3.5 yo DD on 2nd percentile for height and BMI says she's obese!

[Talkiewalky]

I'm so worried about my little girl - she's 3.5 years old and only 89cm which puts her below 2nd centile for height (she's been tracking that line since about 18 months), but her weight is and always has been on the 50th.

She looks a bit chunky but in a 'puppy fat' way rather than overweight - chubby cheeks and a pot belly. She's so active - 3 sports classes a week, we walk absolutely everywhere, park and soft play almost every day - she's constantly on the go, and she's full of energy, fast and strong, so I'm not worried about that side of things.

She was always a chubby baby, BF to 18 months and she had full on rolls - so it's not as if her weight has rocketed up, more that her height has just slowed - we've been waiting for a growth spurt, but no sign yet! And checking her BMI now has really freaked me out as she was on something like the 97th percentile!

I took her to the GP at about 2.5 and she basically laughed me out the room - said as long as her tummy is soft not tender she's fine, and all kids grow at different rates. But I can't shake the feeling there is an underlying issue causing her not to grow and also retain the babyish body shape and fat.

Does anyone have any experience similar or advice on how to get GP to take it seriously? Thank you!!

BMI isn't suitable for young children. She sounds fine.

BMI only applies to Caucasian adult men. It's bullshit at the best of times but you certainly can't apply it to a child.

You are at risk of going down a worrying path if you're already obsessing about her weight. The GP was right to laugh you out of the room. If she's healthy, active and has a balanced diet I'm sure things will work out.

I wouldn't worry at this age. I've been told such conflicting advice. My son is 99th percentile for height and is very slender but apparently his BMI is overweight. But he still wears size 6 nappy pants which my two year old nephew wears and my son is 4 (he is autistic). None of the scales make sense

Have you put her measurements into the NHS BMI tool for children?

(It's currently off line as it is being updated).

You can use BMI for children (as doctors we do) but the normal values vary according to their age so the easiest way to check whether it is OK is to use the NHS tool. We talk about BMI centiles too! A BMI above the 98th centime is obese.

You've mentioned her activity levels, but not her food intake. In general, people tend to overfeed toddlers and children. Look at the guidance for portion sizes, lots go by a "fist" so that is the Childs fist size...not an adults.
My son on going to school was identified as being overweight for his height. We took a long hard look at his diet, his activity levels and his sleep. Reduced his food intake, and increased his activity and sleep...he is now 10 and in perfect, in fact on the skinnier side, proportions. But the reality is he DOES have a larger appetite, and needs a careful eye on this as he could easily gain weight through this.
With little children you dont need to try to limit them like a diet, just more meet their nutritional needs but not overfeed...and as they grow the balance will readjust..

Re BMI etc, the red book she has already will have a guide for centiles and she should be on a similar centile for both.

Was she born on the second centile for length or did she drop down the centiles between birth and 18 months? If so, was anyone concerned at the time? Are you and her other parent very short yourselves?

How tall are you and dad? I'd be worried if you're tall.

What's her diet like? If she was a child in a developing country then stunting combined with overweight for height would likely indicate a lack of protein or nutrients. Less likely in the UK but could still happen with a restricted diet.

Are you and her dad short? If it's likely that she will be short because of genetics then I wouldn't worry about her height.

With regards to her weight if she is obese then you need to be proactive. Think about it, a weight of 11 stone would look very different on a woman who is 5ft compared to a woman who is 5'10. It's the same principle with children, your dd is short for age so she will be overweight compared to a child of the same weight who is tall for her age.

I wouldn't recommend putting a 3.5yo on a diet but try to ensure she doesn't gain any more weight for a while so that she can grow into her weight. At this age you have complete control over what she is eating so make sure that she is eating healthy meals and snacks. Look up portion sizes for under 5's, they are smaller than you'd expect.

Sometimes parents can be blind to how overweight their children are. You say she looks chunky in a puppy fat way. "Chunky" and "puppy fat" are phrases almost always used by parents who don't want to admit that their children are overweight. Your child being overweight is not the end of the world and it doesn't make you a terrible parent but you do have the choice to make changes for her health now while she is still so young. If you are worried then take her back to the gp.

There's no such thing as puppy fat. It's no different to any other state of being overweight.

I know not quite the same, but my dd is on the 98th centile for height and weight which makes her overweight I think. You wouldn't think that to look at her. She looks slim and does loads of sports and lots of walking. That being said, I am now really mindful of her portion sizes and the things she is eating, to try and maintain this current weight as she grows taller.

