By how much would limiting TV food advertising reduce childhood obesity?

This is the question researchers from Netherlands and Australia asked in their recent article published in the European Journal of Public Health. TV food advertising has attracted considerable public scrutiny, especially from experts in nutrition and public health. There is a popular belief that food advertising plays a big role in influencing food choices and brand awareness among young kids. As a result, kids get hooked on processed food and snacks full of fat, salt and sugar. Clearly, this could be one reason why we have a rapidly rising rate of childhood obesity believe most experts.

Beliefs and opinions are common, but thoughtful scientific inquiry to support them is rare. That is why I found this article interesting because it tackles this tricky problem through a good scientific approach. The researchers candidly acknowledge that the effect of advertising is difficult to study in a direct way. In fact they did not find a single study which quantified the effect of advertising and body weight in a realistic setting. Instead, they looked at changes in the total energy intake due to TV advertising based on a single study from 1983, which concluded that an extra 25 minutes/week of exposure to TV advertisements would cause a child to eat one extra snack which would increase his energy intake by 1.4%.

This is a very small effect. The researchers then decided to set up an expert panel of academics and asked them to complete a questionnaire to estimate the effect of TV advertising on energy intake and effect of energy intake on BMI. Surprisingly, they got a very poor response rate – only 8 out of 33 completed their questionnaires. As a result, there was considerable bias and uncertainty in the data.

Bottom line, they came to the following conclusions:

1. If all TV advertising (about 80 minutes/week) was stopped, the prevalence of obesity will drop by 2.7% in boys and by 2.4% in girls
2. Based on the “expert panel” response, they estimated these numbers to be a reduction of 6.8% in boys and 6% in girls
3. They estimated that about 1 in 7, or as many as 1 in 3 children would not be obese if there were no TV advertising

Overall, these numbers have a very large amount of uncertainty. The evidence against the effect of TV advertising is weak and calls to ban or limit TV advertising are largely based on personal opinions.

Personally, we have not experienced the effect of TV food advertising in our household because we hardly watch any TV. Mostly our twins watch animated shows on demand where we completely bypass the advertisements.

I am not a supporter of cheap junk food. But I also do not support the idea of banning TV advertising. I continue to believe that the best protection against such advertising is to build the wall of your family’s own personal brand which defines your approach to food and nutrition.

Parents: what is your opinion? Do you think that your family’s food choices are strongly affected by TV advertising? Would you support a complete ban on food advertising to kids?

©2010 Littlestomaks.com

News about childhood obesity is everywhere these days. Hardly a day goes by without a screaming headline in the media about this issue. Jamie Oliver has further popularized it by his TV show and even Mrs Obama has taken up this cause via her Let’s Move campaign. There is no doubt that we must address childhood obesity, but what about the problem of underweight and short stature? How worried should a parent be if their toddler falls under the 5th percentile in weight and height?

Recently, registered dietitian Teresa Wagner tackled a reader question in our Ask the Expert column about a toddler not gaining weight. I received a follow up email from another reader who was worried that her 8 month old child was below the 5th percentile and not eating much. The tone of her message reflected her extreme worry and frustration at not knowing what to do.

There is a reason why our media does not focus on this problem. The numbers, when taken as a whole nationwide are not that high. See below a chart based on the 2008 data CDC’s Pediatric Nutrition Surveillance System (PedNSS) on growth indicators. The PedNSS system is a public health surveillance system which monitors the nutritional status of children from low income families under Federal programs. Data comes from public health clinics where these children are seen for routine care, nutrition education and supplemental food.

Percentage of children 2-5 years old who are underweight or of short stature is between 3-5% for Whites, Blacks and Hispanics. These numbers are even smaller for American Indians and Alaskan Natives. Compared to the 20-30% obesity rates, these numbers are too low to capture the attention of mainstream media and policy makers. Besides, the media loves to show extreme images of either very fat kids or severely malnourished starving kids from the third world countries. Anything else does not make the cut for prime time!

As a parent, it is natural to worry. It becomes a personal issue and fancy nationwide statistics do not make a difference. The frustrating part is that it is not always possible to get enough credible information to make informed decisions. The result is that each day becomes a battle to force feed a child in the hope that she will put on some weight. Since children have a natural ability to regulate their food intake based on their current needs, it may seem like they are not eating enough. Anger, frustration and despair are the emotions most parents feel under these circumstances.

