Friday, March 26, 2010

Small Packages

The other morning, I took Ethan on a little adventure to Barnes and Noble.

We happened to arrive just before a scheduled story time. Great! I thought. What perfect timing!

Unfortunately, story time was aimed at two and three year olds. My kindergartener listened, skeptically, to about three minutes of the cutesy wootsy story and song about ducks and then mortified me by announcing, quite loudly, "THIS IS SO STUPID!" So much for that outing, right?

But something else happened while we were there, something that left an impression on me.

There was an arrestingly adorable boy running around the aisles -- a bright-eyed little towhead named Andrew. He was 19 months old. I know that because I overheard his mother answer a stranger's question. And then I heard the familiar pause, and the apologetic follow-up. "He's just very small for his age."

Oh man, have I been there. My heart sank, reflexively.

I used to say the same thing. Every time. And I still do occasionally, when I can see people looking askance at my tiny son, who at five-and-a-half weighs 33 pounds sopping wet and stands a mighty three foot-four. We used to joke that he was going to drive rear-facing. I know what it feels like to have your husband accidentally dress your almost-four year old in his nine-month-old brother's shorts. And have them fit.

Oh my! said a well-meaning mother at the pool last summer, eying my two boys, who are almost exactly three years apart. You sure had them close together, didn't you?

Well, no. I didn't actually. Not at all.

Ethan has always been small. He was born small -- a few ounces shy of six pounds -- at 38 weeks, due to a somewhat mysterious condition called "IUGR," or intra-uterine growth restriction. Getting him to grow during his first few years was torturous. I held my breath at every weigh-in and familiarized myself with every weight gain trick in the book. One handout from his doctor's office read like some sort of diet parody. "Never eat vegetables plain!" it warns ominously. "Add butter, margarine, cream sauce, hollandaise, cheese sauce, salad dressings, sour cream and mayonnaise." (Not all at once, I hope.) "Plain crackers should have cream cheese, cheese spread, peanut butter, jelly, or margarine to increase calories," it goes on. It recommends canned fruit in heavy syrup over fresh. And my personal favorite, "Choose meats breaded, fried and sauteed in oil or butter." Well, who wouldn't? (There's also a recipe for a chocolate peanut butter milkshake that has -- I kid you not -- 1070 calories a cup. And that's seen as a good thing.)
I never realized, though, that having a child of Ethan's size carries its own unspoken stigma in Momville, where small babies are often viewed as second class citizens. On the mothers' message board I used to frequent, it was standard practice to return from well visits and post your baby's "stats." And though few might admit it aloud, ironically, in a culture where thinness is obsessively prized by adults, when it comes to babies, bigger is most definitely seen as better. "Isabella is in the 95th percentile for weight AGAIN," a mother might crow. Those damned percentiles were seen as scores, as if a baby deemed to be in the 90th percentile for weight was somehow being given a higher grade than one in the 30th. The mothers of babies who were "only" in the 50th percentile or less often posted nervously about what could be wrong with their children. It was hard not to feel defensive, or make self-mocking jokes about our featherweights. My son finally hit 20 pounds at his two year well check. Is there such a thing as a 20 pound two year old?, I asked the pediatrician, only half kidding. He finally debuted on the weight charts -- hello first percentile! -- some time last year.

I know where this comes from, of course. Whether nursed or fed formula, our babies' size can feel like the one tangible, measurable manifestation of our parenting, especially in the first few months of life, when they bring so little else to the table. (Think about it: Why do we put newborns' weight and length on their birth announcements? Um, because there's nothing else to say about them?) Those that grow big and, well, fat, are clearly doing fine, their little plump bodies a literal reflection of their health. And those like Ethan? Their charts are stamped with the gloomy "failure to thrive" label, with all the implications therein.

I watched with great interest, as both a mother and a journalist who's written a great deal on science and health, as the doctors walked the fine line between "He's just small" and "There's something amiss." We tried desperately not to intervene unless it was truly warranted. But one test led to another and another. Poor little -- literally -- Ethan was poked and prodded and schlepped to myriad doctors, one all the way in Philadelphia. At 14 months, after an endoscopy suggested he might have a rare form of food allergy, Ethan was put on a so-called "elemental" diet. For two months, he wasn't allowed to eat or drink anything -- nothing -- but a foul-smelling prescription formula. We propped him in his high chair that Thanksgiving with books and toys, hoping he might not notice the feast he couldn't take part in. For one horrific week I have mostly blocked out of my memory, he had a feeding tube in his nose. Until Dr. Bob Wood, the brilliant guru of pediatric food allergies at Johns Hopkins, stopped the madness. "There are only so many ways you can torture an essentially healthy child," Dr. Wood told us in his measured, reassuring tones. "There's nothing wrong with him."
So in our case, it was all a bad dream. Though he continues to be monitored by doctors we trust, the current feeling is that Ethan is perfectly healthy. He's just...small and thin. Like lots of kids. Like lots of adults. It's nothing for us to be ashamed of. Or apologize for. Or feel the need to explain to random strangers who ask how old he is at the bookstore or the pool. The vessel my amazing, precious son came in is just...small. Not bad. Or diminished. Or lesser. Just small. He's anything but failing to thrive in the things that matter. In fact, I could fill this space with nothing but a record of his breathtaking achievements, the things he can do so effortlessly that belie both his size and his age. But then I would really be breaking a mom rule.
Saccharine aphorisms are hardly my strong suit, but there is one I repeat over and over, like a mantra.

