So I get the concern. I do. My DD has always been on the bigger side. She was like in the 133% for weight at her 2 year old appointment and maybe the 75% for height. Our pedi doesn't really talk about BMI but talks about overall growth concerns and lifestyle. I definitely appreciate that approach and while my instinct is to be defensive because DD looks healthy she just has DD's best interests in mind. Also, sometimes those conversations and diligence DOES lead to something to being wrong. My DD slid down from the 75% height at 4 to the 50% at 5 to the 45% at 6 and to the 13% at 7. Weight % increased a bit. If our pedi wasn't monitoring closely I wouldn't have really known because she was healthy and WAS still growing. We were able to address it, find out why she wasn't growing at the rate she should have been, she grew 4 inches, and now at 8 she's back up to the 50%. Her weight is still in the upper 80% but it's not something I worry about too much. She is active, she loves every vegetable and fruit she has ever met, and we eat a balanced diet. She is allowed treats. She is allowed goldfish. She is pretty great at self limiting and I'd rather her have a lifetime of a healthy eating mindset than restrict what she can/can't have. It sounds like y'all are pretty healthy and active overall so I wouldn't let it concern you.
I think it’s important we as parents don’t impose our own bias in these situations. I’m pretty sure this information goes over my 7 year old head at each appointment. She doesn’t know what BMI is and doesn’t care. DD is on the other end of the spectrum, extremely tiny but she has been since birth. We discuss her weight/build factually. My son is the opposite, very stocky. We also discuss his weight/build factually. I don’t shy away from weight conversations but I dont make them a thing. At 7 and 5 they don’t seem to notice or care. I’m aware they will as they become older but I hope they are used to hearing the whole message of move your body and eat healthy and focus on that vs a number.
BMI is talked about at my kids well childs. It's a matter of fact discussion as we go through the whole list of things - height, weight, BMI, sleep, seatbelts, caffeine, eating habits.
While BMI isn't a super great measurment of health, it is a starting point and a talking point about health. My kids are on the low end of the BMI scale, and we still chat about healthy choices and fruits and vegetable habits.
BMI isn't supposed to be the definite measure of if you're healthy or not, but it's one of many measurements that should be looked at all together. Just like only looking at blood pressure or cholesterol level to define "healthy." It's a tool.
Post by imojoebunny on Dec 12, 2018 20:36:37 GMT -5
If you do not want this discussed in front of your child, ask for a moment with the doctor alone, at the beginning of the appointment, that is an option, but I would not do that. I would, encourage you to have your child advocate to the doctor for themselves. When they say, I am concerned about your weight/BMI, encourage your child to ask questions for themselves. Kids have a way of coming up with concerns and solutions that parents might not think of. Being a self advocate and comfortable talking to doctors directly, rather than, passively accepting their word as gospel, is correlated with getting better medical care throughout life. I am a very tall person with a tiny child, who doctors though something was wrong from before she was born because of her size. Her BMI is now 3%, at 12, which is a step up from the "not on the chart" when she was younger.
For a long time, when I had new doctors who though I wasn't feeding/caring for her appropriately, it was humiliating and not productive. I quickly learned to nip that shit in the bud, and force the doctor to look at real solutions. One thing that was very effective was keeping a food diary, and at 7, possibly a physical activity diary, of the week before our appointments. Doctors love data, and can't speculate that you fed your kid 17 pop tarts, and they spend 9 hours a day on the sofa, if you present them with the data, and ask for real solutions, if they still think there is an issue.
Anyway, all that to say our doctors do bring it up in the exam room with them in it but I’ve never felt it was in a negative way, they ask those questions along with “do you own guns, do they go to school, are they doing well, “you’re not drinking full fat milk right?”
.
What’s wrong with full-fat milk? I’ve never had a doc say anything negative about full-fat milk and have a few doctor friends and relatives who recommend whole milk over reduced-fat, and generally frown upon any kind of reduced fat dairy.
Anyway, all that to say our doctors do bring it up in the exam room with them in it but I’ve never felt it was in a negative way, they ask those questions along with “do you own guns, do they go to school, are they doing well, “you’re not drinking full fat milk right?”
.
What’s wrong with full-fat milk? I’ve never had a doc say anything negative about full-fat milk and have a few doctor friends and relatives who recommend whole milk over reduced-fat, and generally frown upon any kind of reduced fat dairy.
