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 Elephant the scales issue wasn't in a development review, it was in a ghastly grubby clinic where I was expected to sit and wait for an hour because the HV had told me I had to go and appointments weren't available. The baby was three and a half weeks old and the idiot HV was just going to write the weight in the book and hadn't bothered to comment that a 3-1/2 week old baby had lost 10oz. It was at that point I pulled her up. If you had read and absorbed my posts you would be aware this was 17 years ago before cnn's and hva's were introduced.

I met three hv's. One was a daft girl in her 20's who had absolutely no common sense or basic courtesy, ie, turning up on the doorstep at 9am without having made an appointment and I had to run after her afterwards, in my nightie, with her scarf and someone else's file; one was the twit in clinic who was grubby and couldn't even use the scales properly, one was a greasy haired jobsworth whom I have never seen other than looking as though she needs a jolly goode wash (after I changed GPs to try to get a better service); and their boss whom I met after having made a formal complaint told me I had to see the HV service because they would be able to pick up whether I was talking to my baby enough for him to develop speech. Their boss's boss, who actually had two brain cells to rub together, apologised for the lot of them, confirmed I was under no legal obligation ever to see another HV again and with the Head of Children's Services at the sister health trust agreed to hire and fund one of the UK's first dedicated breast feeding cousellors to try to ensure that HVs and midwives were well educated enough in that sub specialism to provide some back-up and proper clinical knowledge in relation to the breast is best mantra.

That little baby who they "needed to track to make sure I spoke to enough for him to develop speech" attends one of the most selective schools in the UK, has 11 A* GCSEs and hopes to read Classics. I challenge any HV to explain to me why I was not treated with a little more respect 17 years ago and justify the cost of a service which on too many occasions falls far too short of the professional and performance standards required of a trained vocational specialist. Is it still somebody else's fault?

I felt bullied and badgered and patronised in the first eight weeks of my baby's life. My husband and I are professionals, the baby was planned and dearly wanted and loved and born into stability and a life of advantage - if the HV service managed to make me feel inadequate and a poor mother - then how on earth does it make those who really need the help feel?

I decided the service was so inadequate by the time my baby was less than two months old that I made a positive election to have nothing more to do with it; wrote to the trust and my GP and they confirmed in writing that was acceptable. When my daughter was expected I wrote again and confirmed I would not require a visit. If ever I had to take my children to hospital in the box asking the name of the HV - I wrote "exercised my right to opt out of a service which is unacceptable and inadequate"

Lesson 1: Learn some basic good manners
Lesson 2: Learn to think about what you are being asked and answer the question posed.
Lesson 3: Record information accurately
Lesson 4: Pay attention to personal hygiene and self presentation
Lesson 5: Pay attention to time keeping and respect the time of others
Lesson 6: Ensure you are well informed an up to date about all your sub specialisms
Lesson 7: Ensure you are able to carry out standard tasks in accordance with reasonable expectations
Lesson 7: Ensure you comply with best practice.
Lesson 8: If you don't understand the reasons behind DoH information don't instruct women to follow it; find out about it so that you can answer questions.

That's all for now. But for HV's, just try to get your heads around how poor your service is for somebody who is well educated and articulate to still be so angry about it 17 years later.

As I have said previously 17 years ago this service cost £20,000,000 and possible much much more. That is a huge amount of money now inflated to continue to pump into a service that doesn't appear to meet the needs or expectations of huge numbers of UK families.

Don't the American association of paediatricians say that sterilising isnt necessary as long as bottles are washed in a dishwasher instead.

DS1 dropped between the 2nd and 9th centile from the 25th. He was small born and remained small for a long time and like OP's baby took 2-4oz each feed. HV insisted I had him weighed weekly and worried me to death about him (but failed completely to pick up my horrific PND ). He did put on weight and grow at his pace but the worry nearly drove me to the edge of my sanity.
Fast forward 4 year DS2 born on 50th centile and shoots up (EBF) to above the 75th centile cue judgey comments about "overfeeding". Seems you can't win.
Ignored HV for DC3 and 4

Married your experience was appalling then and would be appalling now. A shame you didn't have the good fortune of meeting any of the good HVs (and believe it or not there are many).

