Infant Growth Charts And Obesity

At every visit to the paediatrician, new parents’ minds are filled with weight checks, percentages and numbers.

Nearly all new parents can spout off the latest stats on their baby’s weight and height.

Do you have a big baby? You’re probably glowing with pride. After all, isn’t a big baby the measure of health?

Is your baby about or below average weight? You might associate wellness visits with fear and worry, as you wonder whether there’s a reason your little one doesn’t have thunder thighs.

As a culture, we accept adults of all different sizes, builds and weights. However, when it comes to babies, we obsess over numbers.

Infant Growth Charts – Is Our Obsession Fuelling Childhood Obesity?

Researchers have known for a decade that being large and growing quickly in infancy is a big risk factor for childhood obesity, as well as for obesity in adolescence and adulthood.

This review on the subject included data from 24 studies, which assessed the relationship between infant size or growth, from birth to two years, and subsequent obesity.

The conclusion of the review was: ‘Infants who are at the highest end of the distribution for weight or body mass index or who grow rapidly during infancy are at increased risk of subsequent obesity’.

If evidence shows rapidly putting on weight is a risk factor for obesity, and we’re in the midst of an obesity crisis, then why are we still obsessed with infants putting on weight quickly?

Infant Growth Charts And Percentiles – What Do They Mean?

Growth charts are commonly used from birth to five years old to help track a child’s growth. How infants grow is one way to assess their health and development.

However, what isn’t always part of growth chart monitoring is a clear explanation of what the chart means. The most problematic aspect is parents aren’t always told what their child’s percentage really means.

The World Health Organization has growth charts from birth to five years. These charts represent typical growth. However, due to the way these percentages work, half the population will always be above 50% and half below, because the figures represent averages.

A growth chart percentage isn’t like a test mark. Being at 97% isn’t better than being at 45%. And there will always be some children at 3%.

Your child’s specific percentage doesn’t mean very much. What matters is that your child should follow an individual growth curve, rather than be at the top of the chart.

Are Big Babies Unhealthy?

The short answer is that you shouldn’t assume a big baby is unhealthy or obese. The systematic review, above, found large size to represent an increased risk, not the cause of childhood obesity.

Can a big baby be unhealthy? It’s possible but there are many determining factors in what makes infants’ size healthy or unhealthy.

Their in-utero environment, genetics, how they are fed, etc. all contribute to babies’ size and health. Many big babies are quite healthy; it’s simply a question of their individual build.

How babies are fed can affect their size, as well as their current and future health. Some babies will be naturally bigger, while others will be naturally petite.

For example, babies fed on demand at the breast can control their intake. This means they’re able to eat according to hunger, stop when they’re full, and meet their body’s unique needs.

BellyBelly’s IBCLC lactation consultant, Renee Kam, says:

“When a baby is fed directly from the breast, the baby is in control of how much she drinks. She can suck in a way where she gets the milk (nutritive sucking), she can suck in a way where she doesn’t get the milk (non-nutritive sucking), she can be at the breast and rest, or she can just come off.

“For these reasons, breastfeeding a baby according to need (i.e. when she shows feeding cues) ensures she gets exactly the amount of breastmilk she needs to grow in the way she is biologically meant to.

“Therefore, no matter how much weight a breastfed baby gains, she cannot be said to be overweight”.

You can read more in Big Babies – Are They Healthy Or Unhealthy?

With formula feeding, it’s possible for babies to consume more than their bodies naturally need. Bottle-fed babies have less control over their feeds, and sometimes parents encourage babies to finish the bottle even they have stopped showing signs of hunger.

With the introduction of solids, parents might also overfeed their infants. Thinking back to the growth charts, parents might inadvertently assume more food is better to help babies ‘catch up’ on the growth chart.

How Is A Baby’s Size Linked To Risk Of Future Obesity?

Before you jump to conclusions about either how silly or how important it is to worry about babies being overweight, or assume there’s any room for size shaming in infancy, consider this: I had a 4 month old who weighed 20 pounds (9kg). He was huge. Several people suggested there was cause for worry about his future weight.

He was breastfed on demand, and we eventually found our way to baby-led weaning. We went on to encourage him to eat healthy foods to satisfy his hunger, without encouraging him to finish everything, regardless of hunger.

When he was about two weeks old, he had a 48-hour period of being bottle fed, during a hospitalisation.

He was encouraged to finish a 4 ounce (112g) bottle at that time – far more than he needed, especially for a baby accustomed to feeding every two hours. He quickly became used to larger feeds, and I pumped and pumped, assuming he needed that much.

When he was six months old our paediatrician encouraged us to start feeding him three square meals a day. Any less simply wasn’t enough – regardless of his hunger, and despite him taking plenty of breast milk. At each visit I was asked how much he ate and encouraged to feed him more, even though he weighed 24 pounds (10.8kg) at six months.

As mentioned above, we eventually found baby-led weaning. He’s now 10 years old and at a healthy weight.

The point is, we could easily have found ourselves on a path from rapid growth, supersizing bottles, and force-feeding baby food to childhood obesity.

How? Because we interfered with his ability to regulate his own hunger. Combined with the fact there’s no shortage of high calorie processed foods in our society, this could easily have made it harder for him to be at a healthy weight.

Of course, our story is anecdotal and an illustration of a potential problem. A focus on weight checks and bottle sizes, the books and professionals saying how much solid food a baby needs, and an obsession with growth charts, can set parents and babies up for unhealthy feeding habits.

Evidence also shows too much protein in the early years can lead to quick weight gain and increase the risk of obesity. One of the reasons formula fed babies are at an increased risk of obesity is the protein content of formula.

Should We Ignore Growth Charts?

In short, no. Growth charts can serve a purpose. However, it’s vital we use them for their intended purpose, which is simply to monitor a baby’s individual growth curve with regard to expected growth for that age.

We shouldn’t be too focused on percentage figures. Instead we should use the growth chart as just one piece in the puzzle.

A child with a figure under 10% often signals a concern. However, when two of my children fell under 10%, the paediatrician looked at me, just over 5 feet tall and under 100 pounds (45kg), and figured genetics were at play.

To be thorough, it’s wise to rule out any other concerns, but overfeeding children to reach an arbitrary percentage is neither necessary nor healthy.

In my children’s case, had they been showing other signs of being unhealthy, then it might have been necessary to make dietary changes.

What Should We Do To Combat Childhood Obesity?

It is important to follow proper infant feeding guidelines and understand the purpose of growth charts.

As a parent, you can also do the following to reduce your child’s risk of obesity:

• Breastfeed – this is the biologically normal way to feed infants. It provides the proper calories, protein and helps them regulate their hunger.
• If you bottle feed, follow baby’s hunger and satiation cues.
• Consider baby-led weaning when your baby is ready for solid food.
• If you feed your baby purees, be sure to follow baby’s hunger and satiation cues.
• As often as possible, serve healthy whole foods.
• Avoid overfeeding dairy products, as diets high in dairy protein are linked to obesity.

We needn’t replace our obsession with growth charts with obsessing over preventing obesity in our children. It is important, however, to understand the purpose of growth charts, and to be aware of how we can help our children have the best possible start.

It seems the key is to follow baby’s cues for hunger rather than to encourage eating beyond hunger in an attempt to reach a higher growth chart percentage.

There are exceptions, of course – especially with premature or medically fragile infants. If you have concerns about where your child falls on the growth chart, be sure to talk to your doctor or a registered dietician.