Mrs Jones is a tall, slightly overweight mother of Jessica, aged 2 years 6 months. Mrs Jones is concerned about Jessica’s weight and eating habits following an admission to hospital for gastroenteritis two months ago.

Bowel habits are now normal and her height has continued to track along the 75th percentile.

Jessica’s weight and length history is as follows:

Age Weight (kg) Length (cm)
6 months 8.2 67cm
1 yr 10.2 76
18 mnths 12 83
2 yrs 13.5 88
Today 2 yrs 6 mnths 13 93
These questions will help you evaluate the key aspects of normal nutritional requirements during early childhood.

Question 01

What would you recommend to Mrs Jones about Jessica’s weight?
Mrs Jones should try to increase Jessica’s weight
Jessica will increase her own weight over time
Mrs Jones should supplement Jessica’s diet with toddler formula
Jessica’s weight should be monitored weekly
Check answer

Explanation: Weight gain

Jessica’s length has consistently tracked along the 75th percentile. Her weight has previously been on the 75th or 90th which is consistent with her length. Now on the 50th percentilie, Jessica’s weight is still in the healthy range for her height and is consistent with her recent illness.

Mum should not be actively trying to increase her weight – Jessica will do that herself over time. The danger of parents being too controlling of food intake is that children lose their own ability to eat to appetite. Her weight should be checked again in a couple of months and only then should further investigations and interventions be considered, if there are still concerns.

Comments on using growth charts

Different charts and even different printed versions of the same charts will give different percentile readings. Need to look at the overall picture and use clinical judgement.

Children’s height and weight often moves across percentiles in the first year of life.

Birth size is not a good indicator of future height and weight.

Acute changes in weight often sort themselves out. Intervention may do more harm than good eg if parents believe they must push their child to eat more or offer high fat, high sugar foods so that the child doesn’t miss a meal.

Longer term movement across percentiles may however be of concern particularly if there is a clinical problem and a diet history suggests poor intake and feeding issues

Not all healthy children have the same weight and height percentiles ie some are lean, some have more muscle mass. Within 2 percentiles is usually OK.

Weight and height gain is not a good measure of nutritional balance. Only severe vitamin and mineral deficiencies cause slowing of growth and weight gain.
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