Your baby’s weight: Does it matter?
In the first year of life, babies grow at an astonishing rate; they almost triple their birth weight and grow around 25 cm (10 inches) in length. During their check-ups, babies will have their weight, height and head circumference measured and plotted on a growth chart, to assess their rate of growth and compare it to that of other babies their age and gender.
A baby is considered underweight if he or she is seen to cross the centiles on the growth chart downwards; in other words, if their rate of growth is slower than that of other babies their age. With regards to being overweight, a baby is categorised as such if he or she is seen to cross the centiles upwards. Another example of an overweight baby is one where the weight is consistently on a higher centile than the height.
There is no one ideal centile for each child. Healthy children come in all shapes and sizes, and a baby who is in the 5th percentile can be just as healthy as a baby who is in the 95th percentile. Ideally, each child will follow along the same growth pattern over time, growing in height and gaining weight at the same rate, with the height and weight in proportion to one another. This means that usually a child stays on a certain centile on the growth curve.
Following a high or a low centile does not necessarily mean that a baby is healthier or has a growth or weight problem. For example, if a 1 year old boy is on the 10th centiles for both weight and height, 10% of boys his age are shorter and weigh less than he does, and most babies (90%) are taller and weigh more. That just means that he is smaller than average, which usually does not mean there is a problem. If his parents and siblings are also smaller than average, and there are other signs that he is healthy and developing well, we would conclude that there is no cause for concern.
Babies, who do not have the expected growth rates and begin to cross centiles downwards, may be diagnosed with ‘failure to thrive’. This refers to a baby who is unable to take in, retain and utilise the calories needed to gain weight and grow appropriately. Danger signs that a baby is not growing well are feeding difficulties, poor appetite, recurrent vomiting, diarrhoea, reduced number of wet nappies, signs and symptoms of malabsorption, recurrent infections and delayed or regressing developmental milestones. There are several causes for ‘failure to thrive’ and these can be assessed during a paediatric consultation and managed accordingly.
At the opposite end of the spectrum, babies who have a tendency to becoming overweight, are seen to cross the growth centiles upwards. This may be due to several causes, some of which are genetic, endocrinological or environmental. Danger signs that a baby is becoming overweight or obese are a rapid increase in weight over time that is disproportionate to linear growth, dry skin and constipation suggestive of hypothyroidism, a history of damage to the central nervous system and developmental delay.
A baby’s weight concerns should be dealt with as they arise. A delay in doing so may well cause increased clinical risk. In the underweight baby, for example, a delay in diagnosing and treating failure to thrive can lead to nutritional deficiency, recurrent infections, stunting or delayed growth and a delay in development. Some of these may be irreversible and thus have a lifelong effect on the child.
The overweight or obese baby, as is very often highlighted in present times, is at high risk of developing type 2 diabetes, cardiovascular disease, osteoporosis and other musculoskeletal disease in later life. It is thus of extreme importance to pay attention to a baby’s weight if it starts to increase at a higher than expected rate.
Regular paediatric check-ups, during which a baby’s growth weight, height and head circumference are measured and the baby is examined, are the best way to monitor a baby’s growth and ensure that any change in growth rate is noted and addressed. We recommend that these check-ups are done at the time of the baby’s vaccinations as these happen at birth, 2, 4, 6 months, 1 year of age and so on. We also encourage the parents to keep a record of their baby’s growth, so that they can add and refer to it whenever needed in the future. At Infinity Clinic, we also provide a Baby Clinic, which is run by one of our senior nurse specialists, during which she discusses with parents all sorts of issues related to feeding, growth, sleeping and general wellbeing of the baby.
If the baby’s weight issue is found to be due to a clinical problem or disorder, then the parents are strongly urged to follow and adhere to whatever management plan is put in place.
Some of the babies that begin their life as underweight or overweight infants may well grow up to be underweight or obese children. To address these issues, a multidisciplinary approach is needed, involving the parents, carers, medical team and their schools.