I need ham like water Like breath, like rain I need ham like mercy From Heaven's gate Sometimes ham salad or casserole or ham that’s free range, all natural I need ham
We have the opposite end of the BMI spectrum in our house and well visits always ratchet up my mom anxiety because I know what’s going to happen. And that’s with a pediatrician who always is so supportive and says “she’s on her curve, don’t worry” in conjunction with the BMI talk. I always say that one day I won’t come out of the exam room anxious about Scarlett’s weight but today is not that day. Also with growing kids, I feel like they’ll put on some weight and then grow a few inches but if you catch them halfway into that cycle it sort of looks concerning but maybe isn’t.
Anyway, I think it’s important to have a pedi that you trust so if you don’t love the approach it’s okay to seek out another doctor. I know some pedis would be all over me to try and get S to gain weight (losing battle). I’m actually currently nervous about considering a new pedi if she would prefer a female because her pedi is male.
What’s wrong with full-fat milk? I’ve never had a doc say anything negative about full-fat milk and have a few doctor friends and relatives who recommend whole milk over reduced-fat, and generally frown upon any kind of reduced fat dairy.
They told me it had too many calories.
Saaaaaame. Full-fat dairy was the first thing they had us phase out.
I am skeptical about the benefits of skim milk, so we provide 2% but limit quantity.
Anyway, all that to say our doctors do bring it up in the exam room with them in it but I’ve never felt it was in a negative way, they ask those questions along with “do you own guns, do they go to school, are they doing well, “you’re not drinking full fat milk right?”
.
What’s wrong with full-fat milk? I’ve never had a doc say anything negative about full-fat milk and have a few doctor friends and relatives who recommend whole milk over reduced-fat, and generally frown upon any kind of reduced fat dairy.
Part of this depends on how much your kid drinks and their age. When our girls were i want to say 2-3, we were told to go reduced fat because by this point they are eating a lot more and getting plenty of fat in their diets. we have 1 % in our house, lactose free for k. she is my big milk drinker
I need ham like water Like breath, like rain I need ham like mercy From Heaven's gate Sometimes ham salad or casserole or ham that’s free range, all natural I need ham
Post by irishbride2 on Dec 12, 2018 22:26:20 GMT -5
I have a different situation because our pedi is my uncle, so our kids take it a bit more personally.
DD (age 8) is overweight. We are aware and on top of it. We have flat out told our pedi/uncle to only talk about it one on one with us as parents because she is self-conscious and such. BUT I do think doctors need to discuss it, as much as it sucks.
She eats healthy foods/portions but is not active at all. If we let her, she would sit and read all day. Reading is fabulous, but getting her to be active is, too!
Post by Shreddingbetty on Dec 13, 2018 0:42:41 GMT -5
We have to talk about smoking and weight at each visit,...not that that happens but we are supposed to and our EMR makes sure to remind us of that. Absolutely I talk about weight during well child check if there is a concern. I mostly look at their growth curve. And yes kids are different and some are more solid than others. I also think that a lot of people underestimate their kids’ weight. Since there is an increase in childhood obesity I feel that the norm for what a normal weight kids looks like has shifted. Often kids that are concsidered normal for weight are looked at as being too skinny and kids that are overweight are looked at as normal. That said, some kids will never be super skinny When I bring up weight I bring it up from a health perspective. A lot of the patients I see have a strong family history of diabetes. So I talk to them about how maintaining a healthy weight is important to avoid or delay onset of these health problems, I never tell them they need to go on a diet or lose weight. I tell them (kids and parents) that this is a family affair as the kids are not in charge of buying groceries and that more often than not the whole family needs to adopt healthier choices. That yes they can have junk from time to time but it is best not to have it at home because most people will eat it if they have it, whether you’re skinny or overweight. That they should not drink a lot of calories (and yes I tell them to switch from whole milk to either 1 or 2 percent. There is no benefit to drinking whole milk over 2% and once kids are 2 or 3 they no longer need the extra fat for their brain development because they can get it from other foods). I always discuss how they family needs to make dietary changes so that the kids learn healthy habits while growing up (and it benefits everyone) and then hopefully continue once they are on their own. My goal for those kiddos is to not gain weight, not so much that they lose weight unless they are really obese. If they stop gaining weight or at last slow it down a lot they will grow into their weight. Unfortunately a lot of the healthier foods are also more expensive and a lot of our patients struggle financially so it is hard. I do ask them what they eat before I counsel to find out what their habits are so I can adjust my talk as needed. A lot of people also just have no clue how many calories are in certain things that they eat (and don’t necessarily seems like they would have a ton of calories) so we talk about looking at labels for calories and portion sizes. Not to micromanage their caloric intake but to get a better idea of how many calories ther are in their foods. I also ask them about their activities so I do take everything into consideration and don’t just blindly go by BMI. If a kid is 99% on both height and weight then he is a big kid but proportionate. So I like looking at growth curves. But if there is a big descrepancy then I will bring the BMI into the discussion but also mention that just looking at BMI isn’t always accurate.
