Episode 97: Understanding Your Child’s Growth

We’re back! After a year-long break, Anna Lutz, MPH, RD/LDN, CEDRD-S and Elizabeth Davenport, MPH, RD, LD return to the Sunny Side Up Nutrition Podcast with an important conversation about how to support your child’s growth from a weight-inclusive lens.

In this episode, we cover:

  • Tips to prepare for pediatrician visits and advocate for your child.
  • Why the 50th percentile is not the “ideal” plot point on a growth chart.
  • What does it mean when your child crosses percentiles?
  • The importance of focusing on each child’s own growth history.
  • How body diversity plays a role in interpreting growth.
  • Why height and weight data on growth charts is just information.

Episode Transcript

Transcript

Episode 97: Understanding Your Child’s Growth

[Elizabeth]:
 Welcome to Sunny Side Up Nutrition, a podcast created by three moms striving to bring you evidence-based information to help support you and the children in your life. Your hosts are Anna Lutz and me, Elizabeth Davenport, both registered dietitians, and Anna Mackay, a dietitian-to-be and certified personal trainer.

Anna Lutz co-owns Lutz Alexander and Associates Nutrition Therapy in Raleigh, North Carolina. And I co-own Penny Davenport Nutrition in the DC metro area. Anna Mackay is currently completing her dietetic internship. Just a note that this podcast is for informational and educational purposes only. Thanks for being here.

[Anna]:
 Oh my gosh, Elizabeth, it’s so exciting to be back recording again after taking a break for over a year.

[Elizabeth]:
 Yes! I’ve loved recording this podcast with you and Anna Mackay over the years, and I’m so excited for us to dive back in.

[Anna]:
 Me too. The break was really helpful while we rolled out our course—now I’m excited to get started again.

[Elizabeth]:
 Right! And just a quick note for those who are new or may have forgotten: this podcast actually started as Anna Mackay’s grad school project. During COVID, we had planned to do a live class for parents, but obviously, that didn’t happen. So Anna said, “Hey, could I just ask you guys some questions and record a few episodes?” And we did—and enjoyed it so much that we just kept going!

[Anna]:
 That’s right! So today’s episode kicks off a mini-series on topics we cover more deeply in our membership, Take the Frenzy Out of Feeding. And we’re starting with something we hear about a lot—understanding your child’s growth and how to advocate during pediatrician visits.

[Elizabeth]:
 Yes! When kids go to the pediatrician’s office, one thing we always recommend is for parents to advocate for their kids—before or during the appointment. Especially when it comes to how providers discuss weight. What tips do you have for that?

[Anna]:
 Well, growth measurements—height and weight—are an important part of a child’s well visit. That’s how healthcare providers track whether a child is growing. But unlike adults, where it’s more of a “maintenance” check-in, kids are supposed to grow: they need to get taller and gain weight over time.

[Elizabeth]:
 Right. The problem isn’t with measuring—it’s with how that info gets shared.

Here’s the next section of the transcript:

[Anna]:
 But then it’s important to think about—how is this information relayed? To the parents and to the child. Growth charts are complicated. Just the concept of growth is complicated. And so often, as we all know, this information is relayed really quickly and can be misunderstood by a young child.

If it’s something you’re concerned about, we recommend that ahead of time, you send a quick portal message asking your pediatrician not to talk about specific weights in front of your child.

We actually have letters on our website that we developed with Dr. Katja Rowell. You can use the wording from those letters to give your provider a heads-up. I’ve done that in the past, and how it’s played out is that they’ve said, “That’s totally fine,” and they just printed out the growth chart and handed it to me on the way out the door.

Now, I want to acknowledge—it’s a little easier for you and me to do that. Our pediatricians know what we do for a living. So yes, it’s easier for us than for others. But we still have the right, as parents, to say, “If you’re worried about my child’s weight, please let me know—but not in front of my child so I can fully process your concern.”

[Elizabeth]:
 Yes! That’s such great advice and so important. Because it really is confusing to kids. And honestly, it’s confusing to adults too.

[Anna]:
 Absolutely.

[Elizabeth]:
 Getting out ahead of that conversation—before you’re in the room with the doctor—is so important. Because we hear from parents who are trying to figure out how to undo the damage that happened in the office.

[Anna]:
 Right.

[Elizabeth]:
 And most parents—this is not to criticize at all—it’s just that they don’t know they can do that. But unfortunately, the harm does happen. Not because parents fail, but because of how pediatricians are trained to focus.

[Anna]:
 Exactly. It’s not really their fault. It’s part of the larger system.

[Elizabeth]:
 There’s this message that our kids hear all the time—and that we hear as adults—which is “weight gain is bad.” And so when a child is sitting in the office and hears their pediatrician say, “You’ve gained X pounds this year, and that’s not good,” it can be really scary and confusing. Some kids internalize that deeply.

