To think that the Health Visitor should have had a little clue about this...

[backintraining]

I have previously posted on another thread about my DDs feeding concerns and just as I had reached the end of my tether, began questioning my ability as a mum and had flooded the kitchen with tears, a massive weight has been lifted.

DD is just coming up to 7wks, she was born at 7lb 15oz, I tried to BF initally for a few days, long story short I didn't have the milk due to previous operation, she lost loads of weight, became lethargic and I (heartwrenchingly) switched to formula. Anyway, she was incredibly slow to regain her birth weight, has limped her way to gaining weight over the past few weeks and in the last 2 weeks only put on 8oz, she is now 9lb 4oz. She has fallen from 75th centile to under the 25th. Basically she does not feed well, she'll take 2-3ozs MAXIMUM every 3 or 4 hours and has been this way pretty much since we switched. The most I get into her in 24 hours is about 17oz and that has not increased at all even though her weight has slightly. I have tried everything, including waking for more frequent feeds, dreamfeeding, changing positions... always the same result. She has 2oz, burps (or doesn't burp!) then maybe has a bit more then she's done, generally if I have tried to wake her or dreamfeed she refuses. She is otherwise relatively content, alert when awake, peaceful when asleep, regular wet/dirty nappies etc.

Anyway, the HVs have been repeating that she "really isn't having enough in 24 hours", "really isn't gaining the weight she should be", "really should be taking more than that amount at her feeds"....... the final straw was today when I took her to be weighed and HV said: "You need to see the GP for an urgent hospital referral. It may be that you need to see a dietician, this is failure to thrive." Cue me making GPs appointment for this evening in floods of tears thinking the worst.

The GP was absolutely lovely. He explained it as this - the weight a baby is born at is all to do with how the placenta functioned throughout the pregnancy and then how the baby grows is all to do with genetics. He said that in DDs case she was born on 75th centile but is not destined to "grow" along that or be that big. He said that she is feeding and gaining weight in a manner that is allowing her to find her own lower centile. He was furious that the HV had made the comments that she had and said he would be speaking to her.

AIBU to think that the HV should have at least had an idea about this kind of stuff. The basis of their work is monitoring how a baby is growing, are they gaining weight, are they following a particular centile etc?? If someone had told me this weeks ago it could have saved a lot of stress and tears.

YANBU

i had kind off the same problem but my dd would be very happy to eat her own body weight everyday. had the hv making a song and dance that i had to get her weigh every month for 3 months then if her weight didn't come down then i would have to see the gp (8 months old and is 26lbs) so way off the chart

the gp just looked at her, said he wasn't suprised by her weight as she is so long

sorry op that came out all wrong

what i was trying to get at what they all had to do a simple thing to save weeks of worrying for the parents

Wow. I didn't know that about the placenta. That's really interesting because DD never lost any weight after she was born. She just carried on putting on weight when she was born. The HV was really pleased, and a bit shocked, as most babies lose some weight after birth. So my placenta may not have given her enough nutrients when she was inside me...

It's called catching down when babies do this and is surprisingly common.

YANBU but, look at it this way, your baby is fine but the next one in a similar circumstance might be failing to thrive, and its the HVs job to be mega careful about them.

Different thing but the midwife that sent me to hospital with DD1 saved both our lives as it turned out and there was very little sign that something was wrong - but what she said was, these babies are just too precious to take any chances with.

Yabu, failure to thrive is an actual condition and is v serious indeed, but not always easy to diagnose.

As a HV I know lots of GPs who know very little regarding infant feeding! Dropping so much weight can be failure to thrive and she did exactly the right thing in suggesting an urgent referral to a paed or dietician if she felt concerned. A drop of more than 2 centiles is worrying. However, the fact that she gained 4oz per week since that, is fine so I probably would have waited to see if she gains along the same centile now iyswim before referring.

I saw a baby in clinic who similarly had a really low milk intake but it was plenty for him to grow and he gained weight.

I think HV suffering something some of those in any medical profession suffer from , an extreme reluctance to admit they do not know everything and refer on,

this is not just HV it can be GP's not referring to consultant or one consultant not referring to another speciality or to his colleague who knows a bit more about x than he does as he knows more about y

Part of being professional is knowing what you know and what you do not, it can be difficult for younger ones some times as scare of looking incompetent and as getting older no-one wants to think that they are not up to speed and many shades in between

most common things are just that common, occasionally there is a rare reason
your health visitor should have monitored for a couple of weeks and once she realised it did not seem to be changing with her advice; if she was worried she should have referred you and Dc not lectured you as it may have been a rare thing which by persisting could have got worse or lead to delay in daignosis or as with you, realised that while it does not happen with most babies for your DC it was normal

the HV wanted to do a referral, probably because she didn't know what was causing the problem!

That sounds awful :( Sorry you had to go through that. I'm sure there must be some great HVs around, but I don't get why so many of them are obsessed rigidly with how they think babies should gain weight. It must be obvious that all babies are different, and if there is an anomaly then it should of course be checked out or monitored, but to keep making comments (not actually giving advice) and then suddenly switch to telling you to make a GP visit for urgent hospital referral is ridiculous. If she was that concerned and had no concrete advice, why didn't she suggest you see the GP or a paediatric dietician earlier?

BTW, I don't know if you're aware of this, but it might be possible to relactate if you wanted to, even if it has been several weeks since you last breastfed. I'm not in any way saying you should do this, of course, situations change etc and you are probably settled with how things are now. But it could be an option if you were interested at all.