I don’t really like talking about it myself either because it is an uncomfortable subject for patients and therefore also providers. But it is something that needs to be talked about. Unfortunately, at least where I work at, it doesn’t seem to really have a lot of impact.
I have had people get annoyed when I ask them about guns in the home too. But it is just another one of those things we are expected to address to make sure that kids are safe in their home. Government and insurance companies expect us to discuss a lot of these things on a regular basis and look for documentation on it as well.
I have a different situation because our pedi is my uncle, so our kids take it a bit more personally.
DD (age 8) is overweight. We are aware and on top of it. We have flat out told our pedi/uncle to only talk about it one on one with us as parents because she is self-conscious and such. BUT I do think doctors need to discuss it, as much as it sucks.
She eats healthy foods/portions but is not active at all. If we let her, she would sit and read all day. Reading is fabulous, but getting her to be active is, too!
My friend's mom now has a weak heart from a lifetime of not being really active at all. So, this is why i make it about the health of your body and not so much about esthetics. we need to take care of all the working parts we cannot see for good, long term health.
Hopefully, she finds something she likes and it makes that movement and activity more fun than a chore.
Hi, I’m not a parent but I’ve worked on HEDIS quality audits
Having a BMI charts in their patients’ medical record is required for a pediatrics practice to pass a quality audit and they come standard with most EHR systems. I agree that measuring BMI is imperfect, but following the trend line can be helpful. If there is a sudden increase or decrease in year over year BMI, that can flag hormonal issues or just the child gradually over time eating a few more fast food meals or spending a little more time playing on screens instead of being outdoors.
The pediatricians are supposed to give “anticipatory guidance”, which means general positive, pro-active actions the parents and child can take. For example, encourage the child to drink water and fruits and vegetables. Ask the child what kind of exercise they like to do and praise and encourage them to do more. It could also mean things like reminding the child to use a bike helmet for safety.
All this is just to say that most of what you guys are describing would be considered high quality, good care according to the quality standards. I wouldn’t worry that that my child was being personally targeted to weight management if we were receiving the advice above.
This year, my 10 yo DD started checking her weight at the YMCA scale and asking questions about a healthy weight range. She’s always been tall but not as waif-thin as some of her peers. She’s active and porportioned, so discusing a healthy weight range didn’t have much of a sting or a sense of criticism. I struggle with how to have good conversations around eating, fitness, and health. It’s such a minefield to convey body-positive messages without damaging body-shaming ones.
So, after she started to ask questions, I encouraged her to ask her pediatrician at her next well-child check-up. He pulled up her chart, the BMI and showed her where she landed on the growth curve. He spoke in positive terms and I really felt that it was an appropriate conversation to have together. It is tricky. But it isn’t something that I would not have wanted to have with her in the room. But that may have been colored because the message was “you are doing well, keep sugar snacks to a minimum, increase healthy snacks, and stay active.”
Since that appointment, we’ve kept up good eating habits and activity. She’s grown a bit without a weight change, so she looks thinner - in a healthy way.
I hope your future appointments feel less stressful whether you continue with this pediatrician or another. In our practice, we rotate through many doctors which is fine with me. I had a favorite and followed her until she left the practice (so disappointed!). So, it wouldn’t be hard for me to do appointments with someone else. But to answer your question, yes, we have discussed BMI in front of my daughter and it was a part of a productive and healthy conversation.
Post by thatgirl2478 on Dec 13, 2018 10:22:04 GMT -5
My kids have the opposite situation - crazy tall and skinny. While they've never brought up BMI, they do ask in a round about way if they eat enough / are picky eaters (which they aren't, they eat pretty much anything and everything).
Being in nursing school now, and being a part of some medically themed chat boards (clearly an expert ha!), I know most doctors and health professional hate discussing weight because it's always seen as a personal attack because historically weight has always been viewed as a disease the sufferer causes. Which, to some degree may be accurate, but isn't the whole picture by a long shot. Doctors are particularly concerned about childhood obesity because it predisposes them to SO MANY other diseases. So they may be overly concerned about it when it's not really a problem for YOUR child because it is a problem for so many other children.
