From small babies to big kids... weight gain in childhood
In my last post, I talked about how difficult it can be to identify if your child is at risk of gaining too much weight in childhood. Today I'm going to touch on why they might be gaining this weight. There can be lots of contributing factors, but I'm going to talk about two less well-known reasons that I see in my work every day. First up: slow weight gain or faltering growth in infancy and the huge pressure on parents to 'fix' this.
Pressure to get kids to grow
When babies are born, there is an immediate pressure felt by parents to ensure that their child grows properly. We talk about birth weights, weight gained or lost in hospital, and have regular weigh-ins with child health nurses. Don't get me wrong, these are all incredibly important ways of monitoring growth to make sure that kids are able to develop as best they can. Weight loss or slowing weight can be indicative of many health issues that we can treat (e.g. Coeliac disease). BUT, there is so much focus on weight gain (sometimes despite other health indicators) and so much pressure on parents to make sure their child is gaining enough weight. Too many of the parents I work with mistakenly believe that their child is too small or worry that their child is smaller than the other babies/toddlers/children. Often parents think (or are told!) that they need to get their baby to gain more weight to be healthy. There are two options here:
If the baby does NOT actually need to gain more weight, an intervention teaches parents to override their smaller baby's natural hunger cues. However, in a population there are always going to be some babies who are smaller than others, just as there are Mums and Dads who are smaller than others, and this is not something we should be messing with!
In our second option, where the baby does need to gain more weight, the issue needs to be properly managed by health professionals, otherwise these children are at increased risk of developing chronic diseases later in life. The evidence suggests that babies with poor growth in early life may have adapted to be able to survive on lower energy intakes. If we overfeed these smaller children then they are increasingly susceptible to developing obesity, diabetes and cardiovascular disease as adults.
When a child is medically deemed to be gaining too little weight, we use the term "failure to thrive". Seriously is there a more devastating term that we could use to label children? Most parents find this an absolute blow to their confidence with feeding, and it destroys their ability to trust their child to eat enough. So what are they told to do? Often it's to try to 'get' their child to eat more. I've talked a bit about pressure at mealtimes and the division of responsibility in my previous posts. But essentially, pressure on parents to 'get' their child to take more breastmilk/formula or to 'get' their child to eat more, means that parents have to pressure (also read as coax/encourage/bribe/push) their child to eat. They are encouraged to control the mealtime to make sure the child eats enough. The problem is, the evidence overwhelmingly tells us that when kids are pressured to eat or lose control over how much they will eat, the child ultimately eats less overall AND a reduced variety. So essentially, we end up with kids who lose their ability to regulate their own intake, and overburdened parents who feel responsible for how much they can 'get' into their child. Everyone loses.
The next problem is rife. Parents are very rarely told to stop this approach once their child's weight is deemed to be 'satisfactory'. Some parents have had to feed like this for years and it starts to feel normal. As a result, we see a swing from children who aren't gaining enough weight to children who are gaining too much weight. Because all of a sudden we have toddlers or school aged children who can't listen to their own internal cues for appetite, and a parent who only feels successful at a mealtime when their child eats a pre-determined or 'adequate' amount. I think you can see where I'm going with this. Many adults in our society eat according to rules rather than what their body tells them. They eat lunch because it's 12 o'clock. They eat everything dished up to them regardless of hunger. They eat without paying attention. And we've got a significant problem with overweight and obesity in adults.
In summary, we know that weight gain can be monitored to ensure our children are growing in accordance with their genetic potential. But what we need to do better is to make sure that parents know they cannot be held responsible for that number on the scale. Instead parents can be taught ways to encourage catch up growth (when necessary) whilst always knowing that it needs to be monitored and one day stopped. Then, at some point, parents might need to learn a whole new way of feeding their child. Luckily, it is possible to teach children about eating just the right amount for their body to encourage healthy growth and development- and it's something I'm incredibly passionate about doing! Stay tuned for my next discussion about some of the less well-known reasons for increasing levels of unhealthy weight gain in children.
If you have questions about weight gain in childhood, fussy eating or childhood nutrition then email firstname.lastname@example.org and I'll do my best to address them in a blog post. In-home appointments are also available in Perth, Western Australia.