The weight war – battling with numbers
If you ask the parents of healthy children who eat how much their child weighs and how big they are, most of them can only answer the question approximately. If you inquire after the percentile, their expression will likely tell you this is unfamiliar territory. If you then ask after the daily caloric intake, you will receive the answer, “I have no idea, an adequate amount.”
It is an entirely different case with parents of children who were born with an illness or abnormality and/or who exhibit an eating problem or who are fed with a feeding tube. Every day is defined by numbers – the child’s weight is measured several times a week, the calorie count of the enteral nutrition is calculated (perish the thought that the child vomits – then the calorie count is completely inaccurate), the quantity of each meal is measured out.
That this situation would cause stress, seems obvious.
There is even more focus on children who are born small and at a low weight – is the child gaining enough weight? Are they eating/drinking enough? Do they tolerate the tube feeds? It can certainly result in parents spending a large part of their day occupied by trying to get the calculated amounts “into the child” – but children are not receptacles that you can simply fill up with your preferred amount!
Whether it is because the child refuses, spits out, or vomits the food, the calculations often just do not work. It is also possible for a child to simply not gain weight despite sufficient caloric intake.
We often hear references to the dreaded growth charts – but what is there really to that? These charts are based on growth data from thousands of children who are born healthy. There are a broad range of charts, some from WHO (World Health Organization), but also charts validated only for specific countries or geographic locations. For example, charts referring to children from German speaking countries would only include data from German speaking children. There are also charts for children from other areas, such as children of Turkish descent. Taken as a whole, the variety of charts proves that you can use the same data to come to a broad range of conclusions. You could also produce different outcomes by implementing different tools, such as using a variety of scales.
So, what does it mean when a child’s weight is in the 3rd percentile? This indicates that 97% of healthy children in the same age are heavier than that child; 3% are the same weight or lighter. But, the child’s medical history is not taken into consideration in this scenario. It is important to keep in mind that percentile curves refer to healthy children, and it seems essentially unfair to apply them to children who are born prematurely, small for date, or with a serious heart defect. There are some percentile charts specific to children born with genetic syndromes, but these are, unfortunately, rarely used.
Many parents report that they are negatively affected by “looking only at the growth charts” and not acknowledging the child in their entirety. It is important to consider other variables alongside the growth parameters:
- How is the child developing over all?
- How is the child’s motor development?
- What is their physical condition?
- How does the child receive their nutrition?
- Was the child thriving in the past?
Enteral nutrition can certainly be medically indicated and necessary in severely underweight children. However, to see this as the sole “solution” for problems in weight development and thriving can become a problem. In a recent study, we were able to show that 30% of participating children were undernourished, despite being fed completely via feeding tube. The study found that children often tolerate enteral nutrition poorly and many even vomit innumerable times per day. Furthermore, it is important not to forget that the oral tract and esophagus are completely bypassed in tube feeding. In addition, tube fed children are often not closely enough monitored in terms of diet, which can result in inadequate adjustments to the enteral nutrition for the increasing age and growth of the child.
When a child is ready to wean from the tube, it is also critical that the parents “wean” from the numbers – and learn to trust their child.
This is often the place where professional support is necessary, which we are happy to provide.