[Anna]:
 Right. It can cause harm. Unfortunately.

[Elizabeth]:
 Actually, I’ll share one quick story that just came to mind. When my now 21-year-old was 3, we were at her yearly well-child visit, and the pediatrician said, “You’re going to have to watch her weight.”

And I just about lost my mind.

Here’s the next section of the transcript:

[Elizabeth]:
 Right? I didn’t get out ahead of it. It didn’t even occur to me at the time to send a message or talk to the doctor beforehand.

Thankfully, my daughter was young enough that I was able to distract her, but… it was awful. I was so angry.

[Anna]:
 I’m sure you were. And for a three-year-old—who even knows what that kind of comment means?

[Elizabeth]:
 Exactly. So, for parents who’ve experienced something like that, I totally get it. You’re just kind of knocked back and aren’t sure how to respond in the moment.

Let’s shift into talking a little bit more about growth charts—because, really, that comment from the pediatrician came from looking at my daughter’s growth chart. Even though she was following her curve.

So what are some of the common misconceptions parents might have when they look at those charts?

[Anna]:
 Yeah, great question. I think we can also talk about how pediatricians themselves might misunderstand or miscommunicate what the growth chart is telling us—and how we can reframe that through the lens of body diversity.

The biggest misconception I hear is that people believe everyone is supposed to be at the 50th percentile—like that’s the goal.

But remember, we’re talking about human bodies. The growth charts come from thousands and thousands of data points—children’s weights and heights at different ages. It’s essentially a bell curve that represents a large population sample.

And while there’s a lot to unpack about who is represented in that data and how old it is, for now it’s important to understand that the 50th percentile is simply the middle of the curve. It doesn’t mean it’s the healthiest or “best” place to be.

[Elizabeth]:
 Exactly. And if your child is at the 70th percentile for height-for-age, that just means that if they were in a room with 120 kids their age, 70 would be shorter and 30 would be taller.

[Anna]:
 Right. It’s just information.

And what we’re really looking for is whether a child is generally following their curve over time. So if someone was at the 70th percentile for height-for-age and a year later they dropped to the 40th, we’d want to pause and ask, “What’s going on here? Why aren’t they tracking along their usual growth curve?”

But even then—it doesn’t necessarily mean something is wrong. It could be something like delayed puberty. Kids hit growth spurts at different times. So, again, it’s not always a bad thing.

Here’s the next section of the transcript:

[Elizabeth]:
 Where do you think that belief comes from—that everyone should be at the 50th percentile?

[Anna]:
 I don’t know! Because when we use percentiles in other contexts—like academics—people aren’t aiming for the 50th, right? They’re shooting for higher scores. So I’m not sure why that idea got attached to growth charts. It’s a great question. We’ll have to do some research—or if you’re listening and you know, let us know!

[Elizabeth]:
 This leads into my next question: Why is it more important to compare a child’s growth to their own history, rather than to population percentiles?

[Anna]:
 Yes! I touched on this a little earlier. What you really want to look at is whether your child is growing and gaining in a somewhat predictable way.

The truth is, children don’t grow perfectly on a neat curve. They aren’t always 75th percentile for height for age, or 40th for weight. That’s just not how bodies work. People are different, and a lot of factors influence growth.

In general, what’s typical is for a child to follow their own growth pattern over time. So if there’s a big change—a veering off their usual curve—that’s a good time to stop and ask, “What’s going on?”

Then you dig into it. Is this a problem? Or is it not a problem?

[Elizabeth]:
 Right. We do see kids cross percentiles. Can you go more in depth on that? When is it a cause for concern, and when might it not be?

[Anna]:
 Great question. If a child’s weight crosses percentiles downward drastically, that’s typically a red flag. It probably means they’ve lost weight over the past year, and that’s concerning because children should be gaining weight each year—not losing.

So if the growth chart looks like they’re going down a mountain, we want to think about malnutrition or the possibility that they’re not getting enough food for growth and development.

Now, if we’re talking about weight-for-age and they cross percentiles upward drastically, we want to ask: Is puberty starting? Has their activity level changed? Has their intake increased significantly?

Those are all part of the nutrition assessment we’d do as dietitians.

But if there’s a big percentile shift and the child’s eating habits and activity level haven’t changed, and there’s no concern from the family—it may just be that the child is growing as expected for them.

Here’s the next section of the transcript:

[Anna]:
 If a child’s eating behavior has changed—say they’re sneaking food or suddenly there’s a lot more food disappearing—or if their activity level has shifted, like they used to be a competitive swimmer and now they’re recovering from a broken leg, those are important things to consider.

So when I say, “dig in and assess,” I mean: Is this crossing of percentiles a concern, or is it just a change in growth that makes sense in context?

The percentile shift is just a signal. It’s not automatically a problem—it’s a flag that says, “Hey, maybe look into this.”

