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Facts and advice about BMI and obesity in children, written by pediatricians for parents. Children’s body shape changes a lot. Babies should put on a lot of fat during their first year of life. During their toddler years, the fat needs to disappear which it does in most children. Going into adolescence, children put on more fat and muscle again. This is perfectly normal. In this blog, we will go through your child’s weight, a guide to identify whether your child is obese or overweight, and what you can do to help your child.
Fat babies are normal
Babies are often quite fat when they are born. During the first half of the year, they should become even fatter, in other words, cuter! 6 month old babies often have fat rolls everywhere on their whole body, except over the skull. This is great! Weight gain drives height or length, and major growth and development. Pediatricians will worry more about babies who do not gain enough weight.
Breastfeeding – period of accelerated growth
To follow the growth of babies, we use growth curves. The growth curves used in most Swedish medical centers today, have been developed using approximately 3,000 Gothenburg children born in 1974. During the 1970s, both breastfeeding and formula feeding were common in Sweden. Therefore the curves show how a large group of children, who are both breastfed and bottle-fed, grow. Fully-breastfed babies often grow faster than these curves in the first 3-4 months. Then they grow more slowly for a few months. It is usually called a period of accelerated growth. Bottle-fed babies may also have a period of accelerated growth. If you are not aware of this, you might think that the child first grows too quickly, and then the slower growth from 3-5 months of age may seem unhealthy.
Since children under one year cannot be “too fat”, you should, in principle, not deny them food because of what the growth curve looks like. If, on the other hand, your child rises rapidly along the curve, and at the same time seems dissatisfied, vomits after a meal or has copious stools and stomach pain, they may feel better eating a little less food.
After the first birthday, when a baby has become a small toddler and is learning to walk, the small child should slowly become thinner. A one-year-old often consumes significantly much less breast milk or formula than before. Some children have no desire, at all, to eat anything else. That’s when breast milk or formula becomes very important. It gives the child good nutrition for growth and development. Some one-year-olds completely stop breastfeeding or drinking formula. That is perfectly OK, as long as the baby eats enough food and grows according to their growth curve.
During the second year of life, the child often has a big belly and round cheeks, but the fat on the legs begin to disappear.
A four-year-old should have a flat stomach
The weightloss takes time, but four-year-olds should not have a big stomach. Towards the age of 5-6, children’s ribs begin to be visible. Therefore a child starting school is normally really slim. This weight change seems to be important for the child to continue to grow reasonably fast.
The BMI curve determines if a child is overweight
How do you know if a child is overweight? Calculate their BMI. The same BMI formula for adults, apply for children (BMI = weight / height^2). But be aware that normal BMI varies according to the child’s age. We plot the child’s BMI on a standard growth chart and after several measurements, a normal curve is drawn. This is unlike the length and weight curves, where it does not matter which curve the child follows. It is best that the child’s growth follows this curce. If the child is overweight or obese, there are separate curves to follow.
If you want to know whether your child is normal weight, underweight or overweight, ask a healthcare professional at the children’s medical center to examine the BMI curve curve for you.
Obesity in school children
In Sweden, school children are fed until satisfied, and weighed by the school nurse. The school nurse is responsible for monitoring the children’s normal weight. If the child is not of normal weight, the school nurse talks to the parents and can also suggest treatment.
Treatment for overweight children
If you have discovered that your child is overweight, act as early as possible. Unlike adults who need to lose weight, overweight children only need to gain weight more slowly. As the child grows in height or length, the child will become slimmer. It is a slow process and should be so.
Small changes, that are sustainable, is the best solution. Start with one or two changes. Evaluate after a few months. Should you continue or introduce more changes? Until about high school, the child’s eating habits and physical activity are entirely the parent’s responsibility.
More movement, eat less energy-rich foods
All lifestyle changes for obese children are based on two things: more exercise, eat less energy-rich foods.
- If you are two, go through the child’s eating habits with the child’s other parent. Be honest. Does the child eat breakfast? If so, what? Snack? Lunch? Snack? Dinner? Evening snack? Does the child eat at night? Does the child drink anything other than water? If so, how often? How often does the child eat sweets / cake? Candy? Chips? Soft drinks? Juice?
- Compare the child’s habits with good eating habits for preschoolers . A quick reminder. A preschooler should eat breakfast, snacks, lunch, snacks, dinner, possibly an evening snack. One third of the food should be fruit / vegetables, one third protein and one third carbohydrates. Don’t forget to add some healthy fats (nuts or the many types of oils available). The child needs to get calcium through a couple of cheese slices or a couple of glasses of milk a day. Otherwise do not drink anything other than water.
Sweets, buns and soft drinks can be allowed once a week, as a treat, in small quantities (e.g. Saturday sweets).
Choosing what to do first
If you have found one or more things about the child’s eating habits that are not beneficial, choose a change to make first . Choose a change that you think will have a big effect, and that you think you and the child can implement. My order of priority is usually as follows:
- If your child does not have a good breakfast every day, start with that. Ensure that they have a good breakfast at home or at preschool.
- If the child does not have a good dinner every day, start with that. And maybe make healthy lunches on holidays or every day if the child doesn’t get lunch at preschool.
- If your child does not get a good snack every afternoon, then start with that.
- Stop drinking soda / juice / juice besides one glass on Saturday.
- Reduce candy consumption to one small bag on Saturday.
- Stop eating cakes / buns except once on the weekend (cakes or sweets).
- Reduce ice cream intake to once for dessert on the weekend.
- Stop the evening meals (after dinner, that is) or replace it with carrot / cucumber / apple.
Select one change at a time. Talk to the child’s other parent and make a plan for the change to work. Preparing dinner every day is a huge change in a family’s life, especially if you haven’t done it before. Let it take its time. When it doesn’t feel like a burden and becomes the new normal, then it’s time for the next change.
Should I discuss my child’s weight with them?
I do not think you need to talk to preschoolers about their weight, even if they are overweight. But you can talk about what their body needs. Talk about how important it is that the body should get food to nourish it. And explain what foods they are. Explain that the adults in the family have decided that everyone in the family should get food that is good for the body, and explain the changes you will start with.
Overweight school children are often aware that they’re overweight. If this is the case, you can talk about it gently and compassionately. It is important to help children see that there is nothing wrong with them, and nothing wrong with their body. Emphasize that you should help each other together so that the body becomes stronger and the child finds it easier to run and move. Unfortunately, it is common for overweight children to be teased. If this is the case, you should definitely talk to the child’s teacher.
Make sure that the child has the opportunity to move every day. Think about your daily routines. Maybe the child can walk a bit to or from preschool. Can one parent go out and play running games with the children while the other parent prepares dinner? Or can you imagine encouraging non-touching floor play around the coffee table? Put up a climbing wall bar and rings or home ladder in the children’s room? Give the child a kick-bike or trampoline for the summer?
Care for overweight children
If you need more help with your child’s obesity, talk to the children’s medical center or school health care center about how to get in touch with a team. Doctors, nurses, dietitians and physiotherapists are usually available to help families stay motivated and implement change strategies.
A very good book written by an experienced nurse from Sweden’s largest team for overweight children, (Rikscentrum barnobesitas at Astrid Lindgren’s children’s hospital in Huddinge) is ‘An important book about obesity’ by Sofia Trygg Lycke. It is highly recommended if you need more help.
Another great book in English is by Dr Michelle P Maidenberg called Free Your Child from Overeating: A Handbook for Helping Kids and Teens