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.

My DD1 had something similar, though BF so I couldn't tell how much she was actually having. She dropped from 50th centile at birth to below 2nd, and was referred to a paediatrician after not gaining any weight for 2 weeks. But she was happy and healthy otherwise. The paediatrician said she wasn't eating enough and gave me a few pointers to get her to eat more. She picked up a bit and at 2.5 is still small for her age, but on the 7th centile. I don't think she is meant to be bigger.

DD2 started off putting on tons of weight, then settled down and dropped a few centiles too. It was hard not to be worried after my experiences with DD1, but she dropped from near 90th to about 50th, so a different prospect. The HV actually told me that the charts are just to give an idea and some babies just don't follow a smooth line on them.

I don't think you are being unreasonable, as I think what you're saying is not that the HV shouldn't have referred you, but that the extreme things she said to scare you were wrong.

DD dropped from the 92nd centile at birth, then put weight back in very slowly until she hit the 50th. Once she was there, she followed the line perfectly, but it took a long time to get there.

My HV referred me to the GP, but emphasised that it was "just in case". DD was alert etc, so there probably wasn't a problem, but she just wanted to make sure there wasn't any underlying problem which we could catch now.

I think that's a far better way to explain what could be happening, than frightening a new parent, who has already had her hand forced with respect to how she feeds.

Mine dropped from 75th to under 25th and then followed it. My HV said it didn't matter as long as he was following a line. He's still a skinny thing that eats like a horse and never stays still (at nearly 4)

I had this with Dd1. She's 12 now, and I was fairly young when I had her. We read her green book when we were having a sort out not long ago, and it was pretty sad reading actually.

She was 8lb 10oz born so on quite a high percentile, which she gradually dropped off. She was never interested in solids, she preferred milk until she was almost one. I did tell the hv that actually on both of my parents side, and Dh's Mums side, there were no females taller than 5ft 3, but it made no difference. Dh and I are 5ft 6 but both our Dads were 6ft plus.

Her book reads like I wasn't feeding her enough/properly. Luckily I had a very supportive mum so I didn't pay too much attention. It did make me sad reading it back. I remember one incident when I was detailing what food I had offered her. Even though I was only 20, I was making my own food from scratch - before it was fashionable , and Dd wasn't interested. She did however, enjoy sucking on toast. The hv was aghast, and suggested that perhaps I should get some window boxes and grow my own. (we lived in a flat). Since reading it back I've really over thought the whole thing, and decided that my age and Dd's reluctance to grow had us written off!

Anyway I digress, Ds who is now 4, had reflux. His paediatrician told me that birthweight is more a reflection of the mothers health and not to factor it in too much.

So yanbu. But then I think a lot of Hvs could use far more common sense than they do. Not saying you shouldn't have been referred, but they could have done it in a more reassuring way.

Thank you Barbeasty, that is exactly what I am saying. I had already made the decision that had DD not gained a lot of weight yesterday I was going to self refer anyway if the HV wasn't going to. I was just taken aback that the GP offered an explanation that COULD be a straightforward answer, although as I have said previously, I haven't hung on his every word & am seeing a Paed on 18th. Am still not totally settled. DD had 2oz at 3.30am then at 7.30,only took another 2oz. Still totally baffled & slightly worried but not as distraught as I have been because I have been given slight hope that there is POSSIBLY a reasonable explanation.

It's a shame you weren't given more help to establish bf'ing. Trouble with formula feeding is it is easy to obsess about how much they do/don't take. Glad your baby's fine though.

What Barbeasty said. I am amazed at how poor some health professionals people skills are! If you are in the caring profession I think it is extremely important that you display a caring and reassuring manner and treat people sensitively, not put the frighteners on people unnecessarily.

'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.' and in the case of my ds this led to the diagnosis of a massive hole in his heart when he wouldn't feed and was blue. Once that was discovered and he'd had diuretics and they'd sorted out what to do next, then he gained weight. He was 16 last week, but had the HV not been worried, then we may have had major problems.

What centile is your DD on for height?

What the GP told you about the placenta sounds spot on. Our DD was 2 weeks late and was born rather skinny (25th centile for a 42 week baby) but is very tall (about 98% centile). I don't think she was getting what she needed from the placenta at the end of my pregnancy. She is now on about 75% centile for weight, so must have soared through them, but none of the HV we have seen have ever suggested that she ought to have stuck to the one she was born on and rightly so as she is now more in proportion given her height.

I think YABU actually, for every 99 babies like yours who are fine there will be 1 who isn't.....

My DS2 was exactly the same, HV told us to go to GP who referred us straight to hospital and he was in intensive care within 48 hours. He had a very rare condition that took ages to be diagnosed but I dread to think what could if happened if the HV hadn't been so adamant I went to the GP that day.

Dropping 2 centiles is failure to thrive and is a big indicator something could be wrong, surely you would rather she be checked out properly??

DD was born right in the middle of 75th & 50th for length. She hasn't been measured since. but will be at hospital in couple of weeks. I suppose then we will have a better idea of her proportionality.

