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Your Health
For Babies, Bigger Isn't Always Better
From the Wall Street Journal of Mon, 22 Dec 2014 16:20:14 EST
Federal dietary guidelines apply to children above 2 years of age. Infants from birth to age 2 will be included in the guidelines for the first time in 2020.
Federal dietary guidelines apply to children above 2 years of age. Infants from birth to age 2 will be included in the guidelines for the first time in 2020. Corbis

Many parents believe chubbiness in babies is a bragging right. And traditional clinical practice often focuses on making sure infants are gaining enough weight, not worrying about whether it is too much.

But babies who top the charts and gain weight too rapidly may be at a greater risk for obesity, metabolic syndrome and cardiovascular risk-factors at later ages, studies show.

“There’s still this sense that children who are bigger under 2 years of age, that it is OK because it is baby fat and babies will grow out of it,” said Elsie Taveras, chief of the division of general pediatrics at Massachusetts General Hospital. “It’s not so much about restricting what they’re eating, it’s making small changes to reduce the amount they are gaining.”

Body-mass index, the most common measure of obesity, applies to children age 2 years and up. For younger children, pediatricians typically track a baby’s weight-for-length ratio based on a growth curve created by the World Health Organization. Children who are above the 97.7th percentile are considered overweight, said Dr. Taveras. That means a child has a weight-for-length calculation that is the same or higher than 97.7% of babies, and lower than 2.3% of babies.

Experts say there is no ideal or healthiest place for a baby to be on the growth chart. More important are the proportions and growth patterns. Babies whose weight is tracking much higher than their length, for example, may be of concern.

Another red flag is babies growing too rapidly and jumping in percentiles.

Dr. Taveras and Matthew Gillman, director of the Obesity Prevention Program at Harvard Medical School, are involved with Project Viva, a long-term study following 2,000 women and their babies since pregnancy. The children are now in their early teens. The researchers found that more rapid increases in the weight-for-length ratio in the first six months of life were associated with a sharply increased risk of obesity at age 3. The study, involving 559 of the children, was published in the journal Pediatrics in 2009.

“There seems to be this critical period in the first few months of life that is important in lifelong health especially related to weight-related outcomes,” said Dr. Gillman, the project’s principal investigator.

In other work, the researchers found that jumping percentiles in the growth charts in the first two years of life was associated with obesity as much as 10 years later. Especially in the first six months, “the kids who start tracking upward tend to stay tracking upward,” Dr. Gillman said. The study was published in the Archives of Pediatric and Adolescent Medicine in 2011.

Another predictor of weight gain appears to be the amount of sleep babies get, Dr. Gillman said. Teaching babies to self-soothe when they wake up in the middle of the night and not jump to the conclusion that they’re hungry is important, he said.

“I think it’s really important to pay attention to the child’s cues and interactions we parents have with our children,” he said. “If the kid’s growing fine then a big appetite is just fine. If the big appetite is associated with these upward trajectories generally we would think about additional features like physical activity, sleep and television time.”

Rapid weight gain in babies can also be caused by introducing solid food too early (before four months) and giving babies unhealthy fast foods and juice. Introducing salty or sweet foods or beverages can predispose a child to prefer those tastes.

Ian Paul, a professor of pediatrics and public health sciences at Pennsylvania State University College of Medicine, is currently conducting a three-year randomized controlled study that tests parental intervention with 276 children enrolled at birth. Several weeks after the birth, parents are given advice on infant cues and how to tell if they are hungry or if something else is bothering them. Parents are also taught about sleep duration, diet quality, and physical activity. “If babies learn that distress requires eating to calm down, that can carry on throughout childhood,” said Dr. Paul. So if a child is fussy in the back seat of a car or learning to toilet train, they shouldn’t be rewarded with snacks or M&M’s, he said. Preliminary findings of the research will be presented at the annual meeting of the Pediatric Academic Societies in April, he said.

Leann Birch, a professor of nutrition at the University of Georgia who collaborates with Dr. Paul on research, said that once food is introduced, nutritional guidance for parents is scarce. Federal guidelines apply to children above 2 years of age.

“Parents have responsibility for feeding their baby and for making sure their infant or toddler is growing well, but there’s not a lot of evidence-based guidance out there,” said Dr. Birch. She has been participating in meetings convened by the National Institutes of Health to help the agencies responsible for federal dietary guidelines to include young children. Infants from birth to 2 are expected to be included in the guidelines for the first time in 2020, she says.

Dr. Birch noted that parents have a tendency to think higher percentages are best when it comes to growth charts, a perception that needs to change.

A 2010 study in the journal Clinical Pediatrics, for example, found that of 279 parents, 66% whose infant were in the top quartiles preferred they weigh that much.

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