Word of the day – Titillation

Abigail Breslin and Paul Dano in Little Miss Sunshine [lavieboston.com]

Music video day at the park – youtube may rock but it also perturbs. I am not sure how I wandered into children’s dance competitions but it appears to be a very competitive sport. Skilled and with judges that may not have a section on their score card – or more to the point – on their entry form describing and defining parameters about the appropriateness of costume and choreography for a child’s event.

If even very skilled little girls never won a single competition if they chose to enter the stage in red satin and black lace – then probably fewer little girls would be sent onto a stage dressed in tutu bikinis and thigh high stockings.

Emotional growth, step by step

To review economics and the law of supply and demand – “where there is a demand . . . there will always be a supply” – the cost may vary at different times and places. Currently the price is free with open internet access – and I am not against open internet at all – but little girl competitions and manipulation of thumbnails to make it seem like pornography are tactics that titillate enough viewers in the world to run up the both the view count and the comments – insightful and less so, but interested. Pedophilia, boredom, concern for the children, reasons may vary but the underlying truth is – sex does sell, or at least it attracts attention. Good or bad – attention-seeking is a drive also.

Seeking approval outside of yourself, attention-seeking behavior, is also a symptom found on the laundry list of the Adult Children of Alcoholics and Dysfuntional Families group. The hardcover book is only $15 and the yellow workbook is only $10 [adultchildren.org]- I gave copies to several friends and family members. Trying to relive childhood dreams through directing one’s child’s activities in pursuit of  of the lost personal dream can also be a symptom of laundry list living – denying real reasons

If it were a Halloween costume talent show competition and one of the categories was Burlesque theatre review, then it would make more sense to me. A very favorite movie, predating love for the Showtime series, United States of Tara, is the black comedy, “Little Miss Sunshine” that takes a magnifying glass to the underbelly of junior, junior miss talent competitions (grade school beauty shows) and the negatives of traveling with a dead body (Grandpa passed along the way – but it was his time – and the show must go on). Abigail Breslin delivers a Best Supporting Actress winning role in the movie as the dancing dynamo that grandpa had assisted with development of a routine for use in the talent section of a Little Miss Sunshine contest. Some of the men loved the routine while the judges were aghast and the emcee was frantically unsure of how to get the little girl (the actress Abigail) to stop her booty shaking routine.

[Grandpa is still alive in this photo of the family at the ice cream road stop scene from the movie “Little Miss Sunshine” , on imdb.com, Abigail Breslin photo collection.]

Red satin and black lace dressed a different set of girls in the following video from a 2009 world dance competition. They are physically very gifted athletes, performing a tiny sized version of every other music video that has been released. They are training from a young age to do extremely well in an extremely competitive industry – show business – or was that Burlesque theatre – I sometimes forget the terminology commonly in use.

World Dance competition (not sure of details about the event), 2009,  link – while I appreciate the athleticism of the girls dancing in the video, I do not appreciate the underlying message that a little girl dance competition industry supported the development of a routine and costume that could grace any Las Vegas night club stage any night of the week – and deservedly so – they are professionals.  But they are also seven years old and to think about the disciplined effort that they all had to practice to achieve such mastery suggests that they didn’t have many innocent days at the beach.

Mastering a skill has been said to take the equivalent of 10,000 hours of practice (said by psychologist, K. Anders Ericsson, who studied the skill level and practice habits of students at the Berlin Elite Academy of Music, and the research is described by Malcolm Gladwell in his book The Outliers). These little girls didn’t learn the moves the way that I learned the dance moves that replicate horizontal practice hours.  Innocent booty shaking or stylized booty shaking is generally a little less graphic then those talented little seven year old girls managed to imitate, artfully I am sure – they are winners. I am only suggesting that the style that they have mastered the imitation of really doesn’t belong in a child’s dance class – or if it does then – why does it and who got to decide that anyway?

Also red satin and black lace bikini tutus and thigh high stockings don’t belong on any seven to seventeen year old if honesty were truly our policy, not just the best policy.

But who am I to judge anything – I think they are great and it is a standard style of the dance industry – flashy, shiny, and shaken more than stirred.