Please don't tar us all with the same brush though. I've met crappy HVs in my time, crappy teachers, crappy GPs, firemen, police officers, shop assistants etc etc etc. Doesn't mean I think they are all like that or that the services they should provide are a waste of time. I've seen babies falling through centiles who had undiagnosed heart problems. At least one mother of such a baby who told me I was the only one listening as GP after GP dismissed her concerns until one doctor took them seriously and referred the baby who had a severe underlying heart problem which required urgent surgery.

Health visiting is undergoing huge changes at the moment and I for one hope that it will be a success in meeting the needs of those who need the service. The Family Nurse Partnership programme focuses on those at greatest need and results collated over the past twenty years all over the world have shown children of families who were part of the program have better health outcomes, were more able to cope with schooling, less aggression and behavioural probs, less juvenile offending. The results of the pilot studies in the UK have been excellent and one of the few things this Govt are taking forward from the previous Govt. It means that professional parents who generally have better outcomes in all areas will see less of the HV service (unless they ask for it/want it) and the services will focus far more on those whose needs are greater. It still won't be a compulsory service, people can still decline but it does make better use of our skills than in patronising people like married and making them feel inadequate. Much of the new training for health visitors focuses on communication - counselling for example, helping families find their own solutions and recognising that parents are the experts in their own lives. It's long overdue in my opinion and will roll out nationally over the next few years. My Trust is from 2013, some areas are running it already. All based on the Family Partnership Model - long long overdue.
Rambling now.....,,

marriedinwhite - sadly your experience of HVs is not untypical, and things are getting worse. I stopped being a HV three months ago, I jumped at the chance to escape when I managed to get funding for a full time research degree, even though it will mean a huge drop in income - as a HV and community practice teacher training students I was on the top salary scale (£40,000).
There are some frighteningly incompetent (and frighteningly weird) HVs, and I've been banging my head against a brick wall for years trying to change things. I've heard colleagues giving horrendous advice, eg over the phone to a new mother asking for help with her breast fed baby's supposed constipation, HV told the mother to eat All Bran because the fibre would come through in the milk and help the baby I could go on... Unfortunately the nature of the job, working alone, no-one monitoring what they do, means they can carry on being useless and getting paid for it until they retire. Very few people have the confidence to complain officially. Its no use telling the GP, or phoning a manager, it needs to be a proper written complaint to the PCT following the official complaints procedure (info usually on PCT website).
There's a huge amount of money wasted in health visiting because of appalling management and bad practice and I really believe that the service is now so inadequate that it does more harm than good.

I self referred for the exact same reason as the OP after one of the HV claimed my daughters weight could be a sign of neglect/abuse and SS would be involved.

After those comments as a new mother you are a nervous wreck.

The GP put my mind at rest but still referred me because I insisted (because of the SS threat). A friend who is a SW in my area confirmed that they have had reports like this in the past from the clinic.

Paed took one look at DD and asked why we were there (not as rude as that sounds!). I explained everything and they immediately guessed the name of the HV concerned, they also accurately guessed I had been berated for breastfeeding.

That's how I know about catching down.

In this case a formal complaint was made by the Paed and myself about the HV because so many anxious mothers had ended up at the hospital. Not a single SS referral that woman had made was based on anything other than her opinions about BF and FTT.

My daughter was not, and never has failed to thrive and yet I was subjected to the anguish of a possible SS visit (which in turn may have jepodised my job).

Sadly it seems she is not a one off. However since then we have only dealt with the Head of HV Services for checks etc and DD is still low on the charts but a happy, healthy (very healthy who eats like a horse) 2 year old.

I think the hv was right, better to be safe than sorry.
however, I feel that just checking the wight is wrong, also lenghth should be taken to give a better picture.

I am so so so happy that my two are beyond all this

Both were born big, but caught down and were 2nd centile wonders within the first 2 months or so

both gained consistently - dd 4oz a week, ds 6 oz a week, but this wasn't enough - my hv for ds said he ought to be gaining a pound a week - he was 6 weeks prem! . They were both happy, pink cheeked and meeting milestones, but this wasn't enough

i was in hell feeling like i was failing them, and weaned them on supercalorific foods and...they still were small. Even when they ate shitloads of carb stuffed, cream drenched, butter soaked foods

at 4 and 2 they are still lean.

i wish i could have that preweaning time back, it was miserable and how i didn't end with PND was a total fucking miracle

there are a number of reasons why we aren't having a third child, and it may not be the most important one, but dreading going through that misery a third time is deffo one of them

UptownAbbie - as a HV though you obviously realise not all HVs are incompetent. You evidently were very competent and so are others ( I can relate to the "banging head" thing at times though).

