Tracking Baby’s Growth: What Really Matters | Dr. Vaneet Parmar | The Parent Lab x Nestlé FamilyNes

Kriti Vij: As parents, we remember our baby’s birth weight. But here’s a shocking truth that I found out: your child’s birth weight alone says almost nothing about your child’s long-term health. 

Kriti Vij: In India today, one in three children under the age of five is stunted. One in five is wasted. These numbers are not just statistics. They’re warnings. Because tracking and supporting growth in the first 2 years decides whether our children will reach their true growth potential or not. 

Kriti Vij: Hi, I’m Kriti Vij. This is The Parent Lab. Today’s guest is the Director of Pediatrics at Fortis Memorial Research Institute, Gurgaon, with over 20 years of experience in pediatric and neonatal care. Please welcome Dr. Vaneet Parmar. Hi, doctor. 

Dr. Vaneet Parmar: Hello. Thank you so much, Kriti. It’s a pleasure and an honour to be featured in The Parent Lab with Parentune. 

Kriti Vij: So, doctor, Indian families obsess over weight, right? When my toddler was born, there was a lot of talk about baby weight. We are really obsessed with that number. Is it dangerous to obsess over that number? Does it signify anything? What do you feel about baby weight? 

Dr. Vaneet Parmar: Well, Kriti, birth weight is an important start. But thereafter, there are so many other factors which we take into account. We see the weight as such. We see the height and the head circumference. We also see the developmental milestones, the cognitive functions and the behavioural skills. So, it is a multi-dimensional thing. There’s no point obsessing about the weight. Yes, birth weight is important for us, but after that, there are so many other things which we see. 

Kriti Vij: Right. But there’s that rule, right? Triple the birth weight by the first birthday and double the height. Something like that, if I’m not mistaken. 

Dr. Vaneet Parmar: Yes, you’re right. Normally, by 5 months, they should double the weight, and by 12 months, they should triple the weight. That’s a general thing. But [audio unclear: “1.5 kg … at 1 year”]. So, it cannot be true for all kids. 

Kriti Vij: That’s true. 

Dr. Vaneet Parmar: Let me tell you that whenever a baby comes to us, we track the basic things like the height, weight and head circumference. Then we plot these parameters on a graph. These lines are what we call growth charts. You must be knowing about them. 

Kriti Vij: Right. 

Dr. Vaneet Parmar: Basically, these lines are called percentiles. All babies have a different growth curve. So, if they’re going steadily on the curve, parents should not worry about it. Secondly, a mild variation, let’s say a slight shift of one or two percentiles here and there over a period of time, may not mean that there’s a problem as such. But in case there’s a shift of two or more percentiles, then obviously it needs evaluation by the pediatrician. 

Kriti Vij: So, doctor, when the baby reaches 6 months and solids are introduced, what should parents look out for? How can we make that feed a nutrition-heavy feed? 

Dr. Vaneet Parmar: Complementary feeding is basically adding semi-solids or soft foods to the baby’s diet along with breastfeeding. We start at 6 months because there’s a reason behind it: breast milk alone is not sufficient to provide the required nutrition to the baby. 

Kriti Vij: That’s right. 

Dr. Vaneet Parmar: Normally, there’s a pattern for how to start it. You cannot just go haphazard. We start with soft feeds or soft semi-solids. Every month, and that’s what I follow, I ask parents to introduce one more feed, so that by 9 months they are taking three cereal-based meals and preferably two snacks. 

Dr. Vaneet Parmar: Complementary feeding is important because the nutrients required by the baby, especially the proteins, the macronutrients and the micronutrients, are very essential for growth and for brain development as well. Iron, for that matter, is basically a super micronutrient, I would say. Iron plays a big role in immunity and in brain growth. And let me tell parents that brain growth is at its maximum in the first 1,000 days, starting from conception. As a protocol, we are now adding iron supplements for all babies. 

Dr. Vaneet Parmar: You also need to look at the texture of what you are giving. It should be very nutrient-dense. It should be easily digestible. It should be iron-rich. 

