"Overweight" 3 year old

[venus417]

I have a 3 year old whose bmi puts her at 96th centile according to nhs website. She has a slight pot belly but other than that she is a good build. She is strong and very active. Walks everywhere, goes on her balance bike, goes to swimming lessons, gymbastics once a week and nursery. At nursery they play outside for at least 2 hours a day. She eats a lot of fruit (which i know is full of sugar but is still good for you?!) She has treats at both grandparents but we dont stock biscuits or crips at ours. For breakfast its porridge or shreddies, lunch a sandwich or tuna mayo pasta something like that and tea is generally meat with something. For instance its chicken and leak bake today. Cottage pie tomorrow 🤔 so where are we going wrong?? I think she is slightly food obsessed too. Her first question of the day is always "whats for tea tonight?" We all eat together, the same meal, and she helps to cook it (or thinks she does. She will probably grow up thinking its normal to stir chopped onions 😂) advice for healthy snacks/meals or what i am doing wrong will be greatly received!

She's same height as my boy so surprised she's not higher but its amazing what difference a cm or so can make.
The swaps well help overall anyway and she'll probably pop up a few cm in no time and everyone will fret she's too skinny!!

Its different for boys and girls isnt it 😊

Having said this all as well bmi always says my husband is obese but its cos he is a rugby player so he is solid muscle 😂 he hates the use of bmi!

Yeah so she's a good height considering she's a girl and same height as my boy

I wouldn't take much notice. The BMI scale is flawed to begin with, never mind when applied to children.

Unless you can see she is physically overweight and bigger than her peers I'd take it with a pinch of salt.

My daughter was classed as overweight at 4. She's a very happy, healthy 10 year old now, just as she was a happy healthy 4 year old then.

BMI is flawed when used on children the fib/spine test is what my go always tells me to use. Can you see her ribs when she puts her arms out to the side? When she bends slightly can you see her spine?

I posted about my 2 year old a couple of months ago who was coming out overweight at 91st percentile. We started to watch his portion size and snacking - he could eat for England if left to his own devices. But when I measured and weighed him again recently, he'd shot up 3cm but not put on any weight and is firmly in the healthy range again now. Monitor over a few months and she'll probably even out, but watch portions etc in the meantime.

BMI is not flawed in children. It’s a valid tool in conjunction with other visual assessments.

Generally speaking a disparity of 2 centile lines between height and weight is significant. So 25th for height and 75th for weight needs some intervention but nothing drastic, just small changes usually.

Remember overfed children are taller than they’re meant to be so you need to look at the big picture.

I reduced portion size this eve and she ate it all then about an hour later was telling me how hungry she was but gave her a drink, dunked her in the bath and got her to bed. Me and dh dont think she knows what hungry means. She will often say she is full up then minutes later say she is hungry. Made her a chicken salad for lunch at nursery and a yogurt. At nursery they provide snacks which are fruit and toast. Like most people have said I am going to monitor portion size and reassess in a few months. Dh says im stressing over nothing. Its just because I am so slight but like a say dh is built differently.

Remember overfed children are taller than they’re meant to be so you need to look at the big picture
Say what now? So my DH is 6 ft 2 because his mother over fed him and he's really only meant to be 5ft 10?
Can honestly say I've never heard anyone told to feed their child less because they're tall and need to stop growing

Remember overfed children are taller than they’re meant to be so you need to look at the big picture

DD2 has been on the 98th centile for height and weight since birth. She was EBF. I don’t think her height (since birth) is due to her being over fed, more due to the fact that DH is 6ft 4.

No you misunderstand.

A child has a fairly predictable growth pattern range based on parental height and birth size.

If a child is overweight and taller than expected it can be because of overfeeding; if they are on for example the 25th centile as a baby then shoot up the charts and settle on the 90th centile despite being predicted to settle around the 25th to 50th centiles then one may need to consider that they are overfed. It may then trigger puberty slightly earlier which means they attain their adult height at a younger age than they should have done, and cease growing earlier so they don't necessarily end up as tall adults, but may be overweight ones.

Sidge is correct, only about 60-70% of an adults height in goverened by genetics.

The remainder is due to environmental factors, the most significant being nutrition, but sleep also plays a big factor - growth factors (esp igf1) are released during slow wave sleep.

