4 year old on

[mybug]

So my lovely, spunky, sensitive, smart, happy 4 year old dd went for her well-child appt. today and she is 25% for height and 50% for weight. Our doctor told us not to have her on a "diet" because of self-esteem and bad health habits but she said she wants her to maintain her weight while she grows taller to balance out her percentiles. I am so not sure what to think.

She loves to eat, there is no denying it. She eats fruit, loves veggies and does not snack on unhealthy things, we don't even have them in the house. What is making this even harder is that my ds has so many food limitations (he is actually tube fed because of it) and is on a lot of meds so eating is a weird thing in our house to begin with. Both kids are active, energetic and she is otherwise mostly healthy (UTI's and ear infections cured by acupuncture and herbs). She goes to gymnastics and is really pretty good at it, given the extent of four year old gymnastics.

Another complication is that she is adopted and we don't have any health history. I don't know if that matters really, but an item of interest still the same. All I know is that her birth mom is 4'9" and her birth dad is 5'5" and birth mom is drop-dead gorgeous and did not appear (in the one pic we have seen) to have a weight issue at all.

Would you be concerned about her? Are the numbers on a chart something we should really pay attention to? How would you change things if you would? What makes me sad is that when we got home and had dinner, she said she didn't want to eat because she heard the doctor say she shouldn't eat so much. That is not what the doctor said, but it is what she heard. It breaks my heart. It is so annoying how they give you all the helpful healthy eating tips now like they are the first to figure that one out. We know these things and we live that but now I have to either change how she eats or repair the damage done about hearing her weight is an issue.

When she said she didn't want to eat tonight, I told her that whatever we give her to eat is what she should eat and she does not have to worry about how much she eats because we will help her know when/how much and that she is fine. She was relieved and we kept reassuring her that her body is beautiful and reminded her of all the things it does for her. What else can I say?

[pacificbliss]

I am sorry mama. Why would a Dr say something like that?! That is sad. There is no way she should be thinking of her body like that at her age. If she is active it is probably muscle. Muscle weighs more than fat and will serve her well. Maybe discuss with her all the good things about being strong...

[ElliesMomma]

that's incredible. i think i would be looking for a new doctor... one who appreciate the differences in body build are usually genetic, and doesn't obsess about weight "problems" where there are none.

[RoViMama]

Doesn't 50% mean average?  Has she had a growth spurt lately?  My almost 5 yr old grow suddenly a couple month ago.  She probably would have been in the same range until she grew.  I would talk with her about listening to her body and making good food choices.  it sounds like you are on the right course.  I might think about another doc if there were other concerns you have with her.  But I would ask her to talk to you in private next time she has a sensitive matter to discuss.  

[mybug]

Oh bless you all! I thank you for your comments. She is just the sweetest thing and it makes me angry to have her even think this way. She is a ball of muscle. She can do things a lot of other kids her age can't because she is so strong. I agree that it may be the muscle that messes with the ratio. She has been like that for some time and we have not worried before. Our son is teeny tiny from being failure to thrive (he is 7 1/2) and they are totally different in appearance so we have never even thought to compare them, really, why should we?? I would do anything to see a little meat on ds's bones as a matter of fact.

I would change doctors in a heartbeat. But, we have done that many times since ds has been hard to diagnose. We have spent years trying to find the right doctors and have concluded there might not be such a thing in a pediatrician, at least for my son (BTW-just to add, he is finally getting very good care at a Cystic Fibrosis clinic). But, for now, we like having a clinic we can get into the same day and that the practice is small enough that they are have seen the kids at one point or another. That said, there is one older woman who didn't bat an eye at dh when he told her dd gets acu and herbs. Maybe that is who we request when we go. At the very least, I will mention to this doctor that we cannot have these discussions in front of dd. If she doesn't get it then, I will run away from them forever. sigh.

I really appreciate the thoughts though, made me feel lots better!