[Elizabeth]:
 Right. And puberty is such a huge piece of that puzzle.

[Anna]:
 Exactly. On average, girls start their period around age 13. If they go through early puberty, we often see a jump in both weight-for-age and height-for-age on the growth chart. Their growth spurt happens earlier, so they’ll look like they’ve jumped up in percentiles.

On the flip side, late bloomers might seem like they’ve dropped off their curve, but then catch up later. That’s why we look at timing too.

[Elizabeth]:
 You’ve covered a lot! I think one other thing to touch on is height and what it means when a child’s height growth slows earlier than expected. That would cause them to drop in percentile for height, right?

[Anna]:
 Yes! That’s a great point. Again, we’d want to do an assessment. Is this child eating enough? If not, there’s concern that height could be stunted due to malnutrition.

But it could also be that they had their growth spurt early. If you look at the growth curve, it may have shifted to the left—they grew earlier and faster than average and then leveled off earlier. In that case, if a dietitian assesses and sees that the child is eating well, then there’s likely no concern from a nutrition standpoint.

[Elizabeth]:
 That’s such an important distinction.

[Anna]:
 Yes—and one other thing I want to point out from our 20+ years working with clients with eating disorders: when a child is underweight and their growth in height has been impacted, if we get nutrition back on board and the body is nourished again…

[Both]:
 …they grow again!

[Elizabeth]:
 It’s amazing.

[Anna]:
 I’ve seen it. Doctors sometimes say, “It’s been too long—they won’t grow anymore.” And then once the child is eating adequately again, they just shoot up!

Let me continue with the final section of the transcript next.

Here’s the final section of the transcript:

[Anna]:
 It’s amazing. I’ve seen it too—doctors saying, “It’s too late, they won’t grow anymore,” and then once they’re nourished, boom—they grow. It’s just so exciting to see.

[Elizabeth]:
 Bodies are amazing.

[Anna]:
 Exactly. Once someone is being fueled the way their body needs to be fueled, the body can do what it’s supposed to do. It’s really incredible.

[Elizabeth]:
 Totally agree. So is there anything else we want to touch on?

[Anna]:
 One thing that comes to mind is for parents whose kids are at the 2nd or 3rd percentile—or even above the 97th. Often doctors will flag that as a problem because the child isn’t at the 50th percentile.

[Elizabeth]:
 Yes.

[Anna]:
 And I think it’s important to know that pediatricians are trained to be concerned if a child is below the 5th or above the 95th—or sometimes even above the 85th—for weight. And also for height if it’s below the 5th.

But again, body diversity is real. Some kids are genetically meant to be small. Others are meant to be larger. So if a child is at the 2nd percentile for height and their parents are also small, that might make perfect sense.

If a child is low on the growth curve and there’s concern that they’re not getting enough nutrition, then that’s when we should stop and assess. But the goal is not for every child to be at the 50th percentile.

What matters most is that they’re tracking on their own growth curve—whether that’s 2nd percentile or 97th percentile.

[Elizabeth]:
 Such a helpful perspective. As we wrap up, what’s one key takeaway you’d love parents to walk away with?

[Anna]:
 I’d say: remember that growth charts, weight, and height are just information. They’re like a temperature reading. A fever might indicate something’s going on, but the fever itself isn’t the problem—it’s a clue.

Same with growth charts. Weight and height aren’t problems to be solved. They’re just tools to help us ask, “Is everything okay?” In most cases, they’re not cause for concern—they’re neutral data.

[Elizabeth]:
 Yes, such an important reminder. And something for parents to carry into those pediatric visits.

If you’re looking for a deeper dive on this, as we mentioned at the beginning of the episode, we cover this topic in depth in our 12-module membership: Take the Frenzy Out of Feeding. One full module is all about understanding your child’s growth and navigating well-child visits.

Alright—should we bring back our closing question?

[Anna]:
 Yes! Let’s do it.

[Elizabeth]:
 What’s your favorite food right now—and why?

[Anna]:
 We just got back from spring break and went to one of our favorite restaurants in St. Simons, Georgia. They have these amazing crab-stuffed hush puppies. So, if I could have anything for lunch right now, it would be that!

[Elizabeth]:
 Yum! For me—it’s ice cream. Even when it’s cold outside, I love it. My current favorite flavor is Graeter’s Midnight Snack. I’m never awake at midnight, but the ice cream is sooo good. It’s malted milk ice cream with chocolate-covered pretzels, malt balls, maybe some brownie bits. Super comforting.

[Anna]:
 Sounds amazing.

[Elizabeth]:
 Alright, until next time!

[Outro]:
 Thanks for listening! If you enjoyed this episode, please take a moment to rate and review the podcast wherever you listen. And don’t forget—you can join our 12-module program, Take the Frenzy Out of Feeding, by visiting sunnysideupnutrition.com and clicking the membership tab.