Here are 5 questions you can consider to assess the situation and take appropriate actions

Is there a trend in my child’s growth chart numbers?

A single data point on the growth chart, although important, should not cause concern. Take time to understand growth charts and their limitations so you can use them to evaluate the general growth pattern of your child. Another thing to keep in mind is that your child may not be in the normal range for both weight and height. For example, our twins are tall for their age group but lag behind in weight. From this perspective, I like the BMI for age chart because it takes into account both weight and height at the same time. You can use this online calculator for BMI chart or ask your doctor about it.

Is there a medical reason for slow growth?

This is where keeping a close eye on your child’s growth pattern will help you find medical issues that may be affecting her growth. There may be known birth defects or undiagnosed metabolic or digestive disorders. Severe case of reflux like GERD is also a concern. Detecting them early and working with a specialist for corrective action is very important.

Is there a specific reason for poor appetite?

Nearly all toddlers are picky eaters and it is natural for them to frequently show poor appetite. But if it persists over a long period of time, you will need to be extra vigilant so you can find the root cause. Are there food allergies? Special environmental or seasonal triggers? Does a change in menu or feeding schedule help? The important thing is to pay attention to the unique needs of your child so each feeding is most effective. Siblings around the same age, twins or multiples need different treatments based on their individual personalities. Clearly a challenge for most parents, but there is no perfect answer. Practicing the principles of attachment parenting and nutrition can help.

Does my child seem different than his siblings or other family members?

Although it is not always a good idea to compare your children, you have to take into account your family history and genetic makeup. In some ways, a consideration of these factors is probably more important than the growth charts which are based on population averages. If your family ethnicity is not one of mainstream population, it is unlikely that the growth chart standards will be accurate for your child. Evaluate your child’s height, weight and BMI through the lens of your family’s history to determine if there are differences you should be concerned about.

Are there any special circumstances in my family?

Every family goes through ups and downs – financial, emotional or health-related – often over an extended period of time. Assess if you have certain stresses in your personal life or your family situation at the moment. Even toddlers pick on them easily even if they cannot articulate it. If these problems persists over a long period, there may be slow weight gain or even a loss in weight. Recognize these problems early and seek help from family, friends or your doctor to manage them.

One last thing to remember – early childhood height and weight is often a poor predictor of adult height and weight, except in the case of overweight or obesity. You may be surprised how fast your child can grow upon reaching puberty. Keep a close eye on the growth charts, spot the problems early and take appropriate action. No need for excessive worry just because of a couple of low points on the charts!

Most importantly, focus on building healthy eating habits. Offer a variety of foods in healthy balance and moderation.

Are you concerned about an underweight child? Please share your personal story in a comment below.

©2010 Littlestomaks.com

Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

This week, Registered Dietitian Preethi Rahul explains why it is important to know and track the general growth pattern of your toddler using growth charts.

Question: Why is it important to know the general growth pattern of toddlers?

Answer:

To understand the importance of growth pattern of toddlers it is very important to understand what growth is.

Growth is defined as increase in the size of an organism or part of an organism, usually as a result of an increase in the number of cells. Growth is a physical aspect which can be quantified. A child’s physical growth refers to the increases in height and weight and other body changes that occur as a child matures. Hair grows; teeth come in, come out, and come in again; and eventually puberty hits. It’s all part of the growth process.

How do you judge your child’s growth pattern?
There are various tools that can help parents understand their child’s growth pattern. Two most widely used ones are:

Growth charts
The National Center for Health Statistics has developed growth charts that are used to compare a child’s measurements with those of other children the same age. By plotting a child’s measurements on these charts, doctors are able to compare individual growth patterns with data collected on thousands of children. This helps to determine whether a child’s growth is normal compared with others the same age. The charts are a series of percentile curves that show the distribution of growth measurements of children from across the country.

BMI charts
Designed to measure body mass, BMI charts can help to determine whether a child’s weight is appropriate for their height. To get a quick picture of a child’s weight status, the health care professional enters the height, weight, age, and gender. The resulting number is then compared to other children of the same age to see if the child’s weight falls within the normal boundaries.

Here is a good article which tells you 5 things you need to know about growth charts.

Now why is it important to understand your child’s growth pattern?
Children are constantly growing and changing and periodic assessment of their progress allows any problems to be detected and treated early. Most children are assessed by health care professionals only when they are ill, at which time growth and development is not focus of care.