Artist: Beyonce‘, Song: single ladies (?)    7 year old girls going hard on single ladies, link

Youtube Channel:  HaruHaru765     # Views on 12-9-2011:  4,651,503
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While the dancing above is superb,  I prefer the following youthful display of fun and girl power:

Artist: Beyonce’  Song:  (Girls ) Run the World (Sierra Neudeck) link

Youtube Channel: rdneudeck
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Micky Dolenz, in “Circus Boy”

And for a trip back in time, to a more innocent time – a clip from the Television comedy/music video show, “The Monkees”. Each show had a loose plot structure that tied together early versions of what music videos eventually became. The show was somewhat modeled after the Beatles’ movie “A Hard Day’s Night” (these opinions are actually Tom’s musical trivia opinions). My trivial mind can add that in the following video the Monkees are singing portions of a famous children’s poem “Saturday’s child is fair of face” I remember that Wednesday’s child had far to go and one of the days of the week was full of grace but I will need to google a bit to flesh out details of that memory. (per Wikipedia – Mother Goose Rhyme says “Saturday’s child works hard for a living”. – The Monkees , “1966 to 1968, the musical acting quartet was composed of Americans Micky Dolenz, Michael Nesmith and Peter Tork, and Englishman Davy Jones.,” were young adult stars – now that I think about it – they probably had fun  getting to the beach themselves.

*** Micky Dolenz was an American child TV show star. His role was water boy for the elephants in a traveling circus – that sounds like a fun job but I bet elephants drink a lot of water and there weren’t as many electric pumps attached to faucets – a hand pump and bucket may have been involved. Times they have a changed but thirst continues to happen. (happy early birthday – 3-8-1945)   mickydolenz.com/gallery

***Davy Jones, born in Manchester, England (the other Monkees were American) also was a child star beginning at age 11, brief pause at age 14 to pursue becoming a jockey but went back into acting in a traveling show of the musical “Oliver”. His role was a main supporting role as “the Artful Dodger”, the engaging pick pocket that helps the more gentle orphan, Oliver, learn new life skills (pick pocketing and running very fast).  [ DavyJones.net ] [ http://keepupwithjones.davyjones.net/ ]
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Artist: The Monkees television show clip  Song: Saturday’s Child     link – video has Monkees on unicycles

Youtube Channel: utoobuser101

Micky Dolenz, 2009, at Whatever Works

The Monkees can also be seen playing the song live, 2011 Tour, on Youtube, but I like the fun day at the beach version. It reminds me of playing with my sisters and big brother. I also remember being highly offended somewhere around the age of  4 or 5 when my mother started making me wear a shirt in the summertime – everyday – all day long – and my brother still didn’t have to and he was way, way older than I was. It still doesn’t seem fair, not really but I understand a little better now.

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Wikipedia [link] says that Monday’s child was fair of face and Wednesday’s child is full of woe and Thursday’s child (day of the week that you were actually born on) is the one that had far to go.  – I learned of the poem from the book … ??? will have to look around the house – somewhere I still have it.

Nope – not that book actually but I love some of her other books, “Ballet Shoes” and “Dancing Shoes” (originally published as “Wintle’s Wonders“)  [Amazon reviews of an abridged version].

….. children’s novel by (Mary) Noel Streatfield called Thursday’s Child. [Wikipedia]

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In continuing the virtual hunt I found a book assembled by Suzanne Somers, called “Wednesday’s Children”, a collection of celebrities who have shared stories from their childhood experiences. Amazon link to the book 
Amazon Suzanne Somers author page

Excerpt from the one review posted by “a Customer” [link]:

  • Some parts are incredibly shocking but the fact that these people have emerged to live their lives and be in a continual process of healing, is a triumph of their spirits, and to me the triumph of the ultimate spirit of good in the world, after all. An intense but compelling read, and one every abused child should read.

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 http://www.amazon.com/Thursdays-Child-Sonya-Hartnett/dp/0763622036
– children’s book set in Great Depression – Thursday’s child is digging a tunnel under their shanty – cool.
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http://thursdayschildinc.com/
A public Early Intervention program for children under age three, to assist families with children who have been diagnosed with PDD/autism.  -in New York, Early Intervention Programs (EIP) for areas in Brooklyn, Queens, and Staten Island.
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http://www.thursdayschild.org/
A support site for assisting runaway children, teens,

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I had forgotten “Friday’s Child” by Georgette Heyer, “The Big Name In Regency Romance Writing” [Amazon] – have your dictionary nearby if you haven’t read Georgette Heyer before.

Excerpt from the “Editorial Reviews” section:

  • Friday’s Child is a cut above the rest, which is saying quite a lot since this is Georgette Heyer we’re talking about and all her books happen to be fantastic. Friday’s Child is filled with likable characters that stick with you and witty dialogue that will make you laugh out loud. (Katie Trattner Blog Critics 20080903)

;;;;;;;;;;;;;;;;;;;;;;;;;;; ( I ran through all the days of the week and didn’t find it and was going to give up – but I just remembered – The Days – I think it was a family and all the kids were born on different days of the week – eureka! – nope – cleaning the house may be easier after all – the father grew gorgeous dahlias and then had a serious accident and they had to move away to a country estate and take in boarders – not sure but set in England in 1950’s I think.)

