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.

Brevity I don't buy that for one minute. Had she phoned sooner then maybe I would have thought that but I think it's more likely to be what Sandalwood has said. The GP has phoned her, given her a bollocking and she is now backtracking.......... either that or she is an avid MN user and is peed off that I have posted. Who knows.

But she rang and apologised - surely that is a good thing

I'm sorry you've had all this worry though.

I never had a HV so couldn't comment and my friends who have have only good things to say about them.

I did however have a peadiatric nurse who dealt with check up's at the surgery. They did all the weighing/measuring etc. (Spanish country so probably the equivilent?).

So 4 months check up.
PN:how much milk does DS have a day
ME: told her
PN:how much sleep does he have (naps and night)
ME: told her.
PN: OMG he is sleeping through the night, no-way should you let him do that, he'll be too hungry and his blood sugars will drop too low.
Me: well I've started weaning him so he has apple puree and cereals during the day too
PN: looked like she was catching flies like this .
Pead GP: He looks fine, is obviously settled in a routine, I'll see you at 6 months.

She made out I was sytematically starving him and depriving him - and he's had cereal and apple for supper tonight so has obviously suffered no ill effects!

FWIW DS was born on the 75th% tile, stayed there until 2yo and has been on 50th ever since.

He's 7 now btw.

OP - any more concerns about your little one and you now know what to do don't you? You do don't you? Shall I let you into a little secret - you go straight to doctor to get a professional medical opinion.

HV's tick boxes, love paperwork, and can read you leaflets published by the Department of Health (or whatever it's called today). IME they don't do anything that requires the mobilisation of a digit or the application of an iota of commonsense. It's easiest to nod at them let them fill out their paperwork and generally play the game if you can bear it - but do check that they have recorded any important information correctly if you do decide to play along.

OTH, you are under no legal obligation to seek the advice of a health visitor or even to have any involvement with them at all.

Well this has turned out to be a great health visitor bashing thread

Firstly it is shocking that someones HV was unable to see a child with a developmental problem (and I am suspicious if the check was recently that it was a HV anyway, as most of these in most areas are now done by nursery nurses or paediatric nurses which HVs are not always happy about). As a HV I have spotted problems with social ability as young as 8 mths!

Should they all be shot?

Greenmonkies HVs do not expect all babies to follow the 50th centile, all of the centiles are within normal ranges. It is a drop or increase across centiles of more than 2 that worries HVs.

As professionals we are assessed annually to check that core skills have been updated in the KSF, we also have to show professional development through research read, independent study, reflection on practice and attend courses to be shown in an annual appraisal which is more than can be said for most GPs. We also have to demonstrate this to the NMC every 3 years to get re-registered.

FWIW I have had 3 people in a day tell me they are glad it was me who visited and 'not the last one because they were awful'

The problem is that different people expect different things i.e. some people want support but not advice or solutions, others want directions, which makes it difficult to provide what is expected.

I am only sorry that people on here aren't so quick to tell stories of excellent care by their HV and that the minority of poor ones reflect badly on the good ones.

Remember though that the primary concern is for the welfare of the child. Mothers needs are important but not at the expense of the childs wellbeing and therefore some people will not like what has been said.

GPs do not generally 'dress down' health visitors . The conversation will probably have gone like this

I saw x today and she was annoyed/ upset about x,y,z.

HV probably said 'OMG, I didn't realise she felt like that and this was my reason for referral etc, I will need to phone her to apologise.

She will certainly not have been told to apologise! Most HVs have sleepless nights over complaints, replaying conversations and thinking about how things could have been handled differently FWIW.

Unless you told her at the time that you were unhappy with what she had done how could she have known?

OP, YANBU

AnxiousElephant, I have known 3 HV's, 1st was beyond useless, 2nd was better but not very well-informed, 3rd was worth her weight in gold!

It is such an important time for new parents & babies that I think it has such an impact if the advice/help is poor.

