2018-06-01 Linda Kirste is a Registered Dietitian. She works at HealthLinkBC where she operates the Allergy Nutrition Service ― a tele-practice-based service that provides nutrition education, as well as counselling and follow-up care for residents of British Columbia with food allergies. This month, Linda addresses the question that many parents of children with food allergies have – how to ensure their child is growing well and what to do when your child has a low weight. Many parents of children with food allergy worry from time-to-time whether their child is growing well. If you’re concerned about your child’s weight, there are a number of things you can do. Ask your child’s health care provider to monitor your child’s growth which is done by measuring their height and weight at regular intervals. This may include more frequent appointments for a period of time so that the health care provider can closely monitor growth and determine whether your child’s growth is progressing at a healthy rate. Ask to see your child’s growth chart with an explanation about what it reveals. If your child’s growth curve shows signs of low weight (weight faltering), ask for an assessment and a care plan to support you in your efforts to help your child grow to their full growth potential. What does growth monitoring involve? Growth monitoring involves accurately measuring your child’s height and weight at regular intervals and plotting these measurements on a growth chart. Over time your child’s personal growth curves for height, weight, and weight in proportion to height will be revealed. Unexpected changes in their growth curves will show on the growth chart. You can access the World Health Organization (WHO) growth charts that are recommended for Canada. How do growth charts help reveal my child’s growth pattern? The WHO Growth Charts for Canada include a number of standard curves called “percentiles”. Each percentile represents a healthy rate of growth. Higher percentiles indicate a larger or taller child and lower percentiles indicate a smaller or shorter child. For example, a girl at the 75th percentile for height would be taller than 75 out of 100 girls of the same age. Children’s shapes and sizes are influenced by those of their parents. Therefore, children whose parents are taller are more likely to have height measurements that “hug” or “surf” around a higher percentile, while children whose parents are shorter are more likely to have height measurements at a lower percentile. A child’s height and weight percentiles also help their health care provider compare their weight in proportion to their height. When a child’s weight and height are at or close to the same percentile their proportion is said to be “symmetrical” or even. Monitoring a child’s growth includes comparing their weight to their height over time. This helps to pick up any changes that suggest their weight is or may be faltering. Occasional smaller temporary dips away from a child’s usual growth pattern can be normal, especially during or right after a short illness. Before 2 to 3 years of age, and also during puberty, it may be normal for a child’s weight (and/or height) to drift to a new percentile and continue along that path. When this happens, more frequent measurements may help to confirm continued growth at the new percentile. How often should my child’s weight and height be measured by their health care provider? The following provides guidance on when weight and height measurements should be taken. Additional monitoring should be included during other health check-ups/medical visits and based on the child’s growth progress: 0-9 months: At 1 to 2 weeks, then at 1, 2, 4, 6 and 9 months 12 months to 2 years: At 12, 18 and 24 months After 2 years: Once a year is recommended What services are available to assess and provide a care plan for my child? A registered dietitian (RD) can offer to review your child’s dietary intake and eating patterns and explore ways to help your child meet their nutrient needs. Children with food allergies may need extra help to get the nutrients they need for healthy growth. RDs have the training and skills to translate the science of nutrients and healthy eating into practical advice to help your child meet their nutrient needs. Ask your child’s health care provider to refer your child to an RD who works with children. You can also read an earlier post about how to find a registered dietitian. Pediatricians are physicians who are specialized in infant, child, and youth health. They have expertise in ensuring children reach their expected milestones, including their growth potential. Your child’s family doctor or nurse practitioner can refer your child to a pediatrician when additional medical care would be helpful. As part of your child’s health care team, they can offer additional insights and medical expertise and contribute to your child’s personal health care plan. Pediatric allergists are pediatricians who specialize in caring for infants, children, and youth with allergic conditions such as eczema (atopic dermatitis), food allergy, hay fever (allergic rhinitis) and asthma. They can offer children with food allergy concerns additional care such as clarifying food allergies, discussing treatment options and monitoring for signs whether a food allergy is being outgrown. Additional resource Is my child growing well? Check out this Dietitians of Canada resource that addresses some common questions about healthy growth in children Thank you Linda for the great insight! To read Linda’s other articles with us, visit our blog section, or click here to read about: How often should my child with multiple food allergies be assessed by a dietitian? Finding a dietitian Ensuring kids with multiple food allergies receive proper nutrition Tips and recipes for a healthy diet for kids with food allergies Tips for optimizing nutrition in children living with FPIES or EoE Taking supplements to help avoid nutritional deficiencies Great substitutes for each of the priority allergens – including recipes Nourishing children with food allergies – watch the 60 min. webinar Do you have a question you’d like to ask Linda in the months to come? If so, please send it along to us at email@example.com. The post Ask the expert: I’m concerned my child’s weight is too low – what should I do? appeared first on Food Allergy Canada.