J u l e e
Drama Llama
Posts: 6,531
Location: Cincinnati
Jun 28, 2014 2:50:47 GMT
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Post by J u l e e on Aug 11, 2014 3:22:31 GMT
My daughter is 12.5 years old. She is going into the seventh grade. She is 5 feet tall and weighs 75 pounds. She is slight but eats well (she eats anything that is put on the table for her at meals - she may not like it but she does not refuse to eat what she doesn't like) and is active. She is the definition of awkward - physically and emotionally these days.
I may be prickly about this topic (food/weight issues, and the words we use about them) and I truly wonder how it gets handled in other people's experiences. She had an appointment with a doctor who is not her regular pediatrician. We took the appointment with another pediatrician in the practice because she just needed a booster shot before school.
Background - I struggled with an eating disorder when I was younger and throughout college. I really work to have a good relationship with food and fitness. Food and weight are tough topics for me.
Her doctor came into the room and started going over her information from the MA - "Her blood pressure is normal, her eyesight is normal, she is a very tiny person." Those were the words he used. I kind of thought that was a strange thing to say but just let it roll off because I know I'm sensitive to the words people use. Then he goes over her height and weight percentiles and her BMI - all within normal (although weight and BMI were at the very low end) range. He then tells her she is "very skinny and needs to eat more". Just like that. He then tells us about the booster shot, and ends by repeating "she is very skinny and should be eating more. She gets this from you, yes?". WTH? (He had a heavy germanish accent).
I think the word skinny is unacceptable from a medical professional - in front of a 12 year old girl at a really body conscious time (puberty). And that was his recommendation? Eat more. That's all he said. He didn't ask how much or what kinds of foods she's currently eating. He doesn't know that she eats exactly what we do at dinner and helps herself to snacks. He didn't have any suggestions. That was it.
Is that a normal way for a pediatrician to approach this? I felt like writing him a letter. But even writing this feels stupid, like I didn't explain it well enough. Touchy, like I said. What do you think?
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Deleted
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Oct 8, 2024 22:24:06 GMT
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Post by Deleted on Aug 11, 2014 3:27:07 GMT
It should not be said in front of the child!! Maybe send her out and ask the mom about her eating habits. Then, if they are lacking talk to her about eating healthy which can include eating enough calories for some kids.
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Post by mirabelleswalker on Aug 11, 2014 3:31:34 GMT
I don't think it's appropriate.
Her body is going to go through a lot of changes. Even if she's in low percentiles height and weight-wise, she's in the range. Unless he thought she had an endocrine problem, calling her a "tiny person" is neither complimentary nor constructive.
I work in the medical field and I have to say that what people call "skinny" today is what was "normal" when I was a kid, and what is "normal" today would have been considered "overweight" when I was a kid. I think our whole perception of "normal" is off.
I'm sorry that happened. I don't know if I would say something to that doctor, but I would probably not go back to him.
Did your daughter say anything about the interaction?
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Post by Aheartfeltcard on Aug 11, 2014 3:33:06 GMT
She is within normal limits and he has no bedside manner.
I don't think you should waste your energy on him or his words. I think you should stick with what you are doing and tell your daughter "you are within normal limits and he has no bedside manner."
See your regular pediatrician or look for one that is recommended.
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Deleted
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Oct 8, 2024 22:24:06 GMT
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Post by Deleted on Aug 11, 2014 3:38:20 GMT
That was a pretty thoughtless comment he made. I'm not sure a letter would change his ways. I would use that energy to talk to your daughter. Let her know that what he said was inappropriate and that you think she is just fine. When I was that age I was very skinny. It was just in my genetics. My aunt used to say to me all the time that I ate like a bird and that's why I was so skinny. She would say it like it was a bad thing. But I ate a lot! It's just how God built me. Let your daughter know that doctors have to go by numbers and sometimes those numbers don't tell the story of the real world. My daughters are both very thin girls and they eat a lot too! I would never negatively talk about their size or weight. I would be very angry if the dr said anything to my tween about her size. And I would call him out on it because that's how I roll. Then I would assure my daughters that as long as they are eating healthy and taking care of themselves, that's all that mattered.
