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poop and weight labels

Posted by on Dec 15, 2010 in Blog Posts | 24 comments

Many of you probably know what I think of arbitrary labels for children and weight– adults too for that matter! (Please check out and comment on the post about doctors labeling children if you are so inclined!)

Well, I had a funny conversation with a friend the other day and it illustrated the absurdity of it all. We are both moms, feeding our children very well, they sleep well, they have opportunity for physical activity, they are happy and thriving, they are growing in a steady and predictable way. One is at the very top of the growth curve and always has been, the other girl is at the very low end of the growth curve and always has been.

We both shared how we would get worried before their checkups because they are growing at the extremes of the bell curve, but are growing in a healthy way for them. What was crazy was that a few ounces one way or the other would mean a few percentile points. Perhaps enough to be labeled “obese” or “underweight” or flag some concern, when in reality, clinically all was well.

“I hated it when she pooped right before her visit, then I knew her weight would look like it went down,” my friend confided.  I chuckled, because my little one was pooping every other day, and it was more than a few ounces in my estimation.  ” I was worried if she didn’t poop!” I said. “If she pooped, she’d drop a couple percentile points, and no one would care!”

Because really, in small children a few ounces can make a big difference if you live in the land of the extremes and arbitrary labels. ( According to the bell curve, ten percent of us will live at the top and bottom five percents happily and healthily.) In a five-year-old girl, 5 pounds can span the range from “normal” to “obese.” And while a few pounds may not be clinically significant, telling the mom of a five-year old girl that her daughter is ‘obese’ IS significant.

Did any of you worry about weigh-ins?

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  1. Michellers

    My daughter has been off the charts in height and weight since birth and I was worried about getting “the talk” from her pediatrician about her weight. At her 4 year checkup he told me that he wanted to tell me something that he tells all of the parents of high-end of the spectrum kids, and that was: “other parents and kids will treat your daughter as older than she is and wonder why she acts like a 4 year old when she looks like a 6 year old, so just be prepared to explain a lot that she’s just tall for her age.” I was so immensely relieved! On the other hand he always asks her if she’s eating her fruits and vegetables (whatever) and wants to keep her on continuous medication for her asthma (over my dead body)–but I have to love him a little bit for not buying into this size chart hysteria.

    And–as others have noted about their kids–she comes by her size naturally because I was EXACTLY the same way as a kid, taller than everyone else in my grade until high school.

    • katja

      nice! My ped also doesn’t push the weight, but she knows what I do and heard me at grand rounds, so I think she knows how I would take it! She too did the whole, “So, you eat your veggies, right?” Argh. Oh well. Not getting worked up about that one!

  2. Anne

    My son has always been proportionally taller than his weight (I think I’m his only relative under 6 feet tall – so it’s inevitable) and we never had a problem. Then, last checkup, we got a different doctor than his usual (scheduling) and his weight had gone to 75% from 50%. She told me we should “keep an eye on that” to make sure it didn’t “become a pattern”. I was flabbergasted – for once in his life his weight shot up faster than his height and suddenly it’s an issue? I mean it could have been for any number of reasons – he’s 10, he learned how to ride a bike, maybe he put on muscle. But no, I’m supposed to freak out because his weight went up a few percentiles. It just bugged me.

    What I’m really concerned about is how I’m going keep him in shoes when he already grew out of the one’s we bought 3 months ago 🙂

    • katja

      Good for you. It SHOULD bug you. Did she ask any questions about food patterns, how feeding was going, his activity level, his sleep… It is likely totally irrelevant about his weight. It might be appropriate to ask further questions, but not raise the alarm bells. What if your son was a girl… Did the doc say this in front of your son? If your 10 yo daughter heard this, might it be the first seed of body-image issues, dieting etc. Kids roughly follow percentiles, but at times to go up or down. Perhaps it’s also the beginning of the pre-pubertal growth spurt which almost always starts with weight before height. This kins of thing makes me crazy. Buy stock in Stride-rite 🙂

      • jaed

        If your 10 yo daughter heard this, might it be the first seed of body-image issues, dieting etc.

        Boys aren’t immune from body-image issues, also. I think they tend to manifest it in different ways, and there’s not as much social pressure on boys appearance-wise (or to put that better, boys have a wider “permissible” range of body types although boys and girls outside the “permissible” range both suffer). But I do seem to hear more and more stories about boys manifesting anxiety about their bodies and about eating, and also I think this pressure seeds bullying behavior (around weight and appearance) so commonly seen in adult men.

        I’d be just as careful about not letting a pediatrician seed this sort of thinking in a son as in a daughter.

