Re: A great article regarding those picky eaters...it will make you feel better!

On Oct 12, 1:37 pm, Beliavsky <beliav...@xxxxxxx> wrote:

If people of different ethnic groups have different growth profiles,
the answer is NOT to use one sample that represents all groups in
proportion to their size but to have SEPARATE profiles for each
relevant group. Do such profiles exist?

And what do you do when the clinic has the charts for white, Asian,
and Latino but you're out of the black charts and have a new black kid
in clinic? Oops, left out Native Americans. How about Tiger Woods'
children, which one would they use? I could pull out a Latino chart
for my Guatemalan indigenous Mam family but the kid will still likely
be way on the small end. What you suggest might be more
scientifically accurate, but medicine isn't only about science, it's
also about practical reality. Practical reality is that creating
these growth charts is a *huge* endeavor and to multiply that by 4? 5?
8? in order to create an unwieldy system with all sorts of holes in it
would be effort much better spent elsewhere. Especially since there's
an easy formula for using mom and dad's heights to create a predicted
height range for the kid, and that will be much more accurate for that
particular kid.

As a parent, what I ought to know is not what percentage of kids of
the same age are heavier than my child, but whether his current weight
is healthy. Maybe a range of healthy weights could be determined by a
longitudinal study. Simplistically, if 2yo boys weighing more than X
have a lower life expectancy (or say a higher probability of being
obsese as adults) than 2yo boys less than X, I don't want my son to
weigh more than X, regardless of the distribution of weight in the 2yo
boy population. I realize that concluding that X is healthy or
unhealthy is often difficult and that early findings are often
reversed later.

It's recommended that all pediatricians chart weight, height, and BMI
(an assessment of weight for height) at every well child visit. It's
not universally being done yet, but the new growth charts for 2-20
year olds have weight and height on the front and BMI on the back.
Tracking BMI is an easy and practical (of course not perfect) way to
do exactly what you describe.

One of the overarching assumptions behind a lot of this discussion is
that doctors are slaves to the growth chart and don't have an ounce of
common sense. The growth charts aren't perfect and no one thinks they
are. There are patterns that are easily recognizable on the growth
charts as normal variants and some that are clearly bad. There are a
lot of gray zones where it's not entirely clear whether to worry or
not. Oftentimes more data points are necessary, so the doctor might
want a couple of more frequent weight or growth checks, but I don't
think anyone ever died from an extra growth check. Sometimes they
lead to unnecessary interventions but the same is true of any
screening test -- mammograms, pap smears, prostate cancer tests,
whatever. The point is not that they're perfect, but that on balance
they provide useful information and do more good than harm.

Kate, ignorant foot soldier of the medical cartel
and the Bug, 4 years old
and something brewing, 4/08

.

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