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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

To be scared HV thinks I'm neglecting my daughter.

107 replies

RoryPowers · 23/06/2017 07:55

I'll try and keep this brief.
DD is our first baby. When she was born she dropped weight (I know this is normal). I persevered with breastfeeding (I thought this was for the best) I didn't have her weighed but she felt heavier to me.
When the HV came and weighed her she had fallen from the 8th to the 2nd quartile. I felt completely awful like I had been starving her purposely as I had been so intent on breast feeding rather than changing to formula.
She is getting weighed again this morning. I am petrified she hasn't gained again. Whenever I take her to baby groups or on the street people tell me how tiny she is and are shocked by her age.
I love her so much and she is well looked after. She always looks lovely and we are lucky that we can afford to buy her lovely things so on the surface everything looks fine. I'm so scared the HV thinks that this is all a front and that I just think of the baby as a dolly :-(. Any advice or experience or even a handhold will be gratefully received. Thank you.

OP posts:
K425 · 23/06/2017 12:49

DS dropped from 25th to 9th. It was mentioned, but since he had lots of wet and dirty nappies nobody worried. He's remained firmly on the 9th centile for 13 years...

lelapaletute · 23/06/2017 12:56

flying elbows, this is exactly why mother's don't seek help when struggling with PND - the contempt they encounter because nothing is "really" wrong with them, bring dismissed as "the worried well" because they don't have a physical problem. And Have in my experience are not all t consummate dedicated professionals you describe, and a lot of them are frankly injurious to breastfeeding because they know so little about it, don't have time to keep up to date with research, but are too proud to admit that lack of knowledge to mere mother's so peddle a mixture of out of date guidance and good old-fashioned hokum, like telling women with damaged nipples the latch 'looks fine' and their nipples need to 'toughen up', telling women they won't be able to feed because their breasts or nipples are the wrong shape (!!!), telling women their milk isn't adequate and baby needs formula top ups when actually the problem is with latch and milk transfer, telling women they have to stop bf because of thrush, various medications that are perfectly compatible with breastfeeding, if baby is hospitalised etc etc etc. If they had the guts to just put their hands up and admit they don't know, and refer mums to expert guidance and current sources of evidence, a lot more women in the UK would achieve the breastfeeding relationships they WANT desperately to have.

LRDtheFeministDragon · 23/06/2017 13:00

shiny, I didn't read it as doing that at all. I read it as people trying to reassure her that she might be right in feeling unsupported - and she might.

I would think that a good HV will have dealt with a lot of women who are feeling scared or defensive or upset, and won't be remotely fussed by it.

MN can sometimes feel a bit anti-HV, because people naturally talk more about bad experiences, but this thread feels the opposite to me: many people insisting the OP is being silly and the HV won't be anything but perfect. That's not fair either.

LRDtheFeministDragon · 23/06/2017 13:01

Btw - several people mentioned the baby dropping centiles. The OP mentions quartiles. They're not the same.

shinynewusername · 23/06/2017 13:03

several people mentioned the baby dropping centiles. The OP mentions quartiles. They're not the same

The OP must have meant centiles since you can't have an eighth quartile.

OstrichRunning · 23/06/2017 13:05

'I would say make sure you are eating and drinking properly and getting enough food - as that will reflect in your breast milk.'

I'm pretty sure this isn't right; I remember at my antenatal bf class being told there's actually v little relationship between the two, unless the mother is seriously under-nourished.

If you're introducing formula, you could do a bit of pumping alongside bf and formula feeding, to keep developing a good supply. But only if it is important to you - I wouldn't worry. My sister couldn't BF despite best efforts and her to dc are the healthiest kids around.

Look after yourself, you're doing a great job by the sounds of things and it definitely gets easier! Flowers

LRDtheFeministDragon · 23/06/2017 13:06

No, but you can talk in terms of quartiles, so I wondered if we're talking cross-purposes, especially since if it's centiles, it sounds like a very small drop to cause so much concern?

BertieBotts · 24/06/2017 10:15

Baby weight is measured WRT centiles, not quartiles. The entire concept of centiles is never explained and many people are confused about them because unless you've studied statistics it's not the kind of thing which exists in general knowledge.

I know when DS was born I was forever trying to work out which "centile" he was on when he was between two lines, assuming that they ran from 0 to 100 with every number in between, it doesn't work like that, at least in health related weighing - I have no idea how they work in other contexts. (Crash course follows.) In baby weighing you have discrete centile lines, which is the important part, the currently used UK ones are 0.4th, 2nd, 9th, 25th, 50th, 75th, 91st, 98th and 99.6th. Each one of these nine centiles is counted as one even though the gaps between them seem to vary.

