{"componentChunkName":"component---src-templates-post-query-tsx","path":"/blog-post/how-small-is-too-small-part-3-of-3/","result":{"pageContext":{"post":{"slug":"/blog-post/how-small-is-too-small-part-3-of-3/","title":"How small is too small? (part 3 of 3)","date":"Apr 20, 2012","timeToRead":4,"description":"","body":"function _extends() { _extends = Object.assign || function (target) { for (var i = 1; i < arguments.length; i++) { var source = arguments[i]; for (var key in source) { if (Object.prototype.hasOwnProperty.call(source, key)) { target[key] = source[key]; } } } return target; }; return _extends.apply(this, arguments); }\n\nfunction _objectWithoutProperties(source, excluded) { if (source == null) return {}; var target = _objectWithoutPropertiesLoose(source, excluded); var key, i; if (Object.getOwnPropertySymbols) { var sourceSymbolKeys = Object.getOwnPropertySymbols(source); for (i = 0; i < sourceSymbolKeys.length; i++) { key = sourceSymbolKeys[i]; if (excluded.indexOf(key) >= 0) continue; if (!Object.prototype.propertyIsEnumerable.call(source, key)) continue; target[key] = source[key]; } } return target; }\n\nfunction _objectWithoutPropertiesLoose(source, excluded) { if (source == null) return {}; var target = {}; var sourceKeys = Object.keys(source); var key, i; for (i = 0; i < sourceKeys.length; i++) { key = sourceKeys[i]; if (excluded.indexOf(key) >= 0) continue; target[key] = source[key]; } return target; }\n\n/* @jsxRuntime classic */\n\n/* @jsx mdx */\nvar _frontmatter = {\n  \"title\": \"How small is too small? (part 3 of 3)\",\n  \"date\": \"2012-04-20\",\n  \"template\": \"post\",\n  \"slug\": \"how-small-is-too-small-part-3-of-3\",\n  \"postedLink\": \"https://riceinstitute.org/blog/how-small-is-too-small-part-3-of-3/\",\n  \"old-tags\": [\"child-height\"],\n  \"description\": \"\",\n  \"tags\": \"Blog Post\",\n  \"banner\": \"\"\n};\nvar layoutProps = {\n  _frontmatter: _frontmatter\n};\nvar MDXLayout = \"wrapper\";\nreturn function MDXContent(_ref) {\n  var components = _ref.components,\n      props = _objectWithoutProperties(_ref, [\"components\"]);\n\n  return mdx(MDXLayout, _extends({}, layoutProps, props, {\n    components: components,\n    mdxType: \"MDXLayout\"\n  }), mdx(\"p\", null, \"Over the last couple of days, we\\u2019ve thought about how small is too small from a population perspective. But, in my recent fieldwork in Sitapur, I found myself asking the question, \\u201Chow small is too small?\\u201D on an individual level.\"), mdx(\"p\", null, \"From early February to late March, I was spending time in villages near our house in Sitapur, trying to think about factors contributing to the small body sizes of Indian children.\"), mdx(\"p\", null, \"I chose three villages within bicycling distance, and for two months, I spent one day each week in each of them. When I was there, I spent time with women who were in the late stages of pregnancy and who were caring for babies less than two months old.\"), mdx(\"p\", null, \"Each week, I weighed the babies and women and tried to get a sense of what their home life was like. I watched, and sometimes helped them work, held the babies, and talked with the women about what they ate, how they took care of their children, and what their pregnancies and childbirth experiences were like.\"), mdx(\"p\", null, \"The graph below shows six babies\\u2019 weights for age over the study period. For this graph I chose to show weight, rather than height, because it fluctuates more over a short period. (The babies in the graph were picked for the purpose of talking about them in the blog post; they are not representative of my little sample.)\"), mdx(\"p\", null, mdx(\"a\", {\n    parentName: \"p\",\n    \"href\": \"http://riceinstitute.org/wordpress/wp-content/uploads/2012/04/sitapur-for-blog.png\",\n    \"target\": \"_blank\",\n    \"rel\": \"noopener noreferrer\"\n  }, mdx(\"span\", {\n    parentName: \"a\",\n    \"className\": \"gatsby-resp-image-wrapper\",\n    \"style\": {\n      \"position\": \"relative\",\n      \"display\": \"block\",\n      \"marginLeft\": \"auto\",\n      \"marginRight\": \"auto\",\n      \"maxWidth\": \"786px\"\n    }\n  }, \"\\n      \", mdx(\"span\", {\n    parentName: \"span\",\n    \"className\": \"gatsby-resp-image-background-image\",\n    \"style\": {\n      \"paddingBottom\": \"72.5%\",\n      \"position\": \"relative\",\n      \"bottom\": \"0\",\n      \"left\": \"0\",\n      \"backgroundImage\": \"url('data:image/png;base64,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')\",\n      \"backgroundSize\": \"cover\",\n      \"display\": \"block\"\n    }\n  }), \"\\n  \", mdx(\"img\", {\n    parentName: \"span\",\n    \"className\": \"gatsby-resp-image-image\",\n    \"alt\": \"sitapur for blog\",\n    \"title\": \"sitapur for blog\",\n    \"src\": \"/static/50ce5a47e2294757ec6e76352c2eb6a4/d1ce0/sitapur-for-blog.png\",\n    \"srcSet\": [\"/static/50ce5a47e2294757ec6e76352c2eb6a4/36ca5/sitapur-for-blog.png 200w\", \"/static/50ce5a47e2294757ec6e76352c2eb6a4/25cf9/sitapur-for-blog.png 520w\", \"/static/50ce5a47e2294757ec6e76352c2eb6a4/d1ce0/sitapur-for-blog.png 786w\"],\n    \"sizes\": \"(max-width: 786px) 100vw, 786px\",\n    \"style\": {\n      \"width\": \"100%\",\n      \"height\": \"100%\",\n      \"margin\": \"0\",\n      \"verticalAlign\": \"middle\",\n      \"position\": \"absolute\",\n      \"top\": \"0\",\n      \"left\": \"0\"\n    },\n    \"loading\": \"lazy\"\n  }), \"\\n    \"))), mdx(\"p\", null, \"I\\u2019ve labeled each of the babies\\u2019 growth curves by their mother\\u2019s names (changed for confidentiality), because women in Sitapur tend not to give babies names until they are older, and will likely survive.\"), mdx(\"p\", null, \"The graph shows the growth trajectories of six babies. Two babies, Ram Kali\\u2019s son, and Sunita\\u2019s daughter seemed to be doing well. Compared to other babies in Sitapur, they were large for their age. Ram Kali\\u2019s son even improved his weight for age over the study period. As you will recall from the picture of falling average z-scores, this is fairly uncommon.\"), mdx(\"p\", null, \"I don\\u2019t know for sure ideas why these babies did so much better than the others, their houses were no cleaner and their families were no richer. Both of their mothers, however, were not as thin as many of the others, and breastfed frequently.\"), mdx(\"p\", null, \"Sachi\\u2019s daughter, in the middle of the graph, is a baby who seemed to be doing OK compared to the other babies in the sample. She was neither the biggest nor the smallest, and as you can see from her flat weight for age line, she neither stopped growing nor had any major growth spurts. A few weeks into the study, I compared the babies\\u2019 sizes to reference population for the first time. I was surprised to learn that Sachi\\u2019s baby, and a couple of others who I thought were doing OK, actually had z-scores of -2. In Sitapur, they look normal, but they are very small by reference standards.\"), mdx(\"p\", null, \"Each week, when I went to visit the babies, there were three in particular about whom I worried. Vimla\\u2019s baby, Mina\\u2019s baby, and Lila\\u2019s baby were much smaller than the rest, and were gaining very little weight.\"), mdx(\"p\", null, \"As you may know from a previous post, I weighed Lila\\u2019s baby the day after he was born, and found that he was at the cut-off for low birth weight, 2.5 kgs, or about 5.5 lbs. After that, Lila was happy to have me visit them, but asked me not to weigh him because she thought repeated weighing might make him sick. So, over the seven weeks that I got to know them, I could see that he was not gaining weight properly, but I didn\\u2019t know how bad things were until the day before I was about to leave to visit the US, when Lila said that I could weigh him again. It turned out that he had gone from a z-score of-2 to a z-score of -4.25. He had gained only 200 grams, or less than a half of a pound, in the 7 weeks since his birth.\"), mdx(\"p\", null, \"Vimla\\u2019s baby, a little girl, was only about nine days old when I met her. She seemed thin to begin with, but as time went on she gained less and less weight, and her mother started to feed her cow\\u2019s milk in addition to breastmilk. Vimla worried about how small she was, and took her to a doctor. She often waved pieces of roti-dough over the baby to keep evil spirits away.\"), mdx(\"p\", null, \"Mina\\u2019s daughter was not drinking breastmilk when I met her. She was about a month old. Her family said she vomited breastmilk violently, and they\\u2019d taken her to a traditional healer as well as the district hospital. Now, she drinks only cow\\u2019s milk. I was fairly worried that the combination of possible disease from bottle feeding and inadequate nutrition from the cow\\u2019s milk would compromise her health, but at one point, she did start to gain weight. Then, the week after she began to gain weight, her uncle died in a motorcycle accident. The family was in mourning. After that, Mina\\u2019s daughter stopped growing again.\"), mdx(\"p\", null, \"I am guessing that the babies like Sachi\\u2019s will probably survive, despite the damage they may suffer from being stunted and underweight as children. Statistically, Ram Kali\\u2019s and Sunita\\u2019s babies will be better off as adults because of their relatively successful growth as children.\"), mdx(\"p\", null, \"I think often about Lila\\u2019s, Vimla\\u2019s and Mina\\u2019s babies these days. At what point are babies so small, and growing so poorly, that they are unlikely to survive? Will they be there when I get back? How small is too small?\"));\n}\n;\nMDXContent.isMDXComponent = true;","tags":[{"name":"Blog Post","slug":"blog-post"}],"banner":null}}},"staticQueryHashes":["318001574","3787687951","3787687951"]}