******* A major problem in our society is that the definition of “abused child” can become very blurred – are 7 year old circus performers abused or in training for an exciting and fulfilling career in the circus?

***Take note that in the poem, below,  the word “gay” had a different common usage than the more typically used definition today tends to imply. However one might pause and reflect on the joyfulness that that original meaning of the word gay actually implies. It is joyful to embrace ones inner nature and proudly live life following nature’s instinctual messages. Who are any of us to judge anyone’s choices in life but our own.

from Wikipedia page:

Common modern versions include:

Monday’s child is fair of face
Tuesday’s child is full of grace,
Wednesday’s child is full of woe,
Thursday’s child has far to go,
Friday’s child is loving and giving,
Saturday’s child works hard for a living,
But the child who is born on the Sabbath Day
Is bonny and blithe and good and gay.[1]
~~~~end of my original post, I removed the images which were not mine.
The point of that post which may have been unclear in the rambling style I was using was simply for parents of young actors and dancers to be cautious about leaving their children alone with talent scouts or other adult trainers who might manipulate the child into doing things which the child can’t possibly understand or might understand but who might think pleasing the adult in order to win a competition or a role is more important to their parents than protecting themselves.

Communicating from a place of equality is important for a healthy relationship in my opinion, and in other health professionals too. Training materials about communicating from equal perspectives have been developed for use with domestic violence and batterers but the handouts might be helpful for anyone who feels they may be in a business or personal relationship where communicating seems to not go as expected. Power struggles can be part of many types of relationships not just within families.

Training materials about equality within a conversation or within a relationship, the Power and Control and Equality Wheels, were developed for helping victims of domestic violence and batterers learn how to recognize problem behaviors within their communication and actions. Family therapists may work with the whole family to practice new ways to communicate because if one person tries to change on their own the others may feel the new style of communication is an attack rather than an attempt by the previously unassertive person to try to communicate their needs.

The handouts may be helpful for most age groups as emotional manipulation or abuse of power and control can occur in many types of relationships not just between couples. Discussing the difference between equal exchanges in a conversation and unequal ones in a calm neutral setting may be helpful to prevent a difficult exchange from ever happening in the first place.

  • Power and Control and Equality Wheels:  The Power and Control Wheel (I.21) was developed by the Domestic Abuse Intervention Programs (DAIP). (I.22) Manipulative behaviors are grouped into eight categories in the model. An additional Equality Wheel (I.23) was developed to help guide batterers and victims of emotional or physical abuse towards healthier ways to interact. It is grouped into eight equivalent categories with examples of healthier ways to interact with each other. Problems frequently can involve communication issues by both people in a relationship.

Crisis Hotlines and Resources:

  • U.S. National Suicide Prevention Hotline: Call 1-800-273-8255, Available 24 hours everyday. (I.16.suicidepreventionlifeline.org)
  • National Helpline: Substance Abuse and Mental Health Services Administration: “SAMHSA’s National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service), is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.”  (I.17.samhsa.org)
  • Rape, Abuse and Incest National Network, RAINN Hotline: 1-800-656-HOPE, (I.18.RAINN.org)
  • National Domestic Violence Hotline: 24/7 confidential support at 1−800−799−7233 or TTY 1−800−787−3224. (I.19.thehotline.org)
  • Child Welfare Information Gateway: a variety of toll-free hotline numbers for concerns involving the safety of children. (I.20)

See a healthcare provider for medical advice, diagnosis or treatment.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

Still not easy being a kid -but especially hard being an over-weight kid-

Sad news story of the day – 8 year old boy in foster care because of “medical neglect“: “A spokeswoman says the county removed the child because caseworkers saw his mother’s inability to reduce his weight as medical neglect.

Now if we put all children over a certain size in foster care, then . . . .  it is impossible my mind can’t even take that sentence anywhere.

Home is a family, even a struggling one.

We can’t put all overweight children – even really overweight children in foster care – we can’t force parents to reduce their child’s weight . . . . because we can’t do that. We could chop off the child’s foot or hand or trim the little chubby body with liposuction . . . but that wouldn’t work either. Liposuction has been found to create little floating clots of death (rare and I need to fact check that but there are some complications with fat globs going places they ought not go.)

So are gastric bypass surgeries that far off if we “have to do something” to help those poor parents reduce their child’s weight? Obviously diet and exercise aren’t working. This summer it was decided that a nutrition appointment would be classified as a C recommendation because studies hadn’t found that much effectiveness for one physician office appointment on nutrition. A series of nutrition appointments with a nutrition professional had been found more effective but the two types of activities were lumped together under the C recommendation – or “we didn’t find this very effective and therefore don’t bother to recommend it” category. Well I don’t recommend a nutrition appointment with a physician either so I guess I do agree with the government health care recommendation after all.

