kids’ corner - case study
by Kate Harrod-Wild
Paediatric Dietitian
Toddler obesity
I have previously described two
size but his parents were apparently
morbidly obese toddlers under my
unconcerned. Mum was six months
care and here describe a further
pregnant at the time of the ap-
case.
pointment and Dad worked away,
Bella was referred to the paedi-
so Mum was the main caregiver,
atric dietitians by her Health Visitor.
although she worked full time while
At referral she was two years four
Bella was cared for by her maternal
months and was 19.52kg (>99.6th
aunt. However, Mum was about to
centile) on the Health Visitor’s scales.
go on maternity leave.
This compares with a birth weight
From diet history, milk intake was
of 1.67kg (50th centile) at 32 weeks
down to 500mls per day (from a
gestation.
bottle). Mum completed a food di-
Six weeks later at follow up Bella’s
The Health Visitor reported that
ary which showed a daily intake of
weight had reduced to 23.0kg at a
she had breast fed well for eight
about 1200kcals/d, which is gener-
height of 96.6cms and her BMI had
months and had weaned on to
ally appropriate for her age (EAR:
reduced to 24.7. Mum was follow-
solids without problems. Initial growth
1165kcals/d). However, there was
ing the meal plan and was adher-
had been on the 25th centile,
obviously a need to reduce her
ing to the limit on milk by diluting it.
increasing to the 75th centile at 18
weight gain (or effect a small weight
Night waking was a problem and
weeks and to the 98th centile at one
loss), therefore an approximate
Mum was advised to consult the
year. By the age of 16 months her
calorie intake per day of 800kcals/d
Health Visitor for help with a behav-
weight was above the 99.6th cen-
was selected and a meal plan pro-
ioural management plan for sleep.
tile. The Health Visitor reported that vided to the family; this has proved
Mum returned once the baby was
she had been drinking milk day and more successful in these families with
born (another girl) for further fol-
night, up to four pints (two litres) in 24 very overweight children compared
low up when Bella was two years
hours. with generalised advice. To effect
nine months old. Despite Christmas
On the advice of the Health Visi- this reduction, Mum was asked to
occurring since her last visit, as
tor, Mum managed to reduce this avoid high fat meat products and
well as the birth of the new baby,
to two pints (one litre) a day. Bella added sugar drinks. Mum was offer-
Bella’s weight had again reduced to
was otherwise described as having ing an added sugar muesli, so she
22.4kg, which at a height of 98.9cms
a ‘balanced’ diet. Mum was con- was advised to switch to another
now gave a BMI of 22.9 however,
cerned about the weight gain. Bella cereal and to use semi-skimmed milk
Mum felt this was partly due to a
was being investigated for asthma (maximum of one pint a day, includ-
chest infection. Mum continued to
– although there was uncertainty as ing for cereal). In addition Mum
exercise strict control over her intake.
to whether breathlessness was due was advised to reduce portion sizes
Mum was encouraged to continue
to asthma or her excessive weight. generally and to use a smaller plate
and to tackle the issue of bottle use
On her first visit to the dietitian to help minimise the impact of this
with the Health Visitor once she felt
six weeks later, Bella weighed change.
more settled with the baby. Bella
23.6kg (>99.6th centile) at a height In addition, referral to our paedia-
will continued to be monitored at
of 96.4cms (98th centile) giving a trician with an interest in endocrinol-
intervals to ensure appropriate linear
BMI of 25.3 (>99.6th centile). Mum
ogy was recommended to the GP to
growth and progress towards a more
was very concerned about Bella’s
check for any underlying cause for appropriate weight.
weight. Mum herself is slim, but Dad
Bella’s obesity. He is currently arrang- This case study illustrates how
and his family were described by
ing relevant investigations, but feels much a determined and positive
Mum as ‘big’. Mum reported that
there is no obvious endocrine cause parental attitude can affect out-
one of Bella’s cousins was a similar
for her excessive weight gain. come in this difficult to treat group.
Quotes of the month
“
Junk food marketing messages are skewing children’s ideas of what is
normal food, and is undermining their understanding of treats.
Dr Mike Knapton, British Heart Foundation
”
NHDmag.com May ‘08 - issue 34 33
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