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Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience:  33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
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# I have a question. My daughter has not gained much weight in

### Resolved Question:

I have a question. My daughter has not gained much weight in 8 months...like 2 pounds, but her height has grown 2.25 inches. When she was a baby she was always all weight no height at one visit, then all height no weight at next visit! She's coming up on 5, so I assume this is just her pattern. As long as she growing more in one or the other, she's pretty healthy right? I could see if she's owing in neither area...but she's grown a lot in height. She was like 14% at her well baby last July and now height she's like 22%. So that's a good thing right? I feel like I worry too much on those percentiles! :-)
Submitted: 3 years ago.
Category: Pediatrics
Expert:  Dr. A. Clark replied 3 years ago.

Dr. A. Clark :

I'm happy that you have asked me to assist you with your child and hope that you can benefit from my many years of helping parents like you.

Dr. A. Clark :

The percentiles can be confusing if you look only one point in time vs the trend, AND you have to remember, these charts were created by measuring thousands of children from birth through 18 years of age and then statistically analyzing them to create a chart. As long as your child is growing along some percentile over time then you need not worry, especially in the first year when lots of babies have not really hit the percentile they will grow on later.

Customer:

Her ped was my ped, and he says he doesn't rely on the percentiles....he says it growth on a whole! So I'm assuming that's good that her height has excelledore this year than weight!

Dr. A. Clark :

The linear (length) growth is more important, as well as head circumference, than the weight and is more reliable.

Dr. A. Clark :

Good, that means he, like me, is practical and has seen thousands of babies over the years and recognizes problems even without the charts!

Customer:

Her head was always above 90 %...it was just height and weight that fluctuate! Wh end she was young like 2ish she was in like the 38th for height, then he explained they settle into their own pattern and she stayed around 14th for height....so she's stayed at that same pattern her lately, now her heightens like 22 and weight went from 43 to like 31-37...so I guess that's the norm?

Dr. A. Clark :

If you look at weight, for instance, and watch what happens to their weight gain in the first year, you can see that there is a rapid growth for the first 2-4 months, with most kids doubling their birth weight by 4-6 months, but not tripling until a year. And, if babies continued to grow for three years the same way they do the first year, then your 3 year old would weigh 180 pounds (20 at 1, 60 at 2 and thus 180 by 3)!!

Dr. A. Clark :

Linear growth is more predictive than weight for predicting, looking also at parental size and siblings, but you really don't get much of a trend until 3-5 years.

Customer:

sO as long as she doesn't go from 43 to 0...we are ok? I know u said my ped must be like yours and recognize problems...u didn't mean her fluctuation was a problem right?

Dr. A. Clark :

Yep

Dr. A. Clark :

Fluctuation is not significant in the first year especially and even later.

Dr. A. Clark :

Height percentiles are less subject to fluctuate.

Customer:

Like I said the last two years her height has been about the same trend (between 14-22) and her weight to between (31-43). So we are good there?

Dr. A. Clark :

For girls, the age they enter puberty is also important for growth compared to peers and that is very dependent on when you (if you are the mom) started puberty.

Dr. A. Clark :

She is fine, as her pediatrician has assured you.

Dr. A. Clark :

If you don't have a chart handy you can find it at our website at:

Dr. A. Clark :

www.acutekidscare.com/health and then select the one for girls up to 18 years. You have to be very careful to plot her points exactly for her age and measurements.

Customer:

I'm 5'7 (taller for a girl) her dad is 5'8 (shorter for a guy) so he's like 20th or so percentile and she's about the same so the Dr said when she was 3 and she dropped to the 18th from 35th that she was just falling into her genetically programmed height! He said they usually find their own pattern around that age bc they get on their own eating/growth pattern?

Dr. A. Clark :

Right. Being a bit taller is in her favor since I suspect you started your periods after 12 (average Caucasian girls start at 11 or so) and girls continue to accelerate in height until their first period and then stop growing within a year or so.

Dr. A. Clark :

The later girls hit puberty the taller they will be and likewise the earlier the shorter they will be.

Customer:

So fluctuation is normal for her age...(she's almost 5). as ling as she doesn't drop like off the charts?

Dr. A. Clark :

Right

Customer:

I was in 8th grade when I hit puberty...my mom is 5'3 maybe and my dad is 6'0. I was a late bloomer!

Dr. A. Clark :

She has a good chance that your late puberty will compensate for Dad's less than average (5-10) height.

Dr. A. Clark :

I'm seeing a sick kid but will be right back.

Customer:

Like I said her head has always been about the same give or take a few points...it's just her height n weight that fluctuate...

Dr. A. Clark :

As long as her brain is growing that is the most important thing anyway!

Dr. A. Clark :

At her age kids just don't gain that much weight or in height until around 7-9.

Customer:

The only thing that scared me was a "newer" ped saw her at 3 year (maybe a little older) and she went to the 18 from 35th height and he wanted to measure her at every visit, but her ped that was my ped saw her at her 4 year old check up and told me he was going by her 2 yr. Height which was obvious to change bc she was "settling in" to her own growth pattern and quit the measuring at every visit bc he said that's what happens...

Dr. A. Clark :

My grandkids' doctors get crazy like that sometimes and then I have to calm down their mothers and reassure them that all is well. The younger and less experienced the doctor the more they have to rely on charts, graphs, books, etc to guide them.

Dr. A. Clark :

As I tell our younger docs who come on board with us in our pediatric urgent care clinics: knowing that a tomato is a fruit is "knowledge" while realizing that it doesn't go in a fruit salad is "wisdom" - big difference experience brings!

Dr. A. Clark :

Sadly, with the limits placed on the hours residents can work now they get way less experience at outpatient pediatrics. Our new docs come out of training with few practical skills for dealing with common childhood diseases and accidents or much experience counseling parents. I have to teach them how to suture, read xrays, remove a foreign object from the eye, ear, nose, etc. Frustrating for me and for parents like you so I'm glad you have a seasoned pediatricXXXXX XXXXXke me to see!

Dr. A. Clark :

Please let me know if you have further questions and if not have a good evening.

Dr. A. Clark :
Please remember as you exit chat to rate my service as that is the only way experts are compensated for their time! If you feel unsatisfied with my answer at all please don't exit but just hit the REPLY tab and let me know of the issue or question that you have. I will be happy to continue working with you and will do everything I can to provide you with the service you seek and I hope that I can earn an excellent rating from you.

Dr. A. Clark :

I hope you found my comments to be helpful and if so I trust you will return to chat to rate my work favorably. Thanks.

Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience: 33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
Customer: replied 3 years ago.

So basically you are saying at her age (almost 5) she can go from 43 to 31-37 on weight and she might just be finding her own pattern and it's normal...as long as she doesn't just hit 0? I think the highest percent in weight she has been was 47 since she started walking....but now we are at a point where she is a picky eater too. The last year I know she wants pizza, spaghetti, or chicken, or a hot dog. She will eat potatoes...but she is very very picky!

Expert:  Dr. A. Clark replied 3 years ago.
Absolutely as she is growing in spurts right now so her pounds and inches may or may not increase but her age does so the percentiles change accordingly.

That is the typical toddler diet and amazingly kids can survive on the same 3-4 food for months!
Customer: replied 3 years ago.

Thanks again!

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