If I had forgotten to mention Iodine lately, I will again – iodine and selenium and magnesium and zinc and too much calcium and vitamin D all add to obesity problems due to the metabolic imbalance and lack of enzymes that are essential to start repairing and rebuilding crucial building blocks.

We can only grow healthy brain and heart cells in petri dishes if the petri dishes are well fed.

The poor child in foster care may very well be better off (but I am highly suspicious)- stories in the news are gossip until pictures and video and eye witness accounts can be shared.

My first question with any overweight child or parent was “What types of beverages are being consumed regularly?” One three month cycle later and the parent often responded to the “how is the picky eating problem? with a slightly confused “No problem any more, thanks for asking.” Juice and milk were frequently either filling the kids up enough that they weren’t eating other stuff well and were too skinny or they were also eating the other stuff and were too “chunky”. I really don’t use the word fat – generally. This current news story about an”obese” 200 pound child is just so sad. That child is not alone, the weight might be excessive but there are many obese children now. Four year old’s that weigh 80 pounds, and two year old’s that weigh 40 pounds are becoming much more common. (I might expect a four year old to weigh 40-50 pounds and a 2 year old to weigh 25ish). [Growth chart post]

If we can’t “make” our adults the “right” weight, then how can we expect parents to be able to force their children into the “right” weight. Circumstances vary and this child may be in a bad situation but then let us label the variety of bad or neglectful factors. If pop and junk food and television shows are the only thing available and the child is overweight, then why is that family much different than any other family with junky diets and television habits.

Do we have any proof that the child was being force fed or fattened up on purpose. What constitutes medical neglect?

  1. Is the child filthy with yeast growing behind his ears and in other flesh folds?
  2. Is there diaper rash (eight year old version).
  3. Is the child somewhat muscular with reasonable respiratory fitness – aka does the child get to play physically and is healthy enough to run and jump (ponderously but,  hey, strength comes from hauling that weight around all day).
  4. Other usual indicators of health and a healthy family home are eyes that are curious and moist – sparkling; skin that is moist and elastic without eczema, easy bruising or frequent skin infections; hair that is strong rather than brittle and not thinning or sparse.

Health can occur at a variety of sizes and healthy family relationships can also occur at a variety of sizes …
I ask again what is “medical neglect” . . . really what is medical neglect . . .  neglect of health perhaps.

200 is just a number. A sad number for an eight year old, but really just a number that tells me very little except that prejudice is alive and well in America.

Got Civil Rights? trade up – ditch the milk – I hear it might reduce magnesium absorption and may lead to obesity and osteoporosis and cancer and exacerbate liver cirrhosis.    I like Civil Rights.

(Take home point – give the child less milk and juice and see if that helps whether in foster care or back home.)

Junk food and beverages that are not water are designed to appeal to the taste receptors. When someone is born with a limited ability to recognize full as well as other people and may also have less impulse control (the Great Dane of an appetite instead of a toy poodle), then weight gain piles up. A home with the quick easy, tasty foods and limited physical play time – is pretty common actually. Children can not be “reasoned” with, their brains aren’t developed fully yet, particularly when under age seven. Young children do not understand abstract / non-real explanations (milk makes strong bones -how- it’s a liquid – seems confusing/ turns out is confusing).

Kids do best with physical hard facts or consistent rules and boundaries. Sometimes because I said so is the best answer and I hadn’t realized that with just my own two – it took my mistakes plus observing others’ successes and mistakes (and reading a lot of Alice Miller and other authors). Joking – because I said so would be handy in a pinch to enforce the family rules that had been more mildly laid out over time. Authoritarian control and spineless wishy-washiness are not the best parenting tactics to promote independent thinkers. Positive loving discipline means reasonable rules about helping each other and keeping one’s stuff out of the shared spaces and expected lines of communication / when to expect someone home.

Little kids and medium and old kids may resist boundaries but some reasonable rules are necessary to promote health. “Medical neglect” seems like an unreasonable term to use about body size. Is the plan to strap the child to a treadmill in the doctor’s office on fortified gruel and just run, run, run until the excess weight is lost? I hope not – not just for the obvious reasons (that would be wrong, um ‘kay), but also because control and deprivation of food for a child can simply compound the weight problem into a hoarding, controlling, binging problem – overweight child stealing and hiding food from foster parents – foster parents with locks on every food supply in the house – PICA cravings leading to eating of non-food items – lead poisoning and more acute toxicity – possibilities of problems just are like a jack pot – cascading glittering jewels of medical blunder or is that wonder (wonder why a child is in foster care when so many children are hurting.)


