Diet-Free Well Child Visits

I took my children to each of their well child visits over the last several weeks. It was the first time we had been to the pediatrician’s office in over a year. During the pandemic, there has been so much focus in the media about weight gain and specifically weight gain of children. As the world continues to open up I wanted to remind you what IS important about your child’s health and that you CAN ask your pediatrician not to discuss weight in front of your child.

This year has been an extremely challenging one for children and teenagers. In my nutrition private practice we have seen an astronomical increase in referrals for children and teens with eating disorders. I’ve had pediatricians ask me how they can discuss weight and food differently in their offices and how they can support children and their families more with these topics. This time is highlighting why we need to take the focus off of weight and onto true indicators of health. If your pediatrician is interested in learning about eating disorder prevention, they may want to check out this webinar I offered through National Center for Excellence in Eating Disorders: NCEED.

Weight gain is a sign of health

One thing to remember is that children gain weight. They are supposed to be gaining weight. Some children may have gained more weight than “expected” over this last year with changes in activity level and eating schedules or just genetically how they are individually intended to grow. I know, for example, one of my children doesn’t eat very much when they are in the school cafeteria. The cafeteria can be full of noise, smells, and other distractions. It’s often that a lot of their lunch comes back in their lunchbox. However, they ate a full lunch while they were home doing virtual school this year. This was a change in their eating schedule that may have affected how my child gained and grew this year.

Although we think it’s a good idea for doctors not to discuss weight in front of children, it is important that children are weighed and measured once a year to make sure they are growing and gaining. A lack of growth in height or if a child doesn’t gain weight or loses weight, can be an indicator that something concerning is going on. Weight and height need to be monitored, but the interpretation of growth can be abstract and confusing for a child to understand, and best left up to the adults.

Girl with dark wavy hair sits at a table studying with a water bottle. She smiles at the camera. — By Jeswin Thomas via Unsplash

Asking your pediatrician

We’ve gotten feedback from parents that it can feel awkward to ask a pediatrician not to discuss their child’s weight in front of their child. That makes so much sense, as this is going against what is commonplace in most pediatricians’ offices. However, one thing to remember, is this request is in line with the American Pediatric Association. As parents, we can shift the conversation that happens at the well child visit. This shift is protective against eating disorders and creates space to focus on more important health parameters and true health promoting behaviors.

I know each pediatrician’s office operates differently, and I have lots of privileges that make it possible for me to request this of my children’s doctor. I understand that not all parents feel as if they can make this request of their child’s doctor. My hope is discussing weight directly with a young child stops being a part of the well child visit and that soon parents don’t have to request this.

Contact your pediatrician before the visit

How I personally handle this is I send an electronic message to the physician prior to the well child visit. I’ll say, “As a reminder, please do not discuss my child’s weight in front of my child. Feel free to print out their growth chart and if you have any questions or concerns we can discuss privately.” You can also consider sending or handing your pediatrician this letter that I wrote with Katja Rowell. Several years ago, when my children were younger, I verbally asked the pediatrician to stop discussing weight in front of them for future visits. I have been lucky enough that the pediatrician listened and has followed my request.

So, if you’re not talking to your pediatrician about your child’s weight, what IS important for your pediatrician to be asking you and or your child about?

What are indicators of true health in children?

Child sleeping with a stuffed teddy bear.

Mental Health - The pandemic has taken a toll on our children’s mental health. Children have been more isolated and so much was taken away from them. It’s important for health professionals to be checking in on how a child is doing mood-wise, what they are enjoying/looking forward to and what mental health support they may need.
Sleep - Children need sleep! The American Pediatric Association recommends that children 3-5 years old get 10-13 hours of sleep per night, children 6-12 years old get 9-12 hours of sleep per night, and children ages 13-18 years old get 8-10 hours of sleep per night. Getting less sleep than needed has been linked to increased risk of health and behavioral concerns.
Exercise - Exercise or movement helps our health in so many ways. Just as children have different personalities, children have different perpencities for exercise. As parents, it’s our job to provide our children with opportunities to move their bodies in ways they enjoy. We like how Ellyn Satter discusses exercise. Discussing screen limits is one way movement can be encouraged.
Safety - Pediatricians ask important questions about safety in the home. Including seatbelt use, gun safety and bike helmets use.
Food - We’re not big fans of the pediatrician asking young children if they’re eating enough vegetables. Questions about specific foods need to be directed to the parents and responsive feeding education and support offered to the parents. The most important food topic a pediatrician can screen for is food insecurity. Food insecurity is a risk factor for health problems, including eating disorders.

Once the focus is off of weight and height, it’s amazing what can happen in the doctor’s visit. A true connection can occur and true indicators of health focused on.