Growth Charts

[Amanda3266]

Okay - here's a challenge to all you brilliant Mumsnetters?

Why do some babies start off on one centile then suddenly and dramatically drop to another?
A few babies coming to my clinics (I'm a HV for anyone who doesn't already know }are doing this at present. In all the cases we've got I think it's entirely normal - with one baby I know her big sister did exactly the same. All are developing normally and seem (apart from one) to be eating well. I have no concerns about any of them (and neither have the parents) but just wonder why some kids do this.

I'm looking elsewhere to see what I can find as well - but just interested in what other people thought. Did your child do this? The babies seem too well to have any kind of growth disorder. My opinion at present is that they are just variations of normailty - we all develop at different speeds and that sometimes this fluctuates. However, I know some of my colleagues fret much more about this type of thing.
I know some of the older charts reflect bottlefed babies - our new ones (in the last 4 months) don't - they are based upon breastfed babies.

What did your babies do?
Mine started off on the 50th centile - went above the 99.8th centile by 6 months and then with crawling and walking went back to the 50th and now doesn't move from there.

Mandy

My midwife though that getting measured wrongly in hospital/difference of scales may be the problem. DS was 75% in lenght when measured in hospital but 50% a few days later, I supose that it must be very difficult to measure accurately the lenght of a baby, after all it's not flat and never stays still

Now regarding the scales, a different midwife came to measure DS one day and instead of placing the scale on the floor she placed it over a desk that was not perfectly balanced and told us he had lost almost 15% of the weight, the regular MW measure it a day afterwards with the scale on the floor and he had not lost weight but gained it...

I guess the margi of error is larger for a tiny baby...

My DS was 9 lb 10 oz at birth so in the 90s on the chart but soon dropped to somewhere between 25 and 50 while being breastfed. Then when weaned (he loved his solids) went back up to the 91 %ile where he stayed until 18 months. He never crawled/shuffled and so was a late mover which I think is why he was late to move the baby fat. He is now at about 60 I think - aged 3.11.

DD appears to be following a similar pattern. Although she was born smaller (8lb 12) but she again dropped and appears to be making it back up now that at 8 months she is well into solids but like DS showing no interest in crawling.

I think we give birth to big babies in my family and then they sort of adjust to what they should be. I was 9lb 5oz but am now only 5' 4" and a size 10. And my sister who is currently 2 days overdue has been told to expect a big baby.

That could be a reason - do find that differences in scales are sometimes terrible.

Sometimes wonder if growth charts are more trouble than they are worth.

Well... they are definitively a cause of stress BUT if it was not for the chart we would have not realised that DS was not doing very well after an operation (he droped to 10-15%)

Interesting thread. I think Chandra raised a really good point regarding accurate measuring. My ds dropped almost a centile at weaning (he was bf for 12 months). At that time I noticed that lots of his clothes were getting tight under the legs and I was sure he had grown quite rapidly in length but the HV wouldn't measure his length until his 8 month check. He had jumped up a centile for lenghth. So his shape had changed.

mine started of on 50th dove to well under 0.4 stayed there until her 2nd birthday
now she is on 9th for weight but still 0.4 for height
she is tiny, but they tried to label her a fail to thrive, but dieticians use a different scale called thrive lines and guess what
she was not a fail to thrive
there is often more to the centiles than first meets the eye
my ds however has been on 99 all his life and is still there aged 10...

Yep! There does need to be recognition that a child's shape can change. I feel true disorders of growth and weight are very rare and that sometimes the drops in centile just indicate normality and the adjustment to solids.

Mandy

well dd does have a genetic condition which predisposes her to poor weight gain and shorter than average height but my paediatrican said, I am looking at your daughter and I am telling you she is fine, look at the baby not the scales
Obviously this will not apply in all cases but for us it was a revelation, after submitting ourselves and dd to 4 weigh ins a week...

Amanda, do you know where the centile charts for plotting a child's bmi are (if anywhere) on-line? My dd (2 and 9 months) is at top of growth chart for height and weight and my sil says she should lose weight. She doesn't look fat to me though.

Another consideration could be post term babies. Why is the EDD on the chart not taken into account for post term. For premature babies, they shift the age to account for how old the baby would be if he/she had come into the world on schedule. My dd was two weeks and two days overdue, and when I asked the HV why she wasn't being marked as two weeks older on the chart she said "oh we don't do that." I said "Why not?" And she just looked at me like I had asked to explain why the sky is blue. So, perhaps some big babies who then turn average are actually older.

Incidentally, DD was measuring in the 90 percentile. To say this is uncharacteristic for my family doesn't even begin to describe it. I am 5' - 1". The talles woman in my family is 5'-4". DH famil is roughly the same size. And, whilst you never get him to admit it, he's not more than 5'-5". DD is now an average height almost 2 year old. I'm thinkin those 16 days overdue explain the discrepancy. Oh but, "we don't do that." Perhaps it was just my area. Do other areas adjust for post term dates?

Dinny, isn't it in the back of your litlle red book?

