“The Dreaded Weigh-in”: why the mere mention of percentiles strikes fear into the heart of many a mother.

"And this is when they told be you were worryingly underweight...and this is where you were clinically obese..."

“And this is when they told me you were worryingly underweight…and this is when you were clinically obese…”

*Disclaimer: This post contains anger and research. Research I tells ya!*

If you had an FAQs web page for your baby, what does she weigh now? surely would come second, following closely behind how is he sleeping? in the list of questions you wish you didn’t have to answer seven million times a day. And it’s a weird question, really, because most people have little frame of reference when it comes to the weight of a 3-month-old. What does 13lbs 6oz, or whatever, that actually mean to anyone? But seeing as we are a society obsessed with dieting, calories and obesity, it’s not surprising our children have been dragged into it too.

In my area (South Manchester) we are lucky enough to have well-baby clinics running almost every day of the week. It’s pretty fab to know that, if I want to, I can just rock up at a sure start centre and get some advice. I have had really good experiences with them. But over the past few months more and more mums I know have started avoiding clinics. In response to another post of mine on a friend referred to them as “the dreaded weigh-ins”.

Name have been changed to protect the identity of these mums. Obvs.

Aaaargh and Noooo aren’t their real names. Obvs.

When my son was very small he didn’t gain weight quickly enough and we were sent to hospital and I cried and all that crap. In the end I was grateful they checked everything was okay and since he’s been on formula (at the advice of my fantastic HV) he’s been following his 75th-80th percentile like a good little boy. Consequently I haven’t experienced much hassle at baby clinics. But I’m one of the lucky ones.

A lot of my friends haven’t been so lucky. Let me tell you about them.

We have Fab Mum A. Fab Mum A is a lovely lovely person who cares for her baby very well indeed. I have never seen her feed him anything out of a packet (which I do regularly) and he’s obviously a healthy, happy chappy. Oh, and she’s tall, like tall. So’s her husband. So’s her son. Funnily enough.

So, Fab Mum A successfully breastfed her son pretty much exclusively up to 6 months then she tried to introduce formula more, so that he would take a bottle when she went back to work. Around that time she started weaning him (at 6 months because she followed the guidelines) and she got him weighed so she could monitor his progress. All very commendable. Enter the dreaded weigh in! Her son’s weight had jumped up to the 98th percentile. Dun dun der! She was quizzed on what she fed him when, how she was weaning him etc. The health visitor reassured her that she was doing everything right but decided to add “If you weren’t still doing some breast-feeding I would have put him on weight management”. WHAT? If you’re not going to put someone’s baby on ‘weight management’ (whatever that means) don’t bloody say it at all! That’s all they will go away with; that and the dread of the next appointment with the scales.

Turns out that Fab Mum A’s baby has stayed on the 98% percentile. Because, guess what? That’s how percentiles work. Someone has to be at 1% and someone else at 99%. They can’t all be between 25% and 75%. Otherwise it’s not a percentile, it’s a ‘please fit your child between these brackets’ exercise. (we will return to that idea later). Also, in my area they don’t take the baby’s length into account. Arrrrrgh.

Now let’s turn to Wonderful Mum B. Wonderful Mum B is a kick ass single mum whose son is now 2-years-old and he’s a little marvel. At his 2-year health assessment Wonderful Mum B decided to open up to the health visitor about her low moods and got a bit tearful. How brilliant that she found a safe space to do that, right? Wrong! Because after that part of the meeting she went on to be told that her son was obese. OBESE. He’s two years old! Okay, I know there are parents out there who put cola in their baby’s bottle (no, really) and give them a packet of crisps for tea but if you know the child is getting a healthy diet then back off. Just. Back. Off. The health visitor wasn’t horrible about it or anything but she did make that infamous weight management referral. Incidentally my friend’s son grew 5 cm and remained the same weight so, you know, definitely worth getting upset about. Grrrrr.

Last but not least Briliant Mum C who had a very similar experience to me with breast-feeding. She was told her son wasn’t putting on weight quickly enough and that they were very concerned for his well-being. Not to worry her or anything. Of course she got tearful because, you know, worry, breast-feeding-guilt and all that. So then they kept asking her if she had support at home. She kept saying yes I imagine, so why did they keep asking? I’m sure there were good intentions but to her it seemed that they thought only someone without support would have a baby with slow weight gain. She felt awful. Anyway, more recently she was told her son is overweight. Good one. Bleurgh.

I’m no expert but maybe, just maybe, not all babies and children gain weight in ‘perfect curve’ sort of a way. Maybe they have growth spurts. Maybe some of them take a while to get going and then chub out. When I was little I definitely followed the ‘fill-and-stretch’ model of growth. I would fill out a bit then suddenly have a spurt and turn beanpole-esque, then I would chub up again and then, well you get the picture. All I’m saying is perhaps this percentile-obsession isn’t so healthy.

Now, here comes the research bit, concentrate:

So what are these percentiles based on anyway? I mean they can’t be based on the averages for the babies they are actually measuring because that would involve a crazy and expensive data collection and the constant reproduction of charts to ‘fit the curve’. So I assumed that they were just based on UK averages from a few years ago. A reasonable assumption. But I was wrong.

Until around 2009 the percentiles were based on 1980s data which documented the typical weights of babies in the UK. This covered a wide range of children; bottle and breast-fed. It didn’t make a distinction between healthy and unhealthy children either. So basically, it was a percentile. Obviously this data needed updating and I’m it had quite a few flaws but I’m confused by what it was replaced with.

The current World Health Organisation UK percentile charts are based on breast-fed, healthy babies. The data has been take from around 8,500 infants in 6 different countries. Does anyone else find this odd? Here’s the WHO explanation:

"How children should grow". Yeah, that seems like something you can regulate.

“How children should grow”. Yeah, that seems like something you can regulate.

So there you go. If anyone tells you that your child is on the 1st/100th percentile remember that this does not mean that they are the heaviest/lightest child in the country. It means that they are as heavy/light as the heaviest/lightest breastfed kid out of the 8,500 healthy Brazilian, Ghanaian, Norwegian, American, Omanian and Indian children whose weights make up the chart’s data.

Why didn’t we know this? Why didn’t anyone tell us? In a society that screams from the page of every other magazine ‘LOSE WEIGHT FATTY’ why didn’t anyone think about how this could deeply effect the anxiety levels of parents??

It’s common knowledge that formula-fed babies tend to be a bit heavier. Ok, the difference between the charts isn’t that much (see below) but does anyone else feel like they’ve been misled? Worried unnecessarily? Or just kept out of the loop?

Suddenly I understand why I know so many people who have been told their children are overweight.

Of course, this doesn’t answer the other questions about our children being expected to grow on an even trajectory, or why people won’t just let small babies be small babies. What it does show is that the information we receive is always based on what someone somewhere has decided. That someone may be pre-eminently intelligent and, in the long run, absolutely correct in their decisions. But I wonder if they ever considered how those decisions would make the parents who are trying their best (which is, like 98% I reckon) feel.

I don’t know, dear reader, I just don’t know. I mean, I really know nothing about this so please do ask those who do. Perhaps there are Health Visitors who question it too, or who can explain it to us (comments welcome).

What I do know is this; next time someone tells you that your baby’s percentile is all wrong when you know that your child is healthy and happy, you should just tell them to b*gger off! 

 

 

 

 Further info:

Lots information resources on WHO growth charts.

NHS research review: do bigger babies turn into obese kids.

Even percentiles are subjective, apparently.

Even percentiles are subjective, apparently.

 

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