I think some of the investment going on in terms of Family Nurse Partnership teams is fabulous. I am so keen to get going with this and support young families. I absolutely LOVE my job and am fortunate to be able to say this. I like feeling I have made a difference and increased someone's confidence in themselves.

I totally get what you are saying though and a trained HV on £34k should NOT be giving crap advice.

YANBU at all. You poor thing. HVs have the oddest ideas on wight gain.

FWIW, my eldest was born at 98 centiles and then dropped to less than 25th, where she has remained for the next nine years of her life . She was not meant to be on the 98th centile - she's a skinny lanky sporty girl with gangly arms and legs, she was never meant to be bigger!! And I've just seen her eat and entire pizza in Pizza Hut

Weight and size is not determined by birth weight and anyone who says it is are bonkers in my honest opinion.

NorfolkNChance, that's awful!

I am really pissed off with our HVs. they told me DD was overweight and not growing tall enough. I've been really worried (even though seemed odd as DD one of the tallest in her class).

Then on our local website, someone posts they ended up at a paediatric endrocrinologist as our useless HVs can't accurately measure a child's height no matter how many times they try. at the specialist, the child turned out to be totally normal for height and on exactly the same point on the growth curve as she'd always been.

seeing a pattern here...

Not all HVs are crap. She was concerned and she referred, better that than dismiss it and do nothing.

Sometimes that referral for FTT, whilst worrying for the parent, can save a baby's life.

DS - Birthweight 7lb 3oz and slipped to 2nd centile at one point. DS is now 17, 6'2", about 13stone 2lb and a prop forward. Incredibly fit! DD - Birthweight 8lb 13oz - always a solid child (we are a well built family with teutonic genes) who rarely left the 90th centile for height or weight who developed early and started her periods at 10. At 13 she's 5'3(ish) and weighs 7st 9lb. Baby growth charts - pah!! It's a miniscule part of being a mother and many other things matter much more, ie, support, love, good schools, confidence building, sorting their friendship troubles and self esteem.

DD2 9lb 80z at birth, at 16 7st 11lb, dropped from 95th centile to 30th in 4 weeks. Fortunately DH was a GP and she was our 3rd, always been really healthy, has never had antibiotics even. Just enjoy your baby.

Marriedinwhite, I could have written your post! I so felt like I was a bad mother because DD just wouldn't put weight.

I am a health professional myself and DH has a Phd in microbiology and yet we were repeatedly belittled and made to feel that we were not doing the best for our much wanted daughter.

In the end we took advice from a friend who is a paediatrician, she told us to tell the HV to "Fuck Off" but we managed to phrase it a little better than that!

We refused any intervention from the HV service with our next 2 DC's and our household was all the calmer for it.

I have worked with many health care professionals over the years but in terms of utter arrogance and ignorance there is something very worrying about the health visiting service.

I also find it concerning that they are re registered only every 3 years when the majority of HCP's are reviewed every 2.

serin, HV's have to re register every year.

YANBU. I agree that HV should encourage referral/visit to GP if there are concerns, but as your baby has been following a growth curve for several weeks I don't see why she was a concern. I also think that a more supportive 'there may be a problem, so we'll have her checked her just in case' is more useful than 'this is failure to thrive, you must get her referred'.

There is some new research which shows that if Mum is on a drip during labour, weight at birth will also be higher than expected as baby absorbs more liquid from the placenta (not sure of exact reasoning, was discussed in some bf peer support training I've been on recently). The course teacher was saying that it's beginning to be accepted that a 24 hour weight is a more useful starting point than immediately after birth.

OP, have you done the calculation in the red book with yours and DDs Dad's heights? For my DC, it showed they would be between 1st and 25th centile, as their Dad is very short for a man and I'm only average. I've always found it useful to be able to say to HV that all our family is short, as my DC have always been on lowest centile and DD2 has dropped off in height a couple of times, but caught up again after a couple of months.

