In my 50-plus years of pediatric practice, I have consulted with thousands of parents about the confusing diagnosis of failure to thrive. The problem isn’t with growth charts. We include them in most of our books. What parents often don’t consider is that growth charts represent a percentage. They are an average of thousands of children.
Your child is a person, not a percentage. If your child fits lower than average on the growth chart, it’s not a red flag. It’s more like a yellow flag. It’s something you might want to mention to your pediatrician.
Factors that May Influence Where Your Toddler Fits on the Growth Chart
If you suspect your child is undernourished, and that this may be compromising his/her optimal growth, then journal all the things below to discuss with your pediatrician.
When one or both parents are genetically lean, their child will often measure above average on height in a growth chart but below average on weight. Lean does not mean skinny. It means having the right percentage of body fat for your body type.
On the other hand, a child who is naturally big muscled and big boned will often plot just the opposite: higher percentage on the weight chart but lower on the height chart.
A third body type would be a child who is genetically big muscled, big boned and of big height. This child may plot in the 75th percentile on both height and weight. These three variants are usually quite normal.
This simply means the way we eat, not a weight-loss program. Watch for signs that your child may not be getting enough nutrition, and journal the ones you want to mention to your healthcare provider.
Pale skin may be a sign of low hemoglobin. Pale earlobes are a telltale sign of nutrition-induced paleness. That’s because the earlobe is very richly supplied with blood vessels. Toddlers who have loose, stretchy, wrinkly skin instead of adorable baby fat may also be undernourished.
3. Formula-fed vs. breastfed
Children who were breastfed will often maintain their adorable baby fat over a longer time than those who were formula fed, because mother’s milk is 40–50 percent fat. (Remember, the brain grows fastest during the first five years. So, you are feeding a little fathead! Unless advised by your pediatrician, low-fat diets are a no-no for children. Instead, think of a smart-fat diet. The brain is 60 percent fat.)
4. The scale and plotting errors
Be sure to check your child’s weight a second or third time because wiggly, squiggly children are often challenging to plot accurately.
How to Fill Nutritional Gaps
Here are the things I have learned over 50 years that work most of the time.
1. Don’t be wimpy
Many parents today will say, “Oh honey, you don’t like deviled eggs? I’ll make some mac and cheese out of the box for you.” It may not be immediate but a hungry child will eat what they’re served if they don’t have a choice.
2. Serve more “grow foods”
I use this term to mean foods that are nutrient-dense. They pack the most nutrition per calorie, per volume. This is very important especially when feeding picky eaters because tiny children have tiny tummies.
At any age, the size of our stomach is the size of our fist. Theoretically, you want to feed children a fist-full of nutrient dense food per meal. Some of my favorite grow foods are wild salmon; eggs (healthy fats and protein for a measly 75 calories); avocado (the fattest fruit on the planet; remember you’re feeding your fathead); nut butters; olive oil; sweet potatoes; tofu; yogurt (whole milk, organic, plain); lentils; and blueberries.
3. Try the sipping solution
Many children who are undernourished are also under hydrated. One of the top feeding strategies that I have found over my decades in pediatric practice, that corrects the most nutritional deficiencies in the most children, is what I call the sipping solution.
Making a daily smoothie has been a Sears family nutritional adventure for many decades. They are a great way to sneak in nutritious foods. If you’re looking for shortcuts, please resist the urge to feed your child smoothie powders, such as sports or protein powders, that are made for adults.
Look for grow food powders, such as Healthy Heights, to make sure your child is getting the right macronutrients and micronutrients for optimal growth, such as protein (preferably whey or powder from bone broth), vitamin D, iron, calcium, potassium, vitamins A and C, zinc and fiber.
4. Dr. Bill’s nibble tray
Our sixth child, Matthew, was a picky eater. We were so busy with our other children that we couldn’t hover around making sure he ate every bite of his veggies.
Our fun solution was to fill an ice cube tray or muffin tin with nutritious nibbles. We gave each food a fun name such as banana wheels and cheese on trees (lightly steamed broccoli florets dipped in cheese). Toddlers love to dip their food.
So, in five of the nibble compartments, add guacamole, plain and organic full-fat yogurt, cheese sauce, hummus and olive oil. By the end of the day, the nibble tray was empty, Matthew’s tummy was full. We were in charge of what he ate, and he was in charge of how he ate it.
5. Show me the science
Your precious child, the most valuable creation in the universe, deserves the best food surrounded by science. When shopping for food supplements, look for the science on the company’s website. If they have done the research, they’re going to be proud of it and want it right in front of you.
This is why I recommend Healthy Heights shake mixes. They are clinically studied and pediatrician developed to help children achieve optimal growth. In some cases, the Grow Daily 3+ formula may even qualify for medical insurance reimbursement. Another huge perk: The serving size is just four ounces. So it’s small enough for children to easily consume the entire amount, even when served as a beverage along with their meal.
Once children reach the age of 3, they often have a mindset about the order of things in their world. This includes their food. Any alternative is unacceptable. The picky eater stage is usually one that passes or at least mellows over time. Our job as parents is simply to buy the right food, prepare it nutritiously (steamed rather than boiled, baked rather than fried), and serve it creatively. Leave the rest up to the kids.
William Sears, M.D. has been advising parents on how to raise healthier families for over 50 years. He received his medical training at Harvard Medical School’s Children’s Hospital in Boston and The Hospital for Sick Children in Toronto, the world’s largest children’s hospital, where he was associate ward chief of the newborn intensive care unit before serving as the chief of pediatrics at Toronto Western Hospital, a teaching hospital of the University of Toronto. He has served as a voluntary professor of pediatrics at the University of Toronto, University of South Carolina, University of Southern California School of Medicine, and University of California Irvine.
The father of 8 children, he and his wife Martha have written more than 45 books and hundreds of articles on parenting, childcare, nutrition and healthy aging. He is the co-founder of the Dr. Sears Wellness Institute for training health coaches, and he runs the health and parenting website AskDrSears.com. Dr. Sears and his contribution to family health were featured on the cover of TIME Magazine in May 2012. He is noted for his science-made-simple-and-fun approach to family health. Dr. Sears is a member of Media Relations Agency’s panel of highly respected third-party experts. He may be compensated to educate and express his professional opinions, through the media, about certain products.