Q&A; is my 3-year-old fat?

Frequent commenter Carla writes:

"So I just got back from my 3 year old daughter's well-child check up. Doctor said she looks great.  Just for kicks, I looked up her height/weight percentiles and BMI -- and discover that, at 37.5 inches, and 37.5 pounds, BMI 18.8, she is overweight???  At those stats, she is over the 95th percentile weight and about the 6oth height.  Her weight percentiles have ranged widely in her life, from 50th at birth, to about 15th at 1 year, to 60th at 2 years.  I am 5-3, 120 lbs, my husband 5-8, 160, so we're not big people.

I think we eat pretty healthy in our house, though I could probably push the fruits/veggies more as snacks than things like pretzels and goldfish.  She does get some desserts, but not lots of candy/sweets, and no juice (just doesn't like it).  Like many toddlers, she likes things like macaroni and cheese, quesadillas, chicken tenders, etc etc more than spinach and broccoli, but I try.  She is quite picky and I get tired of making things she won't eat so maybe I am giving her too much starch?  She is very active and gets lots of time running around at the park and preschool, though no organized sports (she is 3, after all). 

Now, she doesn't seem particularly petite to me, but I certainly wouldn't call her fat, either.  More to the point, how much should I worry about this?  I don't want to give her a complex -- but nor do I want her to get off to a bad start in life.  Help!"

At 3 she's still growing, and all the height and weight stuff is still evening out. You can't really pay attention to the charts, since they don't take into account all the stuff that's unique to your family and to her.

I have one who was almost off the charts for weight at around that age, but this is what I focused on instead to figure out if he was healthy:

1. What he ate. Was he getting a range of vitamins? Halfway decent variety? Enough good fat? Not too much sugar? He was fine, although probably ate a few too many bagels over the course of a month. It sounds like you've got the diet covered as much as anyone can at this age. It's relaly hard to go low starch with toddlers.

2. How much exercise he gets. Mine ran around constantly. It sounds like your daughter does, too.Perfect.

3. How his mood was. If his energy was good, he was sleeping decently, and he wasn't having unusual behavior (spacey) or angry outburts he couldn't seem to control (both those things can be signs of bad reactions to things he's eating)  then things were OK. It sounds like there are no problems like this with your daughter.

Forget about the charts for right now. My bet is that this time next year you'll be wondering if she's too skinny.

Comments

[Gretchen]

Remember that it's not uncommon for kids to gain weight, then suddenly shoot up in height while staying the same weight. I was an extreme case of that as a kid ... I'd get noticeably chubby, then grow two inches in the course of a month. Chub out, grow up. Unfortunately, the last time I got chubby there wasn't a growth spurt afterward, but that's a story for another time.

Anyway, if your child is all over the charts for height and weight, it may just be because you're recording the stats at various points in the growth spurt cycle.

[Katie]

When my now 4.5 year old was two she was 36 inches and 36 pounds. She has always been off the charts but I'm not worried about it. Like you I need to push the veggies more (she loves fruit) but both my husband and I are tall. I was freakishly tall when I was in grade school.
It all evens out in the end. Your concern now shows you watching what does in her and make sure she gets the best.

[Tabetha]

I agree with Gretchen on the growth spurts. It sounds like you are doing a great job!

[d. feldman]

BMI is only a rough estimate and tells nothing about body composition--a very active kid is going to have a lot of muscle, which is denser than fat. Athletes routinely have "overweight" BMIs (scores >25).

BMI may not be a useful tool for young or active people, much less toddlers (click on my name for a study done on college students).

I second Gretchen's observation that some kids chub out and then shoot upwards. Also, a kid could easily have a grandparent's body type, and not necessarily be built like mom or dad.

[Melissa]

My stepson was a chubber/shooter. He would go through these stages where he had no appetite and you had to force him to eat half his dinner. Then a few weeks later he'd eat everything in site (watch your fingers). Somewhere in between he'd shoot up an inch or two.

