bad advice from dr. regarding my young teen daughter
Queen_JessieA
Posts: 1,059 Member
My 13 daughter went in for her sports physical and well check up today and saw a nurse practitioner. She is 4'11" and 108 pounds (down from 115 five months ago). She has been watching what she eats and working out and I have been encouraging her NOT to go below 1200 cals. My daughter is a pretty picky eater. She doesn't eat a lot of meat (which doesn't bother me, but the rest of my family ARE meat eaters, so I worry that she isn't getting a balanced diet). She will eat chicken and sometimes ground turkey breast (like in home made sloppy joes or a home made turkey burger).
So, what concerns me is that:
A) the NP encouraged her to keep losing weight. I think she is perfect the way she is!!
the NP told her not to drop below 1000 cals (yes, a THOUSAND) (I told her I had heard and read that anything below 1200 was not good)
C) She told us that we should incorporate protein shakes into her diet ~ but only as a meal replacement and NOT an add on to a meal or snack
Am I right to be sort of worried about this?? Now I am going to have to battle with my daughter over what a professional said. You know how 13 year olds are
So, what concerns me is that:
A) the NP encouraged her to keep losing weight. I think she is perfect the way she is!!
the NP told her not to drop below 1000 cals (yes, a THOUSAND) (I told her I had heard and read that anything below 1200 was not good)C) She told us that we should incorporate protein shakes into her diet ~ but only as a meal replacement and NOT an add on to a meal or snack
Am I right to be sort of worried about this?? Now I am going to have to battle with my daughter over what a professional said. You know how 13 year olds are
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Replies
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Your a mom trust your gut.
And Go see a dietician se sounds like she doest have a clue.0 -
1200 may not even be the right amount for her. Figure out her BMR and make sure she doesn't net below that. I calculated it using the link below and it said 1341. Make sure she eats her exercise calories back! I think protein shakes are a good thing, but as a meal replacement I'm not so sure.
http://www.pediatriconcall.com/FORDOCTOR/pedcalc/basel_energy_expenditure.aspx
Of course, if she is a good weight for her age and height, I wouldn't make her try to lose weight!0 -
Hi, I have three daughters and can see your concern. I am on board with you.. I would be weary of any professional advocating under 1200 cal and protein shakes.. I also hope that the conversation this professional had was not in front of your daughter.
13 is such a vulnerable age as far as body image.. They are in the cross over of feeling like adults but their bodys still developing therefore holding onto some extra "baby fat".. My youngest had that now she is 15 and has grown three inches and has thinned out.
My opinion in regards to girls is never to give food power... Provide healthy options at home and show them that they can enjoy the junk stuff in moderation that its not "bad" I honestly feel that if they are getting good food at home and are encouraged to be active it will work itself out.
Your the mom... trust you gut... noone knows your child like you...
just my two cents.... good luck...xoxo0 -
If you check a teen bmi calculator she is in the healthy range. I don't know why a medical professional would suggest meal replacements for a young teen, and to me 1000 calories at 13 does not sound right. When I was a teen a cardiologist told me going days without eating purposely & otherwise regularly skipping meals was a normal thing teen girls did and no cause for worry since I wasn't in the underweight range, then refused to do the echocardiogram my doctor ordered after I had an abnormal EKG. I only mention this because doctors and nurse practitioners aren't perfect, make mistakes, and occasionally say really dumb stuff. All you can do is your best to instill a healthy body image and sense of self worth and emphasize healthy habits. I hope your daughter will listen to you as well. I feel like childhood & adolescence is no time to be counting calories unless the child is actually dangerously overweight. I hope everything goes okay
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Hi, I have three daughters and can see your concern. I am on board with you.. I would be weary of any professional advocating under 1200 cal and protein shakes.. I also hope that the conversation this professional had was not in front of your daughter.
13 is such a vulnerable age as far as body image.. They are in the cross over of feeling like adults but their bodys still developing therefore holding onto some extra "baby fat".. My youngest had that now she is 15 and has grown three inches and has thinned out.
