Weight/Height vs Standard Deviations

[Guest guest]

Hi Pat,

Can you explain the calculation regarding the standard deviations? I

thought the chart that appears on the back of the typical growth

chart, the one that shows weight plotted against height, was a

reasonable way of determining how 'over weight' a kid is. Are you

saying Dr. H doesn't use that chart when evaluating the proper

weight?

, at one years old, was over the 50%-ile on that curve

(weight/height), but most of her life, she has hovered around 25%-

ile. It does surprise me a little that she is even that low

because she doesn't appear skinny to me at all. (She has a g-tube) I

assumed it was more a reflection of the increase in childhood obesity

(in other words, isn't so skinny, but the general population is

just really overweight)

I will be so upset if she develops insulin-resistance diabetes due to

my 'force' feeding her with a g-tube back in those early days. I've

always said to her doctors, " Tell me what weight you want her to be.

She has a g-tube. Anything is possible. "

Now I am confused.

Thanks in advance for your explanation!

Irene

Mom to 6 3/4 years old, 38 pounds, 43 "

> Hi Amy,

>

> Don't want to burst your bubble, but be careful with the weight

gain. Dr H

> explained to us that RSS kids are prone to insulin resistance, and

TypeII

> diabetes, and being " over " weight is not good for them.

>

> We were thrilled because was finally on a chart, too. He was

> tracking between the 10-25% on the weight-for-height chart in July.

When Dr

> H calculated his Standard Deviations, and compared his weight SDs

and height

> SDs she wasn't happy with the ratio, the weight being too different

from the

> height. She lowered 's feed rates (he is 100% g-tube fed).

When we

> saw our GI, here at home, she was concerned because was

falling off

> the chart, but Dr H said that he was doing great, his SDs for

weight and

> height were coming closer together. Another balancing act for RSS

parents to

> think about.

>

> Glad to hear the Avery is doing so well, though, and that you

worked thing

> out with your Ped. Sometimes you just have to let them know where

you stand.

> KUDOS MOM!! Great job advocating for Avery!

>

> Pat (g-ma to , RSS, 22 months, 19# 13oz, 29.5 " , Prevacid,

Zantac,

> Singulair, GT)

[Guest guest]

Hi pat-

This is heather again.

I was reading one of the letters you posted and once again I have a few

questions? Our ped keeps telling me to keep pushing laikyn with her fedding

pump

at night, should I be doing that? She is now at 43cc/hr and he wants to keep

increasing it every week by 5cc. It seems that her eating during the day has

decreased some ever since the increase started. She has started to gain some

but he wants her to gain 1/2oz a day. Is that realalistic?? Also what is the

weight/height thing all about. Laikyn does not see a GI doc so should we

start seeing someone loke that?? Thanks again pat-- Your like a little angel

to

me and my little laikyn!!!!

Thanks

[Guest guest]

,

Dr. H. always uses the weight for height chart when we see her. She

has for years. BUT she can also tell by looking at a child whether

or not that child is overweight to her liking.

That being said, Max for years has been over the 50%ile for weight

for height. He is not fat, does not appear fat, but he is not

skinny, either. He has maintained his weight somewhere between 99

and 102 pounds for a long, long time and is growing bit by bit. To

me, his legs and arms look skinny, his face is thinner than it used

to be (it's starting to look so much older now!!!), but he does have

a slight belly. Dr. H. has never complained, so we just do what we

are doing.

If is in the 25%ile for weight for height, then I think you

are okay. I would not worry about it at all. That means that she

weighs a bit less for her height than other kids her size. Relax.

Jodi

[Guest guest]

Hi Irene,

Actually, Dr told me that the formula to calculate Standard Deviations (SD)

is too complex for us mere mortals. I was a little put out by the comment,

since I majored in Math! She did all the calculating, and I'm sure that any

GI should know how to do it. This is currently Dr H's way of determining a

correct weight for her RSS kids.

I can say that Dr H said that for to be at a good weight, he would

probably fall off the weight-for-height chart, but not to worry about it.

When she calculated his SDs at the convention in July, his weight SD

was -3.17 and his height SD was -3.66, a .49 difference. At our first GI

visit in Sept, when the GI was concerned with falling off the

weight-for-height chart, the difference was only .37, and Dr H was happy

that the two numbers were moving closer together. However, by the next GI

visit in Oct, had gained 1# 3oz and only grown 1cm. This brought the

difference to .68, and Dr H was very concerned. She, once again, lowered his

feed rate, and warned us about the problems of building a high fat mass in

RSS kids.

She, also, calculated his weight gain over different periods of time. Before

the convention he was gaining at a rate of 18.07 gm/day, between the

convention and the first GI appt this rate dropped to 9.75gm/day, and she

stated that she wanted to get it to no more than 9gm/day. Unfortunately by

upping his cc/hr rate only 1cc for both daytime and nighttime, his weight

gain rate jumped back up to 13.16gm/day. We have now dropped his feed rates

1cc/hr during the day, and 2cc/hr during the night, and our baby that used

to need 160kcal/kg/day is not on an 80kcal/kg/day diet! LOL

I do know that she also used how he " looks " to determine that he was too

fat. As far as I can tell, it is a combination of how fat they are, where

the fat is accumulating, and how low their muscle tone is. looks

chubby all over to me, but she was concerned that he seems chubbiest in his

tummy, butt, and thighs.

I hope this helps explain some of what you were asking. I should say that

also has a problem with his BSLs. Before the convention he was

consistently high (135-165), but this seemed to level out once his weight

gain rate slowed. Now, he is bouncing all over the place. In the last two

weeks he has been anywhere between 31 and 180, and both those readings

happened in the same day! Being that he is on continual feeds, his BSLs

should be more stable.

[Guest guest]

BUT she can also tell by looking at a child whether

>or not that child is overweight to her liking.

I'm sorry if I sound disrespectful to Dr. H, but I've had so much

conflicting advice from different physicians that I just have to ask - how

do we know that she is not just being arbitrary about what is too fat?

Does she ever measure a person's body fat, either by caliper method or by

something like the electric scale we have that sends a small current

through the body? Does she have more of a quantitative 'back-up' to what

she can tell by sight?

Inga

[Guest guest]

Inga,

She does not use a special scale or calibration device. She is just

a " witch " with a sixth sense. To be fair, she does have

calculations, but she can look at a child and just know.

This may be hard for you to understand, but I'll give a personal

example. I am/was a special ed teacher. (I hope that become AM in

the near future.) I can have a 5 minute or less conversation with a

child and know if that child has learning problems to a certain

degree. It just comes naturally. When I do a birthday party at the

cooking studio, I can pick out almost every single child who is

classified and, while I may not know the diagnosis, I can certainly

tell who needs special attention/instructions. It just comes from

working with hundreds of special ed students.

Dr. H. is the same. She has seen hundreds of RSS patients. She

just knows what to look for and it pops out in her head. I know it

is hard for you to conceive, but that is just the way she is. Even

she, however, will admit when she is wrong, but not in those words.

I proved that theory when we saw her on Tuesday and she saw how well

Max looked and how happy he is in school. She had predicted that he

would never make it this far in a public high school and that we

should immediately take him out. We decided to stick through it and

Max is thriving better than ever before! While she did not admit

that she was wrong, she did remark on how happy she was with my son.

Jodi