Nurses of Canada recommends a change from use of the current Centers for Disease Control and Prevention 2000 growth references (which are based on American children and are not controlled for optimal nutrition and health care) to the WHO growth standards. Canadian growth charts using WHO growth data are now recommended in the RBR’09 for both breastfed and formula-fed infants, as they more closely represent optimal growth, are applicable for children of many ethnic backgrounds, and are more sensitive in detecting overweight and obese children. These charts and additional material to aid physicians and health care providers in this change can be found at

    Growth measurement for premature infants less than 37 weeks’ gestation should be corrected for gestational age for up to 24 to 36 months."

    As a physician, I agree with much of what you are saying - I think there needs to be more emphasis on clinical judgment and less on the numbers but that being said, I think growth charts are still an important tool for health care professionals to use and do aid in the identification of children who have concerns/underlying problems. You may want to check with your practitioner to see if they have the new or older growth charts and rest assured that if your child seems healthy and is developing normally, chances are she is perfectly healthy.

    If you would like the full article or the references, let me know.


  2. Thanks Susan, that's really helpful! Would love to see the article. You can send me an email by clicking on my profile (I think my email is up there somewhere...)


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