Diet and Nutrition

2 year old below all list weight growth chart

11/10/2009

Question:

My son will be 2 in a week. He currently weighs about 22 lbs. At age 1 he was just under 20 lbs. He eats really well for a toddler but just seems to not hold onto any weight. He also gets colds constantly. Our pediatrician whom I really like has kind of brushed it off that he may just be a little guy and as long as he is eating healthy and hasn`t lost weight we shouldn`t worry. But I can`t help but to wonder why he isn`t gaining. He doesn`t even look like he should be two. He`s about on par with height maybe a little short. Should we continue to press the issue or just chalk it up to him maybe being on the smaller side? He has had a Celiac blood test because my sister has Celiac but it was negative. No one else in our families have any disorders involving weight and we are tall but average weight people. Please any guidance would help.

Answer:

A weight of 22 pounds may be okay. It depends on his height. My grandson was just under 20 pounds at age 1, and now at 15 months is 20.4 pounds. This puts him at the 5th percentile in weight. His height puts him in the 25th percentile. Though his weight is not at the same percentile as his height, the doctor, parents, and I aren't concerned because he eats well. Plot your son's height and weight on a growth chart that you can find at the following URL:

http://www.cdc.gov/growthcharts/clinical_charts.htm#Set1

On the screen that comes up look for the Boys Length-for-age and Weight-for-age (first block of charts). Click on one of the choices and plot your son's height and weight on the chart. At 22 pounds he is below the 5th percentile in height, but I don't know his height, so can't compare the percentiles to see how close or far apart they are. Plot his weight and height at age one and now and see if the percentiles have changed drastically. If the percentiles are fairly similar for both ages (and the line has the same curve as the charts) there probably isn't any cause for concern. If the percentile for weight has fallen dramatically compared to height, then you might want to continue pressing the pediatrician for a possible explanation. If he gets colds constantly he may need more calories (but you should make sure they are 'healthy' calories). If he has a small stomach this might mean you need to change to a feeding schedule that offers your son healthy food every 2 hours or so. You might consider offering whole milk beyond age 2 even though pediatric recommendations are to change from whole to low-fat milk at this age. 1 and 2-year olds get very busy with play, so you may have to work food into the play schedule. Also, they eat slowly if there is any chewing involved because they don't have a full mouth of teeth yet. Perhaps a bite of a peanut butter (or almond or cashew butter) and jelly sandwich (made with a 100% whole grain bread) every time he goes down the slide; or a few raisins or other dried fruit. Top it off with a few sips of milk. A toasted cheese sandwich or French toast (sticks or fingers?), or hummus and Triscuits might also be used the same way. 4 ounce containers of yogurt may also work into the play schedule. All will work for any meal or snack. You aren't limited to eggs and cereal for breakfast, and other eating times could include these traditional breakfast foods.

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Response by:

Sharron Coplin, MS, RD, LD
Lecturer, Food & Nutrition
Department of Human Nutrition
College of Education and Human Ecology
The Ohio State University