BMI In Young Children...Kind Of A Vent/Request For Info? I Guess?

[SilverSabre25]

Specifically, a boy who just turned three two weeks ago.

DCM called me today (we're sort of friends, she wanted to kinda vent/chat/share about this) and said that they were just leaving dcb's well-child check-up and the doc told her that his BMI was way too high. I forget the number she said, but he's about 35 lbs and 33 inches tall or something like that. Not *that* much different from my own 33 lb/40 inch 3.5 who is consistently 75th/90th for weight/height.

Anyway, I'm like you're kidding me...the doctor is quibbling about the BMI of a three year old?!? Last I read, BMI scales are NOT accurate OR appropriate for children under 5 or 10 or 18 or something like that.

We are NOT talking about a sedentary child who eats nothing but junk food! He's a very active little boy (VERY active...his favorite form of locomotion these days is jumping everywhere...literally), we watch almost NO TV here and he watches very little at home, we do NOT serve junk foods here and he doesn't get them at home either, he eats very well and very balanced, doesn't get juice or milk much (not on food program, don't flip out), rarely has sweets.

Looking at him, he's a very normal little boy...a bit on the heavy side right now, perhaps. I was just thinking the other day that he still looks very "toddler" vs. the more adult-proportioned "child". His arms and legs are still chubby, but baby/toddler chubby, nothing too unusual. Some kids, you look at them and say, "Wow, that's a fat kid...". DCB, you look at and say, "Look! a kid!"

I suggested to mom that he's just on the heavy side atm because he might be gearing up for a growth spurt. She relaxed a little bit at that point and admitted that sounds likely. I stressed to her that I'm pretty sure that BMI in young children isn't an appropriate measure of anything, and that since he's active, healthy, and eats very well, there's nothing to freak out about or worry about. There are very few if any of the suggested dietary changes that I can make here, and dcm said that very few of them applied at home either.

But still...really? BMI for a three year old?

I know, I know. Fat-phobia is kind of out of control nowadays. Glad you have a level head and can recognize when to intervene in a kid's diet and when not to. If she brings up the topic again, just remind her that you and she are doing everything right already. And tell her to switch doctors. Seriously. If she can't for insurance purposes, tell her to do some research and go to the next appointment armed with information for HIM.

Doctors, like everyone else, are very silly sometimes!

[youretooloud]

Yep.. they watch that these days.

I have a neighbor kid who is almost three years old and weighs nearly 85lbs. The kid literally has food in both hands all day long, all night long, whenever you see him, he has food. The other day, he was waddling around the street with a bag of mini powdered sugar doughnuts and I'm fairly positive he ate the whole bag by himself. I've seen him eat a full bag of marshmallows by himself.

So, thanks to parents like this, doctors now need to say something to the other parents so they don't end up with an obese child. It's a lot easier to maintain chubbiness in grade school than it is to loose 200lbs when that child grows up.

http://pediatrics.about.com/cs/usefu...l_bmi_calc.htm

[Mrs.Ky]

This doc may have been reading his chart wrong. My little girl when she had her 3 year old well visit 6 months ago was 30 pounds and 60 percent for weight I think and 3 feet tall which is 75 percent I think that child is no where near heavy. U wanna know big my middle child was 30 pounds at 1 years old LOL he is as skinny as a rail now only 60 pounds at 8 years old.

[nannyde]

She needs to thank her lucky stars that her doctor DOES something about addressing obesity. The biggest impediment now for counselling parents of young chldren is there are very little ways for them to be compensated for their counselling. Docs don't want to do it for free and they DON'T want to deal with an upset parent who has been told their child weighs too much. That takes time and time is money.

So first she should say a blessing for the Dr. VERY cool of them to even discuss it with her.

Childhood obesity is a huge medical issue. The fastest growing group right now is elementary aged kids BUT very very soon it will be preschoolers.

When it comes to addressing this the doc has height/weight... averages for the age.. and BMI. That's IT.

We can't use percentiles because the kids are getting heavier younger. Percentiles don't work when so much of the group is overweight. BMI is the only way to measure it without measuring against the group.