I'm not saying weight is a problem for your kiddo. They may just be in an growth stage where this is how they are shaped and as they grow & mature things will even out. They probably eat a balanced diet and get enough activity. But without asking the questions, the doctor can't know if they are eating twinkies and chicken nuggets exclusively and only exercise their thumbs while playing video games. So the doctor asks so they can provide information on health promotion activity that may help kids who are in the early stages of weight gain due to inappropriate diet/sedentary lifestyle.
Post by DotAndBuzz on Dec 13, 2018 10:33:43 GMT -5
Yes, their weights are discussed at every visit.
We are on the other end of the spectrum, and my pedi told us my kid is right on the cusp of Failure to Thrive. Her weight percentile has always been right around 4-5%ile, but a she's growing taller, and about to start puberty, her weight is becoming more of an issue.
Knowing that she's technically nearly classified as that sucks though - because it makes me feel like I failed her, and I "can't" get her to a "better" BMI, despite 10+ years of working on it. Even though we're on full fat dairy over here (per pedi), loads of protein offered with every meal, are addressing some mental health stuff that has come to the forefront and impacts her food choices....she just doesn't eat much, is active, and has a dad that is long and lean. I definitely get that there personal feelings that come to the table on these discussions.
From my point of view, it is the pediatrician's job to discuss health, and weight (despite our own emotions surrounding it), is a component of health. Not the ONLY component, but it is a factor. My kid is at risk for certain health conditions in her lifetime because of her weight (menstruation irregularities, osteoporosis, she's really sensitive to heat, a stomach bug used to land her in the ER for dehydration about 25% of the time). Obesity increases the risk for other illnesses, and we, as a population, have a steadily rising percentage of adults, and kids, who are now obese, and have a higher body fat percentage than in generations past. Pediatricians are on the frontline of this, as they are monitoring the health of our upcoming generations. It's a sucky conversation to have, but I think it's vitally important that pediatricians don't shy away from this. Obviously they shouldn't be judgmental assholes in their approach, but avoiding the topic entirely won't make it non-existent.
The one thing I don't like though, is that yours talked about weight/BMI with her in the room. I never discuss that around my kids, including at the doctor. When we discuss the topic with them at the pedi, it's framed as healthy habits, and foods/activity that will help our bodies with healthy growth so they can have energy for playing and learning. For a more frank discussion about numbers, I have the kids leave the room.
The pediatricians are supposed to give “anticipatory guidance”, which means general positive, pro-active actions the parents and child can take. For example, encourage the child to drink water and fruits and vegetables. Ask the child what kind of exercise they like to do and praise and encourage them to do more. It could also mean things like reminding the child to use a bike helmet for safety.
All this is just to say that most of what you guys are describing would be considered high quality, good care according to the quality standards. I wouldn’t worry that that my child was being personally targeted to weight management if we were receiving the advice above.
Thanks - I appreciate your input.
All in all, I would characterize the doctor's interactions as falling in this category. She did discuss numbers (which of course don't mean much to my 7-year-old), and she was clearly trying to be subtle. She did ask what my daughter's favorite green vegetable was and encouraged her to eat more of that. All that is well within the range of appropriate in my mind.
As I mentioned in my OP, I'm sensitive to the topic after an entire life of interacting with doctors and others about my weight. Even at my fittest, I was a long distance runner, but I was muscular and stocky. My kids are not likely to grow up to be lanky gazelles - they just don't have the genes for it. So I worry about her self-esteem in our body-focused society when she inevitably isn't the smallest of her friends. And it's hard to anticipate that inevitability now, when she's only 7 years old.
Post by iheartbanjos on Dec 13, 2018 11:29:33 GMT -5
I would be concerned if my pedi did not discuss my childrens’ growth. Isn’t that basically the point of a well child visit?
Our pediatrician mostly talks to my girls (5 and 8) during their appointments. He asks them about food, sleeping, activities, etc. They are old enough to understand self care and making healthy choices.
Post by textbookcase on Dec 13, 2018 11:33:56 GMT -5
This drives me up the freaking wall. My oldest (14) is told at every well check that she needs to lose 5 pounds, because her BMI is in the higher range. She's definitely "thick" but I wouldn't call her overweight or obese. She's happy with her body and I hate that a doctor tells a 14 year old girl to diet every time she's in his office. Then on the flip side, my younger two are tall and skinny and he tells them they need to drink pediasure and gain 5 pounds every time they're in his office. Where's the happy medium?
This actually just came up at my youngest sons well check as well. His BMI came back high and I did notice some weight gain but like you, I was surprised he outside of normal range and wasnt concerned. He is 9 and wears a 9/10 clothing.
