Why Is Little Bear So ... Little?

It was about the third time in one week that someone at the store asked how old Little Bear was, then commented “she’s so little for her age!” after finding out she was nearly 9 months. Now, I’m not around many little ones. I have nothing to compare Little Bear’s size against … and really have absolutely no idea what a 9 month old should look like. After hearing how small she was, though, for the third time, I thought: maybe I should weigh her.

A caveat: I don’t believe in all the “norms” that we like to place children into. We are a country that loves percentiles, statistics, and averages. We like to poke, measure, prod … and compare. Being a nurse, I have been trained in looking at numbers and comparing them to norms. Every patient I see I must take blood pressures, heart rates, etc. and report numbers that are outside these norms. It’s what we love to do in the medical field.

Here’s the problem, however. Our children (for the most part) are not sick. They are not ill. They are healthy, growing, and thriving. They are fed good foods, live in sanitary conditions, and given plenty of attention and love. It’s one of the wonderful perks of living a middle class lifestyle in a first world country. And yet we still want to measure and compare, measure and compare. Let me be completely honest: Little Bear has not been to the doctor’s office since she was 7 weeks old. I am aware of what milestones she should be meeting, know her better than anyone else on this planet, and trust that I will recognize any changes that would warrant a visit to the doctor’s office. Because of this, I also have not worried about weighing and measuring her. So until recently, I had absolutely no idea where Little Bear fit on the growth chart. And quite honestly, I didn’t really care.

And then I gave in. Last week, after hearing how “small” she was yet again, I finally climbed on the scale with Little Bear and discovered she weighed roughly 15 pounds. Of course this number meant absolutely nothing to me since I hadn’t seen a growth chart since nursing school. Little Bear was eating good foods, drinking plenty of my breastmilk, crawling all over the place, and interacting with her environment. I knew there was nothing wrong with her. Yet when I pulled up the CDC growth chart and saw that my 9 month old fell into the bottom 3^rd-5^th percentile for weight, yet the top 75^th percentile for height, I started to wonder. And then to worry. And then I got mad at myself for wondering and worrying, because I knew there was nothing wrong my Little Bear. But still … it stayed on my mind.

And then I talked with my neighbor, a retired midwife from Arizona. When I told her my concerns about Little Bear’s weight, she laughed. “You’re still breastfeeding, right?” Yes. “Well, the CDC’s growth charts are based on the U.S. population of babies, most of whom are bottlefed either from birth or from 3 months on. Bottlefed babies simply weigh more on average … so the charts are all skewed. You have to look at the World Health Organization’s growth charts if you are breastfeeding exclusively.” And so I did. And Little Bear was in the close to the 25^th percentile. Yep, that’s right. She went from almost being off the chart percentile-wise, to right in the norm. I have had 4 friends recently share with me that their babies have shown up “very small” on growth charts. One friend even shared that her pediatrician ordered multiple blood tests on her poor son just to confirm that there was nothing wrong with him! All four of these friends have exclusively breastfed their babies. Then again, I have a friend who exclusively breastfed and her baby was considered "overweight" statistically ... and her pediatrician told her to feed him less! At two years of age his weight has leveled and off and he is now considered in the "normal" range (even though he still breastfeeds when he wants). After just a few Google searches I discovered the following about growth charts:

1.     1. The Center for Disease Control and Prevention (CDC) came out with a growth chart in 2000 that many pediatricians still use. This growth chart was made based on U.S. data. http://www.cdc.gov/nchs/data/series/sr_11/sr11_246.pdf

2.     2. In the U.S. only 50% of babies are breastfed at all; only 1/3 of babies are still receiving some breastmilk at 3+ months. That means that the far majority of babies are receiving all or some formula either from birth or by 3 months of age.

3.     3. Formula fed babies simply weigh more, meaning that the 2000 CDC growth charts are appropriate to use for formula fed babies, but NOT appropriate for breastfed babies.

4.     4. In 2006 The World Health Organization (WHO) produced their own growth charts that are more representative of breastfed babies throughout the world. These charts are based on babies being exclusively breastfed for 4+ months, and still breastfeeding at 12 months of age. http://www.cdc.gov/growthcharts/who_charts.htm

5.     5. The CDC now recommends that pediatricians use the WHO’s growth charts for the first 2 years of life. Unfortunately, this advice is not always followed by pediatricians.

With my father’s analytical/engineering genes flowing strongly through my blood, I struggle with remembering that numbers and statistics and norms are just that … numbers, statistics, and norms. They may, and they may not, mean anything. Yet it is nice to know that the WHO has a growth chart that more accurately represents the growth of breastfed babies. Because we are a country that likes to analyze and place kids into percentiles, at least we can do it more appropriately now.  The challenge remains, however, to keep that mother’s intuition in the forefront – out ahead of all the numbers and statistics. We spend every morning and night with our little ones. We were there when they took their first breath. We watch them as they learn to crawl, clap, laugh, and smile. We know what their different cries mean. And we know when something is wrong, and we usually know when something isn’t. Our challenge as mothers (and fathers), then, is to look at all these “norms” … look at our unique son or daughter … and trust our instincts. To date, my mother’s intuition has yet to be wrong.