The problem lies in what 'poor' advice is. The problem being that some parents do not want to hear good advice because they don't believe in the method of choice, then when the HV sensitively advises something she thinks will be right for that parent and doesn't work then the flaming begins.

AnxiousElephant - I really hope that this isn't an HV bashing thread. All of the HV we have seen (we moved house so quite a few) have been great - willing and able to answer questions, know exactly where the boundary between them and the GP is, open to differing parenting techniques. I wasn't sure about HV before DD arrive as I had read too many MN HV bashing threads, but I have been pleasantly surprised by the service offered. And it is brilliant to have a drop-in clinic for those little niggles that you aren't sure merit a GP's appointment when it is so hard to get them, even if it is just for a "should I get this checked out with the GP or not" opinion. I just wish that a HV style service existed for adults.

AnxiousElephant

She could have used some common sense before spouting this shite...

"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."

As professionals we are assessed annually to check that core skills have been updated in the KSF, we also have to show professional development through research read, independent study, reflection on practice and attend courses to be shown in an annual appraisal which is more than can be said for most GPs. We also have to demonstrate this to the NMC every 3 years to get re-registered

Clearly the assessment proceedure needs looking at.

I am only sorry that people on here aren't so quick to tell stories of excellent care by their HV and that the minority of poor ones reflect badly on the good ones

FWIW I have had 3 people in a day tell me they are glad it was me who visited and 'not the last one because they were awful'

Perhaphs try accepting that it's the majority of HV's that are crap, not the minority.

As I said earlier - HV's are arrogant &/or ignorant on the whole.

Well, for me it wasn't a minority of poor ones, it was a majority.

And it was 'badly-informed, poor advice' from HV's who hadn't read notes, were not interested, tbh and lots of others in my area felt the same.

I am not daft. I know 'poor advice' when I hear it, it was not "good advice but not what I wanted to hear", it was poor advice.

But as I said, the good HV really outshone the others.

"GP has phoned her, given her a bollocking and she is now backtracking"

You know that HVs don't work for GPs right? Nor are they subordinate to them in the sense that a GP would attempt to give a HV a 'bollocking'.

Glad to hear it MrsVoltar that the good one outshone the poor. I really hope that things improve for the service. If we do our jobs correctly then it is a very good service. I think all practitioners know colleagues who fall short and try subtley to change their practice. For example I went to a mother who had been told to stretch out feeds with a bf baby at 3 weeks! I saw the baby in clinic and it had dropped down centiles. I later read this advice in the notes, went back to see the mum to correct it and they continued to bf, baby thrived after that. The colleague was manipulated into a 'refresher breastfeeding course' by the team leader, under the guise of 'essential annual update'.

Exactly my point dotty

My dd was born 91st percentile, lost over 20% in first ten days cue two hospital trips, went down to 20th percentile, regained birth weight at about five weeks, settled at 50th percentile aged about three months to eight months and now aged ten months is about 90th percentile again. We mix fed her from day three and still do.
Much love. It's horrid and you feel judged. But she will be ok and you will be too. X

my first HV was close to retirement and very small herself and very sensible. She never had any concerns about my children being below 2nd centile for weight as she could see they were in proportion for their height. When they were measured they were below 0.02 centile line for height so weight was above average for the height. My babies were all born at average weight but dropped immediately to 2nd centile and remained totally constant and reached all milestones very early.

I cannot understand weight not being linked to height as it is meaningless without this. Unfortunately my replacement HV was absolutely dreadful and documented total lies in the medical records which luckily I am able to prove as such in my complaints. For example she had documented that I insisted on breastfeeding despite being advised not to (I was unaware that anyone had every advised such a thing).

I have to say I have been totally horrified by my experience. It has made me very wary of what may be being recorded about anyone as my HV had not mentioned any concerns about anything to me at all.

This it what I go with when assessing FTT www.patient.co.uk/doctor/Growth-and-Failure-to-Thrive.htm

Weight is linked to height (or should be!). However, in the PCT where I work they have no length mats to measure height! This is very frustrating for us all and certainly not ideal impo.

