To tell my HV I will NOT restrict DS's food intake

[thefuturesnotourstosee]

we've just come home from DS's one year HV check. DS has alwiays been a big baby and today he measured the 99th centile for both weight and height.

HV told me he was overweight and I should restrict his food intake. I told her I wanted to talk to the GP about this as I disagreed with her and she told me "he should be no higher than the 80th centile, you're clearly overfeeding him its obvious you don't need the doctor to tell you that".

I politely told her Id seek a second opinion scooped up DS and walked out.

Had his weight and height been substantially out of proportion I may have engaged but I don't think there's a problem. AIBU?

I've just put your DS's stats into a calculator and he's actually a bit higher for height than he is for weight. So he's taller than he is heavy.

With him not walking yet I would imagine that gap will widen when he starts to walk. As long as you're feeding him healthy food and still giving him breast milk, he'll be fine.

As for your HV's interpretation of centiles - words fail.

I don't think many HVs know how the percentile thing works or how to plot graphs.
I used to go to a clinic where we were seen by whichever member of the team was available so we saw about 20 of them before I gave it up as a bad job and only one of them knew how to plot a graph. I had all manner of crazy advice, DS at one point was apparently so underweight we had to be monitored weekly and then not to long after that was over weight and I had to watch what he was eating.
I went home and redrew the graph with the numbers they'd put in the book and it was a perfect, smooth curve between the 25th and the 50th so I never went back again.

Do mumsnetters all have massive children? Whenever these centiles are mentioned all anyone ever says is 'DS is on the 99th centile for height and the 90th for weight' or something. Where are all the small babies? Or are the measurements really out of date?

I don't think so - DS1 is very tall but at 5 is the same height and weight as his 8yo cousin. There are certainly children older than him in his class that only come up to his shoulder or his ear.

As he is the same percentile for height and weight, he is probably fine and in proportion.

However there are other things to take into account, such as the height/ weight of you and your DS's father, and his height/weight at birth

If you or his father are in the highest percentiles it is probably just genetic, and it is normal for him to be that size. However if you are both average or below average height/weight it might be a concern.

His size in proportion to his birth weight may also be relevant. You mentioned that he has always been a big baby, but has he always been in the 90+ percentile? If he used to be e.g. in the 70th percentile at birth, but has dramatically increased that would be a concern.

It isn't where he is on the height/weight chart that is important, but that he stays at the expected percentile and does not go up or down.

Do mumsnetters all have massive children? In my experience, not medical, I think the issue is that children at the bigger end, including my DD, who is off the charts for height, are just big kids. The very little kids I know, at the very bottom or off the bottom of the charts tend to be children with health issues, preemies, multiples or a combination of those.

I know one little girl who is absolutely tiny, shoes specially made tiny, because she was very ill at birth and in NICU etc. Her Mum wouldn't be on here talking about food or HVs because she has very specialised care and knows this is pretty unique to her case.

DD1 is 5'5'' at 12 and is the second tallest in her class - the tallest being another girl at 5'7''. DD isn't skinny, she is a size 6 and has a definite waist and boobs (bordering on B cup) but she is completely in proportion if a little long limbed - she's 78th centile for weight, 96th for height.

DD2 is 4'10'' at 10, is the tallest in her class, thin as a reed though starting to develop a little bit now - 40th centile for weight, 87th for height.

Both are within normal range, but with widely divergent height/weight centiles - children don't grow according to a set pattern.

And don't even get me started on their enormous feet.

Me! My little girl is on the 0.4th centile. She was a preemie with IUGR. Thankfully she is doing well (eating is a nightmare, but that's another story).

I have beef with HV's. Like Itchy I have rarely met one who has ploted the right place on the graphs, I have to go over them myself!

And bloody centiles!!!!!! Some people are obsessed by them! Does my head in -

Eh, my 2.9yo was weighed and measured by a paediatrician this week and came out 25th for height and 75th for weight. Paed said this was fine, particularly as his father was also very - ahem - solidly built at this age and is now an incredibly lean and ripped adult.

My twins are a bit shorter and skinnier than average. Haven't weighed or measured them for a while.

DS3 however, is almost as heavy as DTS2 (there is 2 yrs 9 months between them!). He is tall for his age and chunky, although definitely not fat. You can see his ribs, like you ought to.

My twins were 36 weekers, and, well, twins! DS3, a 40 weeker singleton has always been a different shape.

My dcs are all below the 25th centile for weight and height. One was at one stage below the 0.4 centile. No health issues (though we had a paed referral to check). Never had any cause to start a thread about it .

I think I may have been blessed with a wonderful health visitor my dd always been on 50th centil e for height and weight, ds born on 25th stayed there for four months and then didn't gain an ounce for 4 months hv didn't panic reassured all along as he looked so healthy/happy/content pead declared him as failing to thrive - eventually discharged with a 'all the best things come in small packages' now two years later he is still little but very noisy and gets checked 3 monthly by the health visitor who has been brilliant throughout :-)

I would be putting in a formal complaint about the HV and how she is giving out potentially dangerous advice based on a complete misunderstanding of the percentiles work.

Short of cutting a few inches off the bottom of your ds's legs he is going to stay - at least in the immediate future - the same height. That isn't going to change. And chances are that he will continue growing along at the same rate, albeit in fits and starts rather than in a nice smooth text-book curve but will average out just fine over time.