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Post by Outspoken on Aug 11, 2014 3:40:59 GMT
My daughter is 13.5, going into 8th grade. She is 5'4" and weighs 87 lbs. Her legs are longer than a hot day in August and to say she is skinny is an understatement. I probably would have spoken up defensively! Our pediatrician used to tell us that they would rather see a skinny child than an overweight one (kids are teased, unhealthier - sometimes both physical and emotional, harder to overcome, etc). I have always worried about her weight but I have seen her eat! Ultimately, you are her mother and you know her best! Don't let yourself - or your DD - get bullied!
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J u l e e
Drama Llama
Posts: 6,531
Location: Cincinnati
Jun 28, 2014 2:50:47 GMT
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Post by J u l e e on Aug 11, 2014 3:49:37 GMT
Okay, I'm not being overly sensitive. Thank you all. I was at a loss for words on the spot, and even if I had thought of something I probably wouldn't have right then. Quinn was super uncomfortable. She knows we don't use people's weight or size to describe them, so she kind of gave me the questioning look when he said it. We have always stressed that we "eat when we're hungry and stop when we're full" and she has done that. I didn't make a big deal about it. She is a horribly literal child, so I did explain to her afterward that I didn't want her to think she had to eat more ever, that only she knows what her body feels like and to "eat when..." - and she finished with me saying, "I'm hungry and stop when I'm full." So hopefully that message is louder in her ears than the careless comment by the doctor. We'll make sure we don't see him again.
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Post by lesleyanne on Aug 11, 2014 4:36:06 GMT
Yeah, he was wrong. But I wouldn't perseverate on it with your DD. I think you explained it great (that's almost to the word what I say to my also very-slim DD) and your words are much more relevant in her life that the doctors. So going over it once and then moving on is a great way to handle this error in his bedside manner.
As an aside, is she slim due to any medications she might be on? DD [HASH]1 is very slim but tall and has difficulty maintaining weight but it is directly related to her medication. There have been times in the past when she would have higher fat content milk (like 1/2 and 1/2) on her cereal and other little ways to boost caloric intake when she was getting too out of balance with height/weight.
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Post by andreasmom on Aug 11, 2014 5:00:20 GMT
She is within the range right? He should not have said anything unless she was under or there were any other concerns! It is a hot button for me too. One of my dd's is 25th percentile. The other one is 95th (height and weight) and it kills me everytime we need to discuss their weight. One is "too skinny" and the other one is "big". I'm sorry but both are healthy. Healthy is my word of choice!
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Deleted
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Oct 8, 2024 22:24:06 GMT
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Post by Deleted on Aug 11, 2014 5:07:45 GMT
Probably not. It seemed like an opportune time for you to open a dialogue re: how much and what she does eat and that she doesn't normally gain. Are you not at all concerned?
DGD Ashlynn is extremely petite despite being full term and DD does often discuss it with the doctor. Of six kids, she is the only tiny one.
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Post by psoccer on Aug 11, 2014 5:12:24 GMT
I have had the same issue as Andrea'smom. I would schedule my children's physicals back to back, and I always felt like Goldilocks. One was too thin, one was too fat...although they fell within the normal, one just fell way on the low end, and one way on the high end. It sounds like you did a great job talking with your daughter, but I then let it go and use a different pediatrician next time.
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Deleted
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Oct 8, 2024 22:24:06 GMT
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Post by Deleted on Aug 11, 2014 5:13:31 GMT
He has horrible bedside manners. At the very least he should have asked what she normally eats, how much she normally eats, and then it would have shown him that it isn't simply a matter of her eating more.
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scorpeao
Pearl Clutcher
Posts: 4,521
Location: NorCal USA
Jun 25, 2014 21:04:54 GMT
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Post by scorpeao on Aug 11, 2014 5:15:39 GMT
We had the opposite problem. Although my dd's doctor didn't say she was fat she did get a lengthy lecture about her weight. The doctor delved into eating habits and suggested alternatives. I sat there and cringed the entire time...up to that point I'd always just hammered home eat right and stay active and you'll be the weight you are meant to be. My dd is now 17 and she's grown 4 inches since then and hasn't gained an ounce.
