Child Growth Charts—Just Another Means of Making Parents Feel Like Doofuses

10/07/2009

It's a universal law of siblings that if one likes a particular food, the other detests it. My three-year-olds are no exception.

This makes preparing any meal for them a complex mathematical equation, and I'm no math genius. Just ask my friends. Ever since I lost my tip-calculator cheat-sheet, I'm a wreck when the restaurant check comes.

But there I stand in the kitchen each night at dinner time. Head on the fridge. Calculating.

"Now, let's see. If I give them carrots, Punk will eat them but not T-Rex. Better throw in corn or T-Rex won't get a vegetable. Wait. Last time he didn't eat his corn. Crud. Well, they both like hot dogs. If I put sauerkraut on there, that would count as a vegetable, right? What am I thinking? No WAY either of them would eat sauerkraut. Plus Punk doesn't like the bun. Or ketchup directly on the wiener. Has to be on the side…."

It goes on like this until I finally hit a combo that will render each kid roughly enough food. Then I act fast, before I forget it.

But if one of them throws off my equation—like Punk did last night when he sent back his chicken and strawberries, yes, strawberries!—it sends me into a tizzy.

I'm all: Oh no, he didn't get his protein, or his fruit, or his vegetable. He's going to be malnourished. He's going to get rickets or something. Maybe scurvy. Or worse, pellagra. Like that case I read about in Deadly Medical Mysteries, where orphans down South went crazy and spasmodic from lack of niacin.

 
Oh Lord, has Punk got a niacin deficiency? He’s losing more baby fat every day. Aside from the old-man potbelly, he's getting downright skeletal. Any minute Child Services is going to haul me off for starving my child.

But the real test comes in the pediatrician's office, when they drag out those height/weight charts with all the percentiles showing how your kid relates to the norm. You know the ones with the tiny sets of numbers down both sides and a bunch of squiggly lines in between.

One glance, and I get flashbacks to the part of high school geometry where they lost me. And then the pediatrician jabs her finger somewhere in the jumble and declares, "Your kid is right THERE."

I'm sorry, where?

All these charts do is confuse the pants off most parents, who, according to a recent study, are apparently as math-challenged as I am. Only a third of parents in the study could accurately pinpoint their kid's age, weight, and percentile on the charts.

 
And there's another big problem. The charts fuel what I call parental inadequacy and slacker-phobia syndrome (PISS)—a constant, maddening fear that your poor parenting is causing your child to fall behind.

Extreme sufferers will resort to bribing whoever they can to get their kids into a Cadillac pre-K with Spanish immersion. Otherwise, their kid will surely never graduate junior high.

And these growth charts? These growth charts only perpetuate PISS. Sitting in the pediatrician's office, I tell her, "Look, just give me the quick translation. Are my kids above normal? Below normal? What?"

She won't give me a straight answer.

"Punk is above the 95th percentile for height, 75th to 90th for weight," she says, impassively. "T-Rex is in the 50th percentile for height, 50th to 75th for weight."

"But what does this mean? Is Punk going to be some sort of towering giant? And his weight is way lower. Should I be feeding him loads of cheesy grits or something? Not that he'd eat them."

"And T-Rex? Why is he so much shorter? Is it the asthma treatments? Don't those steroids stunt growth? It's because he doesn't eat his mac 'n cheese or red beans isn't it? Punk always does. I mean it's great that T-Rex likes strawberries, but where's he getting his protein, you know?"

The pediatrician just looks at me.

Stoic.

"The growth charts indicate that both your kids are on a normal growth track relative to their previous readings and the norms for their age group," she parrots.

There's the rub. She just summed up my whole issue with growth charts.

These measures weren't intended to be a PISS-inducing, standardized-test-like gauge of how your kid stacks up. They're meant to guide doctors on whether your kid's individual growth is standard, helping them ensure there isn't a huge discrepancy between height and weight, for example, or a sudden leveling off in height.

So my question is, why even show them to parents? Just tell parents what they need to know: that their kid is or is not growing normally. Done.

Parents already suffer enough neuroses about their children's development. And now we have Web sites out there exploiting the growth-chart paranoia; one site, which I won't name, uses the measures to peddle human growth hormone.

Kid too short? Buy our product.