http://blog.cleveland.com/metro/2011/11/obese_cleveland_heights_child.html
*** top one is the one with the actual story. –
This does not seem like a neglect case after all, but just a question of whether Foster Care will be considered an effective, albeit, untried weight loss strategy – a diet plan – that Ohio courts want to promote in a precedent setting way.

So a boy on the Honor Roll with a caring mother is now sleeping in a Foster Home and she can only see him for two hours once a week. Let me repeat an eight year old boy, on the honor roll at his school, has been removed from his mother’s custody because he may be at risk for diabetes and hypertension. He doesn’t have either of those conditions and he is being treated for sleep apnea (poor breathing at night which is obesity related and magnesium deficiency related by the by). Being treated – not being neglected.

Some important nutrients and healthy foods: iodine -selenium – B6 – magnesium rich vegetables, nuts, beans, seeds, and cocoa – buckwheat and oats – fenugreek – cinnamon – oregano -ginger

http://news.yahoo.com/ohio-puts-200-pound-third-grader-foster-care-191032515.html

Tax dollars are paying for that Foster Care and now for the sleep apnea treatment as well. Foster kids get Medicaid and usually messed up heads for the rest of their lives but that hardly counts, in America – we aren’t crazy – we are well medicated.

/Disclaimer: Opinions are my own and  the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

Regarding: Couple Accused Of Starving Infant Daughter

What is excessive force? excessive removal of a child from its parents? Starvation if even well intentioned “to reduce risk of high cholesterol and needing a bypass surgery” is neglecting to meet the hunger signals and body language shown by crying and fussing in a typical infant. If an infant is too malnourished however they will be listless and not fuss much at all. A loving parent might think things are okay because the baby is quiet. This blog discusses types of failure to thrive – reasons for no weight gain – my main question unanswered from the newspaper article is what happened with the infant’s head circumference and height/age and length/weight curves.

Couple Accused of Starving Baby,” the Assoc. Press,  New York Daily News (11-17-11) [articles.nydailynews.com]

I recently wrote about occasionally having written nutrition assessment letters in support of a few “dinky” WIC children and their parents who were regularly offering a healthy variety of food.  In the article I suggested that the common problem with that segment of my caseload was undiagnosed congenital hypothyroidism. Now I knew the children and parents that I wrote about and I had worked with them monthly or quarterly and measured their dinky, adorable, thriving in their own tiny way, children.

The other common thing amongst the little tykes was their growth chart patterns. There are three types of growth charts to be aware of regarding young children:

1. The head circumference isn’t discussed much but it will be the last curve “to fall off the chart” due to failure to thrive. An infant’s head is bigger than the passage already, so nature designed it to catch up and grow a little more rapidly outside of mom the first two years of life and then hatsize changes very little into adulthood. The neborn head circumference average is roughly 12-14 inches, by 3-6 months it may be 16-18 inches around, by one to two years old 20-22 inches. adult’s may be 24 inches around. I didn’t use a tape measure but mine is roughly 23 inches (level ribbon or tape measure held about one inch above the ears at the wide spot of the forehead/back of head – biggest loop that you can slide up and down with stiff tape measure but heald a little taut, really loose adds a quarter to half inch.)

To get back to malnourishment – the body always sacrifices itself for the brain, and the heart and lungs are second most important (or just as maybe that’s a type of trinity of life). A child that is “failing to thrive” or not growing normally may be doing so for physical malfunction reasons – plenty of food is being offered and/or even going in but the child is still not growing (and may be throwing up all over the laundry). Organic failure to thrive is due to physical  problems with the stomach and reflux, or underlying genetic malfunction effecting metabolic pathways, or unidentified disease, or nutrient deficiency, or other reasons – known and unknown. Recording daily food being offered , amounts consumed and symptoms that occur and then tallying up all the intake nutrient values to see if it “should” be meeting average needs is a tool that I used when investigating non-growing / non-thriving children.

One of the children that probably would have died without my intervention needed communication assistance for organic failure to thrive due to malformed stomach and constant regurgitation. The parents were somewhat learning disabled, not necessarily by a definition but it can make it easy to make the wrong assumptions. I bought a dry erase board for them to make it easier to immediately record how big a bottle was made and how much was eaten – what was offered and what was consumed and then the info was copied later onto paper for me – the infant ended up needing surgery. Turned out that lots was going in and there was tons of dirty laundry but the couple wasn’t able to communicate that to the doctor.