The other thing to consider is that the mothers are becoming increasingly obese as a group. In the next decade these kinds of measurements are going to go all the way to in utero because of the obesity issues with pregnant women.

Being aghast at the thought of addressing this with a three year old will be OLD NEWS here in a few years. It will go all the way to infants soon enough. We can't afford NOT to do it. We have to.

We need to SUPPORT docs who are willing to take the time to address this during well child visits. We also need to start PAYING them to do it so they do it with every kid from birth on. We need to be willing to pay for frequent doc visits JUST to do height and weight so that there is accountability and truth to the parents.

The research is coming in RIGHT NOW about how the height/weight/bmi of toddlers is indicating the chances of kids being overweight school agers especially in poor kids, african american kids, and hispanic kids. They are the biggest risk group of them all.

I thnk we all need to start having these conversations. I think we need to look at the way we feed kids, the exercise they have AND very very importantly the way they PLAY. We need to look at the best ways to get bang for the buck in the way we set up their play areas, the amount of time they are doing "school" in the sit position, and what they are doing OUTSIDE. We need to look at what we can do to offer them a good workout in their whole day. We also need to look at what barriers child care providers have to offer the best exercise ... which IMO is the real pressure we all have to make sure there are NO injuries AND the cost of healthy whole foods so we can feed them fresh pure food.

So Silver... maybe turn this around with her and tell her how LUCKY she is to have a doc who would have this convo with her and to not be offended but be grateful, humble, and go BACK for a recheck when they say to come back.

[youretooloud]

I agree with Nanny. I think as a country, we need to pay attention. If your three year old looks a little chunky, he or she may not grow into it.

I love "Biggest Loser" and some of those very young people aren't to blame for their obesity.. they were heavy at age six and seven. I feel bad for them because they didn't do it to themselves, it was done to them. Their parents might as well have put a cigarette in their mouth and lit it.

The doctor wasn't saying the little boy was overweight. He's saying the child is at risk, and lets watch this now, rather than wait til he's a 100 lb second grader.

[Kaddidle Care]

I think if obesity runs in the family then she should/could be concerned, but not as concerned as youretooloud's neighbor's family should be. Good Golly! An 85lb. 3 year old? That's abuse! Food Abuse!

3 is usually a time when they start to slow down on food, in fact, I found it rather hard to keep weight on a 3 year old.

It's a new fad and I guess the Pediatricians are all jumping on it. If they hit 4 and they've still got what looks like elastic bands around their wrists, then it's time to address it. I guess there's nothing wrong with looking at what you're feeding your kid though.

My question is this: The Dr. that told the mother her son's BMI was too high - what was his suggestion if any? You don't tell a mother something like that without a game plan.

[SilverSabre25]

Nanny, I realize that it's a big and growing (puns not intended, lol) problem in our country...I'm just feeling awful for my dcm and the dcb that the doctor is making such a big deal out of it. The dcm was borderline freaking out when she talked to me. She feels like a terrible mother for her son being this way, and she thought she was doing everything right. She *is* doing everything right, as in, he eats well both here and at home, is active, is not a TV-watching-couch-potato, etc. She can't figure out what she "did wrong" and feels like utter crap. My heart goes out to her, it really does. Now she's questioning every move she has ever made as his mom.

I swear that I learned just two years ago that BMIs were NOT recommended as diagnostics for such young children, simply because they are growing so fast and they often "bulk up" just before a growth spurt, so their measurements/numbers on a given day may not be very representative of their overall condition.

Some kids/parents/families need a wake-up call...and some maybe not so much. I honestly, really, truly do not think this dcb is overweight. The 14 month old I was watching over the winter who was bursting out of 24 month clothes and weighed almost as much as my 3 yo--SHE was overweight. This boy? Yeah not so much.

[SilverSabre25]

Originally Posted by Kaddidle Care

My question is this: The Dr. that told the mother her son's BMI was too high - what was his suggestion if any? You don't tell a mother something like that without a game plan.

Let's see...take him off whole milk and put him on skim, quit giving him juice, no more fries and chicken nuggets, no more candy and soda...

Wanna know the kicker?

He doesn't eat that stuff.

