Posts Tagged ‘WHO’

Percentiles, Explained

Wednesday, August 5th, 2015

Percentiles, ExplainedIf you’ve taken your little one to a well-child checkup, you’ve probably heard the numbers. In fact, you might be more motivated to know the numbers than your pediatrician. In the many ways we concern ourselves with our children’s development and milestones, growth percentiles are among the most tangible. “We’re in the 90th percentile,” your friend touts. You might feel anything from disappointment in your child’s growth to annoyance at your friend’s pride. Take a deep breath and let those feelings go, because that is not what the growth chart is about.

Percentiles provide comparison of typical growth, not for the sake of comparison so much as to ensure your child’s general well-being. If your child is in the 50th percentile for height, among 100 children about fifty would be taller and fifty shorter than your child. Height and weight measurements continue through the years of adolescence, while doctors only monitor head circumference for the first three years of life when development is so rapid. Observing head circumference allows doctors to assess adequate brain development in a child and rule out any concerns if little or excess growth occurs.

Two common charts come from the Center for Disease Control and Prevention (CDC) in the United States and the World Health Organization (WHO). WHO growth standards utilize 6 countries in the world that provide “optimal growth” environments for children ages 0 to 59 months. The six countries include: Brazil, Ghana, India, Norway, Oman, and the United States. This means that, among other things, both mothers and babies studied met the minimum international nutrition recommendations for optimal health. The project was funded by a combination of governments, United Nations agencies, and the Bill and Melinda Gates Foundation.

WHO more fully represents growth standards associated with breast-fed children compared to the CDC. Even the CDC says its own charts lack some of the methodological standard that WHO utilizes. CDC uses small sample sizes in the first 6 months of life compared to WHO’s frequent evaluations over time (longitudinally) of a more representative population. The CDC’s charts were updated in 2000 to better represent America’s diversity.

The bottom line is WHO growth standards more fully incorporate breast-fed children in their growth curves and have more accurate data in the early months. WHO also more fully represents a global perspective on “optimal” growth as opposed to simply a comparison of typical growth in the United States. This could matter for a family who has a healthy but lower birth weight child or a child who is exclusively breast fed beyond the more typical 0-6 months in the United States.

Ultimately, you know your child best. Your child’s individual curve is most important. If your child has always stayed in the 25th percentile, your child’s smaller stature is not necessarily concerning. If your child was always in the 75th percentile and, in the last year, has fallen to the 25th percentile, your doctor might be concerned about why your child has not continued to grow as is typically (or optimally) expected. Even still, a small dip or jump here and there can be typical as children hit growth spurts, have illnesses, and picky habits at different times. Genes, the environment, nutrition, and activity can affect your child’s growth.

Growth charts offer a clinical impression of a child’s growth at any given age, but if used wisely, they also provide room for the nuances of every individual child’s unique story.

Lynette Moran shares her life with her husband and two sons, ages 1 and 3 years. She has cloth diapered both since birth and enjoys all things eco-friendly and mindful living.

Why Nursing a Toddler Isn’t Selfish

Thursday, August 14th, 2014

It’s a comment I see anytime the debate on full-term nursing is brought up: That mom is just being selfish.

Full-term nursing shouldn’t be a debate—the American Academy of Pediatrics and the World Health Organization both agree that nursing until 12 months is a minimum recommendation. By 12 months of age, most babies are now toddlers.

There’s no magical age at which breast milk quits having nutritional benefits. It has the same amazing nutritional content all along. As babies grow, it is replaced by solid foods more easily. But it’s the baby that changes, not the milk.