When it comes to Ethan, I always say, we like to focus on the things about him that are big: his heart and his brain.

I shared that thought with Andrew's mom at Barnes and Noble the other morning. I hope one day four years from now, she'll hear another mom defensively explain that her son is small for his age. And she'll pass it on.

Photo by Matt Mendelsohn
Click to see it full-size

24 comments:

  1. So right! Of course, the moment Ethan opens his mouth, the age-error moves in the other direction, no doubt. Cognitively, you've got a 10 year-old!

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  2. So well said, as usual. And I think new moms are freaked out no matter what when they compare their children to others. I still feel the shame of Sam being the last kid in our playgroup to master the fine art of the pincer grasp. (I'm sort of kidding.)

    Beautiful boys.

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  3. Awesome. My friend just wrote this book, which Ethan can read one day (well technically he could read it now; his brain is that big):

    http://www.amazon.com/Short-Walking-Tall-When-Youre/dp/159643323X

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  4. Great post! Connolly is small too- he's more like 25% for height and 10% for weight. Our docs have NEVER been worried about him, but, of course, we have. Mainly because it seems like everyone else's baby is 90% and above. How on earth can everyone be 90% and above... this is a CURVE people! A distribution, not a score. I actually think people lie about their children's stats a lot because no one wants to talk about having their child be 25% of anything.

    Although we know this, repeat it to ourselves over and over, we still fret over all the wasted bites, every half un-drunk Pediasure (in our house it's called Bear because, um, it has a bear on the front. Yep, we're original!). Today, C had a pediatrician appt because he's been coughing- Brian called me triumphantly with his weight... get ready for it... 27 lb! At 22 months. Whew, sounds like we've been worrying over nothing.

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  5. Thanks, everyone!

    And, OMG, Linda. Off to buy that book. Like right now!

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  6. Gosh I am now remembering your struggles when Ethan was younger - Sydney is a peanut too - hit 21 pounds at 2 years - I am not sure that is on the charts either - apparently 2% is the bottom of the chart, so it's a catch all - so I'm not sure if she's 2% or lower. She's been 25% for height all along. But we are not worried. Her daddy was also super tiny, and both of us are not huge adults! She's going to be small! The bonus is I get to use clothes for multiple seasons, and some of it, 2 years in a row :)

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  7. Wonderful post and very well written..I face this situation with my elder son since he was born , who is now 8 but looks 6...you know in my country(India) we say -it's all about brain, height and weight doesn't matter(I know it's entirely not true), but I like to remember it whenever I face a situation to explain his mismatched age & weight-height combo..

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  8. Perfect Jen! Just perfect!
    Love it -- you're an awesome mom.

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  9. I loved reading this and getting to know you better. I held my breath slightly hoping the next paragraph wasn't going to say there had been an awful diagnosis. I'm so glad he is healthy.

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  10. Dearest Jen, well said, as always!

    A trip down memory lane:
    - Seth weighed in at 5 -13 at birth
    - at two he was 21 pounds (before he got sick and lost a bunch...)
    - at five he was 31 pounds
    - at nine he was 48 pounds
    - he's about to turn 18, weighs 150, and is taller than any of us

    We've always said what he lacked in stature he made up for in presence. Good things come in small packages, even when they get big!

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  11. as the mother of the 1 pound wonder baby who has grown to be the 39 pound 8 year old, i have to say that i love this. i have always told my son that great things always, always start little. it's true. my son may be head and shoulders smaller than his peers but he is the bravest, strongest man in the whole, wide world!

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  12. This is my first time reading your blog and I am now in tears. Your son's size does not matter if he is a healthy child, and he sounds not just healthy, but remarkable, and with no "failure to thrive" at all. He is loved, which is how he will continue to grow physically, mentally, spiritually into a wonderful adult. I wish you all well.

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  13. I'm right there with you. My daughter KC is 10 and for height and weight is not on the charts yet. She wears a size 6/7 slim. I'm always saying, 'She's small for her age.' It's because when I say she's 10, I see the look in the other mom or dad's eyes. I,too, have dragged her to every imaginable doctor. She even spent a year getting an injection every day to see if that would stimulate her growth. It did not. And, we stopped the madness of shots. Now, we just make sure she eats healthy and we hope she grows.

    I've never read your blog before. This was wonderfully written.