Kriti Vij: So, doctor, when I see a bowl and I want to feed my toddler, my aim becomes, “I have to finish this bowl.” I don’t call this a very healthy habit, but it’s naturally what I guess most new parents would want to do. 

Dr. Vaneet Parmar: True. 

Kriti Vij: Sometimes that bowl is lacking, like you said, a lot of macronutrients and micronutrients. Can you touch a little upon what should be included in that bowl? What should we be looking out for? 

Dr. Vaneet Parmar: Rightly said. There are a lot of misconceptions and unrealistic expectations from the child. What I would suggest is: let the child decide. There are two things which we follow. One, these days we encourage baby-led feeding. Baby-led feeding means the baby takes the lead on how much and what to eat. That also helps the baby learn hunger and satiety, or fullness, cues. 

Dr. Vaneet Parmar: There’s also a concept which I would highlight: the My Plate concept. My Plate is a visual guide to make sure that you’re giving a balanced and nutrient-dense diet to your baby. Half of the plate should be vegetables and fruits. They should be green leafy vegetables, tubers and roots. The fruits can be green, red or yellow, because all fruits have a different nutritional value. Then there should be proteins. When I say proteins, I mean pulses, meat, fish and eggs. These things are very important. It gives the child more or less everything. 

Kriti Vij: The sound of this plate is great. There’s a plate, and it’s got all the macro and micronutrients that you would like to give to the child. But it is not always consumed. How do we create good portions or interesting combinations so that a nutrient-rich diet is actually going inside the child? 

Dr. Vaneet Parmar: I was talking about the visual guide. Apart from proteins, fruits and vegetables, you should also have cereals, which is one quarter of the plate: your brown rice, your whole wheat and your ragi. It should be appealing to the baby as well. And one very important thing which I would highlight is that eating or feeding should be a very happy and enjoyable experience for the baby. I see a lot of parents force-feeding the child because that is their expectation. 

Kriti Vij: That’s true. 

Dr. Vaneet Parmar: If the child starts associating feeding or eating with distress, it becomes a big issue. You don’t have to worry about the portion size as such. We should ensure dietary diversity. Dietary diversity means you have a plate where you are getting proteins and vitamins. Proteins are the building blocks; they help in so many other functions. Iron, as I told you, helps in brain growth and immunity. Then you have zinc, which helps in appetite and also plays an important part in immunity. Then you have calcium and vitamin D, which help in bone mineralisation. So, if you ensure there’s a minimum dietary diversity in the diet you are giving, it takes care of most of the nutritional needs of the baby. 

Kriti Vij: And is it true that in India we see a lot of anaemic children? Do you see that a lot in your practice? 

Dr. Vaneet Parmar: Not much in my practice, but you’ll be surprised to know that the National Family Health Survey, a recent survey, says that the incidence of iron deficiency anaemia in children under 5 years is almost 50 to 60%. Yes, iron deficiency is a big issue. And like I said, it’s one of the very important micronutrients for wholesome growth. 

Dr. Vaneet Parmar: North India especially is obsessed with milk and milk products, and that is the poorest source of iron. So, we have kids who are good in weight and look very healthy, but they’re deficient in iron, because they’re predominantly on milk and a milk-based diet. 

Dr. Vaneet Parmar: The second problem is the vegetarian diet. I’m not against a vegetarian diet; it’s good. But iron absorption from a vegetarian diet is minimal, whereas a non-vegetarian diet has iron which is easily absorbed. So, green leafy vegetables and fruits, pomegranate for that matter, don’t have a lot of iron, but they help in the absorption of iron. Guava is one. 

Kriti Vij: Oh, okay. Guava is very rich in iron? 

Dr. Vaneet Parmar: It’s not that rich in iron as such. 

Kriti Vij: So, doctor, you mentioned texture progression. What is texture progression? 

Dr. Vaneet Parmar: The texture of the food you’re giving the baby plays a very critical part after 6 months of age. Why I say so is because, you’ll be surprised, it helps your baby’s sensory skills and fine motor skills. What we normally advise is that you start with soft foods, then pureed foods. But then you have to progress. You have to change the texture and shift to mashed foods thereafter. Then it could be soft lumpy foods, slightly thicker and lumpier foods, and then finally finger foods at around 8 to 9 months. 

