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Healthy
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Children and Weight
"Sally hardly eats and she just looks like skin and bones. I wonder if there is something wrong and what I should do?”
Every Monday morning Joel comes in really hungry; but he is so plump, I don’t want to let him eat so much.”
“What is so bad about a two-year-old being chubby? After all, don’t most children outgrow their baby fat?”
Caregivers may have more opportunity than parents to observe a child’s eating habits since they may be providing the child with two meals and snacks. They may not be able to tell if there is a problem with a child’s weight, but they do notice a child’s appetite. Parents frequently ask their children’s caregivers for advice on feeding and whether their child has eaten too much or not enough; however, caregivers may not know how to respond to parents because they usually are not experts in nutrition. Knowing some basic information about children and weight can help caregivers understand how children grow. However, it is important to refer parents to nutritionists, childcare health consultants, and pediatricians to answer specific questions.
Weight Charts
The National Health Center for Statistics publishes guidelines for children’s growth based on current scientific knowledge. The Center produces a series of graphs to chart a child’s weight and height. Graphs are available for different measurements based on age, height, and weight and are divided into percentiles. These percentiles are used to compare one child to all other children of the same age and gender.
For example, if a boy is determined to be at the 50th percentile, it means that half of the boys are larger and half are smaller than this child. This comparison allows pediatricians to decide if the child is underweight (less than the 5th percentile), overweight (greater than the 95th percentile) or at risk for overweight (85th-95th percentile).
Historically, height and weight charts were used to document growth. In May 2000, the Centers for Disease Control (CDC) released revised growth charts and also the new Body Mass Index (BMI)-for-age charts, which are recommended for children over two years old. There is an increasing emphasis on the use of these charts; BMI-for-age is a better measure of the impact of a child’s size for his or her overall health than the simple weight for height plot comparison. Caregivers and parents should be aware, however, that like the height and weight charts, BMI is a screening tool used to identify individuals who are underweight, overweight, or at risk of overweight. BMI is not a diagnostic tool.
Weight Status
Both nature (genetics) and nurture (the child’s environment) play a role in determining an individual’s weight status. The weight of the mother has been shown to be a key predictor of a child’s size. If a mother is overweight, it is more likely that her child will become overweight. But this does not mean that her child must inevitably be overweight. Healthy food choices and regular physical activity during childhood can help a child maintain a healthy weight whether or not the mother is overweight. While there is little that can be done about genetic heritage, having control over lifestyle choices and behaviors can make a difference.
As part of each day in your childcare program, you provide for the child’s nutritional needs and facilitate the child’s physical activity (or lack thereof). Weight can be affected not only by what a child is fed, but also how a child is fed. An environment where there is too much or too little food, where food is withheld, or where foods are used as rewards can create eating habits that reflect these patterns. A balanced approach to foods can help children grow up with healthy eating behaviors.
Fitness and physical activity habits are impacted not only by how much physical activity a child gets, but also by modeling by physically active adults. Including fun physical fitness activities into the daily routine encourages children to keep active and helps with weight along with showing children the importance of everyday exercise.
Health Risks
Child caregivers may or may not know where a child falls in the growth charts. Programs that include health screening as part of care may include this information in a child’s records. Caregivers may also acquire this information from parents. For example, if a parent mentions that a child is in the 75th percentile, knowing what that means can help you gauge where the child is compared to other children.
In general, children who fall in the bottom or top percentiles (under the 5th and over the 95th) are at higher risk for health problems than children who fall somewhere in the middle. However, many smaller (thinner) children as well as some larger (heavier) children can be as healthy (or even healthier) as those children who fall elsewhere throughout the scale. Children also may be at the bottom or top of the charts for a few months and then level out to a more moderate height and weight as their growth and age changes.
If a child’s weight-to-height ratio is under the 5th percentile, it may indicate that the child is undernourished. However, children who were born prematurely, born to families who are of short stature, or who are simply small at birth may routinely fall under the 5th percentile.
If all other aspects of the child appear normal, being below the 5th percentile may not be a problem. If, however, the child is always tired, cannot concentrate, is constantly sick, has sunken eyes, is dehydrated, or shows other signs of malnutrition, this child should be seen by a health professional. Because malnutrition may be a sign of physical abuse, caregivers should take appropriate steps in terms of reporting the case to the authorities.
Complications associated with being overweight in childhood are similar to those experienced by adults: a higher risk of developing type II diabetes, hypertension, and joint and breathing problems. In addition, large children often are subjected to teasing and exclusion, which can lead to low self-esteem and other psychological problems. Also, the longer the child is overweight or the more overweight the child is, the more likely the child will be an overweight adult.
Madeline Seigman-Grant, PhD, RD
University of Nevada Cooperative Extension, Las Vegas, NV
Resources
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS/K-24, Atlanta GA 30341-3717; 770-488-5820; www.cdc.gov/nccdphp/dnpa/growthcharts/training.htm
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