Small Size, Big Mealtime Battles

My youngest daughter turned four this March, a fact that surprises most people when they see her for the first time. At 26 pounds and just over 35 inches, Lily still fits in clothes that would be snug on the average two-year-old. Toddlers tower over her, and her legs barely reach the pedals of the tricycle that our kindergartener outgrew years ago.

Let’s be realistic: I’m only 5 feet 2 inches myself, and my husband is no giant. Our children were never destined for basketball stardom or the state rowing championship. But Lily isn’t small only because of genetics: she was born nine weeks early after a complicated pregnancy, weighing two pounds and five ounces when she entered the world. Lily met the neonatal intensive care unit’s definition of a classic “grower and feeder:” free of the many complications premature babies often face, she simply needed to get bigger.

Fast forward four years to today, and “getting bigger” is still the overriding goal when it comes to feeding Lily. It is the sacred mantra my husband and I hear beating in our heads whenever our family sits down for a meal. If our oldest daughter decides not to eat, we sigh, but it ends there. With Lily, who at this writing is exactly at the 0.37 percentile on the growth chart (that is, compared to 1,000 other four-year-olds, she would be smaller than all but three of them), we don’t feel we have the luxury of letting it go.

Instead, the way we nourish our youngest daughter has become the ultimate exercise in strategic thinking, designed to get her to consume as many calories as possible. Protein and fats take center stage in her meals and snacks, and whole milk is a staple in our household. I make animal-shaped sandwiches and pancakes cut out like snowflakes, generously topped with butter. My husband has become an expert in preparing protein-packed meals, sneaking almond butter into smoothies, and strategically serving the ground beef and cheese before the lettuce and tomatoes on taco night. We’ve even been known to snatch the carrots off Lily’s plate so she has no choice but to gravitate to the higher-calorie options.

When our daughter eats a decent amount, we all breathe easier and high five each other across the table for a job well done. When she refuses, leaping from her chair for the seventh time to go play with toys, peace rapidly dissolves and the dinner table becomes a power struggle where no one wins.

“I’m full,” she announces, after two bites of toast, some blueberries or a sliver of cheese.

“You are not,” I respond, taking her into my lap and aiming a forkful of food at her mouth, trying to cover the desperation in my voice.

Sensing we are losing the battle, my husband and I use all the tools at our disposal. We coax, bargain, and wheedle.

“Just three bites, c’mon sweetie, you like this stuff!”

“If you eat one more piece of cheese, you can go play with your toys.”

“Dada would be very happy if you would finish just one half of your sandwich.”

It’s possible that our approach is horribly wrong. Eating therapist and author Ellyn Satter maintains that once you’ve presented a healthy and balanced plate of food to your child, your job is done. Only your child can decide if, and how much, he or she will eat.(1)

As much as I agree with this logic, I worry that without our finagling, pleading, maneuvering and planning, our girl would wither away to a mere shell of her already petite self. On the rare occasions we’ve tried to be hands-off and not force the issue of her barely half-eaten meal, inevitably we can’t help but micromanage the situation, running back to the kitchen after bath time to prepare a hasty snack of cheese, crackers and nuts.

It’s not just mealtime that reminds us how important nutrition is when it comes to our youngest daughter, and how badly we want to get it right. It’s every visit to the pediatrician, when Lily steps on the scale or lines up against the measuring tape and we hold our breath, waiting to see the final sum, the result of all our tears, sweat and frustration. It’s the casual comments from strangers, and even friends and family, who can’t help but notice her tiny stature. 

“Oh, she’s such a peanut!”

“Well, hello, baby! Aren’t you adorable?”

Lily scowls when people look at her and call her “baby,” as if she knows they’re not taking her seriously.

Every mention of my daughter’s size brings me back to the pregnancy, to the frightening and unexpected setbacks and the 41 days she spent in the neonatal intensive care unit, fighting to gain one more fraction of an ounce. She came home at 37 weeks, weighing in at four pounds.

I’m still heartbroken that my own body couldn’t nourish my child better during the pregnancy, but I can’t let that color the way I parent her today. I don’t want my worries about my daughter’s growth to impact her negatively, or give her the sense that she’s not acceptable at whatever size she may be.

Ellen Frankel, an author and eating disorder therapist who is 4 feet 8 ½ inches tall, describes her experience growing up as a short child with loving parents who were very concerned about her height. During the teenage years, Ellen’s mother would prepare daily high-protein breakfasts, and measured her daughter’s growth every month against the garage door, making a pencil mark that never got any higher. Today, Ellen still remembers the mark, calling it a “black spot that I associated with failure despite my successes.”(2)

In a society that often presents mixed messages about food, nutrition and appearance, I’m still trying to find the right balance in the way I approach these issues with my own children. I know that I want my daughters to grow up with a healthy, positive attitude toward food, to think of it as fuel for the fun activities they want to accomplish. I want them to enjoy a little bit of everything as they explore and develop their own palates. But most of all, I want them to know intrinsically that their value doesn’t depend on their physical size or appearance. Life is not about what their bodies can’t do, but what they can do. I think about the role models who can support this message, like the Olympian gymnasts who might appear diminutive but have nerves of steel and strong muscles to match. I smile when I think of Yoda, the small and powerful Jedi Master who famously asked, “Judge me by my size, do you?”

On the advice of our pediatrician, we’ll visit an endocrinologist to confirm that Lily’s growth pattern isn’t the result of an underlying deficiency that needs treatment. No one is expecting any surprises. The most likely explanation for our daughter’s stature is that she’s simply small because of genetics, and she’s following her own steady growth curve. If indeed this is the case, the knowledge should be freeing.

It will always be tough for me to resist the impulse to control my daughter’s eating, to do whatever I can to make her bigger. But I know mealtime will be much more peaceful if I can accept this fact: that no matter how much we plan, strategize and agonize, regardless of what the number on the scale happens to read today, our daughter will reach the size she was meant to be.

~ ~ ~
Sources: 
(1) Satter, Ellyn. How to Get Your Kid to Eat…But Not Too Much. Boulder: Bull Publishing Company, 1987.
(2) Frankel, Ellen. Beyond Measure: A Memoir About Short Stature & Inner Growth. Nashville: Pearlsong Press, 2006.

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