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.

Anxious you have just said exactly what the Head of Children's Services at the Health Trust said 17 years ago. Nothing has changed and nothing will change until the service is subjected to a total root and branch review. It was a disgrace and remains a disgrace and all mothers across the land should refuse to engage with it and badger and bother their GP's until something constructive is done about a service which GPs sub contract into and actually are ultimately responsible for and ought to be held accountable for its effectiveness.

Anxious - glad to know you think food stains are funny and may be moderately acceptable. Perhaps HVs would look a bit more professional in uniform and if there are problems with stains (ie, vomit, etc.) they could wear an apron in clinic. I certainly wouldn't have wanted a child of mine coming into contact with another's body fluids, dried or otherwise. I think it's a question of standards.

AnxiousElephants - I'm sorry, but this is annoying me. The other day I suggested that the OP on another thread didn't actually need to sterilise her bottles if they were washed thoroughly and you went on & on in your patronising tone

Chipping you cannot see milk bacteria, I'm a HV which means it is my job to know the correct guidelines and I would contest that I have read much more in this respect! For a small baby (under 1 year) bottles should always be sterilised. From 6 months there is no need to sterilise spoons, cups or plates/ dishes or dummies. Not sterilising bottles leaves babies susceptible to gastric infections which is dangerous at such a young age. I suggest you educate yourself by reading the WHO document on causes of infant death in the developing world - mostly diarrhoea and vomiting/ malnutrition due to inadequate clean water and sterilising facilities.

You have absolutely no idea who I am, what I do, what qualifications I have or anything but of course - you are a HV so you must be listened to.

It's just fucking laughable.

GPs are not responsible for health visitors! GPs also do not have the same skills as health visitors. In all honesty most parents/ GPs do not understand the role of the HV. As a fairly newly qualified HV I want to change practice but my practice is stifled by commissioners and what they want. For example we have CNNs doing 8 month reviews/ 2 year reviews - the 8 mth is where we have a great opportunity for health promotion/ development review and the 2yr review is the last opportunity to see children before school unless there is a specified problem but we are no longer responsible directly for them and have to trust the team to do a good job iyswim. I don't like it. Yet most of our work is with vulnerable families which are not represented in equal numbers on here! That is where we do the best work on behalf of children.

The old joke comes to mind:

What's the difference between God & a HV

God doesn't think he's a HV

Yes chipping I did, I also gave links regarding best practice. I said what I said because it is best practice. Please share if you are a specialist in the field and I will bow to your superior knowledge .

Bottle washing is inadequate in preventing bacteria in teats as brushes do not reach all crevices. Water in which hands can be placed does not kill bacteria because it isn't hot enough to kill bacteria.

Thank goodness GPs have different skills to HVs. They tend to be highly educated professionals who needed to be very intelligent to start their training. They also commission the services of the HVs associated with their practices because the baby is registered as a patient. As such they need to start taking more responsibility for the quality of the service.

Kindly explain why I would allow somebody who cannot set the scales properly, cannot record a weight properly and gets arsy when picked up about to carry out any checks in relation to my child? Further why do you think it funny that the same person couldn't be bothered to make sure she was clean.

AnxiousElephant - there you go again. You are a newly qualified HV. I am not going to argue with your enthusiam, that would be cruel. However, you may like to reflect on the fact that you are a 'newly qualified HV' and accept that you many not actually know everything & may not be the fountain of all knowledge on MN. You may want to do a little more research.

Chipping I get quite annoyed at people who suggest HVs do not have qualifications and that they are not professional. I know few GPs who have masters degrees. They are different species. GPs are not experts in children/ development, they are doctors. There are numerous doctors who misdiagnose patients and kill them! Take Harold Shipman for example....... As a newly qualified I have spent the last years with my head buried in research within various issues of child health, I do not suggest that I cannot learn. However, I do know the latest evidence/ research/ thinking in child health. I also have experience as a CM which enables fairly accurate judgement in development (because I have read widely and observed behaviour) I am also a parent of 2 small children. I also have a vast life experience having been homeless, unemployed and struggling at points in my life. I also have a partner who may or may not be around so understand single parenting. Like I said, please share your experience and qualifications because I am sure it will be valuable.

hang on a minute... Harold Shipman !!!!!!!!!!!