Blagh.

I, for one, am going to forget I ever heard of these wretched charts. Just doing my daily number crunching on which kid will eat what is math enough for me.

Comments

[grace]

Cybermom, you must have been raised Catholic (mea culpa, mea culpa) to suffer so much guilt over your kids' growth charts and nutrition. Your boys sound like they eat a lot of foods other kids won't - carrots, corn, fruits etc... I know kids raised on sugary cereals and milk and practically nothing else who turned out just fine...!

[Cyberchondriacmom]

I just had no idea kids were this resistant to veggies, healthy food in general. I mean, I heard moms complain, but I had no real concept.

And then even the foods you'd think they'd inhale, like mac 'n cheese--well one doesn't like it. pizza they don't always want.

what the????

[grace]

Yeah, I've seen kids burn out on mac 'n cheese, pizza too - it gets to be too much of a good thing if served up too often. And sometimes kids just aren't as hungry as you think. They might have had a big lunch at daycare that you weren't there to witness... You might try giving them more of a "supper" during the week - cheesy toast, french toast (has egg in it!) etc and leave pushing the veggies for the w/e.

[penny]

I suppose the fact that you get so PISSed about these things shows you're a caring mom. But hey, just relax, and let the kids grow at their own pace. Forget the charts!

[Charles]

You shouldn't blame the growth charts if you don't understand them. They were not designed or intended for a lay audience. The CDC's own instructions make it clear that they are intended for a clinical audience:

"This guide instructs health care providers on how to use and interpret the CDC Growth Charts to assess physical growth in children and adolescents. Using these charts, health care providers can compare growth in infants, children, and adolescents with a nationally representative reference based on children of all ages and racial or ethnic groups."

http://www.cdc.gov/nccdphp/dnpa/growthcharts/guide_intro.htm

These charts are simply a means of plotting where one child stands relative to the observations of many others. The curves don't present an "ideal" but rather a median, ie a midpoint, where half the kids are above and half below -- the 50/50 point -- and percentiles, representing 75/25, 95/5, and so on. It is not a scorecard; where a child is on the chart isn't necesssarily "good" and "bad," and no one should feel like a doofus for not instantly and fully understanding this information, especially without interpretation by health professionals. Does the average person read their own MRI results? Is there a faction of patients complaining that the MRI should be redesigned or abolished because they can't make any sense of it, because the results can only be read by trained specialists? Because the lay person is not trained to read diagnostic images, does the whole business need to be reconsidered? Of course not. The MRI is not a consumer product. And neither are the growth charts.

So don't blame the information -- it's not the information's fault. It is the job of the clinician to perform (or indicate) testing and measurement, evaluate the resulting data, then make the patient understand what the situation is and deliver recommendations as necessary: lose weight, change your diet, take this medication, have surgery, etc. If the clinician fails to communicate the meanings and actions required to the patient, the failure is with the clinician, not with the patient and not with the information.

All the chart can do is provide raw information: where your child lies relative to those others that have been measured. What that means, and what if anything you should do about it, is the job of the clinician to make you understand.

[sng]

Hey Charles, don't take this Cybermom too seriously. She obviously gets the purpose of the growth charts - reread blog, 6th-last paragraph - but the point is the EFFECT such data have on the majority of parents being faced with them, and that is to diminish their sense of competence as parents. In fact, I'm wondering if we aren't being drowned in a plethora of data that is kind of interesting at best but mostly useless in fact.

[cyberchondriacmom]

Don't take me seriously? hmmph. ;-)

But really, I get what Charles is saying -- and I think we agree more than than we disagree.

The charts are really meant to help health professionals ensure that kids are developing normally, that there aren't problems.

They're not meant to be a tool for lay folks like me (parents). The idea is the doc sees where your kid is on the trajectory, then explains that to you, the parent.

The problem is this often doesn't happen -- docs often DON'T interpret the info for parents. Just show 'em the charts and let 'em think it's yet another scorecard indicating their kid doesn't measure up.

That's why I think docs should either use them as they were intended, or just not use them with parents at all.

And the worst is when I look out there on the Web and see that these charts are being used to exploit parental fear and feelings of inadequacy by selling growth hormone.

That definitely is not what the charts were intended to do.