However my pedi was great about it because he also said he is not concerned with the numbers on the screen so much but he wanted us to just pay closer attention to the healthy lifestyle points. Which was basically ensuring he gets 5 servings of fruits and veggies a day, exercise/activity, drinking water over sugery drinks, proper sleep. He also brought it up because DS qualified for a study they offered.
I did not enroll in the strudy because I felt, this may just be a phase for DS and that he will even out in time. If I see he is gaining more over the next few months, I will probably call and ask about the study. But it did make me revisit his diet a little.
This drives me up the freaking wall. My oldest (14) is told at every well check that she needs to lose 5 pounds, because her BMI is in the higher range. She's definitely "thick" but I wouldn't call her overweight or obese. She's happy with her body and I hate that a doctor tells a 14 year old girl to diet every time she's in his office. Then on the flip side, my younger two are tall and skinny and he tells them they need to drink pediasure and gain 5 pounds every time they're in his office. Where's the happy medium?
Oh fuck no. This is way different - who advises a child to lose weight?
I have one kids that has been the average height of a child 4 years older than her for years. She is 8 and is 5 foot 2. The pediatric guidelines say if she is over the 85% for weight for her age (not her height) then that’s a concern. She would look emaciated if she was below the 85th percentile of a child a foot shorter than her.
My 4 year old is 86% BMI but he isn't chubby at all. He's 92nd percentile for height and 94th percentile for weight and just built heavy I think. I'm not concerned at all about him. Nothing was mentioned.
My 6 year old was 92% BMI but she's also 98th percentile for height and 96th percentile for weight. She maybe has more of a belly on her but again wouldn't consider her overweight. Again, nothing was mentioned about her (or if it was, it was in passing).
My oldest (9 year old) had it mentioned to me when she was maybe 6 or 7 at her well visit. I can't remember her percentile and I can't look it up in the system, but her last visit she was down to 67% BMI. She is my smaller one on the curve though, she's 56th percentile for height and 64th percentile for weight. I remember when the pediatrician told me it was on the higher end for her I was horrified bc overweight on her had never crossed my mind. EVER. So then I started polling all my friends and family to see if I just couldn't see it. Everybody said she was totally fine.
My kids are athletic and move a lot. I think they are also pretty muscular because they are HEAVY. But they really aren't too chubby. We eat treats and stuff, we aren't the strictest eaters by any means. But we do try to stay active.
I guess I would just say don't freak out. If they look like healthy kids, then they probably are. The BMI is sometimes deceiving. Keeping moving, try to eat healthy when you can as a family. You are doing good mama!
The pediatricians are supposed to give “anticipatory guidance”, which means general positive, pro-active actions the parents and child can take. For example, encourage the child to drink water and fruits and vegetables. Ask the child what kind of exercise they like to do and praise and encourage them to do more. It could also mean things like reminding the child to use a bike helmet for safety.
All this is just to say that most of what you guys are describing would be considered high quality, good care according to the quality standards. I wouldn’t worry that that my child was being personally targeted to weight management if we were receiving the advice above.
Thanks - I appreciate your input.
All in all, I would characterize the doctor's interactions as falling in this category. She did discuss numbers (which of course don't mean much to my 7-year-old), and she was clearly trying to be subtle. She did ask what my daughter's favorite green vegetable was and encouraged her to eat more of that. All that is well within the range of appropriate in my mind.
As I mentioned in my OP, I'm sensitive to the topic after an entire life of interacting with doctors and others about my weight. Even at my fittest, I was a long distance runner, but I was muscular and stocky. My kids are not likely to grow up to be lanky gazelles - they just don't have the genes for it. So I worry about her self-esteem in our body-focused society when she inevitably isn't the smallest of her friends. And it's hard to anticipate that inevitability now, when she's only 7 years old.
I think one of the great things you can do is give her images of professional/college female athletes. they are strong, muscular and usually in great shape. No matter what we do as parents, at some point they are going to feel certain things about their bodies, so perhaps giving them images to show how much beauty is out there, that beauty is a body that is strong and healthy. I have an athletic build. There is no getting around it. lol But to me, that is beautiful. Women who have muscles and strength is awesome.
I have a good friend from high school who was always a great athlete with really strong, muscular legs. it was simply how she is built. after years of having this love/hate with her body, she got her personal training certification and has started her own women's work out group and is in amazing shape and has never been happier. embracing who you are and all that you can be is an amazing thing.