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Ask The Expert Archive

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Growth and Nutrition Archive Questions

Below are Growth and Nutrition Experts’s answers to Growth and Nutrition questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 27.

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Q : 1

I think my baby may be too small for her age. After her 6-month checkup, she weighed 6kg and was 60cm. She's breastfed three times a day. Should something else be done for her?

Based on WHO growth charts, the baby's weight-for-age is about the 3rd percentile, her length-for-age is just below the 3rd percentile, and her weight-for-length is between the 50th and 75th percentile, meaning that compared to other infant girls of the same age, she is shorter and weighs less than almost all of them. However, she is proportional. For specific recommendations on her growth, nutritional needs, and feeding behavior, she should be followed by her pediatrician and by WIC, if you are eligible.

Q : 2

What kind of nutrition is suitable for having a boy or a girl?

Gender determination is not related to nutrition. Healthy nutrition helps women give birth to healthy babies.

Q : 3

My 4-month-old son has been breastfed exclusively. My milk production is higher at night and lesser in the day, so I started to combine breastfeeding with formula. He has refused the bottle, so I use my pumped milk in his food. He is breastfeed 2-3 times a day and gets cerealac with pumped milk or water 2 times a day.

It seems you are working very hard to meet your baby's needs. He is getting 2-3 good breast-feeding sessions per day, along with cereal mixed with pumped milk. This may be adequate. Babies do not need water. Please discuss his growth with the baby's doctor to determine if his growth is normal and when to add other foods.

Q : 4

My 9-month-old son has not grown much in length over the last three months. Currently his weight is 21 lbs 2 oz, 28 inches. Do we have reason to be concerned?

According to the new WHO growth charts, your son is currently just below the 50% for length for age and at the 75% weight for age. We suggest you have his growth re-measured. If indeed the growth is not appropriately increasing, his physician will suggest a medical work-up. This type of individual variability within the normal range is not unusual, assuming that the child is healthy and eating well.

Q : 5

I have a 6-week-old grandson who is having a lot of gas after every feeding. His mother has chosen not to breastfeed and he's been getting powdered formula. Some of my other grandchildren had problems with milk intolerance. How soon can a child have goat's milk?

The American Academy of Pediatrics does not recommend the use of goat's or cow's milk products in infants under one year because they can cause intestinal irritation and anemia. Infants under one year of age who are allergic to cow's milk-based formulas, soy formulas, or hypoallergenic formulas are sometimes put on goat's milk formula, but only with consultation from the baby's doctor or a pediatric nutritionist.

Q : 6

What do the percentages given at well visits mean, in terms of height, weight, head, etc.?

The percentiles compare your child's growth with the growth of other children of the same age or height - there are separate growth charts for boys and girls. Ideal growth is between the 5th and 85th percentiles. For example, if your child is at the 50th percentile weight-for-age, 50% of children of her age are heavier and 50% are lighter. If she is at the 20th percentile, 80% of children of her age are heavier and 20% are lighter. Although weight-for-age is a common measurement, it is difficult to interpret without knowing your child's height. Height-for-age is a measure of your child's height. If your child is at the 70th percentile height-for-age, 30% of children of his age are taller and 70% are shorter. Weight-for-height or body mass index (BMI) is a measure of how heavy or thin your child is in comparison to her height. If your child is at the 85th percentile weight-for-height, 15% of children of the same height are heavier and 85% are lighter. At this point, she would be classified as overweight. Growth is best understood by looking at changes in your child's weight and height over time. Your pediatrician can help you interpret your child's growth.

Q : 7

What is the change in the child with failure to thrive from the normal child? What metabolic pathway is disturbed?

There are not consistent criteria to define failure to thrive (FTT). Many clinicians use the following criteria: Based on growth charts: Weight/length or BMI < 5th or 3rd percentile and weight/age has decreased across 2 major centiles. Causes of failure-to-thrive are often multifaceted. For example, in the USA and other industrialized countries, FTT is often associated with behavior or feeding problems, mealtime stress, confusion regarding children's nutritional requirements, neglect, or food insecurity. Medical conditions, such as gastrointestinal reflux, allergies, or oral motor problems may also play a role. Children with FTT are often evaluated in an interdisciplinary clinic with expertise in early growth and development, although in many cases, the exact cause cannot be determined. With early intervention, many children with FTT experience catch-up growth. Long term consequences often depend on the severity and chronicity of the FTT. In low and middle-income countries, food insecurity, infections, and other environmental conditions may result in malnutrition, a more serious form of FTT than is commonly seen in the USA. Chronic malnutrition can lead to stunting, along with academic and behavioral problems. Because there are multiple causes of failure-to-thrive, metabolic pathways are not always involved. Here are some credible websites that can provide you with more information:

Q : 8

How has the incidence of obesity in children changed in the past 30 years and what has contributed to this increase?

