Normal body-weight

The emphasis laid upon the relationship between height and age is far overshadowed by that laid upon the relationship between body-weight and age. A child of a certain age is commonly supposed to have a certain weight, and if below this weight is considered an underweight child. As in the case of height, average weight is invariably taken as the normal weight. Normal tables or average tables have been prepared, and almost every writer combines several of the earlier series and obtains his own individual normal which he uses for his study. The very fact that this divergence and uncertainty exist in the minds of all students of the physiology of childhood shows that there has been an unwritten hesitation to accept as normal many of these values. We believe that with children certainly we should no longer consider the average as normal. With adults there are a large number of overweight individuals to compensate for the number of underweight individuals, so that the average value for body-weight represents a median line with approximately the same proportion of overweights as underweights. With children the situation is quite the reverse. The number of overweight children, even using the erroneous term "normal" when applied to the average, are much fewer than the number of underweights. On standing in front of any of our public schools and noting the condition of the children running out at the end of a day's session, one may see at a glance that the obviously overweight children are very few indeed, while those who are obviously underweight usually pass by more rapidly than they can be counted. On this ground, therefore, to take an average value for children seems wholly erroneous.

If a child is seemingly underweight for a given age, this may be due in part to his short stature -- possibly a racial characteristic -- or may be due to a deficiency in the growth-promoting factors in the diet. In other words, underweight may be simply a concurrent factor with short stature, or, if the height is up to the average and the child is still noticeably underweight, this condition may be due distinctly to an insufficient caloric intake. This latter is the more probable and more common situation. If we refer again to our data for privateschool children, we will recall that at all ages they were measurably heavier for their age than were the other normal series that we have reported, both our own laboratory series and the earlier standard series. As we pointed out, however, their greater weight is in large part due to their greater height. Still, the fact that outdoor environment, better medical attention, and probably better dietetic conditions have produced a larger and better conditioned child than the ordinary, especially in our public schools, is a factor that must not be overlooked.

So-called "normal weight" is not normal, but is merely average. We believe that our ideal figures, as represented in our curves for private-school children, more truly represent the normal and that pediatricians should strive for the higher weight for age as exhibited by our private-school children rather than for the average weight for age, although here again we clearly recognize the differences in nationality in mixed groups, such as those being studied in any of the public schools, and the probably purer strain of nationality in our private schools.