Response to a concerned mom
In response to my post 'Stop Forcing My Daughter To Eat!' -- about people forcing my daughter to join the dreaded ‘clean plate club,' -- a reader wrote in with an all-too-common concern:
This is a timely article for me. My 10-year-old daughter's doctor recently told me that he is concerned that she does not weigh enough. Her weight is in the 6th percentile. (She is 54" tall and weighs ~60 lbs.) She is extremely healthy, rarely getting sick, and participates in ballet and ice skating. She is thriving academically as well.
In our home, we also speak of food as healthy, less healthy and not healthy. She naturally gravitates toward whole foods, eating many fresh fruits, vegetables, nuts, whole grain bread, eggs and cheese. She will eat only the occasional hamburger and chicken cutlet. Most other processed foods are repulsive to her. Okay, she likes sugary treats, but I limit them to a few times a week and in reasonable portions. My doctor feels I should do anything to get more weight on her, even if that means extra junk food. I vehemently disagree. Her appetite is small; the junk food will only push out healthier alternatives.
I should add that my grown son was/is similarly lean, and he ate a lot of food. My husband and I are a healthy weight, though as adults we work at it (exercise regularly and make healthy food choices). I am nervous about opposing the doctor's directive, but I feel worse about forcing my daughter to eat beyond her body's hunger signals.
Any thoughts would be greatly appreciated.
Here is what I'd say to this wise mother:
My first thought is that your daughter is so lucky to have an insightful mother who is on her side, who is eager to do what's best for her and who listens to her child's mind and body. I also feel good for her that you are looking at her holistically, at her life, her activity level...viewing her eating habits (what, how, when, how much) within the context of her entire life seems wise.
That said, I am not a doctor nor am I a nutritionist. I'm a mom who has been to many of both and has had a wide range of experiences with folks in those fields. I'm asking my fellow Psych Today bloggers with expertise in that area to offer their own advice as well, and look forward to hearing from them.
You write that you ‘vehemently disagree' with the doctor's recommendation, to "do anything to get more weight on her, even if that means extra junk food."
If you feel like your doctor is not listening to or hearing you, if you feel that what a doctor is recommending to you about your child feels wrong, goes against your instincts and makes you extremely uncomfortable, I think this doctor is not for you.
It is one thing to feel like a surgeon has lousy bedside manner, doesn't listen, is an arrogant jerk, but is technically brilliant. A pediatrician must be somebody you can talk to, who respects and really gets your parenting views and with whom you feel comfortable and safe disagreeing, asking for more information or asking for alternative solutions. Recommending you cram your kid full of junk food to fatten her up doesn't seem like the kind of prescription a parent like yourself would go for.
I would get a second opinion from a pediatrician you feel comfortable talking to. Ask friends for recommendations. I don't know where you're from, but there may be a local parenting organization or co-op or someplace that may share your values where you could get names of good doctors.
Have this conversation with the doctor out of earshot of your daughter. It's best if you can both speak frankly and without worrying about what and how she's hearing this. Remember, to a 10-year-old girl, every word about her body lands in wet concrete and sets.
Explain everything to the doctor that you just wrote to me; the whole context of her growth, her life, her activities, her sibling, etc.. I'd want to be sure the doctor understood the context of these numbers. See what this doctor says. If this one also recommends weight gain, ask for more details, and make sure you describe your discomfort and the way your family eats. Then ask for a recommendation for a good nutritionist and lots of resources you can explore to come up with the healthiest and most comfortable strategy. Maybe peanut butter protein shakes or bars would do the trick (barring a peanut allergy, of course.) This could be an opportunity to talk with your daughter about more healthful eating, about finding ways, times and foods she likes, to make sure she understands where this is coming from, that it is NOT about how she looks, but about science - about the chemical makeup of her body needing more tools. (Again, if that is indeed the case. A good doctor would fully engage your daughter in this conversation in a way that gives her confidence, information and strategies that offer many opportunities for success.)
The bottom line is you need a doctor you can work with productively and a plan you feel good about. If Mama don't wanna to do it, it ain't gonna get done.
Here is an excellent (and much appreciated) response from fellow blogger Michael J. Formica. His blog is Enlightened Living:
Michael offers this terrific advice and reassurance:
Sounds a lot less like the need for expertise and a lot more like the need for common sense and perspective on the part of the mother. Let's see -- we have an otherwise healthy pre-pubescent girl who is quite active in two physically demanding athletic activities. She doesn't like processed foods, eats what amounts to a dairy-inclusive vegan diet, doesn't eat too many sweets and has a family history of small/lean development in her brother. My sense is that the only real issue here is that the doctor is agenda driven and can't think outside the box -- and probably that the girl isn't getting enough protein and good fat in her diet, which is the usual shortfall with the kind of diet she enjoys, at any age.
The situation reminds me of a dear friend of mine's 16-year-old daughter who, at 5'6" weighs over 140 lbs. -- first blush says, "Ooh, maybe she needs to lose some weight." -- except that she's a competitive figure skater and is nothing but titanium-solid muscle...or the doctor who not so long ago walked into an exam room calculating my BMI without looking at me (I am 5'6" on a good day, and weigh about 170) and said, "Looks like you need to start exercising and lose some weight" -- I may be pushing 50, but I have a 32-inch waistline!
The grim reminder -- doctors _practice_ medicine, and that quip comes from an MD friend of mine. Seriously, we are not used to seeing a truly healthy body presentation in this country and, for us, what is actually healthy, often doesn't "look right" or "meet the critieria", etc.
Best advice for the mom is to investigate expanding her cooking repertoire into the formal vegan side of things to accommodate the child's tastes. My good friend Marybeth Abrams is a gourmet vegan chef and she, her kids, her parents, her sibs, her sibs spouses and kids and both her ex-husbands are all strict vegan. They are all not only lean, muscular and healthy, but positively freaking glow. She does this thing with chick peas and seaweed that you would swear on your life is tuna fish and her tofu stroganoff not only beats a beef stroganoff hands down every time, but tastes like beef stroganoff to boot -- it's the paprika.
I hope this helps our reader. I'd welcome any additional comments, thougths or advice on this topic.