DS between 0.4th and 2nd centile for height, 2nd for head circumference and weight

[Wollyfish]

DS was born at 34 weeks weighing 4lb 9, he was a fairly good feeder on both milk and puree (although still smallish) but he has only grown 1 cm over the last few months and put on half a pound. Since going on to a normal diet his intake is very poor. I would give him more milk or even puree if I thought he would eat it but he now refuses that too. He will not at all be fed so is struggling to feed himself with a spoon which may not be helping. I know it is normal for children to become fussy at this age but I am particularly worried as he is so small. Paternal genes are tall and my family are average, I am the shortest one but I found my old health record and I was following the 25th (I know the centiles are different for girls). The health visitor says he is just destined to be small. I am trying not to be too worried but am concerned this will cause problems for him in later life.

How old is he now?

Are you still using the adjusted measures (ie pretending he is 6 weeks younger than he is) when looking at the centiles?

My DD2 was 7 weeks prem. I can't help much as we adopted her when she was 2.5. However her FC found the only way to get enough food into her was loads and loads of small meals. Even when she came at 2.5 she was on 9 separate eating times per day, including 3 bottles of milk.

My understanding is that you only generally need to be worried when they drop on the centile charts, after all 1 out of 100 children will be on the 1st percentile.

Hopefully someone more knowledgeable will be along in a while.

He's 21 months now and the HV told me to stop correcting the age now, however I tend to still subtract the 6 weeks for comparison and he's still pretty diddy. That probably does account for why he seemed higher on the charts in his first year.
I have tried the small meals, but then I seemed to eat hardly anything at a time, so I was advised to space them out without snacks. I am still going with morning and night milk, milk if he misses a meal, and adding olive oil to food. Did DD2 catch up in the end?

DD2 (now age 11) has small genes (her sister has stopped growing at under 5'2"), so is still low on the percentiles lines.
However she has a very good appetite and boundless energy and very healthy.
She is 'behind' on a few areas, but it is difficult to tell what is genes, what is early neglect, and what is due to being prem.

if you have concerns then please run them via the GP. This isn't the HV's remit.

My little girl was 5 weeks early and weighed less that yours. She's now 2 years 7 months she's still in 12-18 month old clothes she grows upwards but hasn't put any weight on for months. She weighs less than a 12 month old according to clothes sizes. But she's just small, nothing wrong or anything.

I have been to the GP who passed it back to the HV and said that the HV team can do referrals to dietitian/paediatrician.
She also said an HV would be better to ask as they look at babies all the time where she is in general practice.
I guess I could go back to a different GP.

How is your DD's appetite, purple? My DS is very active and moves constantly, so is probably burning off the little he eats. Bur he doesn't seem to require any more. I am beginning to think he is indeed simply destined to be small.

OP, I would insist on a referral (either HV or GP). I have been there (other issues but similar situation that everybody fobbed me off). In the end I refused to leave the GPs room without referral (literally refused to get up - I was that desperate). 9 months later DD got a dx from paed for a severe and life long disability. listen to your gut

Op, I agree with whatamess. Don't let yourself be fobbed off, insist on a referral to a paediatrician. He might just be small, but there might be a reason for his slow growth - a reason which could be treated! In any case, a child that is that small and failing to grow needs to be seen by a specialist, not an HV.

I appreciate the advice. My gut feeling is to check it out, yes. I know someone has to be the smallest and he was premature. But I only want the best for him. If there is anything I can do to help him I will. Of course I will love him whatever his height but I think I would be failing him if I ignored it for the sake of his physical and possibly future mental health. And if it went untreated because of being minimised that would be a shame. I am very sorry to hear about your DD whatamess. Good on you for standing your ground.

My eldest was 4lb 12oz born at 36 weeks. At 2 he was off the bottom of the weight chart and around the 9th centile for height. We spent the first three years of his life back and forward to the hospital for tests and monitoring - he stayed by far the smallest in his class for years. When he was 14 he did nothing but eat and grow for a whole year and went up over a foot and four shoe sizes in that time, ending up almost the tallest in his class. He's now a very healthy 22 year old who is 5'10" and slightly on the chubby side.

Fuzzymum, that's great to hear! Perhaps he just hasn't started growing in earnest yet. I shall see about monitoring to cover all bases. But it's good to hear a positive story. Thank you.

Our HV said (at DD's 1 yr check) that she would do referrals for children who were 0.4th centile or below, but not above that.

This tallies with what it says in the red book growth charts (just checked) which is "Being very small or very big can sometimes be associated with underlying illness. There is no single threshold below which a child’s weight or height is definitely abnormal, but only 4 per
1000 children who are growing optimally are below the 0.4th
centile, so these children should be assessed at some point to
exclude any problems."

Sounds like your DS is just above 0.4th centile for height and 2nd for weight so wouldn't be referred on this test.

However in your case it looks as though your DS was born on the 25th centile for 34 weeks (like you as a baby). The fact he's now dropped to the 2nd centile might mean there is a good reason to refer.

I would go to the HV, emphasise not only his size/centile now but also that he has dropped two centile lines, and ask for a referral. Better to get checked out IMO - it may be nothing but what's the harm in having an extra check.

My DS was born at 37 weeks at was 5lb 12 oz. He had a lot of health problems in his first two years and he was 0.4 centile for height and similar for weight. I remember when he was at nursery, he was more than a head shorter than every other child in his year group.

It turned out he needed his tonsils out. He also had reflux which he needed medication for until he was 7. Once we got these issues under control, he has caught up a lot - he's no longer the shortest in his class and although he's small build, he plays sport 3 times a week and he's really healthy. So, it may be worth looking for an underlying cause, but even if there is one, it might be one that can be resolved.

Minipie - that's exsctly what i thought.
I am awaiting referral letters from a dietitian. The GP wants to do that route first before seeing a paediatrician.
Thank tou everyone for all your help.
Sorry for mistakes - on phone .

Hey bit late to the thread!

My ds was born 31 weeks weighing 2lbs 11oz and was IUGR. He's now 3 1/2 years and weighs 29lbs and he's 88cm, which is 9th in weight and not on the charts for height. His cousin 15 months younger is bigger than him, his trousers are 18/24 months mostly. The paeds/ dietitian were never bothered as he follows his own line which is what's important. He is the smallest at nursery but developmentally on track. He eats like a horse but is very active. The children at nursery currently don't comment on his size which is good I do worry about school ages. But he's such a personality and everyone loves him wherever he goes. If ds is following a line i think he's doing well. Good luck with the dietitian/paeds

My little boy is also very sociable and charming! And also very active, which must keep the weight down. Thank you everyone for contributing.