When Growth Charts Tell a Different Story
Recognizing Malnutrition in Kids Who Don’t ‘Look Sick’
When it comes to malnutrition in children, many believe that it’s something that appears obvious - dramatic or visible weight loss, a child who “looks thin”, or a sudden decrease in food intake. As a Registered Dietitian specializing in Pediatric Nutrition, I work with children all the time who may appear to be in a “normal” body size at first glance, but taking a closer look reveals more. Because in reality, malnutrition in children can be much more subtle and come without significant warning signs.
For parents, it may be difficult to notice some of the more “quiet” indicators. Maybe their child presents in an average sized body, clothes still seem to fit, they still see their child eating, they still have energy to participate in sports, etc. Nothing specifically jumps out that something is wrong. Despite this, their growth chart may be telling a very different story that appearance alone can’t capture.
How can growth charts help detect malnutrition?
Growth charts reveal patterns our eyes can’t. A child who once followed a predictable curve may begin to drift downward over months or years. Growth in terms of height may start to slow before weight changes become obvious, or maybe height continues to track while weight gain slows or stalls completely.
For a child who may have previously tracked higher on the growth curve, sometimes this drop in weight or stall might not even be acknowledged by medical providers since the child isn’t considered underweight, and weight changes could be easily attributed to “healthier dietary choices”, a child “growing into their weight”, or increased physical activity. While these shifts may happen slowly over time, they can often signal that a child’s intake isn’t keeping up with their needs.
What is the cause of "invisible” malnutrition?
The reasons behind this kind of “invisible” malnutrition aren’t often simple. They could range from eating disorders, sensory sensitivities, chronic GI symptoms, food allergies, high energy needs, or recovery from illness. Early recognition matters because malnutrition affects far more than weight. It can influence energy, mood, immune function, bone health, and long‑term growth potential.
When families notice something feels “off,” that instinct is worth acknowledging. Asking a pediatrician to review the growth chart over time, sharing even small feeding concerns, or connecting with a pediatric dietitian can open the door to gentle, supportive interventions that help a child thrive without pressure or shame.
Faith Wright, MS, RD, LD is a Registered Dietitian in Crestwood, MO and works virtually with clients across the U.S. She has advanced experience and training in Eating Disorders and Sports Nutrition, and specializes in working with pediatric clients at all levels of care - from hospital in outpatient settings.