We serve water 99% of the time here. We don't serve fried foods at daycare and he doesn't get them at home either. They don't eat out. He gets primarily water at home, too. There aren't tons of sweets either place.

part of dcm's flipping out while she was talking to me was that she can't think where to "improve" his diet, because it doesn't contain any of that stuff with anything that even vaguely could be called regularity.

[nannyde]

Originally Posted by Kaddidle Care

My question is this: The Dr. that told the mother her son's BMI was too high - what was his suggestion if any? You don't tell a mother something like that without a game plan.

Well the problem is that once you even SUGGEST this the parent hears nothing else afterwards. It's a process.

[nannyde]

Originally Posted by SilverSabre25

Let's see...take him off whole milk and put him on skim, quit giving him juice, no more fries and chicken nuggets, no more candy and soda...

Wanna know the kicker?

He doesn't eat that stuff.

We serve water 99% of the time here. We don't serve fried foods at daycare and he doesn't get them at home either. They don't eat out. He gets primarily water at home, too. There aren't tons of sweets either place.

part of dcm's flipping out while she was talking to me was that she can't think where to "improve" his diet, because it doesn't contain any of that stuff with anything that even vaguely could be called regularity.

What about portion size and the amount he exercises?

Don't sweat it now. Just listen to her and let her have time to process this.

[SilverSabre25]

Originally Posted by nannyde

What about portion size and the amount he exercises?

Don't sweat it now. Just listen to her and let her have time to process this.

Portion amount--here at least, it's the correct amounts per the food program, or at least close to it. I'm not on the food program so I'm not anal about it. If anything, it's less--esp 'cause he doesn't eat it all most of the time. Home, I'm guessing it's about the same.

Exercise...hahahaha! He's a three year old boy. His main form of getting around is to either run or hop everywhere. I curb the running as much as I can inside but he is BUSY--he doesn't stop moving and the active toys are the ones he prefers. In good weather we spend most of the day outside, and his favorite things to do are run, run around pushing a large truck, and run, in that order. In not so good weather, he bounces everywhere inside. My whole group is very active...and mostly boys. Kid can't sit still. I know that at home his mom lets him play outside with the dog, so he gets a lot of outside time at home too.

[Lucy]

I have to say, I'm surprised at these responses . Are you kidding me? If he's eating healthy and is very active as OP says he is, then he's fine. Good lord -- he just turned THREE. To suggest, in effect, that he needs to diet is absurd. So he's a tad chunky, but jeez. I have an 8 yr old boy who was "chunky" too. At 18 months, he was a tank and was wearing a 3T. This boy is now tall and thin.

I could understand if this 3 yr old was actually fat. We've all seen those fat toddlers on Maury Povich. But this sounds like a normal, healthy, chunky kid. He'll grow out of it. I'm shocked at the reactions.

[elle73]

My son is 2 1/2 and weighs 35pounds, he's pretty tall for his age, our Dr said he is fine and very healthy he's not fat or chunky but very solid and also its just the way he is built too. My daughter was a very chubby baby and she is 6 now and thin and tiny, so the dcm shouldn't worry about her son like you said he's active and eats healthy.

I once had a mother interview with me that told me she did not want me feeding her 1yr old daughter any snacks, just lunch and that was it during the day because she did not want her getting fat, I couldn't believe it!!!

[jen]

Just out of curiosity, is Mom is over-weight?

[SilverSabre25]

Originally Posted by jen

Just out of curiosity, is Mom is over-weight?

No, not exactly. She's not a stick like dcd is, but she's definitely not "fat". I'd say she's about average.

[jen]

Originally Posted by SilverSabre25

No, not exactly. She's not a stick like dcd is, but she's definitely not "fat". I'd say she's about average.

Ah, I thought maybe doc was making assumptions based on Mom's weight.

Originally Posted by SilverSabre25

Let's see...take him off whole milk and put him on skim, quit giving him juice, no more fries and chicken nuggets, no more candy and soda...

Wanna know the kicker?

He doesn't eat that stuff.

