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Children's Health

18-month baby not gaining weight



My son is 18 months old and during his last well being visit the doctor said that he was 90 percentile height and head circumferance but that he dropped to below 50% in weight. Now he weighs 24 pounds, exactly as when he was 9 months old. I am really concenred to see that he didn`t gain any weight in 9 months but the doctor says I shouldn`t worry since he is doing well at all other levels. Apart from 4 colds since he was born, he is generally healthy, active and happy. His vocabulary includes about 60 words, he makes all kinds of gestures and imitates sounds and knows how to use a spoon and leaf through books. But he has a very small appetite, he seems to eat only enough to not feel the bite of hunger since he wouldn`t take more than 3 or 4 bites at every meal. I still breasfeed him. Should I believe his doctor and stop worrying about his weight? thank you.


I think you should believe your son's doctor - and for several reasons. First of all, toddlers normally do have a marked drop in appetite to match their drop in growth rate. Children typically drop their growth rate in half at 5-6 months of age and then drop that growth rate in half at 12 months of age. Nature very wisely drops back their appetites so that they do not overeat and become overweight.

On a 2000 CDC growth chart, his weight is at the 25th percentile. I don't know what it was before, but he is well positioned in the area of normal growth. Toddlerhood marks the period of time when children move toward their genetically programmed normal growth pattern. It is not unusual to see them move downwards in weight velocity. Also, there is a normal growth phenomenon called adiposity rebound that occurs usually around 5 years of age. From toddlerhood to early school age children become slimmer and reach a point of maximum leanness after which body fatness (adiposity) begins to increase or rebound again.

Secondly, toddlers' stomachs are smaller than adult stomachs. They need smaller portion sizes. Typical serving sizes for toddlers are 1-2 tablespoons of fruits and vegetables for each year of life, 1/4 to 1/2 cup of pasta, rice, or potatoes, 1/4-1/2 slice of bread, 2 crackers, 6 ounces of milk or juice. Eating frequent, small meals is an ideal way to fuel the active toddler with ongoing sources of energy and nourishment from healthful foods throughout the day.

Thirdly, by 18 months children have discovered that they are separate individuals from their parents. Toddlerhood is all about discovering one's own likes and dislikes and declaring independence from parents. Many toddlers do this through rejecting foods, especially new foods, or engaging their unsuspecting parents in warfare around eating. Parents never win these battles.

If this is happening in your house, remain calm and refuse to engage in battle. Prepare healthy meals and snacks at regularly spaced intervals and leave the eating to your child. Do not prepare different foods for your child, but do make sure to offer at least one food he likes at each meal and serve whole grain breads with meals so that he can have bread should he choose not to eat other foods. If you offer choices for snacks, limit the choices to only 2 options and make sure they are healthy options.

Most importantly, your son is active, happy, and developing well. This is the best proof that he is fine. If you are looking for super books on feeding your child, I highly recommend Ellyn Satter's books, Child of Mine: Feeding Your Child with Love and Good Sense and Your Child's Weight: Helping without Harming. The American Academy of Pediatrics also has new materials for parents on childhood nutrition available in their book store on-line at www.aap.org.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University