Please remember that these are only guidelines. Any concerns should be discussed with your pediatrician.

If you are concerned that your child is overweight, talk to your pediatrician. Your doctor will measure your child's height and weight and should calculate a BMI (Body Mass Index) to compare your child to other children of the same age. Now take a step back and take a deep breath. This is a very sensitive issue for children and your approach can have lasting effects on your child's feelings about their body and their relationship with food. Read on for some tips and more information. Be sure to read the previous article for more tips on keeping a healthy lifestyle.

1. Do not single the child out and offer different children different foods. This can be difficult when you have one very thin child and one who tends to gain weight, but it can be managed by what you keep in the house.

2. Stress that the whole family is trying to eat healthy so we can have strong healthy bodies. Model an acceptance of a variety of body shapes. Take into account your child's natural body shape and do not try to fit him or her into a mold that may not be reasonable. Usually the goal is to stop rapid weight gain and allow linear growth (growing taller) to slim the child down. Weight loss in a growing child is usually not necessary.

3. If you know it is not healthy and you know it is a high fat, high calorie food with little nutritional value-DON'T BUY IT. Children get plenty of treats in everyday life, at parties, fom grandparents, at sports events, so choose carefully what you want to have in the house.

4. Pack your child's lunch. Most school lunches are laden with fat, calories and artificial ingredients. Talk to your child about what they like to eat and pack a healthy version of it for lunch. Better yet, let them pack their lunch with your help. It seems like small portions of a lot of different things make the most satisfying lunches for my children. (A few carrots, a small yogurt, a few grapes and a sandwich would get an A+ from them.) A bit labor intensive for those making the lunch but I think it is worth it.

5. Model reasonable portions. If your child wants more at mealtime (even if you feel like it is more than they need) it is usually best not to limit them. Mealtime should be pleasant and children should not leave the table feeling deprived or criticized. If you have a child that only wants to eat three portions of the starch and none of the fruits or vegetables offered, I would gently remind them that eating a balanced meal is important and that they should try a bit more of the other foods. As I mentioned in the previous article, we encourage our children to try one bite for each year of age. The counting usually distracts them enough that they will try the food. Just be sure not to push it to the point that it becomes a battle. This is just one of those battles that they will always win.

6. Be sure to always have at least one fruit and one vegetable at dinner. We want to offer a healthy variety and also this helps the child feel full and satisfied.

7. Acknowledge the media's role in your child's relationship with food and their perception of their own bodies. Helping a child realize that thin bodies are not necessarily healthy bodies and that there is a range of body types and shapes can help you communicate to your child that your focus is healthy living and not fitting everyone into the media's mold of attractiveness.

8. Teach your children to practice mindful eating. Take your time when you eat. Sit down and enjoy your food. Ask them how the foods taste different. Is one sweet? Do you like the potatoes smooth or lumpy? Try anything to help them tune into what they are eating. Tuning into hunger and eating helps us to know when we are hungry and to stop eating when our bodies are no longer hungry. Sounds pretty basic but I know alot of us forget this simple step!

9. Encourage your children to drink water. Beverage calories can really add up. For a school age child the goal should be: about two cups of milk, one cup of juice and the rest water.

10. Exercise!! Make it fun! Make it a family affair!

Weight is a very sensitive issue that needs to be handled carefully. There are weight management clinics that may be helpful to the family that is really struggling. If your child is eating three reasonable meals, healthful snacks and is getting exercise every day then back off!! You have done your part and you need to look at things long term. Remember, your part is to help your child make healthy choices. Beyond this, genetics is a potent force and making your child feel accepted and loved may be more important than trying to fit your child into a certain percentile.

About Amy Anzilotti, M.D.