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How do I address the issue and importance of nutrition to my son and daughter-in-law without appearing meddlesome? When he is with us, he seems to be eating all the time so I'm not even sure that is the problem. My Grandson is 16 months old and is still wearing clothing only up to 9 months. His parents are slightly below average in size themselves. In the last four months, he has grown one inch and has gained one pound. The doctor said she won't be very concerned unless she doesn't see a growth spurt by his 2nd birthday. I'm not sure they should wait that long to see if there is a problem. Other than his size, he is developing well - walking, speech, coordination, etc. Should we be concerned and how can I discuss which foods would be better to give him than others?


Sue Cox Replied: Thank you for your question which is one that many grandparents ask. Usually babies have their big weight gains in the first months of life. When they become active they, like adults who are eating nutritious food, use up most of the calories in movement. The most important things to know about how children are developing and growing well are the things that you have mentioned: movement, coordination, speech etc. As grandparents all we can do is to hope that we have educated our children about good nutrition as they grow so they will continue to eat nutritious food for the rest of their lives and for us to provide good nutrition when our families visit. Trying to educate new parents can be a thankless task and push them away from us. Smile and believe what the doctor has said - that he is a well developed, (I'm sure cute!) little boy with genetically fine features.
Posted On 2009-10-08 18:57:37
Janet Whalley Replied: Your grandson's growth is slower than most toddlers, but that does not necessarily mean that there is a big problem. The most reassuring comment that you made was the one with the doctor's comment. She is aware of the problem and will be following up at his later visits. If you remain concerned, you could ask your son to talk to the doctor at the next visit and ask about what would be done if the growth problem remains at age two.

Then if he wishes, he could ask if they should do something sooner. Also, the fact that your grandson is developing normally in other domains is reassuring. As children mature they grow and develop in several different domains - physical, mental, social, small muscle coordination and large muscle coordination. It seems that when a child is growing in one domain that the others often lag behind. That could be the case for your grandson. Or he may always be smaller than his peers.
It sounds like your son and daughter-in-law have told you about talking with the doctor so they may have some concerns too. I would talk to them about what they are doing to promote their son's growth. Though the growth delay might not be related to your grandson's diet, you could ask if they are giving him any special foods and try to offer those at your home too. It's OK to tell your son about his eating patterns as a little boy and how you tried to offer a variety of good foods. Then you can talk about what you think are the best foods. Avoid telling them what to do, just tell them about your experiences. Your goal is to keep the lines of communication open so they will talk to you about your grandson's next health report.
If your son and daughter-in-law are reading a book or an internet site about feeding toddlers, ask to read it too. It's helpful to learn about common eating patterns for toddlers. A few characteristics come to mind. Toddlers like to snack more than they like to sit down for a big meal. Because they are working on fine motor skills, toddlers love finger foods. They may show certain food preferences, but they benefit from having a variety of foods at different times of the day. A good diet for toddlers is like a good diet for an older child and adults. It includes eating a variety of vegetables and fruits. (Different colored ones have different vitamins and minerals.) Many toddlers like their vegetables slightly steamed rather than raw. To provide whole grains, toddlers love having a small bowl of their favorite dry cereal - though it needs to be a nutritious one. Protein foods for toddlers usually include cheese sticks, easily chewed bites of meat and plenty of milk. You may want to go to your local bookstore or look on the internet for books about feeding young children.

Being a grandparent is joyful, but like parenting, it can also be challenging.
Best wishes,
Janet Whalley

Posted On 2009-10-07 14:08:30
Charlotte Cowan, M.D. Replied: You have asked several questions at once.
The most obvious is about the pattern of a child's growth and when to be concerned.

One of the gold standards in pediatric care is that height, weight (and head circumference until about age 3) are measured at every well visit, carefully tracking growth. What matters most is the child's growth along his "own" growth curve.

There are times when children dip or cross from one percentile to another. Sometimes this coincides with when they begin to walk, and height is measured instead of length; sometimes this happens when a child is measured soon after a recent illness.

But I would not wait until a child is two years old to assess whether a problem might be present. It will be interesting and important to see what your grandson's weight and height are at his 18 month well visit. If he is falling off his growth curve, then it would be appropriate to ask why.

The second and more subtle question is how much you can suggest to the parents of your grandchildren without being obtrusive and without threatening your primary relationship with your own child. This is tricky indeed. Every family is different. I suspect that it would be smart to air your concerns ONCE, suggest that X or Y or Z be brought to the attention of the pediatrician, and leave it at that. Your child will come back to you for advice when, if and as she wants to.

I hope this helps-- and hang in there.
Charlotte Cowan, M.D.

Posted On 2009-10-05 10:30:57
Eleanor Taylor Replied: As a grandparent, it is natural for you to be concerned about your grandson and to want the best for your family. However, the parents seem to be seeking the advice of a doctor who is monitoring all aspects of your grandson's growth and development. While your grandson is small, it sounds like his doctor is not worried about his size at this time especially since the parents are both below average. As for what your grandson is eating, children go through times when growth is not as rapid, and they often eat less during those weeks or months. Toddlers love to graze throughout the day and eat with their fingers, which is one way they naturally eat the amount of food they need. Periods of food rejection are also normal. One subtle way to help parents is through gifts of books about developmental norms including eating behaviors and nutritional needs. If you do this in the spirit of helping, but not criticizing, your grown children will appreciate your generosity and you will keep open the lines supportive communication over the years. Moreover, take the time to read these books yourself so you can feel relaxed and reassured.
Posted On 2009-10-03 16:46:12
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