My opinion in regards to girls is never to give food power... Provide healthy options at home and show them that they can enjoy the junk stuff in moderation that its not "bad" I honestly feel that if they are getting good food at home and are encouraged to be active it will work itself out.
Your the mom... trust you gut... noone knows your child like you...
just my two cents.... good luck...xoxo
Thanks for all the advice from all of you so far! And for this, too. You said what I was thinking but I so un-eloquently said. Yes, the NP did say all of this in front of her. And I have been trying to let her know how beautiful she is, inside AND out. She truly doesn't need to lose anymore. She is slightly the middle line of the average (but well in the healthy weight range) for her height and age.
I love how you said not to give food power. What a good way to think.
I never thought she needed to lose even at 115 pounds, but she would get so upset about how she felt she would cry for hours, so we started going to the gym more together and she would try to make better choices with her food. I just told her to make sure not to go below 1200.
Thanks
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http://www.fitnessfrog.com/calculators/tdee-calculator.html
4'11" 108 lb female even if she is getting NO exercise (i.e. going to school, not participating in a gym class, not walking to or from school, just between classes, etc)
Her TDEE (total day energy expenditure is about 1600 calories which means that is maintenance calories for her if she does not exercise at all.
The LEAST she should be eating if she wants to lose weight is 1200 (but again, at 108 she is already at a healthy weight. If she wants to get leaner, sure, but she should continue eating around 1600, and possibly manage macros (i.e. eat more protein, less carbs). I'm a vegetarian, so if she isn't eating much meat she may be like me and want to sub some of her normal calories for protein supplements, but again, she's not in need of losing weight!0 -
I feel like childhood & adolescence is no time to be counting calories unless the child is actually dangerously overweight.
THIS.
She's too young to be counting calories and worrying about weight - She's still growing, her weight is going to continue to fluctuate throughout her teens. It's just better for her not worry about, and make sure she's healthy.
Don't even get me started on the 1000 calories comment.... :grumble:0 -
Doctors get very little instruction on nutrition, and it tends to be very traditional and vague.
On top of that, nurse practitioners are not doctors. They get significantly less instruction, and the material is taught at a significantly lower level.
Advice from an NP regarding nutrition should not be treated as gospel.0 -
I think I would find a nutritionist that has a lot of experience with growing kids. I would probably go without her first to ask my questions. I would be worried about:
1. Restricting calories too much while she is still growing
2. Effects on puberty
3. Her self image if put on a "diet" and the possibility of developing an eating disorder.
Does she get exercise? Maybe incorporate some family fun time that involves getting out and moving around instead of just worrying about calories. I do not think a 13 year old should be counting calories. Have the whole family focus on eating and being healthier instead of just her.
( by the way, I am a child counselor. This is kind of what I do for a living. The NP may not have ant idea what this could do to her psychologically)
Maybe some people who were told to lose weight as a child could chime in with their experiences.0 -
I don't agree with what she told you at all. 108 is a good solid weight for her size. She is still in the early development of vital organs and those need to be nourished. You are the mom and if it doesn't sound right then I would not follow the advice. Best of luck!0
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I would take what the nurse said with a grain of salt because they don't have much training/education in nutrition and/or sports nutrition.
For someone your daughter's height, 1000 cals is not completely crazy but the fact that she is 13, active and already light means she can eat a lot more while still building muscle/losing fat.
Protein shakes are awesome, especially if she isn't getting much protein from her plant based diet (if she doesn't eat much beans, etc) and depending on how nutritious and calorie dense the shake is, she may use it as a replacement or addition to her regular meals.
You should take her to a nutritionist who also specializes in sports nutrition and plant based diets. She does not need to be restricting down to 1,000 and honestly I think 1,200 is even pretty low for someone her age/size with a seemingly normal/healthy metabolism.
