Size Matters Again

We are just back from The Girl's 15 month check up at our new pediatrician's shiny and clean office.  Good Lord, I can't tell you how much nicer this doctor's office was than our one at home.  They had separate sick and well patient waiting rooms, clean toys and books, and a general air of competence.  This may be reason enough to love the suburbs.

The appointment was fine, but I was finally forced to have a real conversation about an issue I've been wanting to avoid: The Girl's size.

As I've noted before, she's big.  At 15 months, she's 33 inches and 32 lbs.  According to the pediatrician and this chart, that puts her above the 95th percentile for height and weight, but of course it's the weight that's getting the attention.  

The Boy was big too--although not quite this big--back in the days that he was a happy go lucky young toddler who would eat just about anything that I put down in front of him.  He quickly became a picky older toddler who ate almost nothing and was constantly on the move.  He lost his toddler tummy soon enough.

So, on the one hand, since I've BTDT with The Boy, I wonder if I shouldn't just give The Girl more time.  She started to walk 2 months later than The Boy and is only just now becoming truly frenzied in her physical activity.  She hasn't become a picky eater and still eats just about anything (which may be exactly the problem), but if she's anything like The Boy, that window will close soon.

But on the other hand, as a person who has struggled with her weight for most of her life (or more to the point, not really done enough about it to struggle), I want to do anything I can to help my daughter now so that she doesn't have to worry about it later.  The pediatrician suggests being more diligent about portion size, really pushing the vegetables and fruits ahead of anything else, and switching from whole milk to 2%.  None of those changes are earth shattering or particularly difficult (at least in theory), but the milk recommendation gives me pause.  This study seems to say that lower fat milk doesn't jeopardize neurological development, but I've heard the whole milk until age 2 recommendation for so long that I worry maybe I'm somehow prioritizing thinness above brain function.  Would I have worried the same way about The Girl if she was a boy?  What' next?  Giving her a talking Barbie to tell her that math is hard?

I need advice here, people.  Personal stories welcome--and I'd be especially appreciative of any resources about nutrition in toddlers (beyond Ellyn Satter whose books I'm consulting as soon as I press "Save").  

Comments

[VHMPrincess]

My best friend has 2 kids that are GIANTS. At age 10 mos, the girl wore a size 5 diaper and 2T clothes.

The son, who is the same age as my son, was always TWO SIZES bigger - wider and taller.

Now, at age 6, he is only 1 inch taller than my son and probably weighs almost exactly the same as my son - I think it all evens out to their general body type by the time they are 5-ish.

Let her eat - make sure she gets the whole milk she needs. She'll slim down naturally later. As long as she's not heavy because she lives on candy and fast food, don't sweat it.

[BethanyWD]

I had to go back and look to see how big my now three year old girl was at 15 months. She was 34 inches and 30 pounds. The only thing that's a drawback (in my opinion) to having a tall child is that people assume she's older than she is (and therefore, expects her to act like a 5 year old, since she's about that height now at 3!). She'll probably continue to slim down as she's walking more and running around.

In my opinion (you did sort of ask, right), I think your daughter is probably fine, though I would consider switching to 2% milk. And in terms of her eating, I wouldn't limit any of the "good" foods, like fruit and veggies, but perhaps keep an eye out on sugars and processed foods (no HoHos, etc), with, of course!, treats every now and then. Moderation is good for EVERYONE in the family (I need to take my own advice, too!). Whenever you see those super overwieght kids (on Montell, etc.) they always survive on sugary snacks and Hostess Cupcakes).

I hear you, though, it's so difficult to want better for your own daughter in terms of a relationship with our bodies. It's a difficult pill to swallow.

[Slim]

My husband's family has a tendency towards high cholesterol, so my main interest was in shaping taste buds to prefer lower-fat options. Then too, I knew my kids were willing to ingest plenty of fat, and this way I figured I could steer them towards the more-healthful stuff and away from the delicious, delicious saturated stuff that's in dairy.
Like you, I wasn't worried about weight so much -- my kids turn sticklike after a certain age -- but I did care about food preferences.

[Sara]

Can I just ask - did you make any interventions with your boy?

If you didn't - I'd do the same with her.

