Ask the Pediatrician: Dr. Molly

Category: Weight

Handling the prepuberty bulge in kids

Everybody goes through puberty whether they want to or not and most kids weather the changes and adjustments quite well. One of the changes has to do with weight.

In the year or so before puberty kicks in, many kids get a little roun, especially their faces and bellies. This can cause worry for parents and children alike. Most often I encounter this concern as I am pulled aside in the hallway as I am about to enter the exam room to see an 11- or 12-year-old when the parents whisper to me they are concerned their child is getting fat. Most of the time I can reassure these parents after looking at the growth curve and the child that this round look is nothing more than the body's prelude to puberty.

Most parents remain somewhat concerned, though, because most middle school-aged kids aren't known for their love of healthy eating. Most kids will eat candy and chips with abandon even if they are somewhat concerned about their bodies, and this worries parents. With obesity rates so much higher, nipping things in the bud is increasingly important. The challenge is that this is a fine line to walk. Parents understand that everything we say and do can have one of two effects at this age: no effect at all or profound and devastating effects. OK, I understand this is a wild exaggeration but it is the way things seem, isn't it? If we say too much about our child's round appearance and eating habits, we worry we will make her so self-conscious she'll stop eating and become anorexic, but if we don't say enough she will end up obese! Quite a conundrum. Here's my advice on how to approach kids this age:

Start by weighing and measuring the height of your child and then plotting that data on the CDC growth curves based on your child's gender or age. If the height percentile and weight percentiles match (or are pretty close) you can be even more sure that this is not concerning and strictly cosmetic. Even if the height percentile is 50th and the weight is 70th, there is little need for concern. Only when the percentiles are significantly off (50th for height and more than 90th for weight for example) do you need to be concerned that issues of true overweight are present. If that is the case, see your pediatrician to talk about this issue.

It helps a lot if leading up to this time your family already has well-established, good eating habits in place. These include scheduled meal and snack times and limited unplanned snacking. In other words, have breakfast, lunch and dinner as regular parts of your day (even if they can't all be shared together as a family) and have scheduled snack time(s). If your kids get used to being able to go to the pantry and grab a snack whenever they feel like it, controlling it later is tough. In addition, have certain foods available for snacks and others available only on special occasions. For example, if your family pattern is to have an afterschool snack, offering fruits, yogurt or peanut butter crackers as the choices will make life easier later than routinely offering cookies, ice cream and chips. These other foods can of course be a part of life, but on special occasions rather than whenever the child chooses. If you haven't scheduled snack times and exerted some control over the choices, now is the time to do this. Put aside a basket in the pantry with the snack choices and put the junky food out of sight. That way no matter what your child chooses, you won't need to comment or criticize.

Another suggestion, with Halloween fast approaching, is to let your child eat several pieces of candy when first received (some parents even let the child eat as much as they want at that one time) and then give the rest away. Another alternative is to have the child put aside enough candy to have a piece every day for a specific time frame and give the rest away. This allows the child some control and pleasure but limits the total amount consumed. It is important to apply these guidelines to everyone in the family, not just the child in question.

Don't point out the fact that you think your child is gaining too much weight or looks chubby. Believe it or not, many kids who are just about to enter puberty are blissfully unaware and if you can gently encourage good snack choices and regular meal times (along with good portion sizes) you can achieve what you are trying to do without encouraging your child to focus on his appearance in this way. If your child brings up the subject of his weight with you, this can be a time to talk about controlling portion sizes and snacks and come up with a plan together. Make sure you communicate that you love your child no matter what and that we all have things we need to work on at times. If your child is significantly overweight and brings it up with you, ask him if he wants to talk to his pediatrician about strategies to get healthier.

Lastly, remember most kids will adjust their eating patterns on their own as they progress through puberty and after as a result of peer pressure or self image. The less you do to focus on the specifics of what your child is eating, the less apt he or she will be to see food as a method of power and control in the relationship between the two of you and use eating (or not eating) as a method of passive rebellion. Most children who are normal weight for height all through grade school who appear to bulk up before puberty will use that extra bulk for the huge growth spurt to come and will end up just as well balanced as they were before puberty started.