Ignore HV they have changing guidelines and at the risk of sounding OLD - they lack common sense. My LO was off their charts for height and weight at 2 months and I was told to cut back his feeds! He still is way off the charts :) but I have stopped worrying about it.
Take it with a pinch of salt, keep maternal guilt at a distance. Your dr is right, babies follow a centile path roughly. Ff or bf they shall grow in proportion. I have stopped weighing my 16mo DS as each visit leaves me feeling inadequate as a mother.
If baby is eating, sleeping and being alert in between - its fine!
Hth I often think I gave birth to an invisible twin called anxiety with DS. Constant presence!

Better to check, my friends baby was not thriving and kept getting palmed off by GP and health visitor. Try formula, try different bottles, etc. The baby ended up being blue lighted to hospital when the mum self referred to a pead who realised baby was possibly minutes from death. It was a very rare condition but really, why bother with the weight checks if there is no follow on if the baby isn't gaining weight satisfactorily.

I am ever so sorry you had to go through such stress but unfortunately HV do make mistakes. I would've rather my HV and local hospital had been so cautious and maybe OTT though. DD was sick. But they refused to see it because she was bfed. How could it possibly be that a bfed baby got ill?

Babies are so precious that I'd rather go through a bit of fear and a lot of stress but double checking and triple checking that everything is ok.

Hope you feel better now and best of luck for the future :)

Oh god i remember that feeling. DD lost loads of weight after her birth and barely fed. we were getting in an oz or 2 every four hours and did it where we tried to feed her every 2 hours, had to set the alarm for night time but she still wouldn't take anything. she was born 6lb 12 and at her lowest was 5lb 9 the midwife said to me that if she had no improvement within the next day or two we would have to bring her to hospital. cue floods and floods of tears i was devastated. however two days later we were at the hospital as her heel prick has showed up congenital hypothyroidism and she had no thyroid gland and so was not eating or crying and sleeping all the time. she was immediately put on medication and in a few days was drinking 4-6oz a go and has thrived since, she is not the biggest but growing well. the relief was unbelievable, its horrible being told that there is something wrong with your baby but we were fortunate that it was fixable.

I think what the HV did was best. I'd rather feel slightly foolish with a GP then in an ambulance.

Thanks for replying. It's good to hear different views. I know the HV is just doing her job but my thoughts are that rather than repeating that DD wasn't feeding enough etc she maybe - as a HV, whose work is ruled by centiles - should have this bit of knowledge to be more reassuring.

Yes I will listen all day to what she has to say, but rather than state the obvious she could've have said "this" may well be the reason DD doesn't take much milk, but let's monitor her and see if it is the answer. Instead I have had 6wks of DD following a line, albeit lower than the one she was born on, but have continually been told its not good enough. I don't think the HV hasn't done her job right, of course she should refer if a certain box isn't ticked but maybe having this information could've saved a lot of worry.

I have heard that the weight that a baby is born at is to do with genetics and not to do with the "line" they should follow. Makes sense.

Some HVs are only fit for weighing a baby and filling in the red book. It keeps them off the streets. I distrust any "professional" who doesn't have to keep their knowledge and / or skills up-to-date. I won't even go into the shite advice I've had about BF but -

I had a perfectly lovely HV do a developmental check with my son. Lack of eye-contact is a major red-flag and one I had noticed about DS and was really worried about because DS had none.

The HV had eyes going in totally different directions and pronounced his gaze to be absolutely fine in her opinion and nothing to worry about. I wasn't even sure she was talking to me that's how bad her disability was. I feel absolutely fucking awful complaining about that but a person who is incapable of full sight should not be making decisions about the eye-contact and gaze of a child which will affect that child's entire life.

DS was diagnosed with classic autism a few months later at the age of 2.9 because I went to other professionals about it.

YABU. I think the HV did the right thing. If a baby isn't feeding enough they won't grow, what has genetics go to do with that? Why did you automatically believe the GP? Was it because he said what you wanted to hear? Why do people take the word of the GP as gospel?

This is because most HV's think all babies should gain weight bang on the 50th centile line, and don't understand that this is a very generalised guide, and that it's perfectly acceptable for some babies to drop some centiles, or to stay on lower centiles (oddly, they don't seem to worry about babies who are above the 50th centile constantly) and totally lack the ability to use their eyes and look at the baby, make sure they are happy, healthy and gaining weight, in their own time.

YANBU.

No advice or opinion on the situation, I just wanted to wish you well - I hope she continues to do well and that you can relax and enjoy her. :)

Bluepostdepot - I am not questioning what the HV did in terms of a referral, I knew DD wasn't feeding well, I'm the one who has been feeding her for 6wks, my query was should she not be in possesion of the knowledge as imparted by the GP as to why some babies fall or soar through centiles. I haven't taken it as gospel either, but its the first time I've actually been given a possible cause rather than just a 'she's not having enough' but no advice line. Am seeing a Pead in a couple of wks aswell as a follow up.

I agree that it didn't help you in any way that the HV was basically just stating the obvious. Must have been frustrating. I always found that the HV visits were never informative and consisted only of weighing DD. I wasn't worried about her wait. Stopped going at 4 months.
She should've been more informative.

*weight. Not wait.

OP, I know exactly how you feel.

DS1 the same, dripped from the 25th to between the 9th and the 2nd and got referred to the GP, who really wasn't that concerned at all.

He is a perfectly happy 3.5 year old now who I am told by the nursery is one of their brightest boys . Still tiny though, he is in clothes for 2-3 years.

DD is 10 weeks, born over the 50th centile and has now dropped to just below the 25th. She is tiny T 10 pounds 3. Like you I never get over 20 fluid ounces a day and she only takes 3 ounces at a time.

I am sure these HV are just backside covering and follow their text books, I used to get tearful like you but with hindsight there was no need.

Are you small OP? I am 5 feet 2 inches and know that I will never have big babies.

dropped

Yep, am 5'2 aswell, although DH is 6ft & v stocky???