Miss M went back to the doctor yesterday, to check in on her GERD resuming. It's been off/on for a bit, but she's been dropping foods from her 'will eat' list, at an age that dropping foods is not normal. Up to about 5, that's normal. After 5 years old, it generally means something is up.
That 'up' could still be normal, but worth checking.
While we were there, we did her growth check. She's 12th%ile for height, 25th for weight.
When she was born, she was about 25th percentile for weight, and a bit under 50th for length. She stuck that for a long time, climbing up the length/stature curve to a steady 50th%ile. And then she started eating more solids after 15 months, and by 22 months had stopped growing. No inches in height between 15 and 22 months. Er. Yeah, normally that's a spurt period. (That's when we figured out she had Fructose Malabsorption, like her brother.)
Her sister R started the same height and ended up two inches taller than her at that point. she is still 2 inches taller.
On a carefully controlled diet, Miss M slowly climbed back up to 25th, then 50th. 50th stuck for a while, and even looked like she was going to continue to cross up the curve slowly. But then as she got more control over eating on her own (away from parental control), she learned how to sneak foods she shouldn't have, and how to make it look like she only had two pieces of fruit that day instead of the four she'd really had, and how to convince one person to give her another when someone else had already cut her off on a safe-in-moderation food.
I've been doing this for years - working the diet, trying to get them stable, watching for the telltale circles under the eyes, watching for the outbursts of bad behavior that indicate that they've overdone something in the last few days. The behavior is the most intense sign, but the one that hurts the most is seeing their growth curves shift.
I just want them to grow, like they 'should' grow. On one damn curve. Not struggling up a curve then plummeting off one or two standard deviations in a few months. At least we only measure growth every six months (spurts make it too hard to follow, since their curves can look like stair steps if you measure in shorter increments). Plus at New Years. That helps a bit to keep it off my 'things to obsess over parentally' list.
Today, I'm going to obsess.
Midparental height, the normal (medically sound) measure of expected growth range, would put them in the 75th-99th%ile range. If I factor in that my family has some shorter people as well, 50th-99th would be reasonable. That includes the 2 standard deviations below the midpoint that is considered likely to be normal. But once you get to three standard deviations below that midpoint, there are 80% odds that something is medically wrong.
Mr B is five standard deviations below where he started, which was 97th. FIVE. My reality check on the medical implications of that (because lost stature also means losses in many systems) is that one of his doctors, the one who dealt with malabsorbing kids regularly, would break a sweat if he didn't eat well on any given day. Literally.
Miss M has the additional complication of being a twin, and the smaller twin at that. Twin studies show that twins tends to catch up to their full growth curve by around 8 years old. Some sooner, a few later, but generally, by then, they're running on the curve they'll stick for life, and if they hadn't already been on it. Miss R was a normal-for-me sized baby, but Miss M was a bit on the small side. The fact that she'd crossed 'up' to 50th%ile in a year or so suggests she was arcing upward to her 'normal' curve. It's hard to say what it genetically would have been, since the curve got torpedoed by the Fructose Malabsorption (plus, in her case, early onset lactose intolerance).
So she's only 2 standard deviations below her maximum, but her maximum was probably nowhere near her settled curve. Sigh.
Mr B has physical signs commonly associated with Cystic Fibrosis (particularly the broadened fingertips) because his aborption is bad enough to mirror the significant malabsorption that comes with CF. He also has a tendency toward the low stature high weight common to kids who over-consume fructose and polyols (that is, kids who overconsume apple juice in addition to other fructose-rich foods). He's fit, and incredibly strong, but is the most likely to shift toward overweight if he lets up on the physical activity.
Miss M is overweight by height, also, though looking at her you'd think she was a rail. Not sure where she's hiding it.
Sound like I'm completely obsessed with growth yet?
I'm not, most days. But after a growth check, I notice. I notice a lot.
I just want them to grow. Like normal kids.
As a parent, I want to never have to wonder what other systems have been truncated by the lack of nutrients coming in from what they eat. To never have to wonder whether they're making it back up the curves or sticking one or slipping again. To never have to wonder how their lives might be different if they'd had that full growth.