Fat Baby Fat: Can Infants Be Overweight?
Baby fat is cute, right? Those little rolls of chub on teeny thighs, an extra chin or three frames a cherubic face just so. And, in many families, a ‘thriving plump infant’ is both a source of pride and sense of what makes a baby healthy. Well, maybe not actually.
You may have seen them, the 25 pound four month olds, whose parents may be unfairly judged or rudely scolded about how they are overfeeding their baby. Nothing invites unsolicited advice like childrearing. Truth is, some kids will chow. And, if parents are following kids’ cues, even correctly, some kids gain weight avidly. How much calorie intake or weight gain in a baby is ok, and when is it too much? (that we can answer) And, what are the better choices for feeding infants in general? (toughie) Are overweight infants inevitable? (read on and find out).
Here’s the concern: a recent study and a growing body of evidence suggest that for some children, early feeding patterns and rapid weight gain during infancy (even in the first week of life, say some) may have a more profound impact on their tendency to be overweight over their lifespan. Now before your fingers tremble and you drop that spoonful of rice cereal in your lap, let’s first look at what is considered normal for newborns and infants in terms of their weight gain.
In the first month of life, newborns are nutritional dynamos. Feeding and growing tops their agenda. Breastfed infants in the first month may nurse from every 30 minutes to every 2-3 hours on average. If newborns are bottle fed, (with expressed milk or baby formula), they’ll tend to take dainty volumes in the first few weeks, ranging from 1/2 an ounce, up to 2-3 ounces per snort. Growthwise, the breastfed set gain about 4-7 ounces per week during that period (a startlingly rapid amount of growth when you think about it, doubling their body weight by 3 months!). In general, formula fed kids tend to gain a little more weight…which our pending discussion may reveal is part of the problem.
By 2-3 months, breastfed babies usually have established something of a routine in breastfeeding, and nurse every 2-4 hours. Bottlefed babies usually take 4-6 ounces per feed at this age, often around every 3-4 hours if they are formula fed. In the first six months, infants gain about 1-2 pounds a month, growing about an inch every four weeks.
By 4-6 months, bigger stomachs allow babies take more volume when nursing or bottlefeeding, probably running about 4-6 ounces per feed. Over a day, children at this age will consume between 24 and 30 ounces. Some kids will take more, others will take less. In the second half of the first year, babies will gain about a pound and grow about a 1/2 inch a month through their first birthday. In addition, what sort of calories kiddos over 4-6 months consume will change as they advance to solid foods.
Fortunately for parents blessed with a newborn, the primary care clinic is a great way to chart progress and to assess how a child is growing and developing. A child’s weight, length and feeding history can go a long way in helping clinician and family get a sense of a baby’s progress, and how to optimize her growth. Feeding is always in our Top Three Most Discussed topics during these visits, and rightly so (the other topics being, of course, Sleeping and Pooping. Hey, it’s a living!).
Now get this: Almost 10% of children under two years and 21% of children ages 2 to 5 years old are overweight. Customarily, we identify infants and toddlers who are overweight by their tendency to gain weight too quickly, causing them to cross percentiles of weight we plot for their age. Overweight infants and toddlers are at greater risk of becoming obese as they grow up. Treatment of overweight kids is particularly tough, and requires participation by the whole family. Ideally, catching the problem early or preventing it altogether works best. Upcoming changes in pediatric practice and new research may shed more light on how we can do this more effectively.
Currently and for a little while longer, US primary care providers use growth charts developed by the Centers for Disease Control from data on US kids from the 80s and 90s, who had relatively low rates of breastfeeding. Following an announcement last September, US providers will move to growth charts developed by the World Health Organization (WHO), which, utilizing data from children and infants with higher rates of breastfeeding are felt to provide a better standard. The new WHO growth charts will allow clinicians to better assess the growth of breastfed children, research suggests, and will allow earlier and more accurate identification of infants who are gaining weight too quickly. That is a good thing, indeed.
Strategies: new and old.