Dr. Vaneet Parmar: Very commonly, what I see in my practice is that parents continue giving grated and pureed food for fear of choking. Let me reassure them: in my practice of around 23 years, I’ve never seen a healthy child choke because of food, provided the parents are aware of what texture is to be given at what stage. They might gag at times, but that’s how they develop oral motor skills. 

Dr. Vaneet Parmar: One of the very common things we see is what we call a pediatric feeding disorder. The child takes the food and just keeps it on the side. That’s the reason mothers come to us with this problem: “It takes us 2 hours, 3 hours to give one feed. We are feeding the child the whole day.” That happens because of these things. When you’re giving textured food, the jaw muscles come into action, the tongue movements and tongue muscles come into action, and the sensory skills too. So, like I was telling you about baby-led feeding, it could be messy and slightly chaotic, but that’s how the baby starts enjoying it. 

Kriti Vij: That’s true. 

Kriti Vij: So, doctor, there are lots of cute moments between 0 and 18 months of age, right? There’s babbling, pointing, chewing, standing and walking. How would you track these moments, and how important are they in your practice? What are you looking out for? And when is it a red flag? When should parents worry if things are not being met? 

Dr. Vaneet Parmar: There’s always a window; there’s a range. And most kids attain that range. For example, a child crawling at 7 months or a child crawling at 11 months: both are fine with me. So, there’s always a range. Developmental milestones are important, no doubt, but the concern is when they are grossly delayed. At a certain age, there are certain developmental milestones. So, in case all the milestones are grossly delayed, it is a sign of concern. Or if there’s a regression of milestones, if the child is doing something and suddenly stops doing it, that’s more ominous, in fact. That needs a developmental assessment and a total evaluation as such. 

Dr. Vaneet Parmar: Otherwise, we do evaluate the milestones. Most of the time, we look at gross motor skills, fine motor skills and language skills, and we assess them accordingly. And parents, I think, compare: “That child has started walking, and mine…” There cannot be a comparison. All kids have their own schedule and their own style. So, developmental milestones are important, but as long as they are within the range, you need not worry as a parent. 

Dr. Vaneet Parmar: Now, crawling. Like I said, the style and schedule are different for different kids. A child might start with a commando crawl, a crab crawl or a bear crawl. But let me tell you, crawling is not one of the major milestones now. There are kids who start walking directly without having that stage. When you assess crawling, you assess other milestones also, like the pincer grasp, which comes at 9 months. The child should start standing with support and rolling over. So, there are different milestones which we see. If all of them are grossly delayed, it is a problem. If not, it’s okay. 

Kriti Vij: So, doctor, in India, would you say you have seen a rise in preterm births? Is that happening a lot more than it used to? 

Dr. Vaneet Parmar: Well, it depends on the area and the facilities you have. But yes, we have seen a variation as far as preterm birth is concerned. Preterm babies have different growth charts, like I mentioned. The only thing I would like to tell parents is that whenever we assess a preterm child, we look at the corrected age. 

Kriti Vij: Corrected age would mean when they were actually due? 

Dr. Vaneet Parmar: Yes. So, if a child is born, let’s say, 2 months early, the milestones we assess are as per the corrected age, not as per a term baby. 

Dr. Vaneet Parmar: One thing I want to mention about preterm babies is that they have depleted stores, and their nutritional needs are different. So, like I was mentioning, we start the supplements, the nutrition, iron and all that much earlier. As a protocol, in fact, we start around 2 weeks in a preterm child, compared to a term child, where we start at 3 to 4 months. Vitamin D we give to all kids right from birth, whether preterm or term. But we also add calcium and other supplements in a preterm baby for bone density. And most of them catch up sooner or later. 

Kriti Vij: I have noticed as a new parent, and I often have this discussion with my mother, she says, “We didn’t have so many things to worry about. You have these charts that you follow, and then you get anxious and stressed about these things.” Do you think awareness is sometimes a boon, or can it go the other direction? 

