By William “Dr. Bill” Sears, M.D.
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.
1. Genetics: When one or both parents are genetically lean, their child will often measure above average in height in a growth chart but below average in 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: a 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.
2. Diet. 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 a mother’s milk is 40-50% 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% 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.
Do you have a picky eater?
Picky eaters can certainly be frustrating. Once children reach the age of 3, they also tend to have a mindset about the order of things in their world. This includes their food. Any alternative is unacceptable.
I’ve consulted with thousands of parents who panic because their picky eater falls low on the growth charts. They are concerned that their child may be undernourished. They worry that this may compromise their child’s optimal growth.
Here’s the reassuring news: Being a picky eater is part of what it means to be a toddler. There are developmental reasons why your three-year-old pokes at their food. After a rapid growth spurt during their “terrific twos,” toddlers gain weight more slowly. So, of course, they need less food.
They also won’t sit still for long, including at meal times. Snacking throughout the day is more compatible with their busy lifestyles. As parents, our job is to buy the right food, prepare it nutritiously and serve it creatively. Leave the rest up to the kids. The picky eater stage is usually one that passes or at least mellows over time.
Also, 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% fat.
Here’s 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. Feed more grown 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 fists. Theoretically, you want to feed children a fistful of nutrient-dense food per meal.
My favorite growing foods are avocado (the fattest fruit on the planet; remember you’re feeding your fathead), nut butter; olive oil; sweet potatoes; tofu; yogurt (whole milk, organic, plain), lentils, and blueberries. Children between 3 and 4 years of age can begin to comprehend which foods are the most nutritious and why. We would often say to our children, “Eat the food that makes you grow first, and then you can have your fun food.”
1. Make foods relevant to your child’s interests. Call them “soccer foods,” “baseball foods,” or “ballet foods,” and emphasize the fact that these foods will help your child excel in his or her preferred interests.
2. Try the sipping solution. Many children who are undernourished are also underhydrated. One of the top feeding strategies that I have found over my decades in pediatric practice that corrects the most nutritional deficiencies in 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 growing 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); vitamin D, iron, calcium, potassium, vitamins A and C, zinc and fiber.
3. 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 to make 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, organic full-fat yogurt, cheese sauce, hummus, and olive oil. By the end of the day, the nibble tray was empty, and Matthew’s tummy was full. We were in charge of what he ate, and he was in charge of how he ate it.
4. Involve your kids in the process. I must have heard, “Doctor, he won’t eat his vegetables” a thousand times. Yet, the child keeps right on growing. Vegetables require some creative marketing for a picky eater, as they seem to be the most contested food in households with young children. Plant a garden with your child. Let them help care for the plants, harvest the ripe vegetables, and wash and prepare them. They will probably be much more interested in eating what they helped to grow.
How many vegetables do toddlers need? Although kids should be offered three to five servings of veggies a day, for children under five, each serving need only a tablespoon for each year of age. In other words, a two-year-old should ideally consume two tablespoons of vegetables three to five times a day.
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 pediatricians developed them 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.
And finally, use what we call “the bite rule” to encourage the picky eater: “Take one bite, two bites…” (however far you think you can push it without force-feeding). The bite rule at least gets your child to taste new food while giving her some control over the feeding. As much as you possibly can, let your child – and his appetite – set the pace for meals.