The current charts being used are based on predominantly breastfed babies. They also exclude parental smoking. They're intended to be a measure of ideal child growth rather than being simply an observational tool.

"The WHO standards establish growth of the breastfed infant as the norm for growth. [...] The WHO charts reflect growth patterns among children who were predominantly breastfed for at least 4 months and still breastfeeding at 12 months."

This comes from the CDC but refers to the WHO charts developed in 2006, currently used by the NHS and which most PCTs switched to by the end of the 00s. I know this because DS was born in 2008 and he had the old chart but there was lots of discussion online about them changing. I expect each PCT used up their stocks of old books at a different rate but it's now 11 years later, everyone should be using the new charts. If you do want to double check they are available online for anybody to access: UK charts You can also see the training materials in how to read them here: www.who.int/childgrowth/training/en/

If you look at the new charts you will notice that there is a gap between birth and two weeks of age. The old charts don't have this. This is to reflect what we now know about birth weight which is that it is largely irrelevant to a child's natural size and is more related to the size of the mother, the gestation of the baby and to some extent the weight gain of the mother although this is mainly related to gestational diabetes.

Basically, babies can be born smaller or larger than they are "meant" to be and then spend some time catching up or catching down. By two weeks they should be settled on their actual centile, and from here, it's normal that they will move above and below it a small amount as people don't tend to grow in a linear fashion. It's important to remember that growth charts show an average of babies, not "the" average baby. Nobody is average. Don't expect your baby to follow the line, no baby follows the line, especially if you get them weighed very often. (With less frequent weighings, you'll see weight patterns smooth out). They will dip over and under it, and it's normal and expected. A problem is classed as a baby's weight gain line crossing two centiles, and even then, it can sometimes be okay for this to happen, perhaps if a baby is ill, they will temporarily dip as their appetite reduces and then come back up, or sometimes settle on a lower line than previously, but still be healthy.

IME most health visitors don't explain any of this, some will inform you that your baby has dropped or gained centiles, as though you might already know what this means, when most people don't. Some HVs even seem to have a poor understanding of centile charts themselves which I find a bit baffling, as they are not difficult to understand if you have the information, which when it's your job, you really should.

BewareOfTheToddler · 24/06/2017 10:51

I can really sympathise with this. DS lost a lot of weight after he was born as my milk took several days to come in, and he definitely needed a bit more than just colostrum - he lost 17% of his birth weight by day 5 and we were readmitted. Naturally, they kept a close eye on his weight and we mix fed for the first six weeks or so. It took four weeks for him to regain his birth weight.

I got no feeding support whatsoever from our HVs, most of whom were actually quite unkind (I know there are good ones out there, but not in my area, it seems). I did find La Leche League helpful, for both feeding and emotional support.

What I wish I'd done is see a lactation consultant - I ended up doing this when DS was one and it turns out he has an 80% tongue tie, which would explain a lot of the feeding issues we had in the early months. Despite our rocky start, nobody ever checked for tongue tie and I didn't know to ask.

DS started life on the 50th centile, fell to about the 2nd, and then levelled out between the 9th and 25th, where he remains aged almost 2. Ironically, despite being three pounds heavier than me at birth, he weighed to the ounce what I did at the same age for most of the first year! (My mum saved my old weight card.)

Oh, and we are still breastfeeding, despite a rocky start Smile. Do try to get yourself some support - it really helps.

LRDtheFeministDragon · 24/06/2017 10:52

bertie, I had no idea of that! Now utterly confused because our HV refers to the baby being on all sorts of centiles and certainly not just those.

LRDtheFeministDragon · 24/06/2017 10:53

(And when I say 'utterly confused,' yes, I am That Person and what I mean is, unsurprised ...)

daisypond · 24/06/2017 11:22

One of my DC dropped from 9th to below 2nd and then off the bottom of the chart. We had people stopping us in the street, amazed at our walking-talking dolly because DC looked so much younger than real age. We saw nutritionists, feeding specialists, hospital paediatricians, endocrinologists, HVs, GPs. But nothing was ever deemed wrong. Basically, remained on the 2nd percentile for ever - is now 17 and perfectly healthy. We were told there would likely be a delayed puberty which might enable DC to catch up a bit in height. But there wasn't. We learnt to accept it, but there were some tricky times, especially when the DC desperately wished to be taller and look their age.

Beebeeeight · 24/06/2017 11:23

I think your anxiety is more of a problem than the baby's weight.

Did you stop bf because of this but without taking medical advice?

