The quest for ‘NORMAL'

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The Child Development Index helps reassure parents that their child is growing at a healthy rate, but at the same time, it can raise unnecessary concerns.

Recently, I came across a post by a woman asking for advice for her two-year-old daughter, who weighs 10 kilograms, and seemed to have a loss of appetite. Tons of comments were left by fellow mothers, giving all kinds of suggestions. They wrote things like, “Make her rice soup”, “Feed her bananas and eggs”, “Give her pastries” and so on. Someone even recommended “vitamins” that helped increase appetite while another advised getting the two-year-old tested for intestinal worm. Another mother suddenly became concerned for her own infant son, who apparently was the same weight as the two-year-old girl though he is 13 months younger.

After a while, the author of the post wrote, “Thank you, fellow mothers. I’ll pay more attention to my daughter’s diet and help her reach a normal weight. I guess I’m a bad mother.”

There were whirlwinds of more similar posts on public groups, mostly dedicated to mothers and fathers. They’re asking for each other’s know-hows in keeping their children at “normal” weight, height and body mass index. If their child was under or over the appropriate level, parents became anxious and blamed themselves for it. It was appalling to find out that some mothers and fathers were comparing their children and saying things like “a child at a certain age should weigh
this much or be this tall but your child is not…” and even suggesting specific brand supplements before advising to see a doctor. They seem to be standardizing children by their physical development and deem them “abnormal” if they are slightly “off the margin”. Doctors and experts are advising against using various supplements for increasing appetite without a doctor’s prescription. They said this could do more harm than good, not to mention bring about psychological distress to parents. 

Every country has an index or indicator for young children’s physical development. Apparently, these indices tell a parent whether their child is growing healthily or not. So it’s not just parents in Mongolia who monitor their children’s physical development and try to keep them at average.

According to experts who worked in Japan, most Japanese parents focus on their child’s weight rather than height. This is said to be connected to the global increase in obesity, as well as Japan’s perception of beauty. Japan is known for its exceptional health education system and is recognized to have one of the healthiest lifestyles, especially diet, that leads to extended life expectancy. This is probably why Japanese people put more emphasize on weight. According to the Ministry of Health and Ministry of Social Welfare and Labor, the Child Development Index is updated on a regular basis based on research and data, but not so much research has been conducted to evaluate how the index affects the psychology and attitudes of parents.

Past research works by international psychologists and doctor who work with children show that children’s physical development can cause mental distress and anxiety among parents, especially if it isn’t consistent with the index. Due to this, some experts advise against using this type of instrument for measuring children’s development. They added that these instruments could produce biased scores that lead to ill-informed decision if it lacks in reliability and validity.

Every child is different in the way they develop physically and mentally. Children shouldn’t be pressured to reach a certain height or weight based on their age. It’s inappropriate to comment on a child’s weight, height and body shape. It’s also wrong to blame mothers and their way of taking care of their child for a child’s “thinness”, “obesity” or “weak body”. Each child is different and grow at different speed. It’s about time people realized this.

 Highly developed countries such as Switzerland have been proactive in removing old child development indices and develop contemporary height, weight and body mass index references for children through to adulthood. Many parents agree that it is necessary to revise the current index.

Mongolia last renewed its Development Index for Young Children in 2013. Accordingly, children’s growth and development are monitored with the pink booklet for mothers and children’s health checkups. This booklet has a graph and chart on the last page that shows the “standard” height and weight a child should be depending on their age and gender. When children reach puberty, their physical developmentis measures via the body mass index. Depending on location, environment and climate, 96 percent of the Mongolian population and around 90 percent of children under the age of five face Vitamin D deficiency, while 70 percent ofthe population suffer from Vitamin A deficiency, as shown by the fifth Nutrition Status of Mongolian Population report by the Public Health Institute. The report highlighted that 1 of every 3 households in Mongolia consume secure food, with 2 out of 5 children being able to get at least the minimum amount of essential nutrition on a daily basis. In other words, the majority of children in Mongolia are not able to get the nutrition they need to stay healthy. For instance, vegetables and fruits are an important part of a healthy diet and are sources of many essential nutrients but they account for less than 20 percent of Mongolian children’s diet. Moreover, the food children consume has drastically changed over the past decade or so, affecting the growth and development of children. Taking this into account, we can no longer follow an index that was made eight years ago – it must be updated to reflect the current trends in children’s growth. 

Most Mongolians believe that children grow quickly and should be chubby, primarily pushing parents to feed children more than they can handle, causing overweight and obesity in children and leading to concerns that are uncalled for. Pediatrician at Gurvan Gal Children’s Hospital emphasized that many parents in Mongolia make wrong dietary decisions due to their lack of knowledge and information about children’s development.

“Mums and dads often ask me ‘How can I make my child eat more?’ instead of asking the cause of their child’s loss of appetite. They don’t pay attention to any signs or symptoms for illness and think a child would be fine as long as they eat well. They also give all kinds of vitamins distributed through businesses that have chain marketing or pyramid structure schemes. As a result, overweight and obesity are becoming more common among young children,” he said. “World Obesity Federation forecasts that the number of obese children globally will reach 250 million by 2030. Mongolia is predicted to have around 80,000 obese children between the ages of 5 and 19 by 2030. Therefore, parents must assess their child’s growth and development realistically, not just based on the index, and pay attention to helping children grow without some kind of illness or health condition.”

An indicator might help keep track of children’s growth and ensure healthy development but if a parent feels like their child is too obese, too thin, too short or facing any kind of health problem, they should see a doctor instead of asking other mothers for advice. Gullible mothers and fathers could suffer from unnecessary distress, waste their money on things they don’t need or even cost the wellbeing of their perfectly normal child.

Globally, child development indices are measured by three factors -- education, health and nutrition – to see how a child is growing. However, in Mongolia, it seems that the health, especially physical development, is more on the focus. Lack of knowledge and understanding about the index and children’s development, neglecting to see a doctor, poor communication with the family doctor and long-standing stereotypes of children’s weight and height could be driving parents to become overly obsessed by their child’s body and seek unprofessional help. This will surely negatively affect children and their mindset. In addition, the current index must be renewed to suit the modern growth rate of infants and children as well as shift the attention to overall wellbeing and education of the future generations. The current index pressures parents to fatten or slim their children rather than ensuring their wellbeing. We say that everyone is unique and different from each other – this includes children.

Dulguun Bayarsaikhan