Growth in the second year

My son, Sam, was a roly-poly baby who had more than doubled his birth weight by five months, and tripled it by a year, reaching 11.3 kilograms (25 pounds). In his second year, he got quite a bit taller, but had gained only a few more pounds by the 18-month mark. I couldn’t help but think that it was because he seemed to subsist on air.

His appetite apparently vanished along with the flame on his first birthday candles. Yet my doctor assured me Sam was healthy.

According to Montreal paediatrician Valerie Marchand, it’s not unusual for parents to need a little reassurance when a toddler’s growth rate slows and his appetite decreases dramatically in the second year.

Parents should speak to their doctor if they’re concerned, she says, because it’s important to look for problems that might slow the growth rate, including gastrointestinal disorders, food allergy or chronic disease. But in the majority of cases, these kids turn out to be just fine.

Overweight in toddlers is rare but becoming more common. Rarely a metabolic, neurological or physical disorder may be to blame, but often the cause is a diet too high in calories. A doctor assessing a child’s growth will look not only at height and weight gains, but at the overall pattern of growth since birth. “We look to see whether the child has been on roughly the same curve when we plot their height and weight on a growth chart,” explains Marchand, chair of the Canadian Paediatric Society nutrition and gastroenterology committees.

Growth charts are standardized graphs used to compare a child’s height and weight to that of a large number of babies the same age and sex. As a child grows, the plotting reveals a pattern and puts the child in a percentile on the chart. If she’s in the 75th percentile, that means she’s bigger than three-quarters of girls the same age, and smaller than one-quarter of them.

While some minor shifts in a child’s percentile ranking are normal, a huge change in one direction or the other may indicate a problem.

Parents should know that among babies, the range of normal is very wide — anywhere between the fifth and the 95th percentile. For two-year-old girls, that’s height anywhere between 80 and 92 centimetres (31 to 36 inches) and weight between nine and 14 kilograms (20 to 31 pounds). Marchand notes that the measurements for boys and girls are virtually the same in the first two years, with boys being slightly heavier and taller at 12 and 24 months.

A decrease in appetite that corresponds to the slowdown in growth rate is normal for toddlers, but parents may worry that a child isn’t growing because she’s not eating enough.

It’s easy to see why. Toddlers are notoriously picky, and quite often given to food jags. How can a child grow well eating only pasta this week and apples the next, or subsist on a diet of Cheerios and milk?

“If there’s good growth, a child is active and has energy, and isn’t sick all the time, they’re eating enough,” says Marchand. “Forcing children to eat beyond their appetite is never good because they may have bigger problems later on, like an aversion to food.”

Her advice is to offer healthy foods and leave it up to the child whether he eats them. “Don’t aim for perfection, but do take a structured approach,” says Marchand. Offer three meals and snacks a day that include something from three of the four food groups.

If a child is growing very slowly, it may be that he’s not getting enough calories in his diet. Normal toddlers up to the age of two should be drinking homogenized milk and eating full-fat yogurt. If you’re trying to increase calories in your toddler’s diet, look to healthy, calorie-dense foods, like full-fat cheese, nut butters and avocado.

“Be careful not to buy in to advertising campaigns that promote toddler formulas as a way of ensuring adequate growth. They may be useful if the child has growth problems, but should not replace meals and should be used on the recommendation of a paediatrician,” says Marchand.

Growth by the numbers

Here are guidelines for average growth over the first two years:

Birth 12 months 24 months Weight 3.5 kg/7.7 lb 10 kg/22 lb 12.5 kg/27.5 lb Height 50 cm/19.6 in 75 cm/29.5 in 87 cm/34.2 in Head circumference 36 cm/14 in 46 cm/18 in 49 cm/19.2 in