That little boy did weigh his birth weight at two months but he looked starving. His head circumference was practically following a normal curve and his height was only beginning to drop off the chart – really long and skinny with a big head and sunken eyes. He looked very starving and the parents were working very, very hard to care for him for those two months of tons of laundry (the poor may smell bad because food stamps doesn’t pay for laundry soap or laundromats or gasoline to get there – did you want to give that baby a few bottles, burp the spitting up, screaming in stomach pain little tyke, Michele dear, the couple probably did occasionally hire a babysitter or swap labor (you watch my kid today and I’ll watch yours tomorrow.)

2. Back to growth charts- the height growth chart was mentioned above. It will be affected second, head circumference is most protected and weight can slip fairly quickly off the typical pattern.

The growth rate can be slowed down by malnourishment due to lack of food being provided, or lack of absorption of nutrients, or physical regurgitation/spitting up or projectile vomiting or the food, or too much fuel being burned up (common with a minor undiagnosed heart defect – saw one of those also , it took his parents a long time to get appropriate dx as well. Worms and early cancer also might increase calorie needs),

3. Weight gain rate growth is really only valuable if it is compared to the child’s height and to the own child’s previous growth rate. The dinky children that were relatively healthy and growing at an tiny barely plottable growth curve, were still growing and did have their own plottable growth curve (similar to each other BTW). They followed the normal curve but just weren’t on it. they chugged along in a few cases a half inch off the chart which would practically be 25% below “fifth” percentile.

To briefly review Bell curve and normal distribution (fromTarot blog recently) we expect f percent of children to look healthy and normal “oof the chart:” in either direction. Children of Asian descent are not common in Marquette but they always saw the dietitian because they never plotted on the growth chart for weight/height – narrow shoulders, narrow hips, narrow mom and dad. They all matched each other and were offering healthy food every two to three hours – no problems there except with the growth chart assumptions (that fifty percentile is a goal – no it is only a goal for fifty percent of children the other fifty percent would look too fat or too skinny at that weight for height).

4. I think I just started the weight for height growth chart so I thought I better put the number up.

Inorganic failure to thrive is due to parental/caregiver or stress/depression relationship type issues. Occasionally the baby really has no appetite and the parents are offering and offering and the infant isn’t accepting anything – starving itself – that is pretty rare and would take the careful recording of just exactly what is being offered versus what is being consumed (and the estimated amount that was kept down / not spit up). A family that is paranoid about cholesterol and excess weight gain may be offering too little and if stressful feeding interactions are also used the baby may give up rather than continue to fuss for food (too starved of an infant will get listless, apathetic, look a little depressed).

A dinky healthy child will have a bit of cush/moistness to the skin with a little bit of rounding over the muscles and bones, and a healthy glow of youth (moistness factor). A skinny child will be gangly with boniness and ribs showing but not up at the nipple / chest-bone area and dry skin and thin, wispy hair, possibly even falling out easily. A starving model will have chest-bone rib exposure while a thin model will have a bit of flesh rounding out the ribs at least a little. (Offer a skinny model a snack and if she says “No thanks, I’m not hungry” then zinc may be needed – too deficient and the appetite disappears – it can get uncomfortable to eat with too shrunken of a stomach; if she says “No thanks,  I’m not hungry right now but maybe later,” then I’m a little less worried about her.)

A too skinny child will have that body builder appearance where you can see the outline of their muscles very clearly through paper-thin skin (lack of subcutaneous fat was referred to in the Associated Press article). The patella or kneebone will be very knobby and sticking out – it is just floating over the front of the leg suspended by ligaments – stringy cords. Moistness within the joints helps prevent arthritis/joint pain problems and reduce accidents over time. Hydration helps many things and Dr. Batmanghelidj helped asthma patients with more water and sea salt – chemical structure of bleached table salt may be less helpful to the body possibly and it doesn’t taste as good to me at least definitely.

A “dinky” hypothyroid child that followed their own special growth curve two standard deviations off the chart on weight and height for age, might actually plot normally weight is compared to height and head circumference was usually on the grid or just a bit below the fifth percentile. Weight and height compared to their age group were the most “abnormal” and if only weight was looked at the rest of the pattern might be missed. The physical appearance included – if you pick up a dinky child you can still support their bottom in the palm of your hand – narrow bone structure with narrow hips. A straving child will be bony and gangly and achingly sore where all that delicate skin isn’t sqooshy enough to prevent bruising with little pressure. (Stuffed teddy bear with too little stuffing left.)

To sum up – I would need to see the child and ideally see the history of measurements for weight, height and head circumference. If it is a dinky child with parents who are concerned about cholesterol then they may feel comfortable with small size. The tests that were all normal would not have caught congenital hypothyroidism that was due to a thyroid gland that used bromide, fluoride or chloride instead of the iodine (malfunction undetected by a TSH – Thyroid Stimulating Hormone test). Goiter is not evident any longer as a sign of iodine deficiency because the thyroid gland has adapted.