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Deleted
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Oct 8, 2024 22:24:06 GMT
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Post by Deleted on Aug 11, 2014 12:47:44 GMT
The comment about being tiny and skinny wouldn't bother me. I think the suggestion she eat more is more his personal opinion than medical advice and probably should have been discussed. I don't think it's letter-writing worthy, though! I know I find I have about 100 things to say after I leave a doctor's appointment that I don't say at the time due to the hectic nature of the conversation in an office, usually.
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Post by epeanymous on Aug 11, 2014 12:54:07 GMT
I have unfortunately heard a lot of stories like this, although mostly from parents of similar-aged kids who take a similarly tactless approach to dealing with kids who are a little overweight. I don't mean to profile but I am guessing that a generation ago medical professionals were less likely to be educated to the need to handle weight issues carefully. I have a girl the same age, and she would really internalize what that doctor said.
Now, I think it is good for doctors to be proactive about weight issues -- assuming the weight is unhealthy, it doesn't do anyone any good to pretend it is fine, either. But there are better and worse ways to handle it.
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melissa
Pearl Clutcher
Posts: 3,912
Jun 25, 2014 20:45:00 GMT
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Post by melissa on Aug 11, 2014 13:16:54 GMT
I am sorry you were not happy with how this topic was approached.
However, you need to recognize that this needed to be said.It sounds as if this was not the most sensitive approach and not the most thorough either. But when your child is underweight, it is just as important to bring it up as when your child is overweight. At her height, she falls somewhere between the 1st and 3rd percentile for her age. He should have made you aware of this. By definition, anything under the 5th percentile is underweight. Of course, genetics comes into play, but at this stage of the game, as she is near the age of puberty, this is vital. He would have been wrong to not discuss it. In fact, I would be concerned about the effects of a possible delayed puberty because she is underweight. Obviously, he was somewhat concerned but not overly so because he did not ask about diet or other issues that might have led him to additional bloodwork, etc. However, a look at your body habitus (ie genetics) may have been all he needed. I don't know.
My dd is a dancer and has never been that underweight, but her weight has been low enough for a discussion with her pediatrician about her diet and her exercise. Because of her activity level, it is something that the pediatrician keeps an eye on as eating disorders are not uncommon in that population. Dd knows she needs to supplement when her activity levels are very high (she'll add something like an Ensure to get the extra calories in). I am glad her pediatrician keeps an eye out for this sort of thing. It's part of their job!
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Post by refupea on Aug 11, 2014 13:30:15 GMT
I have not read any of the other replies. I must say as her mother to trust your instincts. I also so move on to a different doctor you BOTH feel comfortable with and who takes the proper time to delve into your daughter's health more.
I recall telling my (ex) doctor how tired I had been. She told me, "Get more sleep." Yes, that was it! It turns out I was severely anemic. I know it is a different issue, but the lack of concern is the same. Telling your daughter to eat more and leaving it at that...well, I don't know what to say in an eloquent manner, so I won't say anything.
If you and your daughter feel there is honest cause for concern regarding her weight, then I suggest you search for a new doctor. Ask specific questions when you call to make the appointment.
Most importantly, I am sorry that the two of you were made to feel uncomfortable. Please take of yourselves!!!
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Post by melanell on Aug 11, 2014 13:35:13 GMT
If there was a concern I think it should have been presented differently. I know my my niece's situation how frustrating that can be. My brother has had similar issues with her doctor visits and it's frustrating for him. She gains weight, but not much. She does keep getting taller. She eats well. She's just built that way. And DH goes through the same thing. He eats very well. He gets plenty of exercise. He's strong & healthy. But his entire life he has been classified as "underweight". When he was shopping around for additional health insurance he had one company tell him that there must be something wrong with him, and that they needed to know what it was. He wasn't too pleased with them, let me tell you. Hugs!
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Post by pelirroja on Aug 11, 2014 13:41:44 GMT
OK, so maybe the replacement doc didn't have the best bedside manner but I do think it's good that he addressed the issue (he didn't know her situation so saying something is better than saying nothing). Doc noted your size and saw you are small which probably lessened his level of concern over your DD's slim build. It's not worth a letter writing but just make sure to not request him again. My DDs only see female docs so that might be something you want to consider given your daughter's age.
