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Scaring Parents to Motivate Healthy Feeding? (With a Note About Accurate Measurements)

Posted by on Jan 14, 2014 in Blog Posts | 7 comments

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Does this look like the chart of a child who is “failing to thrive?”

 

Worry, worry, worry! All good parents are doing it!

“She’ll need a feeding tube if you can’t get her to eat more.”

“She has pre-prediabetes…”

The parents I talk to, and emails I read are increasingly suffused with fear and anxiety. A very few cases are true emergencies, with children dropping weight or refusing anything by mouth, but many terrified and tearful parents are facing relatively minor feeding issues and some are even within the range of normal.

I don’t mean to belittle the fear. There should always be an investigation to see if the fear is warranted, but I hope to address with this post my belief that parents are being manipulated and bullied with fear tactics that are at times unwarranted and are almost always unhelpful.

Look at the growth chart above. This is from an infant who was misdiagnosed with “failure to thrive” and a “feeding disorder” and the parents were simply sent away with the vague threat of “Get her to eat more or she’ll need a feeding tube.” (The clinical snapshot? A child with a recent infection and antibiotics with decreased appetite and intake, a mom already anxious, now terrified that her daughter is in grave danger. The trigger was a misplotted weight measurement, but the seeds of fear had been planted and fertilized…)

With that threat of a feeding tube and no support, I’ve had parents admit to screaming at children to eat, force-feeding them while pinned to the floor, sobbing, begging, bribing, holding an infant’s head and forcing in the nipple… Before listening to parents with feeding problems for the last several years,  I would have judged. Now I save my judgement for the system and the clinicians who so poorly serve parents and children.

I hear from parents of larger-than-average kids told their child has “pre-prediabetes” and told the child will die young if they don’t get them to lose weight. Many of these dire warnings are based on arbitrary BMI cutoffs alone with no clinical or historical risk factors, and “pre pre diabetes” is not a thing.

Scared parents without proper support and information can easily fall into counterproductive feeding practices and unwittingly make matters worse.  Alas, I believe instilling fear is the intention, that somehow if parents are scared enough, they will magically get 100 more calories in a day or get the child to stop sneaking sweets at friends’ houses.

Trying to make a child eat more or less, overriding the cues of a screaming or anxious or withdrawing child feels awful and doesn’t help. Feeding from a place of confidence and feeling supported, even in the face of real challenges and uncertainties, gives parents and children the best hope.

Have experts tried to scare you? When were you scared but felt supported? If you feel like a doctor or nurse or feeding expert is using threats and fear-mongering to try to motivate you to achieve calorie or weight goals, is it working?

And PLEASE if there is ever a weight or height measurement that is concerning, insist on a recheck, and PLEASE plot it yourself. I cannot tell you how many growth charts I see with errors.

 

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7 Comments

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  1. Andrea

    Hhhmmmm…. Very true that poorly informed the health professionals are mostly to blame, but I am not sure that inviting parents to self diagnose using the growth charts is the way to go. After all if you are apprehensive and get the chart above, even if your doctor tells you that everything is fine, you will worry all the same and ask for a second opinion, and a third until someone tells you what you want to hear.
    I really think we would all be better off if the charts had never been invented :D

    • katja

      I do think overall, the way the charts are being misused can cause more harm than good, but weight and height are important pieces of the puzzle, but not the only piece! I see more and more healthy kids who don’t grow in that steady way. May drop in height for example, from 90-50% in one year, and then slowly rise again. I think looking at the whole child is critical, and growth is not the only indication of things going well or not! Great points! I showed the correct chart which was reassuring, but I should have shown the one that was an error with a steep decline at the end, which, if correct, would indeed have been concerning, but one could also likely know that just by checking weight. I write a lot about the clinical misapplication of growth charts… Sigh.

  2. Tiffany (The Boob Geek)

    Yes, yes, and yes. This happens so much with breastfed infants. Clinicians who fail to look at the whole picture and rely instead upon their (possibly inaccurate, or at least inconsistent) measurements and poor breastfeeding knowledge harm an otherwise normal breastfeeding relationship, or one that might just need a few tweaks under the observation of a lactation professional. So many doctors/nurses/others start to talk about interventions when there is ONE weight that is off! That’s just a total lack of common sense.