Clues that congenital hypothyroidism might be a problem besides having a two and half year old so small that their bottom fits in the palm of your hand (hard to disguise that oddity and there isn’t a growth chart for it):

1. Mom has hypothyroidism or the symptoms of it but no diagnosis (I do not care what her lab tests say unless she has done a 24 urine collection and had it assessed for iodine content.)

2. Mom has had several children and the baby is one of the youngest. (Mom may have started out with iodine stores but is running lower now because there really isn’t that much fortification or use of iodized table salt and really do we sprinkle on that vitamin D with a slat shaker or vitamin C?)

3. Baby was a twin or triplet . . . or was premature or small for gestational age – although a few of the dinkiest kind of started 7 pounds and just never took off with the more typical, rapid growth rate seen from birth to two and a little slower through preschool.

4. A congenital hypothyroid baby may look like an adorable little midget, pixie, elf child. Big eyes and biggish head compared to the dinky body but perfectly proportioned arms and legs to the body. A little person with other types of dwarfism may have the individual’s head and torso similar in size to that of a typical adult but their arms and legs may be proportionally much shorter than average. Hair on a congenital hypothyroid child may be fine, very soft and baby fine and possibly short with spikiness – nature’s little punk rockers.

5. The dinky child will have an appetite and eat quite normally without any odd quirks, but in vvery small bird like portions – matching their tiny body’s need when calculated based on body weight instead of looking at “recommended intakes” – recommended for the fifty children eating on the fiftieth percentile line perhaps.(autistic kids invariably had quirks in diet preferences or strong opinions.)

6. The iodine content of a urine collection for the child is also a useful indicator as to whether there is much iodine in the diet – lots going in will have more coming out – and a challenge loading dose of iodine can be given and the the urine again measured. The iodine deficient body will retain more of the excess loading dose and the urine will have more than in the first batch but no where near the total that was consumed for the day (I took the loading dose of 50 mg broken into AM and PM – with meals the stuff is a little icky on the stomach – patient forums seem to suggest that sea weed  is more comfortable – don’t know – I use Iodoral.) Fluoride, bromide and chloride levels being excreted can also be monitored – high levels of those reflect the exchange having been made by the malfunctioning thyroid hormone of the non iodine (any port in a storm) for the iodine from the massive influx of the loading dose. The metallic taste in the mouth that can occur during iodine supplementation is theorized to be the bromide / fluoride taste. Yellowish stuff has been reported to stain white clothing (ooze from the skin) – that could be the iodine too it is yellowish, I never checked what color bromide or fluoride are typically.

– there are probably a few more clues and reference links but – brief sum up – Need to see and measure the child – iodine content of the child’s urine would be more concrete in a court than “dinky” although the healthy dinky growth chart pattern would be evidence if all four growth charts were used – Ht/Age, Wt/Age, Ht as Length/Wt, and Head Circumference/Age.

Couple Accused of Starving Baby,” the Assoc. Press,  New York Daily News (11-17-11) [articles.nydailynews.com]
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growth chart info from the CDC website, [link]
Excerpt:
Growth Reference Versus Growth Standard

The CDC and WHO growth charts differ in their overall conceptual approach to describing growth. The WHO charts are growth standards that describe how healthy children should grow under optimal environmental and health conditions. The curves were created based on data from selected communities worldwide, which were chosen according to specific inclusion and exclusion criteria. Deviation from the WHO growth standard should prompt clinicians to determine whether suboptimal environmental conditions exist, and if so, whether they can be corrected.

Whereas the WHO charts describe growth of healthy children in optimal conditions, the 2000 CDC growth charts are a growth reference, not a standard, and describe how certain children grew in a particular place and time. The CDC charts describe the growth of children in the United States during a span of approximately 30 years (1963–1994).

CDC   (***the charts that I used)

The CDC growth curves for children aged Table 1). The curves were anchored at birth using national birth weight data obtained from U.S. birth certificates from 1968–1980 and 1985–1994 and birth length data from Wisconsin and Missouri birth certificates (the only states with these data available on birth certificates) from 1989–1994 (5). Birth data were based on 82 million birth weight measurements and 445,000 birth length measurements.

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Breastfeeding and Growth Patterns  (***The whole section because it is so important)

When the WHO growth curves were created, the difference in growth between primarily formula-fed infants and primarily breastfed infants was an important consideration (12). The WHO charts were based on the premise that the healthy breastfed infant is the standard against which all other infants should be compared. This is consistent with U.S. dietary reference intakes, in which norms for infant intakes of most nutrients are determined on the basis of the composition of human milk and the average volume of human milk intake (21).