What she is saying is that your ds, who is currently in perfect proportions of height:weight - and you sound like you think your ds is proportionally right too - she is saying that your ds needs to lose a fifth of his body weight if he needs to get back down to the 80th percentile (you haven't said for weight, just height, but I'm extrapolating here and assuming she thinks he shouldn't be heavier than 80th percentile either - apologies if I am wrong).

Or that you should effectively starve him so he doesn't grow at the rate that he is obviously destined to do so at the moment.

If you were to follow her advice, you would have a really hungry unhappy child who was not growing as he should do - that's the sort of behaviour that HV are supposed to be picking up on and helping the mum to stop or to protect the child from - not advocating it as the way to treat a child.

Sorry, it's late and I'm rambling a bit but hopefully you get what I mean and will know exactly what figures she was talking about to make a detailed complaint about - but I really think it is something serious that could have serious repercussions for a child if the mother wasn't as switched on as you are and just thought they ought to do exactly what the HV told them to in similar circumstances to these!

I'm in two minds really. Yes there are those dc who are just large - have tall parents etc.

I had two friends when my dc was little and they both complained about a similar interference and later refused to let the school nurse check their dc for weight and height.

They were both very big dc, having been average birth weights. They were a stone heavier than their counterparts at around age 2 - when they only weight 2 stone normally. One did even out when she started walking. The other is obese now.

In hindsight - I'd take it as something you need to watch tbh. It may be something, it may be nothing.

I've got 5 dc. I've no idea what centile any of them were or are on. I never took them to be weighed...ever!

I can't believe people sit in clinics to have their babies weight plotted on a chart- really can't.

Its comment sense.

The other thing I found about quite a lot of our HVs was that quite early on in the consultation they'd decide there was a problem and no matter how much evidence I provided they stuck to their line and that was it.

For example we once went and the HV commented on how short DS was and asked how tall his dad was. Now DH is over 6ft and this convinced her that DS had some kind of problem. It didn't matter that I explained to her that all my family are tiny wee short people so that DS had a fairly good chance of not being the Jolly Giant.

UnevenTan I worry about you. You said "That said, it's not as straightforward as same centile for both = fine, perhaps because of the aforementioned trend for overweight children to grow taller too." Overweight children do no "grow taller" because they are overweight. Some children do get a bit porky before a growth spurt, then the nutrients in their diet produce those things like bones that tend to weigh something. For that reason a child seen as overweight should be reweighed in a few weeks or months to see if there is still an issue.

Centiles are a crude measure on which to be doing anything. A baby who is very low weight may be failing to thrive and unable to grow properly. That may not be due to the amount they are fed but to, for example, milk intolerance. It needs medical advice. It's more of a concern than a baby seeming to be overweight at one measurement.

The suggestion that the food of an 1 year old should be restricted without medical advice proves that this HV is dangerous.

MrsTerryPratchett, I think it's like MIL threads, in that no one posts a thread about unproblematic relationships! HVs are clearly being prompted into being the first line of defence against childhood obesity, so are perhaps over-primed to raise issues with children at the upper end of the centile charts, so there are more posts about that.

I agree, though, that this HV seems dangerously clueless about what centiles mean.

My toddler at his one year check was 50th for weight and 75th for height, but I can literally see him growing out and up in different stages week on week, after a period where not much changed.

I haven't read the whole thread but surely you don't restrict a childs food intake even if they were overweight. I understood that it was about making healthier choices ie. toast instead of choccie biccies, or fruit instead of raisins.

I stopped going to HV because of this - you don't need to see them, it's not mandated!

DS is off the scale for both weight and height at 2.6 - he is the size of a 3.6-year-old and has the shape of one too - he'll be 6'4" looking at the men in my family and his current size. He will never be a whippet, more a great dane, and HV couldn't seem to accept that, despite the fact that you can see his ribs! So I effed off.

Just don't go back. Ever.

Not for this age group - but for age 2-18 there is a WHO chart which has weight centile and height centile on the two axes and then plots whether your child is overweight here. This indicates that if a of 2-8 child is 98th centile for height and weight then they are overweight.

Leaving that aside as your DS is not 2, it is worth looking at the graphs here If you have remembered correctly then saying your 12 month old is 99th centile is fairly meaningless at 87cm. He is well above the 99th centile for height. By describing him as 99th centile you would include any 12 month old over 82 cm, whether they are 83 cm or 90 cm. And it would be reasonable to expect a 90 cm baby to weigh more than an 83 cm baby. The graphs are just not designed with the very tall in mind. He is the average height of a 23 month old (that is where the 50th centile hits 87cm). If he was 23 months then his weight of 12.7 kg (28 lb) would put him between 50th and 75th centile for weight. That strikes me as very much in proportion.

I wish everyone would just ignore hvs all the time. they give the worst advise.

Dd has always been off the charts tall, but around 75th for weight. she dropped down to under 50th for weight as she had feeding issues and hvs refused to help as she wasn't breastfed. then told me I was blatantly under feeding her. I don't bother with them at all, got some medical advice from an actually medically trained person and Dd got happy, fed well and is now between 50th and 75th having been there from about 9m. still off the chart tall.

I have limited interactions with them for ds but they're under the impression he is OK because his height and weight are both 50th. failing to see that actually ds is out of proportion. he has tiny kegs and a long body. our gp thinks its hilarious that they moan about dd's height/weight difference but can't see that about ds (nothing wrong with him of course, he's just not built as standard like a lot of kids)

I'm genuinely wondering if a child is on the 98th centile for height then which centile should they be on for weight in order to not be "overweight"? I was under the impression if a 98th centile height child was more than two centiles lighter weight wise then they'd be classed as underweight?