        • katja

          So true. My friend with her son said a casual comment about “just cutting out a couple hundred calories or so, not a diet or anything” started an obsessive interest in calories etc that they jumped on. You are right that boys can be harmed and alas, studies confirm that they are catching up with body image concerns and dieting behaviors, though statistically they are still fare less likely than girls to suffer and manifest in the same way. The very young children with eating disorders are as or more likely to be boys from my understanding, with more of an anxiety/OCD component. I guess we’d all be better off without the silly labels. Good point about bullying. All thie “obesity prevention” tells kids you could really not be fat if you really wanted to, and opens kids up to assumptions about laziness, overeating etc and bullying. I love my readers! You guys are so smart!

  3. sandrad

    The whole ht. wt. percentile thing is GAAAH! My girl was above the 100th percentile for both until she was one. There were 3 babies in our mother and baby group bigger than her. For babies with northern european ancestry this is not unusual. Yet moms with babies inth 50th percentile were being hasseled. Isn’t the 50th percentile supposed to be “normal”? am I missing something?

    • katja

      Who was hassling the moms? The weight hysteria makes me crazy. I am hearing from more and more parents of infants who’s docs are calling them “obese.” All this does is introduce anxiety, self-doubt and pressure into the feeding relationship which is almost universally counterproductive…

      • sandrad

        Nurses, lactation specialists, Dr.s, I mean isn’t ‘failure to thrive’ based on more than just weight? one poor mom was bringing in her baby to to health clinic to weigh every week day.

        • katja

          crazy! FTT is in theory for <3%. it is a term that is also so judgement laden and terrorizes parents. I'm shocked that these moms of "average" sized kids were hassled…

  4. The WellRounded Mama

    Oh my, yes.

    My pediatrician is really great overall, far better than most, but I keep waiting for the other shoe to drop. I have one son now who has definitely put on a pretty fair amount of weight, as many children do right before puberty, as my other son did just before shooting up prodigiously. My younger son was my smallest baby, the only “average-sized” one, and very average in size until a year or two ago but the change is nerve-wracking.

    I’m sure this gain is related to the pre-puberty thing and will change once his growth spurt begins, but I keep wondering if our wonderful doctor’s gift for not saying anything about outliers will be pushed too far before the growth spurt hits. So far so good, but it’s hard to trust.

    I’m sure with many other doctors we’d be getting “the lecture” so I worry about when our great doc retires or is not available for an appt.

    • katja

      if you’re concerned have you thought about a quick call to the doc to ask them not to talk about it in front of your son? Hang in there with good feeding. My brother too went through the puffy pre-puberty phase. I shudder to think what would have happened if he’d been put on a diet…

  5. Nicole

    Well, you know from my anguished email a few months back that I had the problem of my son (87th percentile) being labeled “at risk for overweight”, even though he is in awesome shape (Presidential Physical Fitness awards, etc.). I have to say that even though I corresponded with the doctor about my uncomfortableness, I have noticed myself feeling differently about feeding him. I hate that I’m second-guessing myself! The truly ridiculous thing is that his little sister (age 2), eats far less healthily than he does but will not get any question about it because she’s tiny for her age. She’s been consistently in the 15th percentile, even though she would eat nothing but meat, cheese, and garlic bread if we’d let her! My son, OTOH, loves veggies, will actually choose carrot sticks over fries (not every time, but with enough regularity that people comment on it)…*sigh* I’m really trying not to get a complex–or, more importantly, give him one.

    • katja

      Ah Nicole, you are precisely why I do what I do. So not right, so wrong on so many levels. What I hate is that it plants the seeds of anxiety and self-doubt, or throws gasoline on the flames of anxieties that are already there. Docs need to assess better than they do (labels are lazy and not accurate assessments of the whole picture, or any of it for that matter) Fear, anxiety, worry only feed pressure with feeding which is always counterproductive. I hope you can stick with it. Read “Your child’s weight” if you haven’t already, come here, I hope for reassurance, a calming voice of reason. I’m sad, but not surprised to hear this. (To be honest, I still have those occasional flash of residual concern when my larger than average has a really big meal.) It takes steady nerves. Hang in there!

  6. Ashley

    Absolutely, but it was all because of my neuroticism and not my doctor. I went 17 days overdue with my baby, and she came out (shocking, I know) at the 98%. She was exclusively breastfed and was always a slow gainer. At 18 months she’s now in the 15%, I think, so the dropping of percentiles has been going on for quite awhile. I have moments of worry about it, but my doctor says “she looks great, you’re doing a great job!” She’s ahead of the curve developmentally, happy, fed on demand, etc. She’s just genetically small. I’m grateful that I have a sane doctor, because I know that dropping percentiles can be a red flag for FTT, which my daughter obviously doesn’t have.

    What’s interesting though is my aunt mailed me a bunch of baby pictures this week, and if you hold up those next to ones of my daughter at similar ages, and we’re pretty much the same size (and have the same face, but that’s besides the point). It really shows to me how much her size is based on her genetics, and thus healthy.