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  14. My son, now 23, was 4 pounds 12 oz at birth (induced at 38 weeks because I have a unicornurate uterus, meaning my uterus is half the size and gets half the blood supply of a normal uterus.) He caught up at 4 months and grew by leaps and bounds. By elementary school, he was chubby. My middle school, he was almost adult-sized -- 5-6" in 6th grade, at which point he promptly stopped growing. So now he is a short adult. Go figure! Poor kid was out of sync at every age! But he's smart, happy, healthy, handsome and now, graduated from college and employed.

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  15. As the mother of another small kid (31lbs at almost 4y and still has the waist cinched on his 2T pants - that are just a mite bit too short) I loved this. It drives me nuts when people ask if we "feed that one" in comparison to his 40lb twin brother. Grrrr..

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  16. My younger daughter will be 6 on 27 April and she's kind of half like your son: for weight, she's never been more than the 20th percentile (right now, she weighs just about 35 lbs) but she's been in the 80th percentile since she was 4 months old (about 3'10" right now). She was tiny at birth - 5 lbs at 37 weeks and 18" - and now resembles spaghetti: pretty long, very thin and very pale-skinned. If you see her sideways, you almost can't see her at all (if you get what I mean).
    BUT. She's bright and cute and funny and spirited and adorable and I wouldn't change a thing!
    Her elder sister was even smaller at birth (a little lighter, a little shorter) and is less tall for her age but less skinny too - in other words, she's slightly above average height and just about average weight. And she's bright and cute and funny and spirited and adorable too.
    I know there's a lot of "parent pressure" about kids' sizes, but really, it doesn't matter AT ALL.
    Your child is healthy and bright and adorable - THAT's what matters! Stuff the snooty mums and their "95th percentile" crap!

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  17. I hate the term "failure to thrive" ~ all you have to do is look at either of your beautiful sons' smiles to know they are thriving, and happy, and loving, and lovable, and growing in the care of a wonderful mother {and father.} *hugs* Dani

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  18. My first child was like a three month old- 9.2 at birth and stayed gargantuan. My next two, respectively were 7.7 and 6.6, and I remember watching them fall off the growth charts and hover under twenty pounds till after their 2nd birthdays- a milestone their brother hit at- um- FOUR MONTHS. (Seriously, he was a weird monster baby.)

    And that carries its own stigma- he looked like a three or four year old, but acted very much like the two year old he was. "He's just really big for his age," I would say, while trying to catch him to chat about yet another mowing down at the Chick-Fil-A plyground.

    With the smaller two, I just kept telling myself that the growth charts were based on 1960s science and stats that didn't fully account for exclusively nursed babies- but my comfort levels varied based on whiche ped we saw in their practice. Some were like, "No big", and some were like "Red Alert! Growth chart drop-off! Code full fat dairy!"

    Your boys are gorgeous.

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  19. Your sweet man sounds PERFECT.

    I have the opposite situation where strangers wonder why my five year-old can't write his name yet or ride a two-wheeler and often acts like a turd in a restaurant - it's because he's a gigantic three year-old. (And he'll always be a tiny baby to me.)

    My judgment is that the judge-rs should be less judge-y.

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  20. Hi- I have a long skinny guy...that can wear is baby brothers clothes too. He is mortified sometimes. I just found your blog. Very refreshing...real writing. Thank GOD! Just wrote a piece on my blog about hating mommy blogs and had no idea when I wrote it about your piece in the NY Times. Here is the link. I think you might enjoy http://withoutablueprint.blogspot.com/

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  21. Absolutely love your line about focusing on the things that are full size. (If that's not taken the wrong way. Heh.)

    I too have a pair of skinny minnies. But I remind myself, as a kid, I was the shortest and skinniest in the class for years. That changed. Oh boy did it change.

    I wish I could tell that mom that 19 months isn't the end. It's just the beginning.

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  22. Thank you so much for this article. I have a Tiny Tim too and I vacillate between thinking he's on the verge of death and perfectly healthy. Because he couldn't be dying and be the happiest little dude around, right?

    It's caused me so much anxiety that I start thinking of doing crazy unhealthy things (maybe just one big bite of ice cream would be okay!) instead of trusting my child's hunger signals. Stressful.

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  23. Ethan is gorgeous, which you already know, but I'm just saying it anyway. :)

    The pendulum swings both ways. My Madeline, two years old in January, is seven/eight pounds bigger than her twin brother. It is rare that I don't get the "Are they twins?" question followed immediately by, "She's so much bigger than he is!"

    Yes. Seeing them everyday, I have noticed. Thank you. :) I have also had people not believe that they were twins. I guess that's the sort of thing other mothers make up sometimes? For giggles?

    I do find myself explaining in advance that she is bigger. This entry is a good reminder to stop that.

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  24. Jen, I just revisited this post (I loved it when you first posted) after a visit to the doctor when, as usual, we found that our little guy is at the 5th percentile for weight. He is happy and healthy and thriving, but every once in a while those percentiles get to me, crazy as it seems. Came here to be reminded that it's a distribution curve, not a measure of worth! And to be reminded of the things are really important. I love that photo of your boys - bursting with joy. And I thought I should let you know that this post has become a touchstone for me.

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