    I wrote a blog post about some of the pitfalls of weight checks here: http://www.theboobgeek.com/blog/weighing-in-on-weigh-ins.html

  3. CoffeeMom

    Our (now ex) pediatrician waited 2 years before suddenly declaring that our (then 11 yr old) son hadn’t been growing properly, dropping from the 95th percentile in height & weight to 50th. He sent us to an endocrinologists full of fear that our son surely had major problems. (To us our son HAD been growing. We could see it in both height and clothing size. We fed him all the time w/o restriction.) It was a fate that said endocrinologist shared office space with a pediatric nutritionist and we got her forms included with his. I took her “write out what your child eats in a week” a step further and provided calorie and fat counts, did some research of my own, talked to other parent friends and discovered that our son was actually malnourished according to calorie/age charts. Thankfully, together both specialists found a children’s feeding disorder clinic who diagnosed him with Selective Eating Disorder/Extreme Picky Eating due to the ex-ped not diagnosing him with reflux which he had from 0-5 (based on our accounts of those years and eating habits.)

    The latter is what pissed us off the most. We remembered those infant and toddler days of the doctor yelling at us at every visit to “stop giving your child so much milk! You have to force him to eat more solids!” (Things that to the clinic’s pediatrician, were clear cut signs of reflux, along with his vomiting of foods that weren’t milk and carbs.) We had started lying to the doctor rather than get yelled at. After all, the growth charts were showing that he was growing…until years later when they suddenly weren’t. :/

    Sorry this is so long. It just struck a chord of some bad memories. On the one hand, the growth charts got our son diagnosed (though we’d figured it out before the clinic results came back.) OTH, had the growth charts not been the sole thing our ex-ped was going by and if he had actually bothered to pay attention when we would tell him our son was constantly throwing up and preferred to eat Cheerios, milk, and bread and other such foods, he might not have developed SED.

    Lastly, those weight charts are what our insurance company went by too. They decided not to pay to have our son treated by the feeding disorders clinic because we “got him growing again” and therefore he was no longer considered malnourished and in need of further treatment.

    We no longer look at growth charts. Our son is nearly 16 and growing just fine by his new doctor’s, and our accounts.

    • katja

      I think growth charts a a valuable piece of the puzzle, and alas it took his growth falling off for his doctor to take seriously something you had been worried and thinking about for a long time! He probably could have been diagnosed, helped earlier. You make a great point. Fear around growth charts that is unnecessary is harmful, but so is blowing off serious issues because growth is stable. Boo both ways. This is the problem when weight is seen as a proxy for health… Sigh.

  4. Kerri Sager

    I am a 36 year old obese woman. I have struggled with my weight since puberty but I’m tall (6’2) and healthy. I finally became pregnant with my first child in 2011. Due to my size, my OBGYN immediately began hounding me about my blood sugar and had fears that I would have an overweight baby. However, I had a relatively healthy pregnancy and gained just the right amount of weight. A week before my due date, they were guesstimating my baby was already over 9 pounds and that I needed to be induced. However, when Lexi was born, she was only 7 lbs 13 oz! Then came the difficulty breast feeding. I was only producing 1 ounce per feeding and had to supplement with formula (which ended up being just formula). Our pediatrician scared us, having us come in weekly for weight checks. As she grew older, he still chastised us about her weight gain, telling us to add olive oil and butter to all of her foods. She was a picky eater from the start. As an obese woman from a family who ate everything, I was baffled. As a social worker, I had already had experience with Failure to Thrive and this pediatrician was beginning to make me think I would expect child protective services at my door. Everyone else in our lives assured us “He’s an idiot!” “She’s perfectly healthy” “She’ll eat when she’s hungry”. We decided to change pediatricians. Our new pediatrician is wonderful! She sees that Lexi is growing and active. She has no concerns about her weight and tells us we shouldn’t have any concerns either because she will probably just be petite which is music to my ears!

    • katja

      So sorry. Pregnancy is already stressful without all that added worry. Well Rounded Mama is a great resource for bigger pregnant moms. And I am “normal” weight and had an almost 10 pound baby :) So glad you are both healthy and happy, and getting better help! If you are worried about how much or the variety she eats, my book, Love Me Feed Me may be a very reassuring and practical resource. Good for you for not trying to make her eat more or gain faster. Petite or not, she can be trusted. Thank you for sharing!

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