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Post by alibama on Aug 11, 2014 13:49:30 GMT
He has horrible bedside manners. At the very least he should have asked what she normally eats, how much she normally eats, and then it would have shown him that it isn't simply a matter of her eating more. I agree with this!
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Post by pretzels on Aug 11, 2014 14:41:12 GMT
I'm with Melissa. Your child is underweight. Someone has to say it. And no, she shouldn't eat until she makes herself sick or anything, but at this point, it is something that needs to be looked into.
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Deleted
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Oct 8, 2024 22:24:06 GMT
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Post by Deleted on Aug 11, 2014 15:11:02 GMT
I have found that non-American doctors are much more straight forward than American doctors. I work in a health clinic and that at least is the way it seems here. I'm not defending what he said because I do think it was rude but that is pretty typical of non-American doctors. I have changed doctors for that exact reason!
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Deleted
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Oct 8, 2024 22:24:06 GMT
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Post by Deleted on Aug 11, 2014 15:15:19 GMT
Melissa posted what a doctor would say so that makes what my friend went through irrelevant at this point.
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Deleted
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Oct 8, 2024 22:24:06 GMT
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Post by Deleted on Aug 11, 2014 15:30:32 GMT
Maybe as Melissa states this did need to be said but I'm sure he could have chosen his words much more carefully. Labels that people put on other people can be incredibly damaging and body image, self esteem and the pre teen years are so complicated you'd think that a doctor would know better. Did he offer any advice on what she should be eating to bulk up a little bit? Weight is also a very difficult subject for me, I've been told by a doctor (on my first visit after moving to Ireland) 'god but you're thin so' whilst being poked in the ribs. Yeah thanks for that I wasn't under any illusions about it!
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Post by bearmom on Aug 11, 2014 15:49:29 GMT
BTDT. Anytime we saw any physician who wasn't dd's regular. They almost always commented on her weight and her heart murmur. My standard response: she's had her murmur evaluated and she has been below the 5th percentile since 2. Maybe because of the murmur, the weight didn't bother me as it appeared that they were questioning all potential health concerns?
I agree his comments could have been better, but working with physicians on a regular basis, some have better bedside manners than others and some are very blunt and will tell you things that others beat around the bush at.
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Post by femalebusiness on Aug 11, 2014 16:01:38 GMT
What a douchbag. So typical of know it all doctors. Sorry your daughter had to hear that.
I've seen doctors with big beer guts having the huevos to tell a patient that they are too fat.
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Post by craftsbycarolyn on Aug 11, 2014 16:02:03 GMT
Yes, terrible bedside manners!!! I think I would say something to your regular doctor the next time you see him..."The other doctor told Quinn she was too skinny and should eat more" ...because all her percentiles were within normal range...
By the way...I love your daughter's name!
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Post by mandasue on Aug 11, 2014 16:10:12 GMT
My child is much younger (she's 5) but her pediatrician has often made the statement that she is just a "tiny thing" meaning imo that everything is well health wise that she's just small. And she always added in that my husband is a very thin man so it was likely genetics. We were told to feed her more fattening foods to try to add some weight when she was 3 but of course, I just keep feeding her like normal.
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melissa
Pearl Clutcher
Posts: 3,912
Jun 25, 2014 20:45:00 GMT
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Post by melissa on Aug 11, 2014 16:15:21 GMT
Ahh... but her percentiles are NOT within normal range for a 12.5 yr old who is 5 feet tall.
Of course, we don't know if she has lived at the 3rd percentile for weight since she was a toddler, but at puberty and beyond, this is concerning.
Her BMI is less than the third percentile but even if you break apart height and weight and use a growth chart, her weight is still at or below the 3rd percentile and her height is in the normal range. That's a discrepancy that should at least raise an eyebrow. How high that eyebrow is raised depends on the situation.
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Post by Darcy Collins on Aug 11, 2014 16:21:01 GMT
I don't fault the doctor for raising the issue, but do understand that his approach wasn't ideal. At my daughter's 12 year appt, her pediatrician spent some time delving into nutrition and activity levels. She was somewhere between 5 and 10 percentile. I think they were also concerned as her percentile had dropped from something like 15 or 20. I thought the doctor approached it in a respectful manner. If she had simply said, "you're too skinny eat more." I would have been annoyed.
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