I had a 10# newborn girl who became a 20# 4 month old and a 25-pound 5 month old. She's always been huge - in both length and mass. And at 15 months she had a buddha belly and dimply little knees, whole nine yards. And no DOCTOR ever said a thing to us about her weight.

I can't say the same about the general public, who felt free to comment "you don't ahve to feed her every time she cries." I did notice that when she was in her brother's handmedowns I did NOT get such comments. Instead, I got "What a big strong boy! He'll be a football player someday!"

(if you follow the link to my blog in my comment and search on "buddha" there's a post with a series of pictures of her up to age 3, when she started to slim out a lot.)

Now, at 5, She's a head taller than the rest of her class (and she's younger than many!) but has a gorgeous and perfectly proportioned little body.

How is her percentile in weight for length? It seems to me that a 95th percentile for height child SHOULD be 95th percentile for weight. There are charts for that statistic that you can check out, if you're interested.

[Bobbi]

As a mother of 4 really big babies (who grew / are growing up to be tall lean kids) I would stay with the whole milk til at least 18 months for brain development, and do what everyone else said. As long as her height and weight are proportionate, don't worry - she'll even out. If her weight starts to outdo her height on the scales, then I'd change things. It's just how our kids grow... :)

[Mrs. Sprinkles]

My girl is bigger than her older brother was, but she also weighed more at birth.

It sounds like she's proportionate, so I wouldn't worry until her weight outstrips her height. My girl was pretty much even in terms of height/weight about a year ago, but now that she's almost two she's getting taller than her weight, if you know what I mean.

I'd put the issue on hold and revisit it later.

[Andrea]

I am guessing everyone will tell you don't worry...but really, don't worry.

I have two big kids (both well over the 97th percentile for height, and between 70-85% on weight), and a lifetime of obesity myself, so I worry about this, too. I also have a niece who was covered in fat rolls until preschool, but now, as a second grader, she's very proportionate. Her parents did have to be very cautious about portion size for a while, and she still has a tendency to keep eating until the plate is empty. Maybe some of us just trend that way.

I would give her some time to really get moving. I would make sure you're offering plenty of "healthy" stuff, reasonable portions of the healthy-but-calorically-dense stuff, and be sparing about having anything that qualifies as junk food around. Avoid caloric drinks other than milk (like juice), and refined carbs (white flour, sugars).

I don't think there's anything magic about whole milk, but I don't think keeping her on it is a bad idea, either. It's only 2-3 glasses a day, right? My kids didn't always finish theirs, either. I did switch my kids to 2% at 18 mos or so, and then to skim after they turned two, just to get them used to the taste of skim and to stop buying so many kinds of milk.

I think the best things you could do now are to encourage her to keep eating a wide variety of fruits/veggies/legumes (my kids slowly got picky as they aged) and to make sure she gets plenty of exercise.

I have friends who, out of a desire to nip any potential weight problem in the bud, are pretty obsessed with their kids' diets, and it's not a pretty sight. To me, that's going to lead to more problems later than a little extra cheese or an occasional cookie now.

Anyway, I'll bet she turns out fine. That chubby toddler phase is a common thing to go through.

[electriclady]

Friends of ours had a baby so large that we (secretly) nicknamed her "Jabba the Baby." In her first Christmas pictures, at age 8 months, she is wider than her 3 year old brother, who can barely get his arms around her. She nursed like a maniac, ate everything under the sun (veggies included) and was super chubby through toddlerhood, and then just evened out. She's now a skinny 7-year-old (with no change in eating habits).

I'm no nutritional expert, but I will say that when we were switching BG from formula to cow's milk, we went through a brief period when we thought it was causing her problems and were giving her soy milk. I noticed that soy milk is lower fat than whole cow's milk (about the same as 2%, actually) and asked the ped about it, and she said it was fine.

[Summer]

I'd worry more about processed sugars (and to a lesser degree, white flour) than about fats. Human bodies, especially growing bodies, need healthy fats. And FWIW, my 25%-for-weight, somewhat lethargic son didn't lose his toddler tummy until, um, this summer, when he was 5 1/2 and we moved to an environment where he's finally getting lots of outdoor activity. (I know, if I was a better mom I would have taken him to the playground more often when we lived in the city, but the playgrounds were covered in broken glass and discarded food and condoms, and also featured lots of graffiti I didn't want him to read. Hey, we've all got our guilt buttons, don't we?)