Tell her that her body is not a "one size fits all" and that she and you should get a second opinion from an actual professional before she decides to change the way she is currently doing things.0 -
I think I would find a nutritionist that has a lot of experience with growing kids. I would probably go without her first to ask my questions. I would be worried about:
1. Restricting calories too much while she is still growing
2. Effects on puberty
3. Her self image if put on a "diet" and the possibility of developing an eating disorder.
Does she get exercise? Maybe incorporate some family fun time that involves getting out and moving around instead of just worrying about calories. I do not think a 13 year old should be counting calories. Have the whole family focus on eating and being healthier instead of just her.
( by the way, I am a child counselor. This is kind of what I do for a living. The NP may not have ant idea what this could do to her psychologically)
Maybe some people who were told to lose weight as a child could chime in with their experiences.
She does go to the gym with me about 3 times a week. And her developing an eating disorder is definitely something that has crossed my mind She got very obsessed about it at one point but seems to have really chilled about it in the last month or so. How do you pull someone away from something they already are convinced is the right way? I mean, she sees me counting my calories. I have a good bit of weight to lose, so it isn't something that I can hide. And I am sure she doesn't want to look like me, you know? I can see her wheels turning. 0 -
13 and dieting? That is a little young (unless she's seriously overweight.) I'd rather focus on physical fitness and activity at that age than calorie restriction. She's still growing and developing and she needs to eat to do that properly.0
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It does sound low, but she is a child and they do not need as many calories as adults anyway. I definitely agree with everyone else saying talk to a nutritionist. Even MDs are only given a very, VERY minimal amount of education about nutrition.0
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I don't really have anything too helpful to add, everyone else has pretty much covered it. Just wanted to say sorry the NP said all those things in front of your daughter. If she was prone to body image issues or disordered eating that "advice" could have been really harmful. I have a 13 year old sister so I know how they are. She is very concerned about her body at this age as well. It sounds like your daughter is perfectly healthy, just try to remind her that she is beautiful every day. And let her know that doctors (and especially nurse practitioners) receive very little nutrition training and that that was bad advice.0
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13 and dieting? That is a little young (unless she's seriously overweight.) I'd rather focus on physical fitness and activity at that age than calorie restriction. She's still growing and developing and she needs to eat to do that properly.
Trust me...that is what I have been encouraging the most. I don't want her battling the cals all her life like I have. Have you ever tried to have a valid conversation with a 13 year old girl? She doesn't listen to a word I say unless it agrees with what she says
She is a great kid. I love her to death. And I love working out with her! I do try to encourage healthy eating habits, too!0 -
My 14-YO daughter is about the same height and weight. I would be shocked if her doctor told me any of those things.
She's a coxswain on her school's rowing team, and it's really beneficial for coxswains to be small (think like a horse jockey but in a boat!). Anyway, her coach (who has a solid background in nutrition) told her she is the exact right size for her height and he would 'rip her a new one' if she dared even considering dieting. He tells that to all his rowers: the teenage years, when brains and bodies are still maturing, is not the time for dieting and depriving their bodies of nourishment.
I'm really aghast that anyone would tell a child to eat less than a thousand calories!0 -
My gosh. I'm no mom or doctor so this may not be my place to talk seeing as I'm only 18 but this doctor sounds clueless.
As a mom, just trust your gut. 13 is such an awkward age already that she does NOT need to be told to eat less or weigh less by some doctor. 108 pounds is absolutely fine for her age.
I was always a chubby kid (but didn't see it at the time) until I started thinning out at 13/14. I grew and my baby fat left. At 13 I realized that I had been chubby before and didn't like it but I still ate normally - it had never crossed my mind to eat less. However, my parents and some other adult family friends thought that I was eating less because of how skinny I got. Luckily I didn't know that until WAY after the fact because otherwise that could have totally given me the idea to start eating less.
All that to say that 13 year old minds are different than adult minds. Keep feeding her the way you have been and don't go replacing meals with protein shakes - if anything ADD them to her diet if you feel she needs more protein.
