Kids grow fast.
In particular, babies and toddlers experience rapid weight gain in their first two years. “In the first year, we expect their weight to triple,” says Maureen Black, professor of pediatrics at the University of Maryland School of Medicine in Baltimore, and director of the school’s Growth and Nutrition Clinic. So a child born weighing 7 pounds will typically weigh around 21 pounds at 12 months.
But just as some kids may pack on too many pounds, others don’t gain enough weight. Black says about 2 to 5 percent of U.S. kids under age 2 are considered underweight — gaining less than they should, based on World Health Organization growth standards.
While childhood obesity understandably commands more attention, since it saddles a growing number of kids with adult health problems, being underweight has its own set of hazards for the very youngest, making it harder for them to fight off infections ranging from common colds to norovirus, a highly contagious bug that can cause gastrointestinal problems; kids with diarrhea can become even more depleted. In severe cases, being underweight can stunt a child’s growth. While that’s a more common issue in developing countries, programs like Women, Infants, and Children, or WIC, in the U.S. intervene to help low-income mothers and children prevent such lifelong consequences. Still it can happen, and it’s one more reason children’s health providers worldwide keep a close eye on growth charts to make sure kids are getting bigger.
“If they’re really underweight, then it can [mean] they’re not getting the nutrients they need, so their bones may not grow well. They can have deficiencies in vitamin D or calcium,” says Dr. Mollie Grow, a pediatrician at Seattle Children’s Hospital and associate professor of pediatrics at the University of Washington. “If they’re not getting enough iron, then they may have difficulty with developing cognitively. If they’re not getting enough calories, they can have height stunting.”
For a child who is underweight, insufficient nutrition, including not consuming adequate iron and zinc, can undermine proper brain development. “During this first year of life is when there’s a phenomenal amount of brain development,” says Black, who has done extensive research on issues related to child growth in the U.S. and other countries like Guatemala, which has the highest rate of stunting in the Western hemisphere. Brain development is contingent on the availability of adequate nutrients, and there’s no going back once that early developmental window passes, she says.
Medical issues can play a role in a child’s faltering weight gain, including being born prematurely or significantly underweight; having gastrointestinal problems or development disorders that make feeding difficult; or acquiring certain infections or food allergies. Many different factors can lead to a child being underweight, says Black, who notes the need for a multi-disciplinary treatment approach that evaluates medical, nutritional and behavioral components that might contribute to a child’s slowdown in weight gain.
“The most common reasons are behavioral,” Black says, though environmental factors can also contribute. Poor access to nutritious food, limited knowledge of healthy fare and sporadic — or unplanned — mealtimes are among the examples.
In some cases, the same issues that contribute to childhood obesity may inhibit healthy weight gain in younger children, such as getting inadequate sleep and being allowed to graze constantly and load up on snacks or guzzle juice at will. That can make it less likely toddlers will eat complete meals, full of the healthy fats and proteins they need to add pounds. What’s more, experts say, distracted dining — where TVs and smartphones garner more attention than food and people — can lead kids to consume more crackers and less nutritious foods. This isn’t only an American phenomenon, Black says, but one observed in many families around the world, where a frenetic 21st-century pace eats away at healthy habits. “They’re busy and basic things such as using mealtime as a family exchange and focusing on what we know are healthy foods is absolutely de-emphasized,” Black says.
Parents, too, can unwittingly contribute to the problem. Concerned that their children aren’t growing , mom and dad may pressure them to eat more, which can backfire as kids grow more obstinate and even less likely to consume filling fruits, veggies, whole grains and other offerings — making meals more dysfunctional and less pleasant for all involved. And while it may be tempting to dangle sweet desserts as the carrot for kids eating their, well, carrots, Black says that too is a mistake. “Use food to satisfy hunger, not as a reward or punishment. Parents are in charge of what food is offered and when it is offered. Children are in charge of how much they eat,” she says. “If they choose not to eat, remain calm and offer the next meal sooner — no rewards with snack foods. Don’t bribe or threaten children.”
Black led research published in December in The Journal of Pediatrics that found young children who were underweight experience greater recovery — gaining more weight — with earlier intervention (before 24 months) using an interdisciplinary approach that included a “skill-building mealtime behavior intervention” employed by the Baltimore-based Growth and Nutrition Clinic she directs. This emphasizes four components, the first being access to healthy fare, from veggies to whole grains, and avoidance of high sugar and salt consumption; butter, oil, cheese or peanut butter are also added in along with nutritional supplements, as needed, after meals to increase kids’ calories.
Another component involves practicing healthy eating habits, such as eliminating grazing, minimizing distractions like TV, engaging in pleasant conversation about the day’s events over meals (versus, for example, focusing the discussion on what the child should be eating) and seating the child at eye level with parents. The third component focuses on kids’ appetite and autonomy, namely, that kids come to the table hungry and parents let them feed themselves. “From about eight months a child can self-feed,” Black says. A final coaching component involves filming caregivers and kids at mealtime for later analysis with families.
Not surprisingly, the video evidence collected confirms that kids take their cues from parents at the dinner table. “We make videos of families and show them to the families — and in every video we have, you can see the child looking at the parent,” Black says. “So we emphasize — and they recognize: ‘Look how important you are to your child. If you want your child to do something, you do it.'”
The researchers note that the study was focused on low-income, predominately black children referred to the clinic, more than half who came from single-caregiver homes. Those with a higher number of risk factors for faltering weight gain — from medical and feeding issues to household factors, such as having a single caregiver, maternal depression and mealtime stress — responded even more favorably to the intervention, with kids on average gaining roughly 2 pounds in six months. “Modest weight gain is ideal because the goal is to help children and families establish healthy habits that will maintain a healthy weight gain,” Black says. “The exact amount of weight gained varied by the child’s age and size.”
More study is needed to determine how the results translate to other demographics and Black intends to study whether a similar approach could help address childhood obesity, something she and other experts say seems likely.
For parents who are concerned about their child’s weight, Grow says it’s important to talk with the child’s doctor first. Some children who are smaller compared with their peers may, in fact, be growing at a healthy rate and not need intervention if there are no underlying medical issues or nutritional deficiencies. “As long as those other things have been ruled out and kids are growing appropriately on their curve, we can be reassured that they’re probably not going to have complications,” she says. Regular well-child visits should alert parents to any issues. For young children who do need help gaining weight, she cheers Black’s holistic approach.
On the flip side, parents concerned their kids aren’t eating enough could exacerbate the problem by giving kids whatever they want — like chicken nuggets all day, any day. “It’s a vicious cycle where they just become very picky eaters because that’s what their parents make them every day,” says Dr. Laura Caserta, pediatrician at Rainbow Babies and Children’s Hospital and an assistant professor of pediatrics at Case Western Reserve University in Cleveland, Ohio.
It’s better from the beginning to serve them what everyone’s eating, she says, with reasonable exceptions: avoiding foods to which they may be allergic or that present choking hazards, for example. Even if that means grinding it up, which, she says, is better than relying on processed food products often marketed to parents of toddlers that are loaded with salt and sugar. Because, experts say, going that route could instead put a child on the course for another weight problem of an all-too-familiar flavor.
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What to Do If Your Child’s Weight Gain Falters originally appeared on usnews.com