[lookatreestar]

i have no idea what percentiles my dd is in but she is 4 (in a few days) and 45lbs, and around 40inches tall and she is all muscle. she is one heavy, solid girl. i do not limit food but i do limit sugar (for our whole household), only drink water/tea etc. am not sure your dd's stats but i wouldn't worry unless there was some abuse/food trauma because most kids can self regulate pretty well. and they go through chunkier/leaner periods and growth spurts etc

[missnoodlesmom]

Those percentiles don't seem so off to me, personally.  Now if she was 5% height and 95% weight, okay...but kids are moving on the charts at this age still (at least mine are, at nearly 3 and 4.5).  My daughter was a really chunky 100% EBF baby and I was told at her 6 month well-check to limit nursing because she was showing markers for childhood obesity!  I was sooooo freaked out.  Right after that she started crawling and thinned out quite a bit.  At her 18 month visit they were "concerned" she wasn't gaining well because she was dropping on the chart for weight quickly.  I switched peds after that because CLEARLY they had no idea what the chart of a breastfed baby often looks like, and their opinions of my child seemed pretty harsh and they were so quick to voice it.

If you are giving her healthy choices, I wouldn't worry about this.  She's a growing girl, and I've found that a lot of kids may have a stage where they have a little extra pudge - they usually grow into it in the long run.  Although your daughter doesn't even seem like she has that extra pudge, so I think the ped may just be wacky!

[Alyantavid]

That's bizarre.  Unless she's jumped up percentiles (like from 1% to 50%) or dropped a great deal, I wouldn't even think about it.  I can't imagine why a doctor would think a 4 year old in the 50% percentile would need to go on a diet.  It sounds like she's doing perfectly and I wouldn't change a thing.

If it helps at all, my 4 year old son is 95% for weight and 90% for height and no one recommended any changes in eating for us.

[4evermom]

It's just all the current hype about BMI.  The discrepancy between 25% height and 50% weight probably came up on the doctor's chart as "at risk for obesity" so she feels obliged to mention it.  But she's trying to be sensitive to the potential of eating disorders and carefully telling you not to put her on a diet.  I've heard a quite a few people complaining about similar experiences.  One has a really solid child who does gymnastics that didn't eat for a few days after hearing the same thing.  I don't know that another doctor would be any better but maybe you can let the doctor know your dd was aware of what she said and took it the wrong way so she can be more discrete in the future.

[mybug]

Well, after reading some posts, I see the whole picture. The BMI/childhood obesity trend is taking over. I totally 100% agree that childhood obesity is a terrible issue (I work in the public schools....) but I think that sometime soon. doctors will have to also consider the person they are talking too. If I had checked that she drinks soda, or mentioned she hates fruit, or anything like that, fine, lecture me. But just because a child is not perfectly square :) doesn't mean there is automatically an issue. 

Lookatreestar, I just have to use this for an example. You gave your dd's #s. Mine is 38 inches and 36 pounds. A total ball of muscle too. Funny how a few pounds or a few inches can change a lot in perspective. I would not bat an eye at either of our girls, they are the way they are. Beautiful, strong, healthy girls who have mom's with their best intentions at heart. 

Thanks to all of you for your opinions. It did help a lot. I am ready to move on and go enjoy my daughter in all her glory ;)

[meemee]

childhood health issues are now looked under one lens without looking at inheritance factors.

dd is tall and huge. her BMI is in the 90s. yeah the 90s. i dont worry about it at all? why? inheritance stuff.

dd eats very well, is plenty active and is a ball of muscle. 

she is just like her dad who was similar to dd at her age. he didnt lose the weight till he was 14. i expect that to happen with dd. 

mama its time to build you 'talking  relationship' with your dd. i had to do that with dd at 5 when her dad and gpa were calling her fat and in fact her dad built a race track in his backyard adn was making her run. it took months of talking to discussing life for her to read beneath the lines (to actually understand what they are meaning to say instead of what words they use). 