Here are a few things you need to know about nursing toddlers:

  1. It’s uncomfortable. When you nurse an infant, you are meeting their needs and all you have to do is sit there and relax. You can even take a nap if you want! Toddlers pinch, they scratch, they turn their heads and look around. They stand up, they sit down. They’re on, they’re off. Sometimes they bite, both intentionally and not. There is nothing fun about this for mom. No one likes being treated like a bounce house.
  2. They grow up gradually. You don’t come home from the hospital with a 25-pound toddler and start nursing. You bring home a tiny baby that becomes this 25-pound toddler. You make little adjustments to your nursing relationship all along the way to make it work for you both. You still know what they look like when they are sleeping, how they act when they’re tired, and when they need you. To outsiders, your baby might seem big, but when you see those eyelids flutter as they nurse off to sleep, it takes you back to your first nights as their new mom.
  3. You can’t make them do it. Nursing requires engagement by both parties. Latching is not an easy task, which is why so many moms and newborns struggle with getting it right at first. So to say that someone is “making” their child continue to nurse is just absurd. Just like you can’t physically make your child chew and swallow a food they don’t like, you can’t make a child nurse. The power to do so or not is theirs and theirs alone.
  4. They really do need it. (Really.) You hear people say that once a baby has teeth or can eat solid food, they don’t need to nurse. The benefits of nursing go well beyond food, even though breast milk is always nutritionally beneficial. Nursing helps babies and toddlers transition, it provides them comfort, and it helps them calm down when their developing emotions are more than they can handle.
  5. It’s a sacrifice but we do it anyway. Moms who nurse toddlers are sacrificing their personal space, their sleep, their comfort, and at times their dignity. When you see a mom nursing a toddler on a bench at the mall, in the waiting room of a doctor’s office, on a plane or bus, rest assured that she is trying her best to enjoy these last fleeting moments. It’s not easy. It’s not about flaunting anything or showing off. We are just caring for our toddler, who not very long ago, used to be a tiny baby.

People might misunderstand the things they hear nursing moms say, like “I will be so sad when she’s done nursing,” or “I don’t want him to wean yet!” or simply, “She’s growing up too fast!” But just like any other stage of life, we find the good, the blissful, even, in things we once found difficult.

Nursing is so hard. You won’t find a mom anywhere who hasn’t groaned, “Already?” at a crying baby in the midst of a growth spurt. But just like any other life stage, you find a way to get through it, and even find parts you love, and when it’s over, it’s bittersweet, even when it was the hardest thing you ever did.

Erin Burt is a freelance writer and mom of three who struggled to nurse her oldest and is enjoying every last session with her youngest. She lives in Queensbury, New York.


Are You Still Nursing?

Friday, May 23rd, 2014


“Are you still nursing?”

Are You Still Nursing?This question was a point of pride with my first baby, since nursing was a struggle. It was a question asked in solidarity: Are you still with us? Are you still hanging in there? Do you need support? The tone was hopeful; the smiles, adoring.

But now, it’s hard when people ask, “Are you STILL nursing?” Because now that word, in all caps even as it hangs in the air between us, means, “She’s too old,” “You’re babying her,” “She doesn’t need it anymore.”

Walking is not an indication of readiness to wean. Either is the development of speech, or the emergence of teeth. Do you know what is an indication? When mother and child are ready to move on. And they do, every single one of them. Because do you know any adults who have to nurse to sleep? Me either.

I never made it this far with my first two babies. I am so proud to be nursing still. But sometimes it’s hard, despite research and recommendations by the AAP and the WHO saying nursing is best well beyond 6 weeks or 6 months. It’s hard when a once-supportive family now disapproves, your husband asks when you’re “going to quit” like it’s a bad habit you can’t kick, and your baby is big and strong enough to do somersaults that twist your nipples around like Silly Putty.

I think we have discovered in our society that biggest isn’t always best. Mass-produced food isn’t the best. Mass-conceptualized education isn’t the best. Giant corporations aren’t the best. That’s because as people, we have a limited scope of knowing and understanding, and when something gets beyond the scope of what we can do well, we either have to fake quality or scale back in order to achieve it. In many of these areas, we’ve chosen to fake it, and now we are feeling the consequences of that decision.

Health care in this country is feeling that edge. Women have realized it, and that’s why many are shifting back to providers who use evidence-based practices when it comes to things like childbirth and infant care. We want someone to come in and really look, really listen, and then respond to us as individuals, not numbers on a bell curve.

That’s why there is no one age, one factor, one indicator of when someone should stop nursing, and there should never be one. We are still nursing because our baby needs to. When they don’t need to anymore, they won’t, and that will be that.

Erin Burt is a freelance writer and still-nursing mother of three girls who lives and writes in Queensbury, New York.