If a child is too small - by which I mean seriously underweight - then the smallness itself can be a medical problem. Children who do not take in enough calories, protein, and other nutrients to grow normally have problems in many body systems. Their brains may not make enough myelin, a fatty substance that allows nerve cells to work right. They can end up with learning problems that are hard to outgrow. Their immune systems may not work well either, so they can end up getting sick more often. And each time they get sick, they stop eating for a while and fall further behind in their nutrition and growth. If this cycle keeps up, children can end up in the hospital or - in the worst case - dead. Around the world, children die from undernutrition and infection all the time. Thankfully, that's rare in rich countries like ours.
I can see that I'm becoming pretty bleak here. The truth is, many small children are just that - small. In other respects, they can be pretty healthy. They may be picky eaters. They may come from families of small people. Sadly, many of them come from families that don't have the money to buy all the food they need. A few years ago, doctors in Boston discovered an effect they called "heat or eat." During the cold months, when home heating bills go up, so does the number of children in the emergency room who are seriously underweight. Why? Because their parents have to choose each month between paying their heating bill and buying the food they need.
In any case, small children raise big questions. If you're a parent of a small child, you might have some questions of your own. You might wonder if your child is really healthy, or if there is some underlying medical issue. You might want to know how you can get your child to eat something other than chicken nuggets. You might need help making ends meet so your family can be warm and well fed. For all of these questions, a pediatrician, family doctor, or nurse practitioner can help. Please use us.