In the WHO charts, 100% of the reference population of infants were breastfed for 12 months and were predominantly breastfed for at least 4 months. In contrast, approximately 50% of the infants in the CDC data set had ever been breastfed, and 33% were still breastfeeding when they reached age 3 months, rates that are lower than those for infant cohorts born today. Data from the CDC National Immunization Survey indicate that in 2007 in the United States, 75% of infants had ever been breastfed, and 58% had been breastfed for at least 3 months (22). In addition, the composition of infant formula has changed considerably during the preceding 35 years (23). Therefore, the current growth of U.S. infants might not be the same as the growth of infants used in the creation of the CDC growth curves.

The expert panel universally agreed that breastfeeding is the optimal form of infant feeding and recognized that the growth of breastfed infants differs from that of formula-fed infants. The panel also recognized that AAP has stated the breastfed infant “is the reference or normative model against which all alternative feeding methods must be measured with regard to growth, health, development, and all other short- and long-term outcomes” (24).

Some U.S. clinicians who are currently using the CDC charts might be unaware of or not understand the growth pattern of exclusively breastfed infants, which differs from that of formula-fed infants. These clinicians might inappropriately recommend that mothers supplement breastfeeding with formula or advise them to wean their infants from breastfeeding completely.

The WHO and CDC charts show different growth patterns that might lead clinicians to different conclusions about variations in growth. Healthy breastfed infants typically gain weight faster than formula-fed infants in the first few months of life but then gain weight more slowly for the remainder of infancy (25,26). Therefore, in the first few months of life, WHO curves show a faster rate of weight gain than the CDC charts for boys and girls (Figures 2 and 3). Use of the WHO charts in the United States might lead to an increase in the misperception of poor growth at this age.

Beginning at approximately age 3 months, WHO curves show a slower rate of weight gain than the CDC charts, both in weight for age and weight for length. Because WHO curves are derived from infants who breastfeed through 12 months, infants who are still breastfeeding at approximately age 3 months are more likely to maintain their percentages on the WHO growth charts but to decrease in percentages on the CDC charts. In contrast, if WHO charts are used to assess the growth of formula-fed infants, these infants might be identified as growing too slowly during the first few months of life but then be identified as gaining weight too quickly after approximately 3 months.

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Recommendations
Use of WHO Growth Charts for Children Aged 0-24 Months

Use of the 2006 WHO international growth standard for the assessment of growth among all children aged 0 to24 months, regardless of type of feeding, is recommended. (The charts are available at [cdc.gov/growthcharts].) When using the WHO growth charts, values of 2 standard deviations above and below the median, or the 2.3rd and 97.7th percentiles (labeled as the 2nd and 98th percentiles on the growth charts), are recommended for identification of children whose growth might be indicative of adverse health conditions. The rationale for use of the WHO growth charts for this age group includes the following: 1) the recognition that breastfeeding is the recommended standard for infant feeding and, unlike the CDC charts, the WHO charts reflect growth patterns among children who were predominantly breastfed for at least 4 months and still breastfeeding at age 12 months; 2) clinicians already use growth charts as a standard for normal growth; and 3) the WHO charts are based on a high-quality study, the MGRS.

Continued Use of CDC Growth Charts for Children Aged 24–59 Months

Use of the CDC growth charts for children aged 24–59 months is recommended. The CDC charts also should be used for older children because the charts extend up to age 20 years, whereas the WHO standards described in this report apply only to children aged 0–59 months. The rationale for continuing to use CDC growth charts includes the following: 1) the methods used to create the WHO and CDC charts are similar after age 24 months, 2) the CDC charts can be used continuously through age 19 years, and 3) transitioning at age 24 months is most feasible because measurements switch from recumbent length to standing height at the this age, necessitating use of new printed charts.

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The estimated prevalence of low weight for age and high weight for length among U.S. children differ depending on whether the CDC charts (using the 5th and 95th percentiles) or the WHO charts (using the 2.3rd and 97.7th percentiles) are used (Figure 6). A substantial difference exists in the prevalence of low weight for age, with the WHO standard showing a lower prevalence beginning at age 6 months. The CDC reference identifies 7%–11% of children aged 6–23 months as having low weight for age, whereas the WHO standard identifies <3%. The WHO standard also identifies fewer infants (aged

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the end of the article is several more long paragraphs – to sum up – The U.S. clinics have not all started using the newer growth charts and recommendations, improved education in their use is recommended as well as a call for more research into what cut-offs / criteria are indicative of poor growth outcomes (just being on or under the 5 or 95th percentile was never assessed for health in either set of grids. Both sets were simply plotting a bunch of children’s measurements using different types of children.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.