Growth measurements must be recorded at regular intervals to indicate growth patterns. Height and weight when taken only once do not lend themselves as interpretation of growth status. Children generally maintain their height and weight in the same growth channels during preschool and early childhood years, although these channels are not well established until after 2 years of age. Individual children sometimes grow at faster or slower rates; nonetheless; they should follow along their same growth channel.

Regular monitoring of growth enables trends to be identified early and intervention or education to be initiated so that long-term growth is not compromised. Weight that increases at a rapid rate and crosses growth channels suggests the development of obesity. A child who appears to be overweight may be advised to boost their physical activity a bit since overweight children have a higher risk of becoming overweight adults than their lighter peers. With early intervention, a small problem need not become a lifelong struggle.

Lack of weight gain or loss of weight over a period of months may be a result of under nutrition , an acute illness, an undiagnosed chronic disease, or significant emotional or family problems.So health care professionals and parents can work together to determine the best way to get the child back on track. Vitamin and mineral deficiencies can also be identified and if they are in the initial stages diet alone would be sufficient to bridge the gaps.
Thus as a responsible parent you need to constantly monitor your child’s growth and take necessary action as and when needed!

©2009 Littlestomaks.com. All Rights Reserved
Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

Source: noe** on Flickr

According to a recent study that looked at data for over 10,000 children between the ages of 2 – 17 years old, you are more likely to give a vitamin and mineral supplement to your child if:

• your child is between 2 – 4 years old
• your child is underweight (BMI < 5th percentile)
• your child is in overall good health and has an active lifestyle
• you have good access to healthcare
• your household income is high
• you are a non-Hispanic White

On the other hand, you are less likely to give a vitamin and mineral supplement to your child if:

• your child is overweight (BMI >85h percentile)
• your child’s overall health is generally poor
• you do not have health insurance
• your child rarely drinks milk
• your household income is at or below poverty level
• you are a Mexican American,  or non-Hispanic African American

It is quite easy to draw a conclusion that children who do not really need supplements are actually more likely to be getting them, while those who may benefit from taking supplements are less likely to take them mainly because they are poor and come from a certain racial background. Here is a headline from a recent article “Kids who need vitamin not getting them while those who get them do not need them” which seems to echo the editorial commentary in the journal Archives of Pediatrics & Adolescent Medicine where the original article is published.

In my opinion, this is an over-simplification of the real situation. This study was based on the 1994-2004 National Health and Nutrition Examination Survey (NHANES) which is claimed to contain nationally representative data on comprehensive dietary supplement use in the United States. Intake of vitamin and mineral supplements in the NHANES database was measured by figuring out if the child had used any of these supplements in the 30 days prior to the interview. Looking at the pattern of vitamin use (or non-use) over just 30 days is not enough to draw a relationship between “health” and “need” of such supplements. The effect of diet and nutritional supplements on health is slow and takes place over the long term. If a child is “healthy” at the time of the interview, and taking supplements, it does not mean that he does not need them. On the same note, if the child is not “healthy” and not taking vitamin supplements, it does not mean that the family cannot afford them. In this regard, I do not agree with the authors of this study on the implications of race and poverty.

While it may be true that if a child is growing up in an affluent family with access to good health care, the parents are well-informed and are able to afford vitamin supplements. However, it is also possible that the child is overweight or not in good health despite the use of multivitamins and regular doctor visits.

In contrast, it may be true that a child growing up in a poor family may not be getting vitamins because they cannot afford them. However, it is also possible that the parents do not simply have the right information to make an informed decision regarding the nutrition and supplements for their children.

Does it mean that you should immediately stop using your current vitamin supplement for your child? Before you jump to such conclusions based on this study, you may want to consider the following -

• While it is always recommended that your child should get all the necessary minerals and vitamins from a balanced diet which includes plenty of fruits and veggies, you should consider using supplements – and continue using them – in certain situations. I have written about them previously in my post 5 Reasons To Consider A Multivitamin Supplement.
• Consult with your doctor, especially if your child is underweight or might be at risk of vitamin deficiency either due to eating habits or a health condition. You may need to switch brands or get a prescription for a pharmaceutical grade multivitamin.
• Continue introducing more fruits and veggies in your child’s diet while keeping him on a good multivitamin supplement.  As long as you do not exceed the recommended dose, or use a mega-vitamin, this should not do any harm. Encourage a good amount of physical activity every day and reduce TV watching and computer games. Keep an eye on his growth pattern and BMI by using a growth chart. Your doctor may advise you to stop or reduce the use of supplements based on the right changes in eating habits, lifestyle and growth patterns.