[JK]

I'd go with what Summer said. Fats aren't that bad for growing kids. Just do lots of low processed foods for the rest of her diet and let her run around outside a lot! :-) Be very active with the kids and it will be good.

[Rebekah]

I don't know ... maybe hold off on going to 2% for a few more months if you have any qualms about it, and focus more on the eating fruits and veggies. That is important, I think. I don't know what I think about the whole portion control thing, unless you know that that is truly an issue.

[JK]

Fats aren't even that bad for full grown people if they are the "good fats" ... Very little saturated and no trans fats.

I don't know how much fat I eat, but I cook with lots of olive oil and I drink cream in my coffee... I keep losing weight with exercise, but no real diet changes.

Fat isn't evil. Neither is protein for most people. The "best" diet is still to be determined. I'm guessing also genetics will play a role in telling us what our best diet is.

[Carla Hinkle]

I think at 15 months I wouldn't worry -- though I would look into switching milk to 2%, I have had several peds mention that it was OK.

I guess I want to give more of a general caution for 6-12 months from now. My older daughter was on the skinny side -- 15% -- at 18 months. I did not appreciate how much growth really slows after 2 and by 3, she was upwards of 95% and much different proportions. Chubby in a way that she wasn't as a younger toddler.

During that time (2 to 3) I did not take care to limit the portion sizes of starches -- she had a little sister born and I gave lots of "treats and she probably had more TV than she needed -- I gave veggies but didn't push enough. So I think I really contributed to her gaining weight beyond what her proportions had been prior to that. I guess I somewhat thought because she had been a skinny-ish baby, I didn't have to watch out so much; and also as a kid I was always petite, not that interested in food, so I sort of assumed she would be like me, and she isn't.

Now at 4.5 she has thinned out somewhat, but is nowhere near as skinny as many of her 4 year old peers. But I think it is because I really try to keep her portions on the small-ish size, offer seconds of veggies and protein before offering seconds of starch, and limit desserts/treats. I really think her size is sensitive to her diet because this summer, when her grandparents were here all summer (they have a condo and come for 8-12 weeks), she got all kinds of extra treats from them and we had lots of ad-hoc, pasta-heavy dinners, and she definitely gained weight.

Now, not to say I made her fat. I think she is a perfectly healthy size now. BUT I do think that she has a liking for sweets and starches, isn't super physical, and will happily sit around with polly pockets and books instead of run around. So I feel like I missed the boat a bit between 2 and 3 and want to make sure to instill healthy eating habits and enjoyment of physical exercise so that she doesn't develop a weight problem at some point.

Just an advisory, I guess. I thought that kids as little as 2-3 would always "self-regulate" their eating (that's what people say) but I don't find it to be so, at least with my older daughter. My younger daughte is the same at 18 months -- 15% -- but I am starting now to keep an eye on what she eats.

[Renee]

Hiya,

Yeah, we are "plump" here too. I blame genes--my bro runs 30 miles a week and is still pudgy. But my hubs fam all died by 58 with stroke, so we are PSYCHO about cardiovascular health with my son.

Since you asked, my first suggestion is fish oil. it has been shown to aid neurological and cardiovascular health in both kids and adults. Just make sure it's been purified (no mercury etc.) and then you can go to fat-free milk and still give your kids the good fat they need.

My hub and I were the worlds PICKIEST eaters as kids, so we expected one. And so we just were fore-warned (and therefore fore-armed) and just kept offering veggies etc. My proudest mom-food-moment was last week when I was just feeling blah and opened the freezer for dinner and offered my son frozen pizza or cauliflower--and he picked the cauliflower...which i put cheese sauce on and call "real deal pirate macaroni and cheese"--

oh, so my other suggestion is to call healthy foods crazy names--we live in pittsburgh, so my son is already aware of the Steelers, so frequently I say "would you like some Steelers watermelon" which is waaaay better than watermelon.

Also, studies show that it takes about 10 presentations of a new food before a kid will jump. so persistence is the key.

Good Luck. Love your blog.

[amywest]

I went back to check on my girls and at 15 months, Alyssa was 33" and 26 lbs. Madison was 31 1/2" and 21 lbs. I did whole milk to two but then went straight to skim and they have been on skim since. My doctor didn't have issue with that as long they stayed on their growth curves, which they have. I would give it time yet, especially if she is just starting to get really active.