    • katja

      SO great you have a sane doctor who sees the big picture. M was 9 lbs 11 ounces, her father was 10 4 ounces, her Great gramma was over 10 lbs, and a really chubby little girl in her black and white photos! (she is now 90 on no meds, living independently…) genetics has SO much to do with it. Thanks for the post!

  7. Albe

    Yes, I worry so much every time we have a check-up. I had to get my twins a weigh-in this summer at 2 and a half, because they’ve always tracked their weight very carefully because neither child has ever been on the curve. They’re both very small but this is especially the case with my doctor. I remember thinking, “It isn’t fair to have this weigh-in during the summer, because their last one was in the winter in heavy pants and sweaters, and now their clothes are much lighter!” We’re now looking at the 3-year check-up and I am kind of dreading the weigh in. I can tell both children have grown taller, but I don’t think they’ve put on much weight, if at all.

    I feel like they’re normal especially because my daughter actually weighs slightly more than I did at her age, and I am a normal, healthy adult. Back then, in the seventies, the doctors never gave my mom any trouble about my weight. But my daughter’s low weight has caused alarm bells to ring since she was a small baby. We have had multiple GI visits, we’ve had dietician visits, we’ve gone through so much pressure and trauma to meet daily calorie goals, and it’s been a nightmare. I gave all of that up over a year ago and I still feel like my daughter’s relationship to food is just recovering to normal after so much early and unhealthy pressure.

    • katja

      I’m so sorry for all you’ve been through! The kids who are healthy, but grow at the extremes are so vulnerable to being messed with, and the poor parents aren’t sure what to do when all the experts are raising the alarm bells and prescribing sometimes harmful intervention. I love that you point out your own weight and growth, and how we just didn’t worry about it back then. I don’t know when doctors got the idea that you were only healthy if you were growing at a certain percentile… I imagine that her trajectory has stayed stable, in spite of backing off the pressure with feeding. I just wish that at-risk populations (premies, kids growing at the extremes) would be better protected and that the parents were supported with feeding optimally. I fyou are on any twin support blogs etc, please pass the work about and my site if you’ve found them helpful. Good luck! I never got that coat and jeans thing either. Also, one visit, my child lost an eight of an inch… Hmmm. Those things matter, a lot in the world of arbitrary labels, and no one pays attention…

      • Jennifer

        I think the problem with inaccurate measurements is quite a big one in this area. I have a chemistry degree so I’ve done quite a lot of measuring of things and calculating the degree of error in those measurments. I remember being shocked at how careless people were when they were measuring my child and yet how seriously they took the results that were generated by their crappy measuring!

        There is always error associated with these measurements and it only increases when you are not measuring carefully!

        Though, to be fair, it was recognized that there was measuring error when my son shrank (lengthwise). Twice.

        • katja

          I love that he shrank, twice! If they are going to make a big deal of it and label a child (which has huge consequences) then they better be darn sure they are doing a more accurate job of it at a minimum.

  8. Lisa

    Yes – I worry because I really don’t like her being weighed. On one hand I understand the value of a longitudinal record of height/weight to make sure she is developing WNL, but the experience of being weighed feels fraught with the danger of opening a pandora’s box of body/weight anxieties. Now that my daughter is five, I will speak to her doctor privately prior to her yearly check-in to tell her NOT to “make a fuss” about the weigh-in and why. She’s been really great so far, so I’m pretty confident she’ll understand and cooperate.

    • katja

      sounds like you have a great doctor, and the right instinct to be proactive and protect your daughter when possible.

  9. AmandaL

    Every. Single. Visit. My pediatrician is… well, I am not sure if she deliberately sets out to make me feel as if I need to study up (or get my son to study up) before each “milestone” visit, but if he’s not even the slightest bit off, she immediately suggests there may be something wrong (‘you mean he’s not drawing an x on paper, but knows the entire alphabet by 2? he needs therapy’). My kid is also in the 97-99% for height, weight, and head, and is perfectly in proportion. But. his weight in in the 97% so I need to WATCH OUT. I pray for the pooping, too, because it can mean significant changes in his weight percentage. Your post made me laugh out loud, because I get exam fatigue every time before we go in for a visit. Maybe this is a sign to switch docs!

    • katja

      Ugh, i’m so tired of that. I’m all for early intervention, but some seem to have lost a sense of reality. kids develop in different ways. Again, it’s looking at the whole picture. M was super verbal, but slower with fine and gross motor skills. When we just look at checklists or arbitrary labels and don’t take the time to ask further questions or investigate, we get this kind of outcome. Glad you got a giggle! Might be a sign to switch docs. See what happens…


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