What is your opinion? Would you do anything differently as a result of this report?

Here is a selection of noteworthy news related to child nutrition. Most of the commentary is mine. I have provided a link for each if you want to read the full story.

It is amazing, and quite encouraging to hear a school Principal say “Childhood obesity, it’s our tsunami, it’s our Katrina”. These are the words of Dr. Yvonne Sanders-Butler of Browns Mill Elementary School in Lithonia, Georgia, which decided to go “sugar free” 10 years ago.

There are no bake sales here, no birthday cupcakes, no cookies or ice cream!

What is even more amazing is what Dr. Yvonne says about the achievements of the school as a result of this policy. In the first six months of the sugar ban, disciplinary incidents went down 23 percent, counseling referrals decreased 30 percent, and in the first years of standardized test scores, reading scores improved 15 percent! Browns Mill was named a national blue ribbon school and a Georgia school of excellence in 2005.

Read the full story here. Also check out the Achieving Academic Excellence Through Nutrition And Exercise page of the school.

News of infant formula made with melamine contaminated milk in China broke in September 2008. In China alone, 4 children died and 53,000 got sick as a result of this reckless act. According to health experts, ingesting melamine causes kidney stones, urinary tract ulcers, and eye and skin irritation. It also robs infants of much-needed nutrition.

Several countries in Asia, Africa and Europe banned products made from Chinese sourced milk. Later in the year, the European Union (EU) banned all baby foods made with Chinese milk.

However, more relevant for the US consumers is this follow-up announcement from the FDA’s director Stephen Sundolf:

“Amounts of the industrial chemical melamine or the melamine-like compound called cyanuric acid that are below 1.0 ppm [1,000 parts per billion] do not raise public health concerns”

Although, 1.0 ppm may appear to be a very small amount, a key question, however, still remains unanswered. Why should there be any trace of this “industrial” chemical melamine in infant formula in the first place? Melamine is a synthetic chemical used in making hard plastic materials, however it can also be produced inside the body from an insecticide called  Cyromazine. It is possible that these chemicals are transferred at ppm levels from food packaging, labeling and raw materials in the food supply. In addition to establishing a “safe” limit, there should be an attempt to remove these chemicals entirely from the supply-chain during production of infant/baby food products.

Read the full story here.

The U.S. Department of Agriculture’s annual report on food security showed that 691,000 children lived in homes where families had to eat non-balanced meals and low-cost food, or even skip meals because of a lack of money. Now this is personally troubling to me! How can it be that on one hand we have an overabundance of food, and a rapidly growing problem of childhood obesity, while at the same time, there are so many children who are growing up hungry. Quite clearly a paradox.

In her recent post Addressing Hunger and Obesity with “Change” Policy, my blogger friend Rebecca Scritchfield is hopeful that Tom Vilsack, when confirmed as President Obama’s Agriculture Secretary, will follow up on his pledge to put “nutrition at the center of all food assistance programs”. Clearly, there is a need for creative ideas to solve this problem. It should be embarrassing to see a child go hungry in America.

Read the full story here.

I found this correlation quite surprising. Dr. Graham MacGregor of St. George’s Hospital Medical School, London, England, who authored a study published in Hypertension: Journal of the American Heart Association in February 2008 told this to CNN:

“Salt is playing a hidden role in the obesity epidemic by causing more intake of sugary soft drinks. Children get habituated to a salty taste. Much of the obesity epidemic is in the hands of the food industry. The most important thing possible is to cook fresh food as much as possible — those meals will have very little salt at all. Virtually no products use salt as a preservative anymore. Choose bread with less salt, choose cereals with less added salt. Try to avoid these very salty ready-made foods.”

Read the full story here.

Consider this – 44 major food and beverage marketers spent $1.6 billion to promote their products to children under 12 and adolescents ages 12 to 17 in the United States in 2006. It is likely that a similar amount was spent in 2007 and 2008. Further, this marketing is “integrated”, that is, it combines the old (TV, print) with the new (internet, sweepstakes, in-store promotion) media.