The incidence of obesity in children over the past 30 years has increased dramatically. Approximately 17% of children/adolescents ages (2-19) are considered obese; this rate has tripled since 1980 when the rate was about 5% and is even higher among low-income children and children of certain racial/ethnic backgrounds (e.g., African Americans, Hispanics). If overweight and obesity are considered, the incidence is 35%, an increase from about 15% 30 years ago. Children who are overweight are a major concern because they are at risk of becoming obese. There are numerous factors that have contributed to this increase - lower physical activity rates and a higher proportion of unhealthy foods are hypothesized to be primary causes, but there are likely many reasons why there has been an increase. There are some helpful websites that address both prevalence and potential causes of childhood obesity. A few reputable sites are listed below:

Q : 9

My son is 7 months old, but his soft spot seems to be quite wide. Is there a certain size it should be or am I just panicking over nothing?

There is no specific size for the soft spot (anterior fontanelle). The soft spot may be felt until it closes, when the child is one to two years of age. Over that period, the fontanelle should continue to close slowly. If there is no measurable improvement, then a pediatrician should be consulted.

Q : 10

Other than mothers milk, can we feed our baby any other things?

For specific guidelines on nutrition, developmental expectations, and behavioral issues, the American Academy of Pediatrics has developed a new website which you may find helpful: Similarly, children's nutritional demands vary based on their age, so knowing whether the child is an infant or toddler is key in developing an appropriate diet. The American Dietetic Association provides dietary guidelines for infants and toddlers at

Q : 11

At what age can you introduce yogurt into an infant's diet?

Yogurt can be introduced into an infant's diet between 9 and 12 months of age. Earlier introduction could lead to a problem digesting the cow milk protein that is contained in yogurt.

Q : 12

My daughter had esophageal atresia and TEF. She had a feeding tube until she was 6 months old, when she had a full correction. Now she refuses to eat and cries when she sees the bottle. What should I do?

Following correction, children may continue to have problems with their ability to swallow. Check with the surgeon or gastroenterologist to make sure the new connection is functioning well. Sometimes children with early feeding trauma develop post traumatic feeding disorders in which feeding is aversive, even frightening, and therefore associated with anxiety. The child may benefit from a systematic desensitization procedure to help reduce her anxiety. A psychologist with expertise in pediatrics and anxiety disorders may be helpful.

Q : 13

My son is 16 and has been told that his growth plates have prematurely closed (height 5'3). No options were offered. No bloodwork done. He has a history of autoimmune neutropenia (resolved) and moderate rosacea. Is it worth it to get another opinion?

Once the growth plates are closed, height growth is minimal. The closure of the growth plates occurs after the youth has gone through the changes of puberty. You should gain a better understanding of his final height if you review his growth over the last several years with his physician. The other medical history is likely unrelated.

Q : 14

Some menu ideas for a finicky 3-year-old child?

Most toddlers grow out of finickiness. Be sure to keep mealtimes pleasant without excessive pressure or stress. A few suggestions: 1. Eat with your child so she can model from you. 2. Stay with a regular routine so child is used to mealtimes and does not get excessively hungry. 3. Give "interesting" foods the child can feed herself (grilled cheese sandwiches cut into shapes). 4. Praise the child for what she eats. 5. Keep meal to 20-30 min. 6. If she does not eat, end the meal and do not stress. Stay positive. Offer the next meal in about 2 hours. 7. Involve child in preparing the meal (mixing, putting napkins on the table, etc.). Do not inadvertently "reward" the child for finickiness by giving lots of attention for not eating and giving extra snacks after the uneaten meal.

Q : 15

Why is it not recommended to feed babies honey?

Babies under one year of age should not be given honey because honey can carry C. botulinum spores. Babies' immune systems are not well enough developed to tolerate botulism. Although infant botulism is rarely fatal, there are many very serious possible effects, including flacid paralysis. Babies should not be given honey in any form.

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