When he was about 9 or 10 my family started making comments to me along the lines of "watch his weight" "he's looking really chubby" "are you feeding him enough healthy things?" "does he get any exercise" to the point that I wanted to scream. He wasn't doing/eating anything different than he had been all along. Fast forward another couple of years - he's now a few days shy of his 12th birthday, is completely "average" for weight and height, but has these enormous hands and feet like a puppy. You can see he's going to be tall and broad, and his skinny dad is a bit frightened.

And now another story, if I may. My next door neighbor has a 4 month old little girl. At her 3 month check up the doc told the mom to quit offering her breast when the baby wanted to be comforted because the baby was falling into the obese category. Obese? At 3 months old? Was he on crack? This is a completely healthy and happy THREE MONTH OLD BABY. We should all be so lucky to have good eaters at that age and a healthy breastfeeding relationship.

So I guess my point is the same as the other posters above - height and weight will fluctuate throughout their growing years and at some point will even out. Don't mind the hype. If something doesn't look or feel right to you then make a change. Sounds to me like all your observations are spot on and you aren't ignoring your child's needs or health.

[Amy]

I think I'm lucky. Here in Canada we don't go with the percentiles. The doctor weighs them, measures them and writes it down in their chart. I've never been concerned about my kids' weight, and they've done the chubby "uh-oh" weight to suddenly growing out of their clothes and turning skinny (a la the "shooting up without gaining weight" sit. described above). I have NO idea what you guys are talking about when you talk about percentiles.

I am lucky, right?

[jessica]

Toddlers still have baby fat and child proportions are different than adult proportions. If the doctor isn't worried about the weight, don't worry and just keep giving her as healthy a diet as toddlers will tolerate. ;)

[Carla Hinkle]

Thank you everyone! I am going to keep an extra-strict eye on the sweets (with her recent birthday and Easter there have been way too many treats in the house) and try to promote fruits and veggies more, and then try not to worry about it.

I emailed my doctor later last night -- she was super-nice and not at all concerned, just said the same things you guys are saying (not too many sweets, lots of activity, but it's not a big deal at 3).

I do worry a little because my daughter's body type is totally different than mine was as a kid -- I was very petite, both short and super skinny -- so I want to be sure I keep her healthy, but I don't want her to ever feel bad about herself if she isn't a small person, KWIM?

Thanks!

[pnuts mama]

good for you, carla, for being observant and cautious when it comes to your daughter and her weight.
our kid is the opposite (thus, pnut) as she consistently scores off the charts or just barely on the charts since she was born early and is a petite kid. i overanalyzed and obsessed over how much she nursed, ate, what she ate ad nauseum until i had a lightbulb moment to just trust my heart- as mentioned so well by moxie and company, she is healthy, has great energy, eats as well as i can expect, and is growing steadily but at her own place on the charts. i've learned to almost ignore the measurements at her checkups, and especially the percentiles.
it sounds like you are doing a great job being aware of what she eats and does, and what she weighs. toss the charts and trust your heart.

[Sue]

I live in Canada too, and my doctor does tell me what the percentiles are, but is more concerned with how the babes are following their own growth curve. My babies just got weighed and immunized yesterday at their 12 month check-up and they are quite different from each other, and that's just from being siblings. They have been given the same eating situation since birth, and just have their own genetics. I'm sure a kid could dip and rise a little even in their own growth pattern just because of, well, lots of things...sickness, developmental stage, level of activity etc. It sounds like your child is completely fine, and our culture is way too obsessed with being fat. In lots of other countries, being a little padded is a sign of health and wealth.

[Summer]

After my son's most recent well-kid appointment, my mom made the comment that she was taught that toddler and little kids should ideally have the same numbers for height and weight. So there you go, Carla, an old wives' tale says that your daughter is perfect!

[smashedpea]

Yup, what everyone else's saying....

Mine was off the chart in both height and weight until about one year old. Somewhere between there and her next check-up, her height went under the curve and her weight remained over. The doc said nothing about it and I don't worry - she runs around all day long, eats mainly healthily (for a toddler, anyway) and seems to be doing just fine.

One of her cousins was a little runt at birth (both height and weight) and is now, at 10, the tallest girl in her class.

It'll all come out right in the end :)