[Kate]

We know a couple where both parents are very tall and not terribly slender (but well proportioned). Their daughters, all four of them, are bigger than average. Their first baby, in particular, was always so big! Really, it was easy to forget she was 3 because she looked like a 5 year old. (She would act 3, though--a huge mental disconnect!) But now she's 8 or 9, still tall, and trim. They live in a small town, so she walks everywhere, and swims, etc.

Re: the milk issue. My daughter had a dairy intolerance, which she outgrew. She was off all dairy from 11-18 months. When she did start again I think we put her on 1% milk, like me and my husband, because she just didn't drink enough of it to justify the expense of a throwing out a quart of whole milk every week. She nursed until she turned 4, and didn't even really develop a taste for it until she was in nursery school (age 3); a few months into that she started asking for milk with meals instead of water. Then we switched to organic 1%.

With my son we were cautious with the dairy intro (see above intolerance) and also went slow. He started drinking more milk earlier, to be like big sis, but I figured he was getting plenty of fat from cheese, poultry, and avocado (a staple food here). Also he nursed through that hard food period (9-18 months).

Long story short: we are all on 1% milk. Higher fat dairy until age 2, when I thought about it, which wasn't all that often.

I really think the keys are to offer healthy choices in moderate sizes. And don't be afraid to say no, not right now, or you've had enough for the moment. Sometimes my kids push away from the table when they are finished, but sometimes they are not great judges of how much they should be eating (which I know goes contrary to the nursing on demand idea--that then they will know when they are full). On rare occasion I will let my daughter have more when I really think her "eyes are bigger than her stomach" and usually 20 minutes later she is asking for children's Pepto.

I'd definitely give your daughter more time to start running and climbing. 15 months is still a baby! (pretty much) With my kids I've found that from ages 2-3 they gain only a couple of pounds but grow quite a big taller.

[Kate]

We know a couple where both parents are very tall and not terribly slender (but well proportioned). Their daughters, all four of them, are bigger than average. Their first baby, in particular, was always so big! Really, it was easy to forget she was 3 because she looked like a 5 year old. (She would act 3, though--a huge mental disconnect!) But now she's 8 or 9, still tall, and trim. They live in a small town, so she walks everywhere, and swims, etc.

Re: the milk issue. My daughter had a dairy intolerance, which she outgrew. She was off all dairy from 11-18 months. When she did start again I think we put her on 1% milk, like me and my husband, because she just didn't drink enough of it to justify the expense of a throwing out a quart of whole milk every week. She nursed until she turned 4, and didn't even really develop a taste for it until she was in nursery school (age 3); a few months into that she started asking for milk with meals instead of water. Then we switched to organic 1%.

With my son we were cautious with the dairy intro (see above intolerance) and also went slow. He started drinking more milk earlier, to be like big sis, but I figured he was getting plenty of fat from cheese, poultry, and avocado (a staple food here). Also he nursed through that hard food period (9-18 months).

Long story short: we are all on 1% milk. Higher fat dairy until age 2, when I thought about it, which wasn't all that often.

I really think the keys are to offer healthy choices in moderate sizes. And don't be afraid to say no, not right now, or you've had enough for the moment. Sometimes my kids push away from the table when they are finished, but sometimes they are not great judges of how much they should be eating (which I know goes contrary to the nursing on demand idea--that then they will know when they are full). On rare occasion I will let my daughter have more when I really think her "eyes are bigger than her stomach" and usually 20 minutes later she is asking for children's Pepto.

I'd definitely give your daughter more time to start running and climbing. 15 months is still a baby! (pretty much) With my kids I've found that from ages 2-3 they gain only a couple of pounds but grow quite a big taller.

[Kate]

Oy, sorry for the double post. I am supposed to be working...serves me right, I guess!

[Heather]

I think as long as you are making sure she's eating her vegetables and other healthy foods, like whole grains (we only eat brown rice in our house and our daughter's learned to prefer it), I don't think you should worry too much about her weight.

If she's in the 95% for height, I think 95% for weight should be normal. I think 15 months is too young to be concerned about her weight. All babies and toddlers have their "milk gut" and they outgrow it. As she gets older you can keep an eye on it, but if you instill good eating practices now, they will last her lifetime.