In analyzing the data, the report calls for all food companies “to adopt and adhere to meaningful, nutrition-based standards for marketing their products to children under 12.” The need for such an advice proves that there is room for improvement in both the message and the products which are targeted for this age group.

Read the full report here.

A report from the American Academy of Pediatrics reccomends that overweight children (BMI between 85th and 95th percentile) and obese children (BMI > 95th percentile) be screened for fasting lipid profile regardless of family history of hyhpertension or other risk factors. Amazingly, it is recommended that such screening should take place after 2 years of age but no later than 10 years of age. For children over 8 years old, and with high LDL (bad cholesterol), cholesterol lowering drugs may be prescribed.

This is quite a radical recommendation which recognizes the rising epidemic of childhood obesity and its consequences on heart disease and other health conditions.

Read the full story here.

Here are a few other noteworthy stories suggested by my Twitter friends:

• @Andamom found the Blue Zones on Oprah Winfrey’s show very interesting where Dr. Mehmet Oz “goes deep inside these blue zones where people live longer than anyone else”. What is their secret? The four “hot spots” featured in the show were Costa Rica’s Nicoya Peninsula; Sardinia, a Mediterranean island 120 miles off the coast of Italy; Loma Linda, California’ and Okinawa, Japan. In all cases, a lifestyle based on eating natural, un-processed foods, lots of hard work and connection with commiunity were the key ingredients to a long, disease-free life.
• @ayalalaufer referred to the work of Professor Charlene Elliott from the University of Calgary, Canada, in her post Fun food:” Is it nutritious? Is it even fun? to show how mixed messages are sent to kids about “nutrition” and “fun” when food products are advertised. Is it misrepresentation? Maybe, but seems like it is still all within the rules. I was amazed to read that “among the 326 fun foods that were of poor nutritional quality, 202 (62%) had nutritional claims”. She rightly suggests that there is no need for kids to have their own special food. Parents should encourage their children to eat what they themselves eat at each meal.
• In Can you really pressure kids to eat healthy? @ayalalaufer links to a study in the scientific journal Appetite which concludes that if you simply cannot build long-term healthy eating habits in your kids if you force or coerce them into eating healthy foods. This is consistent with what Dr. Spock says “children need to want to eat healthy foods”. If you try to force them too much, they will reject it and develop a life-aversion to it even if you think it is good for them.
• In her post Infant feeding choices and obesity, @phdinparenting links to a very interesting report which found that rats that consumed junk food during pregnancy and while breastfeeding had offspring that preferred junk food too. She cautions against switching to formula just because a breastfeeding Mom cannot give up her favorite snack and suggests that breastfeeding itself builds self-regulation in the baby and protects against overeating and obesity later on. It is important to draw a distinction between a pattern of frequent junk food consumption and occasional treat of a favorite snack.

Do you have a nutrition story from 2008 that caught your attention? Feel free to share in the comments section.

Do you find yourself wondering if your child is growing “normally”? Do you find yourself comparing your child’s height or weight with other children when you take her out to play in the park? Do you begin to make plans about how you will change her diet when your doctor informs you that she is below 50th percentile in weight for her age?

If so, you are not alone. It is a natural instinct for any parent to worry about the growth of their child. In my post on Take a Step on the MyPyramid for Preschoolers, I introduced you to how you could make a growth chart for your toddler based on his height and weight. In this post, I provide you more details and suggest a few actions for you to consider as you think about your child’s growth.

Growth charts are based on national population statistics

Data on physical measurements (weight, head circumference, length, standing height etc.) for children of different ages is collected from national surveys and analyzed using statistical methods to prepare the growth charts. These charts show lines for various percentiles, which are used as a reference for comparing the actual measurements. There are two limitations of this method that you should be aware of:

1. Just like the census, national health surveys are not done every year. In fact, the last National Health and Nutritional Examination Survey (NHANES III) was done during 1988 – 1994. This led to a revision of the 1977 growth charts in the year 2000. Amazing, isn’t it, that today’s growth charts are based on data that is 15 years old! Surely, a lot has changed since then.
2. Data is collected based on a “statistical sample”, which is supposed to represent the true nature of the whole population. Although there are some rules for estimating this “statistical sample”, no one can say with 100% confidence that it really represents everybody. In the interest of creating a “normal” growth profile, the researchers have to make some trade-offs and not include various special cases. It is important for you to be aware of what those special cases are. Your pediatrician should be able to advise you if you happen to be one of them.