Well if she is still between 75th and 50th then being on the 25th centile for weight sounds fairly reasonable - some babies are thinner than others. It is really hard to measure the height of a baby accurately, so the whole thing does need to be taken with a pinch of salt. One of my friend's babies "shrank" 4cm in 2 weeks due to inaccuracies.

JoandMax, maybe I haven't worded my OP appropriately or you have misread. I am not berating the HV for the referral, as I have said a few times now. I am questioning why she was not in possession of information regarding centiles etc. which could have put my mind slightly more at ease whilst my DDs feeding & weight gain was being monitored. Am all for referrals to rule out any problems.

YABU, she probably does know these things but is not in a position to say weather the baby is just slow to gain weight or there is a medical problem. It's kinda dangerous if she was to do that. Always better to check IMO.

You were scared and it proved not to be necessary, so you are a bit fed up - understandable. What if the HV had chosen to monitor and then your baby had had a problem? I think you would have wanted an earlier referral. There are some times when there is no right answer.

In my experience HVs are pretty useless. I had completely the opposite problem with mine when DS1 was born - he turned out to have a genetic condition called congenital adrenal hyperplasia which was the cause of his failure to thrive but everyone kept telling me he was fine because he was such a big baby - yes he was big but having been born at 9 1/2 lbs he was 9lbs at nearly 6 weeks - but because 9lb is big at 6 weeks everybody ignored me when I said there was something seriously wrong with him (which there was). Anyway when I had DS2 I pretty much refused to see HVs - relied on maternal instinct instead which got me through as well if not better than relying on HVs. Mostly I think you know if there's something properly wrong - and you behave accordingly.

Good luck with everything anyway.

YANB at all U. That must have been so stressful for you. My DD2 was born on the 91st centile and dropped to the 25th (where she still is) and no mention was made of "failure to thrive" or GP referral. Surely no baby who is actually gaining weight should be labelled in that way.

The majority of HV's should be lined up and shot. Many that post on MN show incredible ignorance & arrogance. It's a shame, because they should be a good source of information & comfort, but on the whole - they are neither. The ones that are great are worth their weight in gold - it's a shame they aren't all 'good ones'.

I agree that it was good to get a referral, but the comments in the weeks leading up to it were spectacularly unhelpful then saying 'you need to see the GP for an urgent hospital referral' is simply scaremongering - completely unnecessary.

I hope your appointment goes well on the 18th.

backintraining I'm so glad your dd is doing well and the GP managed to put your mind at rest.

Thank you for sharing the GP's explanation too. When my DS was born (he's 9 now!) he was like a skinned rabbit, very long, but skin and bone. I overheard midwives speaking about the state of the placenta, and that it was failing-he was induced at 10 days overdue, and her words were "another day and we'd have lost him"

Once he was home, and bf was sorted out, he whacked on 1lb a week for a good few weeks, and the HV, although brilliant in every other way, said she was a bit concerned that he was gaining so much (thought you couldn't overfeed a BF baby???) but what happened was his weight caught up with his length. Basically the reverse of what's happened with your dd, but effectively the same thing. HVs seem to get so caught up in what the actual numbers are without looking at the overall picture. DS is now 9, still tall and slim (as opposed to the bag of bones he was at birth ) and perfect in every way (well when he chooses to be anyway!)

OH MY WORD!!!!!! So I got a phone call from said HV late this afternoon wanting to know if I had managed to see the GP last night. I explained that I had and that GP had said DD wasn't failing to thrive and her weight gain at this time wasn't something he was concerned about.

The HV then said that after I had left the clinic she thought that really she shouldn't have said 'failing to thrive' because DD wasn't actually failing as she was still gaining weight, albeit falling slightly short of the "weekly average", but instead she should have said 'thriving but not as much as we would like her to'.

After I had picked myself up off the floor I told her what the GP had said about placental function/genetics/centiles etc and HV said: "Oh yes, quite a few big babies do this, it's called catching down, that's obviously what DD is doing." She then said: "I think yesterday I was just taken aback because it was the first time I had met DD."

I say again OH MY WORD!!!!!!!!
I now wish to re-phrase my AIBU.

So...... AIBU to think that my HV
a) has totally lost the plot.
b) should really think about retiring.
c) needs to not be there when I visit clinic again.
d) all of the above.

I think it was good she contacted you to follow up and explain. She can't do right for doing wrong

I think she's just been reading your mumsnet posts and feels bad that she has upset you and is trying to apologise!!

backintraining - we had exactly the same explanation for DD3's 'growth' pattern - the placenta nourished her so well she was born bigger than her genetics called for (had had very low blood pressure during her pg which I wonder if is connected [high blood pressure leads to restricted growth] had higher with DD1/2 and they were 7lbers). This was from a senior Paediatrician at the hospital so not a non-specialist GP/HV/bloke off the street.

DD3 was born on the 91st and hit the 2nd%ile at a few months old.

She did have bronchiolitis a LOT so had feeding difficulties for a while which explains the massive dip but as soon as she was better she climbed on the charts but not up to the giddy heights of the 91st%ile. She has since settled between the 9th & 25th%iles for height and weight and is now 2yo (10.5kg & about 82cm).

So she's had the dressing down from the GP and has rung you to try and put things a bit right.