Oh and definately agree that small parents generally produce small offspring. This is something I check and I say something like 'oh is dp or dh tall/small?' then if they are both large/small I take that into account.

latesummer that is bad practice to document saying things that haven't happened, however, unfortunately in the early weeks some mums I have visited have forgotten things I have said, or have deleted it from memory because they don't want to hear it. . FWIW I would never say to not breastfeed before doing everything possible to help baby gain weight and breastfeeding. BM is more calorific than FF anyway.

Well anxious, rather than being manipulated onto a course, perhaps your colleague should have been catapulted into capability. Advice about feeding for a three week old baby is pretty fundamental and if an HV can't give that, what can and HV advise about? Clearly the service hasn't improved at all in the last 17 years.

The first HV who visited me didn't even have the basic courtesy to make an appointment and arrived at 9am when I had a 10 day old baby. She couldn't advise about feeding "breastfeeding mothers put their babies first, bottle feeding mothers put themselves first". After mastitis and probably having developed thrush of the inner breast tissues, when I couldn't bear a bra or a blouse next to me she told me to wrap myself in a blanket and sit by the fire, when I objected the silly little girl in her 20s told me she wasn't an expert and I could always phone the NCT. Her response for informaton about immunisation and the development of allergies resulted in a referral to discuss my baby's breathing problems!!!!. On top of all that she thought she had the right to instruct me to attend a filthy clinic at her behest. Went once and the HV had on a stained cardi and got arsy because she just recorded that the baby had lost 10 ounces - and I asked her to weigh him again because the scales were set to negative when she put the baby on.

Sorry, but in my experience HV's are rude, dim, incompetent and dirty. After first formal complaint her boss told me the HV would be able to make sure if I was speaking to my baby enough for him to develop speech - I hope you agree that was rude and condescending. Made a formal complaint and my GP agreed thereafter to do all the checks.

The HV service 17 years ago cost about 20 million per annnum - major saving for the Cameron/Clegg coalition if you ask me.

married I wholeheartedly agree that what you had was appallingly bad practice and unfortunately the dead wood still needs trimming.

I can assure you that things are improving and bad practice is being highlighted. Unfortunately some things are down to the managers of some PCTs and manager HVs who are old school, trying to do things as they have always done. We are told from above about what we are allowed to do but I do intend to practice as I was trained - by 2 very thorough HVs who know best practice. Take comfort from the fact that only professionals who are practicing according to best practice can teach new practitioners.

Really sorry she had on 'a stained card' and I suppose it depends on what it was stained with - most start off clean and get more stained as the day goes on!

The thing is, unless the placenta is inadequate during pregnancy, the baby will grow in utero to a size and weight dependent on genetics, and then, after birth will continue to thrive and grow along similar lines and according to genetics and adequate feeding.
The HV scared you a bit and was a bit gruff, while the GP tried to reassure you.
The truth is, somewhere in the middle. She was born on the 75th centile so ideally shouldn't be following the 25th centile now and I think the HV did not want it to go on for too long unchecked in case of failure to thrive which basically means failure to grow, due either to serious illness or lack of feeding for a variety of reasons. Failure to grow in babies is serious because it means head development.
If she had left you and reassured you and your baby was then diagnosed with failure to thrive, then she would have failed you.
Sorry but YABU. I think your baby will be fine but needs to be monitored. All the best.

I've come across rotten HVs - my son has a permanently deformed head in part as a result of one. But the HV in this instance sounds like she has been tactless and overcautious, but not awful. Awful would be ignoring a potential problem. And it appears that on learning that she has inadvertently upset the OP, she has bothered to call to apologise. That sounds pretty dedicated and caring to me.

The system probably does need a bit of an overhaul, but I'm not sure what the right system is. The intention - to support mothers and protect/enhance the welfare of babies - is a good one.

If we really cared about that, perhaps we'd be paying HVs a bit more money.