Better sleeper as a child = taller adult (all other things being equal)

I entirely understand that TheTroublesomestTribble, but surely in a child who was born on the 98th centile for length and has never wavered once off that line (now 3), you’d probably say nutrition didn’t have a huge amount to do with her height. Surely it would have been more of a worry if she’d dropped significantly down the centile lines?

Birth size isn't genetic though. Maternal nutrition and health impacts birth size. Indeed one of the risk factors of gestational diabetes in the mother is that it gives rise to abnormally large babies if not controlled. So you can't really take birth size as a child's natural, or expected, size. I believe obesity during pregnancy can also give rise to bigger birth sizes.

I'm not really sure what it means for my children. All four of my children have been tall for their age as toddlers and through primary school. Then the two who've hit puberty have then seen their peers catch up in height. It's as though they do all their growing early.

It's interesting that this is true for all 4 children. This indicates a genetic link but also environmental since they have all been raised similarly. However it was also the case that myself and my two brothers also all "did our growing early" - as in we were taller than peers when younger, but more average height after puberty. We were all certainly fed well. Similarly with my own children, who also always had very healthy sleep habits (another environmental factor). So I can definitely see that environmental factors at play as well as genetic factors.

It's all very interesting. Makes you think.

Very interesting. I didn’t have gestational diabetes and am (and have always been) a healthy weight. I put on 1.5 stone in both pregnancies. As I mentioned above, DD1 is much smaller (25th centile since birth for both height and weight). They both eat the same, although DD2 eats smaller portions than DD1 (they’re 4 and 3 and both pre schoolers so I know exactly what they eat). DD2 has been 98th centile since birth for height and weight.
I come from a very slim, small boned family and DD1 has exactly the same build as me as a child. DH’s family are all much bigger... none overweight but all tall (MIL and SIL are both 5ft11, DH is 6ft4) with larger frames. I’m inclined to think genetics is playing a large part in the differences between the 2 girls as the environmental factors are pretty much identical.

Oh and DD1 (the much smaller one) was a far worse sleeper than DD2 (she didn’t sleep through the night until 3.5, DD2 was a dream in comparison). They’re 4 and 3 now and both sleep a solid 12 hours a night.

Pepper, I think the problem with dismissing BMI and relying on 'can you see if she's over weight' is that as parents we are cap at seeing it. When me and my friends were taking our dc for their 2.5 year checks several were told their dc were over weight, all but one were outraged at being told that this. Later when I took my dd to her check there was a couple with their dd in the same room having the same checks, the little girl was visibly overweight to me , but the parents simply wouldn't hear of it.
Of course BMI isn't perfect but if my dc were over weight and had a much higher weight centile than height I'd want to address it, as pp say it doesn't have to be massive changes just perhaps looking at portion sizes, thirst etc as you are doing op.

Crap not cap!

The trouble is, centiles are a terrible way of measuring anything.

They imply that the dc at the 50th centile is somehow the ideal Bmi when that's not the case, they are just the average (median) bmi.

As we get fatter as a society, the 50th centile will drift further and further up into the overweight/ obese category.

I suspect that now 2 thirds of adults are overweight or obese, the 50th centile is already at least at the very top of the healthy bmi range, if not already into the overweight category

HCP don't use centiles like that at all for babies TheTroublesomestTribble.

There's no expectation that your baby should be on a set centile (say 50th). Just that if a baby is dropping down centiles, this is worrying. Health Visitors look at the change in centile for an individual, not basing any judgment on which centile a baby lies (except perhaps the very extremes)

Update for you ... i wasnt going to do this so soon but i did weigh her this morning and she was 15.4kg and checked that and it puts her at 82nd centile 👍. She has had no junk like chocolate or anything. Grandparents got on board too! We swapped out 1 fruit portion for carrots and cucumbers. As someone else suggested I took the heatwave as an oportunity to give salads and wraps etc for tea. Reduced some portion sizes as well. Going to stick on this route now, she used to ask for chocolate at every opportunity and in the space of 2 weeks thats totally changed and she never asks! So now I dont even need to say no 😂.
Thanks to all for your suggestions and support. Will check her again in another few weeks 👍