Part of the reason things ARE changing is in direct response to just the type of feedback I have seen here. There are too many parents out there who feel ignored or patronised. I honestly think that if these changes don't make a difference then nothing will. I want things to change for the better so that there is less negativity towards HVs in the future and that results of input are more measurable. To be honest if nothing changes then there might just as well NOT be a health visiting service at all.

A very important point, I think Dillydaydreaming, is that parents are able to chose many things in relation to their pregnancy and in relation to the life their child will lead later on. For example, we registered with a GP based on the recommendations of others, chose the hospital where the DC would be born, selected schools on the basis of the individual needs of our children, I attended ante-natal classes with a teacher who had a fantastic reputation locally. The HV was the only professional I have ever had to deal with over whom I have had no choice or say. In those circumstances I believe it is even more important the trusts ensure the service which appears to be mandatory is above and beyond reproach. Do not tell me I have to meet with someone, over whom I have no choice, and then provide someone who is frankly incompetent. It is disrespectful in every way.

And it's yet another thing you were misled about married. The service has never been compulsory.

On the other hand no parent should feel they need to opt out because the advice and service is shoddy. HVs are paid a good salary and should be seen to be worthy of it. At the moment there are a sizeable minority who need to be hoofed out!

Yes, I was misled until I took things to a director of the local community trust. But the HV did not arrive and say I'm here if you need me; you may have other networks to tap into. She arrived and said all mothers have a home visit and it isn't negotiable; she told me I had to take the baby to a clinic even though I didn't want to (Dr's surgery - sick people, etc), refused to make an appointment at the clinic although she insisted I attended so my visits could be recorded. Her boss said I could opt out and my concerns and feelings had been noted and then got another HV to contact me against my instructions. It was only when I took the matter to the top and insisted on a meeting with a director of the community health trust that I established the true position and the fact that although every mother has to be offered access to the service, it is the mother's choice whether to accept it. Disgusting wasn't it - especially as the HV's I saw, and their boss, were totally incompetent and wholly discourteous.

marriedinwhite - HV managers in the PCT I used to work in believed the service was compulsory. Parents would get threatening letters if they dared not to be in for appointments or didn't turn up at the clinic when told to. When I pointed out that we had a duty to offer the service but parents were free to refuse I was told I was wrong and that we had to visit to protect children. So I circulated information from our professional organisation stating that a HV service should be offered but wasn't compulsory. Manager said it didn't make any difference because it was PCT policy. After a heated discussion I made it clear that I'd carry on informing parents that HV contact wasn't compulsory.

Coming to this late as tend to hate HV threads.
I had exactly the same experience but even more extreme DS2 was nearly 11lb at birth and was on the 98th centile. He was really fat! Not a big baby, a bizarre Michelin Man of a baby, all blubber.
When he was in an incubator 4 days later for 48hrs (jaundice), the midwives were trying to get me to express and give him top up feeds! I think this mucked up my milk supply and I gave up bfing after 2 months.
He steadily lost weight but as I had no respect for my HV after experiences with DS1 I trusted myself to say there was nothing wrong, he never went skinny but slimmed down to look 'in proportion' if that makes sense.

He didn't actually regain his birth weight until he was 6 months old.

He found the 25th centile and has followed that ever since and he's 6 in a fortnight and has never deviated.

Luckily I didn't have these problems with my DD when she was a baby - she followed her centile okay. However I had a chat with my HV when DD was 11 months that seriously worried me. I had mentioned that I wanted to stop breastfeeding and as DD was just over 11 months I planned to skip using formula and go straight to cows milk as she would be on that in about 3 weeks anyway. She got very angry with me and told me that babies under 12 months are seriously at risk of infant botulism from drinking cows milk. I was and asked why their guidelines said that cows milk on cereal was okay if it could carry botulism toxin and she said "weetabix coats the intestines and stops children getting ill" . I had a couple of fantastic HVs but there seem to be some awful HVs giving out bad advice, seriously worrying mothers and giving the profession a bad name. I wonder if they get away with it because new mothers are either too busy or too intimidated to complain.