I hope I haven't come across as some know it all 18 year old but I just wanted to share that. If you really want more (better) info for your daughter's nutrition go see a nutrionist. Unfortunately NPs don't always have the best info on everything
edited to add that you did right to make sure she knows she's perfect the way she is. At her age she shouldn't have to worry about diet and calories. Best of luck to you 0 -
Damn...you need to take her to get a second opinion. The NP has to work under a doctor...I'd almost talk to that Dr. and voice your concerns that a professional is telling a young teenager "advice" that could easily lead to an eating disorder!!0
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Someone suggested that you find a nutritionist who specializes in teens (growing children) and I would say the same thing. I don't know if you realize, but her body is not staying in place like it does when you're 28. Her body wants to grow, for another good 5-8 years. She needs to feed it to make sure that it does.
I don't know where you live, but I'm sure you can find a nutritionist who can help you. Most nutritionists I know don't even advocate calorie counting, unless you are severely overweight. They believe that if you eat your veggies and generally eat healthy, your calories won't be crazy. That's the logic you should have as a child, not one where you are counting calories and drinking protein shakes.0 -
Damn...you need to take her to get a second opinion. The NP has to work under a doctor...I'd almost talk to that Dr. and voice your concerns that a professional is telling a young teenager "advice" that could easily lead to an eating disorder!!
yup.0 -
when I was 13, I was 5' and 98#, I got made fun of and called 'anorexic'. It really affected me.
As others have said, NPs are NOT nutritionists, and at 13, I would be more concerned with her getting enough protein to support her growing and changing body.
A consult with a nutritionist that specializes in children/young adults would be the correct route to go. Explain this to your daughter since she may have the "but a 'NURSE' told me this, so it HAS to be true"
best of luck.0 -
I have an 11 year old daughter, she is not stick thin either. She also sees her dad and I counting calories. We tell her we have to do this as adults because we didn't learn ( or didn't care about how to treat our bodies in a healthy way. We only talk about being healthy with her, not losing weight. We tell her kids don't worry about calories because they are still growing, and their bodies fluctuate all the time. Mom and dad aren't getting any taller so we have to do something else. Unfortunately, someone "in authority" already told your daughter to count calories. I would be mad if someone told my daughter this. If she continues to obsess, if it were me, I would get rid of the scales in the house and and keep encouraging healthy snacks. Mine are still younger, so it is easier to control, but they can choose one not healthy thing a day, and then when they are hungry they go for fruit, cheese, nuts, etc.
Just keep telling her over and over how great she is. You may have to do it 100 times to override the stupid NP who said all of that in front of your daughter.
Some people said she is in the normal range? If she doesn't believe you, look it up and show her. That will be another source that isn't her "mom". Because what do we know 0 -
I agree with what everyone else has said. And I offer a little bit of hindsight. My sister was anorexic as a teen. She hardly ate anything. She suffered mild brain damage because a brain needs fat to function properly. 15 years later, she suffers from forgetfulness, dizziness and blackouts, even though she is managing her weight in a healthy way now. Don't accept bad advice from anyone regarding nutrition and weight during the teen years. Get good information, from someone who knows what they're talking about.0
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I feel like I'm fairly well qualified to chime in on this as at 19 I remember those years VERY clearly still. The biggest and most important thing I think to mention is to TALK TO HER ABOUT IT. Make sure she keeps you in the loop on everything she's doing. Once secretive behaviours start, it diminishes by a huge amount what you can do to help. Even if it's not entirely healthy, making sure she tells you everything she's doing in terms of calorie restriction, BEFORE you slowly try to get her to come around...telling her straight up not to obsess and that she's being an unhealthy or silly won't make her stop, it'll just make her hide her behaviours, making any bad decisions exponentially more dangerous.
Secondly, you need to instill in her as strongly as you can that she's at a healthy weight, and that is what is important. When I was that age (just a few years ago!) I developed a serious eating disorder, but had absolutely no-one to talk to about it, and so it just got worse and worse until I landed in hospital, with my mum absolutely distraught and beating herself up about it because she'd had no idea what was going on (she assumed for a while that it was the natural thinning out of early teen years, and didn't realize anything was wrong until it was far too late). If we'd been in a constant, comfortable communication pattern with openness about body image, nutrition and all things calorie-related, I feel like it might not have happened, or at least, sense would've been banged into me before I wound up in hospital with tubes stuck in me.