We serve water 99% of the time here. We don't serve fried foods at daycare and he doesn't get them at home either. They don't eat out. He gets primarily water at home, too. There aren't tons of sweets either place.

part of dcm's flipping out while she was talking to me was that she can't think where to "improve" his diet, because it doesn't contain any of that stuff with anything that even vaguely could be called regularity.

This is why I responded to you the way I did. You aren't serving him junk, his mom isn't serving him junk, and he's not really overweight. He's also active. You don't actually need to make any changes, nor does his mom.

A doctor has a responsibility, IMO, to get to know the patient and find out what the lifestyle is at home, especially if that patient is going to be under their care for another few years. Only after getting to know a patient and KNOWING that the diet is cr*p and there is a very low level of activity should it be "discussed". Otherwise, it's not courage to bring the topic up and make a parent feel guilty about their NOT overweight, active child who eats healthy. It's something else.

I'm not taking up for any parent who chooses to feed their kid a junk food diet (a whole bag of marshmallows? Really? Diabetes, here we come!). I just think that if we read the original post in this situation, the obesity epidemic topic really doesn't apply. What we have is a mom who is now concerned about something she should not be concerned with, and the impact may be that she holds a tighter reign over what her kid is eating, and THAT can backfire and actually cause...well, obesity. And I think it's the doctor's fault, because, for whatever reason, he harassed her about something during a doctor's visit that he should not have.

Silver, thank you for encouraging the mom not to get too crazy over this. I'm sure that you and she will keep a proper eye out on the kid's diet and make sure he gets lots of exercise!

ETA: and I was actually serious about her changing docs. If she can't have a simple discussion with him and shut down the harassment by letting him know that her kid DOES eat a healthy diet, then she needs a doctor with whom she can feel free to talk. I let my doctors know upfront what my kid's diet is, and it makes them deal with me in a different way because they know I'm already informed.

[nannyde]

Originally Posted by PeanutsGalore

This is why I responded to you the way I did. You aren't serving him junk, his mom isn't serving him junk, and he's not really overweight. He's also active. You don't actually need to make any changes, nor does his mom.

A doctor has a responsibility, IMO, to get to know the patient and find out what the lifestyle is at home, especially if that patient is going to be under their care for another few years. Only after getting to know a patient and KNOWING that the diet is cr*p and there is a very low level of activity should it be "discussed". Otherwise, it's not courage to bring the topic up and make a parent feel guilty about their NOT overweight, active child who eats healthy. It's something else.

I'm not taking up for any parent who chooses to feed their kid a junk food diet (a whole bag of marshmallows? Really? Diabetes, here we come!). I just think that if we read the original post in this situation, the obesity epidemic topic really doesn't apply. What we have is a mom who is now concerned about something she should not be concerned with, and the impact may be that she holds a tighter reign over what her kid is eating, and THAT can backfire and actually cause...well, obesity. And I think it's the doctor's fault, because, for whatever reason, he harassed her about something during a doctor's visit that he should not have.

Silver, thank you for encouraging the mom not to get too crazy over this. I'm sure that you and she will keep a proper eye out on the kid's diet and make sure he gets lots of exercise!

I don't agree with this at all.

I don't think it's the doctors business to get to know the family. I think it's their business to DO a well child visit when he's being paid to do a well child visit. If the numbers don't add up they don't add up.

Take it from someone who HAS had the discussion with parents about their kids weight... they don't take it well at ALL and they only hear one thing: you are saying something bad about my kid... you are saying my kid is fat.

Doesn't matter if they spent the time or not going thru his diet/exercise/sleep... in the end... when she walks out the door she's thinking the same thing she thought when they brought it up in the office.

Telling a parent the numbers isn't harrassment. It's the first step in "let's keep an eye on this". They could have said "oh his development is most excellent... his physical is perfect with heart, lung, skeletal.... the only concern we have... and it's just a concern that we must keep our eyes on... his BMI is too high... we know that kids who have THIS BMI at this age have an X percent chance of being obese at X age and into adulthood....

Even if they did THAT level of education along side of the compliment sandwhich... the parent is STILL going to walk out the door going "he said my kid was fat".

Family docs will be doing this at well child visits because there is a HUGE market now for dealing with obesity in kids. They just have to figure out how to get paid for it.