Our daughter E was born at the 50th centiles for both weight and height. Around 12-18 months old, she started rapidly falling down both curves, and eventually around age 2-3 she was diagnosed with food allergies (dairy, egg, and soy proteins). She actually turned out to have FPIES (food protein induced enterocolitis syndrome). Regardless, the only treatment is strict avoidance of the offending foods. Even minute quantities of these cause her to have horrible abdominal cramping, nausea, vomiting, and sometimes diarrhea. She became a very picky eater because food often made her feel sick.
Finding foods E likes and doesn’t react to has been challenging. She was able to hold her own, though, and started tracking along the growth curves around 0-1% for height and 5-10% for weight for about 3 years. She is followed by an endocrinologist for her growth and has been diagnosed with idopathic short stature (initially it was felt she had constitutional growth delay). [I suspect her stunted growth has to do with the several years it took to diagnose her allergies, when she wasn’t digesting much of the protein in her diet.]
Anyways, about two years ago now, E started to increase in weight proportionately more than height. This could be because she started enjoying foods more (getting less picky; she had recently outgrown the egg allergy so more foods were now an option as well), so we didn’t worry about it at first. We were actually encouraged that she was eating better. We thought maybe she was getting ready to have a growth spurt…
Then suddenly we realized that she had gained a lot of weight and never did have a corresponding growth spurt. She had rolls of extra skin, double chins, and no longer fit any of her clothes (and not because they were too short). I also noticed that exercise became more difficult for her – she would become winded more frequently and was more resistant to running and active play. Gross motor skills have always been challenging for her with her hemiplegia and she has always preferred to be sedentary, but this was a noticeable change. She had also started complaining about her knees hurting.
Since E is followed quite frequently by various health care professionals (including pediatrician, endocrinologist, and others), I was surprised that no one had expressed any concern about this to us. I did a BMI calculator for children (BMI is calculated differently for kids than adults) online and E was in the 98th centile. (CDC BMI Percentile Calculator for Child and Teen)
Less than the 5th percentile is considered underweight; between 5-85% is a healthy weight; 85-95% is considered overweight; 95% and higher is obese.
I already was aware that being overweight/obese as a child can have significant health consequences. These include cardiovascular disease (including increased stroke risk), continued obesity (over 80% likelihood), type 2 diabetes, asthma, sleep apnea, increased cancer risks, and psychological stress.
It is important to discuss this issue with your child’s health care providers so they can provide advice and monitor progress. Testing for contributing factors is often indicated. Several health issues can cause rapid or unexplained weight gain, including (but not limited to) thyroid disease. Because I have a thyroid condition, we had E’s thyroid levels checked (free T4 and TSH). She also had a CBC and blood glucose screen. These came back normal.
Dieting in children can have very negative effects on growth and development. The goal with overweight/obese children is to try to slow or stop the weight gain while height catches up. (This of course varies with the age and developmental stage of the child).
Instead of “dieting”, we made some long term dietary changes. We decided to control E’s portions for pasta and grains (which she loves) and allow her unlimited fruits and vegetables (which she doesn’t love). She doesn’t tend to overeat meat/protein or dairy (almond/coconut) so we kept that the same. We implemented these changes immediately. The first few weeks were difficult as E struggled with feeling hungry. Somehow she had lost that ability to sense when she was full, even though she had been very good at that when younger. (We had done Baby Led Weaning, which I highly recommend). However, we explained to her the importance of being healthy so that she feels good and so that her body can develop properly.
After several months, she became quite good at stopping eating when she was full, and wouldn’t feel compelled clear her plate even of things she loves. I also have to remind myself not to give her so much food – it is better to give too little and have her request seconds, than to give her too much and have her overeat. So this is a job on my part, to not let my eyes be too big for her stomach! I do require her to finish her fruit sometimes, as she struggles with constipation. If she is still hungry after her fruit, I let her have seconds. But more often than not, she decides she is truly full.
We also deliberately increased her physical activity. We enrolled her in swimming lessons, Taekwon-do, and dance. We also started more deliberately walking around the neighborhood and to parks. I try to incorporate some form of physical activity into every day.
It has been a full year now and although E hasn’t lost any weight, she hasn’t gained any either. Because she grew, she has gone down from 98% to 95% in her BMI. Our goal is to get her BMI down under that 85% into the healthy range.
Here are some resources on childhood obesity from the American Heart Association:
- Understanding Childhood Obesity is an American Heart Association sourcebook on child nutrition and physical activity. Both the full and condensed downloadable PDF versions are an update of the 2005 version.
- AHA Recommendation – Overweight Children – Obese children are more likely to be obese adults. Successfully preventing or treating overweight in childhood may help reduce the risk of heart disease, adult obesity and other complications.
- AHA Scientific Position – Physical Activity and Children – Physical inactivity is a major risk factor for developing heart disease, stroke, high blood pressure, overweight/obesity, and diabetes. The American Heart Association recommends that children and adolescents participate in at least 60 minutes of moderate to vigorous physical activity every day.
- AHA Scientific Position – Dietary Recommendations for Healthy Children – The American Heart Association has specific healthy dietary guideline recommendations for all adults and children over the age of 2 years. more.
I strongly believe that in this life, nothing happens by accident or coincidence – things aren’t determined by fate or luck (good or bad). I believe there is an overarching story – a beautiful picture of love, loss, and redemption – and that there is Someone who cares and is in control. You are already a part of this story, whether you know or believe it or not. While the end of the story has already been written, your own part lays open before you for you to choose your ultimate destiny. Maybe all your life has been leading to this one moment: The Bridge to God.