Are My Kids Underweight?
by Gwenn Schurgin O'Keeffe, MD, FAAP
Dear Dr. Gwenn,
My children dance and do karate and the instructor noticed my kids looked underweight compared to other kids. She suggested I add more fat to their diet. Should I? Their doctor has never said anything about it. I'm not sure what to do.
I have always being an over-weight person, even as a child, so I am very interested in my children's diets. I'm currently 5'5" and weight 230 lbs. My husband was short and average growing up but is now 6' and 200lbs.
I have three kids:
LG is (female) Age 4: 3'2" and 34 lbs. (would like to eat constantly)
IG is (male) Age 6: 3'8" and 44 lbs. (is the picky eater)
AG is (female) Age 8: 4'2" and 48 lbs. (is a good eater)
I try to serve healthy meals and my children enjoy a lot of healthy things that their peers won't eat. We consume low fat dairy and slim milk, eat and snack on a variety of cheeses (like brie etc.). They all enjoy yogurt and even ice cream sometimes too. I serve fish twice a week, beans and beef weekly and we eat a lot of veggies, and chicken.
I have noticed that AG is smaller then everyone her age but I figured she'll blossom soon. It's a challenge as AG can't find clothes to fit as size 6 it too short and just right around the waist. IG is starting to become that way too. He can't wear most size 5 yet because of the wide waist. From photos for our families there is nobody who I would call as skinny as my oldest daughter. It may help to know that my niece has been buying slims for years and is now 12 and starting to fill out.
Thank you for your help.
Signed,
D.G.
Dear DG:
Thanks for your question. You are smart to pay attention to your kids' eating based on your history.
Who recommended the added fat? If it was a healthcare professional, you may want to follow that advice. However, consult your pediatrician if the advice were given by a well-intended family member or friend.
That said, first you need to compare your kids to standard growth charts to see where they fall. For your kids, there is no concern at all. The reason they all appear slim is that they are appropriate heights and weights. Your pediatrician could review their entire growth curve with you to show you the trend but the points in time you send me show there is no problem:
Growth Curves:
IG age 6 male: 50%ile for weight; just over 25%ile for height
LG age 4 female: just under 50%ile for weight; just under 25%ile for height
AG age 8 female: between the 10th and 25%ile for weight; just under 50%ile for height
Just goes to show that appearances can be deceiving and well-intended lay people can cause concern.
LG has a BMI of 16 which is approximately the 75%ile for age
IG has a BMI of 16 which is approximately 50-75%ile for age
AG has a BMI of 13.5 which is below the 5th%ile for age
On paper, none of your kids are truly over weight or underweight. If anything, you'll want to watch LG and IG over time to make sure that BMI dues not creep up. For AG, review her diet and make sure she is getting enough of a balance. She may not be underweight at all but could easily gain a few pounds without concern.
I'd suggest a few things:
1) Call your pediatrician and review your concerns and growth parameters with him or her. While I can give you a perspective of today I can not provide you with the trend
2) Your yoga instructor was certainly well-intended but appearances can be deceiving. Perhaps in the future just smile and don't pay much attention to comments that don't fit what your pediatrician has told you.
3) You and your husband could become outstanding role models for your kids by trying to lose weight. I know this is easier said than done especially since you've been struggling with this your entire life. Studies do support that kids learn from their parents. If you are open and honest with your kids about your struggles they won't internalize the wrong message. Please know I'm not implying they have received the wrong message, just pointing out a potential pitfall.
4) Shop at stores that carry adjustable waist pants such as Old Navy, LL Bean or the Gap.
This is a good example of how well meaning people can get us as parents to worry unnecessarily. If you ever find yourself second guessing yourself or searing on-line for answers, call your pediatrician for a sanity check. Of all the roles that we pediatricians serve for families, that is likely the most important - and what we are here for!
About the Author: Pediatrician, Dr. Gwenn Schurgin O'Keeffe, MD, is a board-certified pediatrician and Fellow of the American Academy of Pediatrics. Dr. Gwenn is an experienced columnist, educator, and practicing pediatrician. Dr. Gwenn strives to write as if she were talking to a parent. As a parent herself, she knows how important it is to obtain information but also understand how precious little time parents have to find that information on the internet. Pediatrics Now was developed to fill that gap and provide a bridge between the parenting and pediatrics worlds.
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Pediatrician, Dr. Gwenn Schurgin O'Keeffe, MD, is a board-certified pediatrician and Fellow of the American Academy of Pediatrics. Dr. Gwenn is an experienced columnist, educator, and practicing pediatrician. Dr. Gwenn strives to write as if she were talking to a parent. As a parent herself, she knows how important it is to obtain information but also understand how precious little time parents have to find that information on the internet. 
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