If she's anything like how I was, trying to steer her completely away from the obsession with calories etc. will just result in her thinking it's something to be ashamed of, and doing it obsessively in secret, with no guidance. I'd say, while this would not necessarily be a good idea for your average early teen, if she's already picked up some obsessive behaviours with calorie-counting, all you can do is steer them in the right direction, possibly by making her a profile on something like MFP, or similar. That way, she'll be bombarded with the right (usually!) advice, and if she is obsessive, at least it'll be "healthy" (yeah, oxymoron, I know, but I'm speaking in relative terms) obsessive rather than unhealthy obsessive: resorting to ED forums, pro-ana sites etc., and doing her own calorie restrictions, which can end up ridiculously low.
Also, appealing to logic was one of the things that eventually helped me out. Articles on metabolism slowing from netting too low, "starvation mode" etc, and about how keeping your metabolism going with high enough calorie levels can result in healthy weight loss, while still maintaining adequate nutrition, really made logical sense to me. As much as right now she might want to lose weight, she hopefully realizes that as she's 13, she really does have to think about the future, and how what she's doing now may result in her finding it HARDER to lose weight at a later stage (story of my life...) due to metabolism damage.
Sorry for the very long and possibly rambling post, this is just something that I feel I can really identify with and need to chime in on. When I was 12, I was about 5'4 and close on 150lbs. By the time I was 14 I was 5'7 and probably right on 100lbs (by that point mum had taken all scales out of the house so I wasn't entirely sure). Major metabolism damage later, and I wound up MAINTAINING at about 130lbs, on only about 1000 calories a day. If she goes down this route, that might be reality for her, which isn't fun!
Markers to watch out for, (from experience!):
-often saying she's just eaten, when she comes home from being out with friends
-taking food to her room or somewhere else in the house to eat it rather than eating with family
-her looking tired all the time
-her being dizzy and/or passing out
-drinking lots of diet soft drinks and/or coffee (appetite suppressants! I'd sometimes go days on a few black coffees, 6 or 7 bottles of coke zero, and maybe an apple)
...i'm sure there's lots more but i'm having a bit of a mental blank now.
Anyway, I hope any of that has been helpful, I just really would hate to think of another young girl going down the same route I did!!!0 -
Thank you all. I will certainly be trying to find a child/teen nutritionist tomorrow.
And Holly, thank you for all of that advice. I am so glad you have recovered!! I keep a very watchful eye on her because I know how easily it is to slip down the path of not eating enough. I struggled a bit with that myself in high school 0 -
BMI is interpreted differently for children and teens as body fat amounts change with age and with sex of the child/teen. BMI for adults does not account for age or sex.
There are BMI for age growth charts that are used as guidelines.
Here's a link that should give you some info you may find interesting and/or useful:
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html
"However, BMI is not a diagnostic tool. For example, a child may have a high BMI for age and sex, but to determine if excess fat is a problem, a health care provider would need to perform further assessments. These assessments might include skinfold thickness measurements, evaluations of diet, physical activity, family history, and other appropriate health screenings."0 -
Trust you mumstincts.0
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A lot of GP's love to give nutrition advice and many don't have a clue. Even as an adult, I don't talk to my GP about nutrition any further than "I would like some blood tests to check my iron/vitamin/etc. levels." Find a doctor who specializes in nutrition and preferably one has experience working with children and see what they say.0
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False, most teens actually need more calories than adults. Puberty and growth need a lot of calories to sustain properly.It does sound low, but she is a child and they do not need as many calories as adults anyway. I definitely agree with everyone else saying talk to a nutritionist. Even MDs are only given a very, VERY minimal amount of education about nutrition.
OP, she's a healthy weight. She should not be counting calories at all. She still has roughly 10 years of growth and physical development ahead of her, restricting calories can have severe consequences on that.0
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