“Why is that baby healthier than my baby although they are of the same age? Why is my baby not as tall as that baby? What is the secret to healthy weight gain?” These are the most common thoughts that race through the minds of most mothers who are forever comparing their baby’s weight and height with other babies of the same age. They worry themselves and go on a guilt trip thinking they are not as good as other moms whose babies seem to be taller and chubbier.
To add to the confusion most baby food advertisements and products have chubby babies as their brand ambassadors. The result is mothers want to rush to pediatricians asking for some ‘tonics’ to boost weight gain or head to the stores in search of so called ‘healthy baby foods’ which they feel will magically help their baby grow taller and stronger! A chubby baby is not necessarily a healthy baby and may be at risk of becoming obese in later life. (We will share more on this in another article)
Mom’s please don’t compare your little one to his/her peers. Every child is unique and as long as your baby is healthy, active, eats well and continues to grow at a steady pace there is no cause to worry.
Ideal weight gain at different stages
After the in utero foetal period, infancy (from birth to one year) is the time of most rapid growth. The average weight of a newborn is 3.2 kg. If the baby is less than 2.5kg then it is considered as Low Birth Weight (LBW). Most babies lose some weight after birth but in two weeks’ time regain the lost weight. At around 6 months babies will double their birthweight and by one year will triple their birth weight. The normal birth length is 50-55cms and increases by ½ to 1 inch (about 1.5 to 2.5 centimeters) a month with a 23-25 cm increase in length during the first year.
Between the 1st and 6th year, the growth rate is slower as compared to the first year. In the second year of life, the baby gains approximately 150-200 grams per month. During the second year, the baby gains 4 times its birthweight and increases in height by 7-8 cm. At times baby’s may not show any signs of weight gain for a couple of weeks and then suddenly show a growth spurt later. This is normal and should be considered too.
WHO growth tables and charts
You may ask, “How do I, as a mother, know if my baby is growing at a steady pace or is underweight or overweight?” WHO has come out with growth standards which are a reference for babies all over the world, including India. There are various indicators used to measure growth:
- Body mass index-for-age (BMI-for-age)
There are tables as well as charts for these indicators which help mothers know if their baby is showing required growth. For babies less than 2 years of age weight-for- length is suggested as an ideal indicator for classification of obesity and overweight, while weight-for-age indicator is used for classification of underweight. The focus of this article is on detecting under-nutrition. The next article will discuss overweight and obesity.
Plotting a baby’s measurements over time on a growth chart tells us whether the baby is growing normally or not. Your pediatrician weighs and measures your baby and then plots the baby’s measurements as dots on the chart at each visit. The dots at each visit are joined by a line and this is your baby’s curve/path or trajectory.
Weight-for-length Growth Charts
- In a weight-for-length growth chart, the length in cm is on the horizontal x- axis and weight in kg is on the vertical y-axis.
- Figure 1 is a weight-for-length growth chart for girls and boys from birth to 2 years.
- The median (0 line in growth curve) is the average measurement.
- The Z scores are also called Standard Deviation (SD) scores. They tell you how far your baby’s measurement is from the median or average.
- Below the median 0 line are -1SD, -2SD and -3SD.
- Above the median 0 line are +1SD, +2SD and +3SD.
- A point or a trajectory/curve that is farther away from the median e.g. -3SD or +3SD indicates a growth problem.
- A child whose weight-for-length is – above line 3 is obese
- above line 2 is over-weight
- above line 1 is possible risk of overweight
- below lines -2 and -3 is undernourished
Figure 1. WHO’s weight-for-length charts for boys and girls in the age group 0-2 years. Use them to track your child’s growth.
Weight-for-age Growth Charts
- In a weight-for-age growth chart the age in months or weeks is on the horizontal x- axis and weight in kg is on the vertical y-axis.
- Figure 2 is a weight-for-age growth chart for boys and girls birth to 6 months.
- Babies whose z-scores are below lines -2 & -3 are under-nourished and require further clinical advice.
Figure 2. WHO’s weight-for-age charts for boys and girls in the age group 0-2 years. Use them to track your child’s growth.
Interpreting Growth Curves
A baby who is growing normally will generally be on or between -2 and 2 SD or z-scores of a given indicator. Majority of the babies will grow in a “trajectory/path”, that is, on or between z-score lines and roughly parallel to the median; the trajectory/path may be below or above the median.
While interpreting growth charts we must be vigilant for the following situations, which may indicate a problem or indicate risk.
Figure 3. Stagnant Growth Curve
The baby’s growth line remains constant/ flat (stagnant); i.e. there is no gain in weight or length/height.
Figure 4. Sharp Decline and Incline Growth Curve
There is a sharp incline or decline in the baby’s growth line. (Figure 4)
The third problem scenario is if a baby’s growth curve crosses a z-score line either towards +3 SD or -3 SD drastically.
What if my baby is underweight?
Preterm infants, low birth weight infants may initially exhibit slow growth but will catch up by the end of the second year. If your baby is below -2 SD or z-score or if he/she has not gained weight (stagnant) or lost weight and shown a sharp decline or his growth lines cross z-score lines, then a visit to the pediatrician is due. If the doctor rules out any underlying health problem, then changes in the diet are all that is needed. Here are a few foods that provide good nutrition and help promote healthy weight gain in babies.
Foods that promote healthy weight gain in babies
Since the baby’s stomach is small, it is important that energy and nutrient dense foods are given to the baby. Here is a list of foods to consider:
- Amylase Rich Flour (ARF)made from germinated grains
- High calorie fruits like banana, chickoo or sapota, mango
- Roots and tubers like potato, sweet potato, tapioca, carrot, beet.
- Butter or ghee or malai/cream can be added porridges or khichadi.
- Milk and milk products like yoghurt, paneer, cheese and milk.
- Dals, peas, beans (mashed),
- Powdered nuts, dates/khajur
- Meat, chicken, fish
Many mothers in their zeal to make their babies chubby may add sugar to the meals. This promotes unhealthy weight gain that eventually leads to childhood obesity and dental carries. So do not worry if your baby is chubby or not. Just look out for the growth curves and make sure they gain weight healthily and steadily.
By providing a healthy and nutritious diet, your child will surely be on ‘The Road to Good Health’.