How parents can help their children have a positive relationship with food, exercise and sleep

In his new book, Healthy Parents, Healthy Kids, obesity researcher Dr Nick Fuller presents research-based facts and practical advice to achieve healthy outcomes for your family.

“It’s a whole family approach, a practical guide to help you do your very best for your own health, and for the person you love most in the world: your child” says Dr Fuller from the University of Sydney’s Boden Group based at the Charles Perkins Centre.

Tracking your child’s growth and development

Many parents have been there. 

You’ve taken your happy and seemingly healthy little one for their regular check-up, only to have your GP or Child and Family Health nurse measure your child’s weight and express concern because they’re “overweight”.

As a parent, hearing a healthcare professional voice this concern may be confronting and upsetting, and it’s only natural to act on their advice and immediately take steps to manage your child’s weight.

But it’s vitally important not to fixate on your child’s weight – particularly during their first two years.

So, here's everything you need to know to help understand your child’s weight as they grow, starting with a quick recap of how growth is measured and assessed.

Child growth charts explained

GPs and nurses use a variety of tools to assess child growth and development, the most common of which is measuring your child’s weight and height during their regular check-ups and plotting these measurements on a growth chart to track and review their physical development. 

Head circumference is also measured and tracked, as this is considered an effective and non-invasive way to identify problems with brain development and health.

Two sets of age-appropriate growth charts are typically used in Australia, covering: 

1. Birth to two years, which adopts World Health Organisation standards developed using studies in six countries measuring the growth of healthy, breastfed infants. 
2. Two to 18 years, which adopts charts established by the US Center for Disease Control for weight, height and Body Mass Index (BMI) created for children and adolescents specifically.

It’s important to note that it’s never appropriate to use the same measures for children as those we use for adults, such as the standard BMI calculation, and that the use of BMI as a measure of healthy weight is itself under increasing scrutiny, so should be interpreted carefully. 

Gender is also factored into child growth charts because girls and boys have different growth rates and patterns.

In essence, growth charts are designed to visualise your child's growth compared to children of the same age and gender, using percentile lines to plot their measurements against the expected range of weights and heights taken from the comparative population. 

Measurements are taken regularly and plotted on the growth chart, creating a growth curve over time to track your child’s development.

A child’s growth is considered healthy when their measurements track consistently along percentile lines. Poor growth is characterised by a child’s weight or height measurements trending downward across percentiles. 

Additionally, in children aged over two, a BMI above the 85th percentile is considered overweight, and a BMI above the 95th percentile is classified as obesity.

Here’s how to become your child’s biggest advocate at the doctors

The practice of measuring and charting your child’s weight, height and head circumference is vital, with growth charts providing a simple but effective indication of your child’s growth and development.

Growth charts can also help your GP or nurse detect any potential medical issues early for further investigation by a specialist.

However, the way in which some GPs, nurses and other healthcare professionals interpret and use growth charts – particularly when it comes to tracking weight during the early stages of a child’s life – can cause unnecessary anxiety and stress for parents.

A child who is under two years of age and tracking above the 85th percentile should never be put on a diet or restricted in terms of their food intake. All children are extremely good at self-regulating their calorie intake across the course of the day, provided they are provided with a diet that is largely made up of nature’s treats (wholegrains, vegetables, fruit, nuts, legumes, meat, fish, eggs, tofu, and dairy products), as opposed to one that is largely processed and fast food, and low in fibre. Children also need ample opportunity to move, including energetic play, as well as sufficient, good quality sleep. Children aged 4 to 11 months need 12 to 16 hours of sleep, including naps, while toddlers should average 11 to 14 hours of sleep daily.

When interpreting growth charts, it's also important to highlight the rapid physical growth children experience up until the age of two is not always linear and fluctuates around children achieving developmental milestones.

For example, the rate at which a child’s body weight increases will slow as they begin crawling and walking. In fact, it’s typical for a baby tracking between the 85th and 97th weight percentile to drop into a lower percentile when they become more mobile and active.

Therefore, it’s vital to assess trends and changes in weight over time for children aged under two. It’s important not to react to a measurement that might be an outlier.

If you child continues to track above the 85th or 95th percentile over the age of two, it is important to re-evaluate your family’s habits to ensure you are offering the principles of a healthy lifestyle in the family home.

Healthy Parents, Healthy Kids is published by Penguin Life.