My point being that GPs don't have to justify their registration every 3 years, they register and then have little regulation unless there is a complaint!

married in the course of my day I have been vomited on, weed on, pood on, unfortunately had ink leak onto my clothes, does that make me a bad HV? Really? No! I have had stained clothes, I'm also not paid fantastically and unfortunately can't afford to replace my clothes with every mark made!

Times have changed .. now there is annual appraisal and revalidation.

Unhappy, yes there is but that is with the immediate supervisor who is usually a colleague. HVs have to justify to their professional regulatory body and provide the evidence they have developed. GPs ? conversation until pretty recently.

I have also had GP clients seeking my professional opinion.

GPs like all Doctors have to now provide evidence of learning and competence to their Appraiser .They are answerable to the GMC.
It is ridiculous to say that lots of GPs misdiagnose their patients and kill them!! If they do that they will be tried for murder like the one single example of a murderer Dr you made ...Harold Shipman.
You sound a bit over confident, you need to calm down and get a bit of experience.

backintraining - I'm so pleased that your DD is fine and that you've been reassured by your Dr.

I agree it wasn't handled well by your HV, though it sounds like it was due to over diligence more than anything else, combined with a hefty dose of poor people skills. Human error at the end of the day, though it's awful that you've been so stressed during a time when you should have been revelling in the role of a new mum. I'm glad it's resolved now.

As for the HV debate on here, I think it's impossible to make generalisations. Surely, like every other profession you get good and bad practitioners. A friend of mine was left in tears by a hyper-critical HV, but mine was an absolute godsend and gave me some valuable advice that I find myself repeating to others in the hope it will help.

I'm awfully sorry but I don't expect to have to deal with professionals who do not look clean. If HVs aren't paid enough to buy clothes then they need to be in uniform. Kindly answer my questions Anxious - you haven't so far but neither did my HV.

unhappy I am not over confident at all, I am well aware of my limitations and refer to other services if it is beyond my expertise. I am coloured by my own view of GPs and friends who have been misdiagnosed with colds who later died of lung cancer, breast lumps that were not palpated effectively and where the tumour had spread, where someone repeatedly visited her GP with bleeding vaginally and cervical cancer was left undiagnosed until it had spread to her liver, bowel, bladder, vagina. Where lymph nodes have been enlarged, hoarse voice and lethargy have been attributed to a virus when in fact there was a neck malignancy. This is not to GP bash, more to demonstrate that everyone has their own experiences and skills and that there are good and bad in every profession, that no matter how good or qualified mistakes can be made.

I would rather refer someone and worry them, than leave them and not refer only to find out later that there is a serious health issue.

Married I thought your question was rhetorical so didn't answer. In answer, I agree that anyone using scales should be able to set them correctly although faults do occur at times with scales. If this was during a development review then it most likely wasn't a HV doing it, also in clinic it usually isn't a HV weighing babies - HVA, CNN and paed nurses do this where I have been trained - they should still be competent though. I agree that it is difficult to trust someone if they can't get the basics right and it is completely unacceptable.

We are not in uniform because that is seen to be too medicalised . It is also beyond the HV control!

The point with Harold Shipman is that it took decades for him to be uncovered! Also I could argue that things for GPs haven't changed if you take the recent Panorama programme into account!

Ah! A bit of HV bashing - good old MN.

In reference to the OP I would have waited before referring on, many babies take several weeks to adjust to the centile line they will follow.
And to the person who commented on GP's having to be intelligent unlike HVs, I have degrees in Biology and also Public Health. Is that intelligent enough for you?

It's a fallacy that all HV's lack common sense - some do and I have worked with one or two like this who have driven me bonkers (one was my HV). Most of us though DO have common sense and ARE intelligent, the OP is not being unreasonable to think the HV should have known the information the GP gave. Perhaps she did and is crap at communication - in the wrong job maybe.
Please don't tar all of us with the same brush though.
A

I dont even know who my health visitor is, 4 months ago mine told me she was leaving and that the new one would continue to come and see me every two months, apparently this is their policy when you have a prem baby and also because I was pg again and there would only be 10 months between the babies.

Haven't heard from her though