I know Im missing the point of the thread but what does 'as long as her tummy is soft not tender' mean?

Soft is tender surely

Or did he mean that you touch her tummy and she doesnt mind because it isnt tender?

No it doesn't, she's on the same centile for height and weight so she's fine.

I did think this but the red book WHO graph shows 98,98 as overweight.

BMI only applies to Caucasian adult men. It's bullshit at the best of times but you certainly can't apply it to a child.
That's not what the Royal College of Paediatrics and Child Health have to say on the matter. From their website..."The BMI centile is a simple and reliable indicator of a healthy body weight in childhood."
Obviously the normal ranges are age specific and it's the BMI centile that is used rather than the raw number, as PP explained but it certainly is applied to children by health professionals.
OP, I don't think you are unreasonable to want this looked at. It may well be absolutely nothing to worry about, but if my child was shorter than 98% of their peers but had a BMI that was higher than a similar percentage, then I would want some reassurance too. Yes, children do grow at different rates, and in all likelihood things will even out in due course but there are also possible nutritional reasons or medical conditions that may cause unusual growth patterns and nobody here can tell you with any degree of certainty whether any of those apply to your child. If you want her properly assessed then I think you should be able to get that and certainly not be laughed at for your concern.
One of my children was absolutely tiny. People told me not to worry because I am really small myself but there was a phase where strangers kept assuming I had twins as he was almost exactly same size as his brother who is in fact 2 years younger so I really was concerned. Eventually my HV referred him to a paediatrician. He had some tests done and nothing abnormal was found, and the paediatrician told me that in all likelihood he would continue to grow slowly but for longer than average, which is indeed what has happened. He's 19 now but is still growing a bit and is actually taller than his brother now. So I was "worrying about nothing" just as all my detractors said. However, the paediatrician said that she agreed that his growth pattern was sufficiently out of the ordinary to justify monitoring and doing some investigations and if he had had something like a growth hormone deficiency then it would have been much better if identified sooner rather than later. She went to great lengths to reassure me that I had not wasted her time. Growth charts are a screening tool to help identify children who need a closer look, that's all. Thankfully most of those who are outside the normal ranges will turn out to be fine but my son's paediatrician said she would rather see lots of healthy children with unusual growth than miss one who has a cause she could have treated.

Soft means soft....non- tender means it doesn't hurt when touched. It's standard medical speak when we examine.

Thanks so much for all the replies! To answer some questions:

Her diet is generally good, the only thing we've tried to decrease is her white bread intake or anything like croissants which she used to have after classes/at coffee shop. She does eat a lot of fruit probably 5 fruit portions every day. She doesn't generally eat a lot at meals and usually less than her peers who we spend time with. She rarely drinks milk.

When I say "puppy fat" I don't mean it in a denying she's overweight way - more in the sense than she has been chunky since she was 3 months old and really peaked at about 6 months - to the point where the HV accused me of lying about feeding her formula when she was actually EBF! So I suppose it feels like she hasn't ever "put on" more weight in her toddler years - just not slimmed out as I would have expected.

We are not a tall family, so in that sense the height alone is not a huge worry yet - just that her growth is so so slow.

I think it was an interesting point about being low in protein? She is not great with meat, so perhaps I need to look at other areas I could increase her protein intake vs carbs.

Re. Soft vs tender with her tummy, yes sorry I meant tender to touch I.e. they gave her a poke and she said it didn't hurt!

What is her diet like?

Do you both eat healthily?

Well I wondered if it meant that but then whats that got to do with obesity?

I think she was just trying to say it wasn't due to a stomach problem or constipation that she still had such a round tummy shape.

Yes, up the protein OP.

Eggs, cheese, felafels, baked beans on wholemeal toast, plain Greek yogurt etc if she isn’t keen on meat, fish and chicken. Would she eat more at meals if she ate less fruit?

My DS is on the 2nd percentile for height and 50th for weight too. He has continued on the same projection his whole life. He is 9 now and looks completely in proportion. She'll be fine.

Does the five fruit include tomatoes, peppers, cucumber, sugar snap peas etc or do you mean only sweet fruit? If you mean five apples or bananas a day then I'd say that's too much and I wouldn't be surprised if she is missing out on enough protein from not eating meals.

BMI is an irrelevant, old fashioned, dated indicator.