Having said that, the current growth charts are still a very useful tool to evaluate the general growth pattern your child in relation  to what is normally expected. Recognize that the researchers do a very good job planning for a national survey to really “fill the gaps” in their current data and understanding. For example, in the NHANES III, they over-sampled infants and toddlers 2 months – 5 years old to properly account for the growth patterns in this age group. They also included a higher number of breastfed children to reflect the rising rates of breastfeeding compared to previous years. They utilized advanced statistical methods to create a better and smooth transition between infants/pre-schoolers and adolescents.

Growth charts are age and sex specific

Different measurements are made on infants (less than 36 months) and toddlers/adolescents (2 – 20 years). For infants, weight, head circumference and head-to-toe height is measured in a lying down position. The measured data is evaluated on these 4 types of growth charts:

1. Length for age
2. Weight for age
3. Head circumference for age
4. Weight for length

In most cases your pediatrician will show you the first two charts; usually blue for a boy and pink for a girl.

For toddlers/adolescents, weight and height is measured in a standing position. The measured data is evaluated on these 3 types of growth charts:

1. Weight for age
2. Stature (height) for age
3. BMI (Body Mass Index) for age

Again, your pediatrician will most likely show you the first two charts. However, the BMI for age is the most important chart in my opinion (see below)

Growth charts do not apply to preemies and other special cases

Data from very low birth weight (VLBW) is  not included in the infant growth charts since their growth patterns are known to be very different from higher weight, full-term infants. If this applies to you, there are other specialized growth rate charts you can ask your pediatrician about. The best general growth charts in this case are based on the the Infant Health and Development Program (IHDP) data, which can be used from 40 weeks to 36 months. It is not, however, without its limitations; so you should have a good discussion with your doctor.

Other special cases include health conditions such as Down syndrome, cerebral palsy and Turner syndrome. Special growth charts are available but again, they have many limitations.

Although, I did not find any discussion on the topic of multiples (twins, triplets etc.) I think that these too are special cases. Usually, multiples have low birth weight and do not go to full-term. Even though, the NHANES III data included low birth weight infants, I did not find any reference of categorizing data for multiples. Multiples may also show different growth patterns, where one of the child grows “normally” but the other(s) lag behind. It is my (selfish) hope that the next national survey will try to account for this gap.

Pay special attention to the BMI for age growth chart

Body Mass Index (BMI) is calculated using both weight and height. It is very easy, and you can use this online calculator simply by entering the age, weight and height. BMI is known to track very well with age, first increasing from birth to 8 months of age, then falling until age 6 and finally rising with age. There are two important things you can learn from the BMI chart with age for your child -

1. Percentile – Your child is at high risk of being overweight if the BMI is between 85th and 95th percentile for his age. If the BMI is over 95th percentile, then the child is considered overweight.
2. Trend in BMI for age chart – the sooner your child’s BMI hits its lowest number, the more likely he  is going to have a higher BMI percentile when he grows up, and greater is his risk of being overweight. Watch the trend in BMI for age over time closely and take action sooner than later.

BMI-for-age chart, Boys, >2 years old

Growth charts are used only as a screening tool

It is important to understand that growth charts are used only as a screening tool and not to diagnose a medical condition. The 5th percentile cut-off is useful to identify infants at risk of overall health and growth problems. The 95th percentile cut-off, especially on the BMI for age chart, is useful for early identification of childhood obesity. However, resist the instinct to be alarmed by a single point on these charts. You should look at a series of points over several visits to understand the overall pattern and assess if there is any unexpected change. If you have a concern, consider making these charts more frequently. With online tools, you don’t have to wait for your next doctor visit.

Take action

Here are 5 actions you can take:

1. Use information to manage your concerns and anxiety over what is a “normal” growth pattern for your child. Hopefully, this article is helpful; however there are a few more resources you can use to learn more about growth charts:
   • CDC’s growth chart website
   • Use and interpretation of growth charts – an instructional guide
   • Recommendations for growth references for VLBW infants
2. Resist the urge to make nutritional changes or goals based on a single data point on a growth chart.
3. If a single data point causes concern, track more often and then make a plan in consultation with your pediatrician.
4. Resist the urge to compare your child with others, or even with his own brothers/sisters. For example, two children with the same BMI could have very different risks based on their age.
5. Take a long term view to your child’s growth.

Feel free to share your personal experience and advice regarding growth charts.