Breastfeeding protects against obesity. For moms who can, breastfeeding exclusively for six months is the healthiest choice. Time and again, studies demonstrate that breastfed kids have a reduced risk of becoming overweight or obese. Short term, infants appear to optimize their intake on breastmilk, resulting in balanced, healthy growth. Longer term, early exposure to exclusive breastfeeding may have lifelong positive impacts on how these kids eat, grow, and gain weight into adulthood. One interesting finding: the odds of being overweight in the future are reduced 4% with every month of breastfeeding.
Formula fed infants may be at greater risk of gaining excessive weight. For some families, infant formula may be an option for all sorts of reasons. As I’ve said: I wholeheartedly support breastfeeding whenever possible, and it is also my job to help inform parents who supplement or turn to infant formulas. I’ll watch a formula fed infant like any other, but based on evolving research, I will forthwith advise parents of these kids to hold off on introducing cereals and solid foods til 6 months.
Why? A recent study from Children’s Hospital, Boston showed last month starting solid foods early (before the recommended 4-6 months of age) in formula fed infants caused a sixfold increase in their odds of obesity at age 3 years. Note Bene: those are increased odds, but not a certainty. This association did not hold up for breastfed babies.
Juices/Sweetened beverages. I say this almost every day: Juice is like dessert. It tastes great, and it may even be made of natural ingredients, but it is not a critical or even necessary part of an infant or toddler’s diet. I agree with the American Academy of Pediatrics recommendation that no juice be given to any child under 6 months, and that only sparing amounts (4-6 ounces) be given to kids older than this. None is fine. Increased juice intake in kids 2 and 3 years old has a clear association with kids being overweight…or staying that way. Juice should be given sparingly, like dessert. It is a treat, not a staple.
Duration and quality of sleep. Infants and toddlers need about 12 hours a day, and most will achieve this through naps and their overnight snoozing. Adolescent and adult literature has clearly established the connection between insufficient sleep and unhealthy weight gain. The same may be true for underslept toddlers. A study of children 6 to 24 months sleeping less than 12 hours a day were twice as likely to be overweight than their better slept counterparts. For parents who have questions about this one, best to run it by your doc on your particular kiddo’s habits.
Childcare settings, and the variety of physical activity and food options they offer, may contribute to increased weight gain in some kids. As a working parent whose three kids spend/spent time in a childcare setting, this pains me to write this. In brief, kids who were cared for outside the home or at home with more informal arrangements (eg a nanny, or a relative) were more likely to be obese at age 3. The risk for being overweight was stronger for children cared for in someone else’s home, or when in the care of a grandparent. I think parents have a pretty good idea what their kids eat at daycare. For some, may seem easier to go with the flow, even if the snacks or foods tend to be less healthy. However, this may be an area where working with childcare providers to offer some healthier choices (more fruits, less juice and junk) for the children may make a difference. It is worth the effort.
And so, what to do with an overweight baby? Lipo? Fad diets? Fat camp? Hardly. Fortunately, parents and primary care providers have ample opportunity to identify babies who appear to be gaining weight too quickly during routine health maintenance visits. As in all things pediatric, some kids’ problems resolve no matter what we do. Regardless, we’ll consider each child individually, in terms of their age, health history and relevant conditions. Also, it is important to get a sense of a baby’s temperament, how they express their cues, and how his parents respond.
Sometimes, it is simply a matter of reviewing the items above, and a daily menu or two, and we have enough info to make a plan. In other cases, it can take a few visits to suss out what is going on. Does every episode of fussing result in a bottle or breast being presented to a baby? Some babies just need a binky or a hug some of the time. Too much milk in a 9 month old? Might be time to offer water after a certain number of bottles or sippy cups. Too many cups of juice? Happens more often than you think. Is the child snacking obsessed? It might be time to consult with a nutritionist and to plumb some ideas for healthier eating, or making a few small lifestyle changes. Is there something else going on, medically, such as the side effect of a medication? When necessary, we may run some tests, consult a specialist or to reconsider a treatment’s side effects.
Feeding babies is fascinating , (messy!) and amazing stuff. And, we primary care providers love to see our families and their thriving, happy babies. When we are poking an infant’s belly, it is both fun, and because we are looking for the Goldilocks Effect. We share the parents’ goal that the child not gain weight too slowly, or too quickly. Best if it’s ‘just right.’
Photo 1 by aamonnaa
Photo 2 by drakesdaddy2002
Cartoon below by me
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