Dr. Vaneet Parmar: You should not overdo it. And trust your pediatrician. Trust your doctor. See, imagine your baby is gaining around 1,000 g a month in the first 3 months. And the same baby is gaining less than 100 g a month at 12 months. So, the growth pattern is different at different stages; the growth pattern changes. And like I said, we look at steady progress, taking all those things into account, not just the weight but other factors as well. So, progress is more important than following a rule book. 

Kriti Vij: Absolutely. 

Dr. Vaneet Parmar: Don’t rely on whatever you read on the net. Trust your pediatrician. And no comparison as such. Don’t compare your baby. 

Kriti Vij: I agree. The more information we come across, whether it’s through WhatsApp groups or ChatGPT or whatever it may be, the anxiety levels of new parents have really shot up. They’ve become overprotective. 

Kriti Vij: So, doctor, when a milestone is not met, of course the first rule is not to get super anxious, because they will hopefully catch up. But when does it become a red flag? When should a parent see a pediatrician with their baby? 

Dr. Vaneet Parmar: There are certain things which should concern them. Like no social smile by 3 months. No neck holding or head holding by 4 to 5 months. At 12 months, if the child is not standing with support. Very poor eye-to-eye contact. Then, no language skills by 18 months. In fact, that’s a red flag sign for which we normally evaluate for autism and other things. But like I said, it is the gross delay and the regression which are red flags anyway. At different stages, different milestones have different timings and different ranges. The only thing I would like to tell parents is that if there’s any gross delay, it’s a red flag, and you should get your child’s developmental assessment done. 

Kriti Vij: So, doctor, I’ve got a fun, interactive session now. I’m going to give you a real parent situation, and you have to tell me whether it is a relaxed situation or a worried situation. 

Dr. Vaneet Parmar: Sure. 

Kriti Vij: Scenario one: “My baby looks healthy and active but hardly eats at mealtimes.” 

Dr. Vaneet Parmar: Relax, and enjoy. Appetite is transient. At times it might go up; at times it might come down. As long as your baby is active, cheerful and playing, you do not need to worry about it. 

Kriti Vij: All right. Scenario two: “My baby is happy and playful but hasn’t started crawling yet at nine months.” 

Dr. Vaneet Parmar: Relax. We discussed that, because crawling is not a must. Your child might skip crawling entirely and start walking directly. It’s always a range, so no issues at all. 

Kriti Vij: Scenario three: “My baby is smaller than other babies of the same age, but the doctor says she’s growing steadily.” 

Dr. Vaneet Parmar: Relax, absolutely. We discussed that if the child is growing steadily and the progress is fine, you need not worry. And you cannot compare your baby with anyone else. Even twins are different. 

Kriti Vij: That’s true. Scenario four: “My baby gained weight really fast in the first few months, but now the growth seems slow.” 

Dr. Vaneet Parmar: Relax, but keep a watch, because growth patterns are different. As I told you, genetics play a part, nutrition plays a part and body type plays a part. If your baby is not gaining weight, or if the baby is losing weight, obviously it’s a red flag, and you should consult your pediatrician. Otherwise, if there’s steady growth, just relax. 

Kriti Vij: So, let’s end with six truths every parent should remember about tracking growth the right way. One: birth weight is a reference point and doesn’t define a child’s overall development. Two: the quality of nutrition is more important than the quantity of feed. Three: healthy growth is about the body, brain and behaviour, not just the weight. Four: patterns over time matter more than single numbers. Five: nutrition, sleep and environment together drive growth. Six: if something feels off, trust your instinct and act early. 

Kriti Vij: Thank you so much, doctor, for being here. I think every new parent must have benefited from this conversation. 

Dr. Vaneet Parmar: Thank you so much, Kriti. The only thing I would like to say at the end is that children are not things to be moulded, but people to be unfolded. 

Kriti Vij: Wow. Well said. 

Dr. Vaneet Parmar: I hope I was able to convey the right messages to all the parents of Parentune. It was wonderful talking to you. Thank you so much. 

Kriti Vij: Thank you so much. And thank you to all the Parentune families for asking the questions that matter. We’ll see you next time on The Parent Lab. Thank you.