[ecoteat]

Wait--did the doctor say these things in front of her? It sounds like he did, which is terrible! Based on what you say here, I can't imagine how her size would at all be a concern.

I know a family with a 12 year old girl that is still in shock that the doctor told them when she was a preschooler that she was overweight. I'd bet her stats were similar to your dd. Her parents simply insisted that was crazy and noted that she has her father's stocky build. Her siblings are like twigs (like their mother) and the doctor said that was a healthy size, which is all total BS. Every one of those kids is perfectly healthy and active and normal. Just like your dd, and mine, who is almost off the charts low for weight and is about 25th %ile for height. Her doctor doesn't bat an eye--the numbers are only one little piece of the puzzle.

[mimie]

Do you really mean her BMI is in the 90s?  Anything over 40 is morbidly obese.  She would have to weigh, like, 300 lbs. to have a BMI of 90 at 8 years old.  Do you mean she is in the 90th percentile for weight?  Because that's different than BMI.

Originally Posted by meemee 

childhood health issues are now looked under one lens without looking at inheritance factors.

dd is tall and huge. her BMI is in the 90s. yeah the 90s. i dont worry about it at all? why? inheritance stuff.

dd eats very well, is plenty active and is a ball of muscle. 

she is just like her dad who was similar to dd at her age. he didnt lose the weight till he was 14. i expect that to happen with dd. 

Oh, and to the OP: I would bristle, too, if my doctor commented on that with those numbers.  My DD has always been a little higher on the  weight percentile than height.  Now, at age 4.5, she is shooting up in height and her weight is  staying the same - pretty normal childhood growth pattern.  I think it would be much more appropriate for a doctor to ask general questions about diet no matter where the child falls on the charts - does the child drink juice or soda, how much fruit and veggies, are they drinking only skim or 1% milk?  Then they can help the family avoid any potential pitfalls without making it all about weight.  It is about health, after all.

[LynnS6]

Originally Posted by mybug 

So my lovely, spunky, sensitive, smart, happy 4 year old dd went for her well-child appt. today and she is 25% for height and 50% for weight. Our doctor told us not to have her on a "diet" because of self-esteem and bad health habits but she said she wants her to maintain her weight while she grows taller to balance out her percentiles. I am so not sure what to think.

A couple of thoughts: Is she getting ready for a spurt in height? My dd always chunks up a bit before she grows taller. Dd has spent her entire life in the 95th percentile for height and somewhere between the 80th and 85th percentile for weight. She was born that way and she hasn't changed her curves in 6 years. Because of that, I'm trying not to be too concerned, even though I can tell she's got a bit of fat right now. (Right now my 9 year old and my 6 year old weigh the same, and I'm trying hard not to freak out.) I'm expecting another height spurt in the next few months and we're just going into summer where she's a lot more active. Given family genetics, my dd is at risk for being overweight and so it is something that's in the back of my mind. But I agree with you, that it's not something that should be talked about in front of her.

Things to think about: How much protein does she get? Protein helps you feel full, and so it might be worth your while to track her protein intake over a couple of days. Ironically, my "chunky" kid eats more protein than my rail thin child. But she also gravitates toward fat and sugar. She simply eats more than her brother, even though he's 3 years older and a good 6" taller.

How much active play do you do together as a family? Things like bike riding, swimming, etc are really good habits to build now. Another mmajor difference between my 2 kids is how sedentary they are. Given a choice, ds will be playing sports (shooting hoops into the nerf basketball net in the kitchen, bugging us to play baseball/basketball, throwing himself on the bed pretending to make diving baseball catches) and dd will be doing something sedentary (playing with stuffed animals, reading, drawing, writing). He just burns more calories than she does because of his type of play. So, I have to be careful about making sure that dd gets large motor exercise -- partly because it really helps her sleep better, but also because it's making sure that she's using up some of those extra calories she consumes.