Children's Health and Shifting Baselines

(photo credit: Brian Harrington Spier)

I was out grocery shopping today with my son, and as always, I was faintly embarrassed. My robust American boy looms over most Tajik kids his same age. He's taller, plumper, and bigger boned. (And he's not fat. He's about 50th percentile, right where he should be in my family of average height folks.) In the States, on the other hand, he looks as average as he is. But one third of Tajik children are stunted, and 5% are wasted. Small wonder my son looks like a giant. It is honestly embarrassing, like he's living proof we use more than our fair share of resources.

Baselines shift so easily. In a culture where kids tend to be fat, average ones like mine look scrawny. Without the reassuring weight charts, I could easily be trying to fatten him up. I mean, I see his ribs when I change his shirt. And most Tajik parents probably can't even tell their kids are stunted.  They are just as big as the kids in the neighborhood, as their cousins and classmates. How are you supposed to know something is wrong? Even doctors can fall into this. If all of your pediatric patients are under the curve on your growth charts, it's easy to assume that Tajik children just run small.

What do we do about these kinds of shifting perceptions? As you might expect, I think a rigorous focus on data is the answer, and better communication. For physicians, their training should include a discussion of the damage done by stunting and wasting, so they don't just shrug it off when kids fall off the growth charts. For parents, photographs of what healthy children look like at different ages would help. Give them a standard for comparison.