Also right before she hits puberty, if she gets a belly, don't fret. It's normal for girls to get this before they have a huge growth spurt. I was like that at around 11 and after that growth spurt I've been a total twig. It made my mother nervous though. She thought I might be getting a weight problem during that time.

[snickollet]

As if you need more comments, but I can't resist.

Maddie has always been 95th for height and 95th for weight. Our pediatrician feels that as long as she is proportional, there's nothing to worry about. If she were 10th percentile for height and 95th for weight, that would be a different story. Makes sense to me.

That said, I was lazy and didn't want to stock two kids of milk for me and the kids, so they switched to 1% at about 16 months with no apparent consequences.

The weight thing is so trick with girls especially. I hate that we have to be thinking about it when they're babies!

[SarcastiCarrie]

I see no problem with 2% milk. It's still really fatty (maybe 5 g fat per serving instead of 9 g like whole milk). And like many others, my child was on soy milk which had 3 g fat per serving.
I'm sure she's getting fats other places besides her milk too (cheese, meats, etc).
And I think giving her the green beans on the high chair tray prior to the other foods is a good idea. One which I should steal. Green Beans first, when they are gone, mac-n-cheese or ham cubes whatever.
I don't think it has as much to do with current weight as setting up good eating habits and preferences for life.

[kathleen999]

We started our boys on 2% at 3 years old. Made no difference in their body types. I have one that is 70% height, 30% weight and the other is 95% for both height and weight. He still has a tummy at almost 4 but what I've noticed is that they both fatten up, then they have a growth spurt and thin out, then fatten up again and repeat. This has been going on since they were 1 or so. I think it's normal and I wouldn't worry too much. We don't feed them junk but they get chocolate milk sometimes and sometimes a cookie.

We have weight issues in our family on one side and my 95th percentile boy seems to take after that side. But the weight problems don't seem to take hold until the 30s. None of us were really fat kids or teens.

I didn't hear any comments about my boy's weight until his 3rd birthday appt. Then they told me that we would have to "watch" it. My dad is 6'5" so I ignored it. I think this is the normal growth pattern for him. He is solid muscle, too, by the way. You pick him up and he is amazingly muscular and extremely heavy for his size. So I would go by your mommy instincts.

[MLB]

My oldest is now nearly five, also a girl, and just lost her toddler tummy this summer. She has always been on the high end of the percentile charts (both, luckily) and that's just how she's built. Noone would ever call her fat, obese, overweight, whatever - but she is solid. I asked the doctor at her four year visit if we should make any changes and he said no - that's just her. And it's true. SHe's always been built like that. I think if you want to switch to 2% milk you can do it, if you push fruits, veggies, whole grains, etc that's never bad, but ultimately at 15 months there's very little you can and should do. And more activity would be great for everyone - not just your little girl. I think one of the reasons my daughter lost the toddler belly this summer was she was so active Every Day - and she loved it.

And my boys are built differently so will never have this issue, which is the only reason it come up for her and not them.

[lulu]

my daughter was off the charts in height and weight as well. I felt terrible about it from about 9 months till about 18 months. At 18 months she was 34 lbs and 34 inches. And then she finally became a picky eater and started running and climbing things and at her 24 month appt she was 33 pounds and 37 inches--very tall for a 24 month old, but her weight gain had leveled off and the pediatrician was happy about it.

All her clothing from last summer and fall, which was too long on her then, but tight around her belly, now fits her perfectly,though some of her pants are actually too big around the waist now--when they were tight at 12 months.

AS for the whole milk vs 2% for big kids under two-- I was given the same recc at her 12 month appt--but I did a little research on my own and from what i could find--there was only one study about this being ok--so i kept her on whole milk, just made sure that i was giving her only healthy food choices, which was so easy before she hit the picky stage. I did not want to risk robbing her brain of those good fats without more evidence that 2% was fine. So, I would trust your gut that you have btdt and not give in to your fears about how she might have weight problems in the future--as long as she is getting healthy food choices from you and seeing you eat healthy stuff, and you give her lots of opportunites every day to run around, she will hit that toddler slim down/picky eater phase and you won't dread her 24 month weigh in.

[liz]

Her height and weight match. There is nothing to worry about. Give her healthy food and let her eat as much of it as she wants. Let her run and play and explore.