Tomorrowillbeachicken · 24/06/2017 11:30

I was here almost six years ago. We struggled with DS' weight for the first year or so and he dropped from 9th to 0.3rd just after birth.
We ended up in hospital and ended up combo feeding (bf topped up with formula) and got very mixed reactions from HVs.
After finding a few that were complete wastes of space we stopped seeing them, especially as all gave different advice and some that thought they knew better than paeditricians.
Sorry that turned into a rant!

But ds is almost six and the first year was scary but looking at him now you wouldn't think that there was ever an issue.

BertieBotts · 24/06/2017 11:44

LRD you should have centile lines in your red book (are they still red?) and these are the ones HVs are supposed to refer to. There's no such thing for example as the "21st centile" unless there's a line which says there is. As far as I can tell, it's arbitrary but they must be based on something. But certainly I used to try and work out which exact centile DS was on and I was informed by TikTok I believe (who has a very good understanding of charts, better than mine, plus she is trained) that this was nonsense and any in-between-lines numbers don't count as centiles.

It seems that if you look at different charts - for example, the international WHO charts or the CDC WHO charts as opposed to the RCPCH WHO charts, they use different centile numbers but there are still a number of discrete lines, it's not a numerical scale from 0-100 with every decimal point possible in between. Or at least, it's not read that way for weight monitoring purposes.

corythatwas · 24/06/2017 12:02

My baby was sent back to hospital and I felt terribly judged. In hindsight, of course, I realise nobody was judging me: they were just anxious to make sure dd was all right.

But I felt like I was failing- because a mother is supposed to keep her baby fed, right?- and consequently I felt that other people must be judging me- because that's what you do with somebody who's failing, right?

It wasn't until 10 years later that I found out that dd's failure to thrive was due to hypotonia and nothing at all to do with my breastfeeding technique.

shinynewusername · 24/06/2017 12:05

You will always get different centile lines if you use different groups of people to create your centile chart. That's because centiles don't tell you what growth should be, only what is typical for the population studied.

So, for example, if you took a group of 1000 American babies and 500 were of Asian origin, your centiles would be different from a group of 1000 white babies, because American people with Asian heritage typically have smaller babies. Asian babies would be on a lower centile on a centile chart based on white babies, than on a chart based on 50:50 white and Asian.

There is a 21st centile; centiles run from 1 to 100. Centiles take all the group studied and chop them up into 100 groups. So, for 1000 babies, you would get 10 babies in the 21st centile (and every other centile).

Centiles are confusing -which is why it is important not to get hung up on what centile your baby is on, only whether it is changing. And - even then - it's only a flag to take a closer look. As PPs have said, the great majority of babies whose growth falls down a few centiles (or even a lot of centiles) have absolutely nothing wrong.

shinynewusername · 24/06/2017 12:08

My baby was sent back to hospital and I felt terribly judged. In hindsight, of course, I realise nobody was judging me: they were just anxious to make sure dd was all right. But I felt like I was failing- because a mother is supposed to keep her baby fed, right?- and consequently I felt that other people must be judging me- because that's what you do with somebody who's failing, right?

This. A million times this.

Feeding your child is the most primal thing in the world. It feels terrible if there is any hint that you might not be doing it right. But every baby is different with a different growth pattern.

daisypond · 24/06/2017 12:14

It's that term "failure to thrive" - we had that, too - that is/feels very judgmental.

Tomorrowillbeachicken · 24/06/2017 12:23

Yes the term 'failure to thrive' was given to DS too. Felt like I was failing at the time too.

shinynewusername · 24/06/2017 12:47

Yes, I agree it is an unhelpful term. It is meant to be neutral - i.e. "we aren't saying there is a medical diagnosis, we are just making an observation." But, of course, the word 'failure' makes it sound anything but neutral. Also, FTT is actually about much more than just going to a lower centile.

Something genuinely neutral like "Lower centile than previously" would be better.

corythatwas · 24/06/2017 15:58

agree that language is unhelpful

at the same time I think "each baby just has a different growth pattern" is almost equally unhelpful
as that suggests that there couldn't possibly be something wrong and you should resist investigation because it's just the way your baby is

which is precisely what I wanted to hear at that stage

but not what dd needed

Writerwannabe83 · 24/06/2017 16:01

Failure to thrive is no longer used any more (or shouldn't be) and has been replaced with Faltering Growth.

Peweee · 24/06/2017 16:31

Yes the term 'failure to thrive' was given to DS too. Felt like I was failing at the time too.

They're stopping this now, or at least in the area I work it. For that exact reason. It makes the parent feel like a failure and it IS judgemental.

flumpybear · 24/06/2017 16:42

My first was in 50th when born and she dropped to the middle I'd 9&2 centiles but followed a line in her weight gain over time - she was fine. I did start to combi feed from about 7 weeks which helped her gain weight

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