A friend of mine ended up having to see a paediatrician with her Dd2 who had plummeted down the centiles since birth. What the Dr said was basically, 'i wish they's throw those centiles away!! Most babies' birth centile is much more to do with how well or not the mother was nourished during pregnancy and they take at least a year to even out to their true centile!!'

i think the Dr had spent all day looking at healthy children who were on high centiles at birth.

Ds1 was on about the 75th for weight at birth he's 6 now and has been hovering around the 50th since he was 1, he's just long and lanky like his dad. He was an immensely long, thin newborn, it was his length alone that put him on a high centile for weight, same with ds2.

Doddle - I had exactly the same thing! The consultant paediatrician took one look at this happy, healthy, alert baby in front of him and asked what my dad was doing nowadays (he used to wrok at the same hospital) .

Ds was born between the 75th and 91st (8lb 15oz) and trundled dwon through the centils until at 6 weeks he was just underneath them - when he was seen by the consultant. He took in seven weeks to regain birth weight.

He said just to ignore the charts, forget about the faff of expressing and get on with enjoying my baby. I was never put under any pressure to stop breast feeding. he said that ds would probably eventually re-adjust and work his was back up to about the 25th - which is actually what he did.

Ds was never going to be huge - dh and I are both small and were skinny as kids. I put his good birth weight down to the excellent start I gave him in utero.

He is now a happy, healthy, energetic 4 year old. At his pre-school check, he was 75th for height and 45th for weight - so ireckon pretty healthy.

I did avoind health visitors when he was young (sorry Amanda 3266 ) in case they hassled me and isntead went to the weekly breast feeding support group at my maternity hospital, staffed by their breast feeding counsellors.

It was them who refrred him, just to be on the safe side. They did say they would like to use him as a good example of a non failure to thrive baby who didn't follow the growth charts.... but there were plenty of others the same, as they often got me to talk to "new" mums who were going through waht I went through, to give them confidence about continuing to breast feed.

Hi dinny - will look and see what I can find for working out bmi.

Prettybird - no need to apologise for staying away from HVs - some get so stressed about these charts that they're best avoided if you have a young baby.
I totally agree that when looking at these "growth" charts you need to look at the child and the family - too many health visitors and midwives do not do this and it undermines breastfeeding mothers greatly. Thankfully, all the charts have recently been changed to reflect true weights for breastfed babies - something the mums I see have found reassuring.
In my experience most babies and children (apart from those with rare growth disorders) will fluctuate in height and weight during the first five years of life.

Mandy

By the way folks - in the interests of everyone knowing their rights - you do know that you are under no obligation to see a health visitor if you don't wish to.

I used to insist they weigh my red book before each weighing so I had an idea if there were variations between scales. They thought I was mad but at least I knew that if he'd lost weight it was all him.

Fantastic idea

thanks for the link, Amanda. they don't plot the bmi for kids under 5 though - says to see your hv or dr... if she is as top of centile chart for both height and weight does that mean she is ok? dinny x

I have noticed with my exclusivley bf DS recently. He was exclusively bf for the first 6 months (as recommended by WHO, UNICEF, etc.) and then I started him on solids at his 6 month birthday. He has dropped from the 25th centile at birth (3.09 kilos) to the 9th centile. This is according to the "red book" chart. He is now around 7.3 kilos. He had doubled his weight by 4 months, which is brilliant.

I have also been using a UNICEF chart which is for bf babies. He seems to be following the 25th centile more accurately on this chart. But he hasn't gained any weight for about 6 weeks now (he had a bad cold for 3 days just before Xmas and actually lost some weight as a result). But he is incredibly energetic, alert, healthy looking, has gorgeous chubby ckeeks, great skin, etc. That is why I no longer think yo-yoing weight is a problem. As some wise person said "look at the baby NOT the chart".

Unfortunately I have an unsupportive HV and GP who have very little knowledge about bf babies. I have never bothered to ask for their advice on weight, because I knew the first thing they would say would be "give him formula". When I told my GP DS wasn't sleeping much at night (he was only a week old for God's sake !) she said "you can probably get away with giving him a bottle of formula at night". I now know that this would have been a sure way that the baby would have ended up on formula for good ! So unfortunately formula seems to be the only suggestion they have for the many so-called "problems" that bf babies have. Of course, I now realise that most of these reasons for switching to formula are "imagined" and that many mothers like myself get harrassed into switiching to formula to "fatten up" baby.

I have a special request to ALL NHS STAFF ! Please, please help breastfeeding mothers who worry about their baby's weight. Don't treat babies like cattle that need "fattening up". According to a recent study by WHO published in the Observer(it is mentioned on the Home Page of Mumsnet) bf-ing mothers have been given inaccurate charts and information about the weight of their babies. In fact, "fat" babies are not so "bonny" after all.

ooh karaj where did you get your UNICEF chart. My HV said all weight charts were based on bottlefed babies and you couldn't get charts for b/f babies!! My DD was prem and the only advice I got was well, give her formula, top her up with formula blah blah. I didn't.

If it make you feel a bit better... I couldn't breastfed for long (won't enter into details as it is already a painful topic for me) anyways, everytime I had a doubt about DS health I most of the time got replies in the terms of "it's your fault! if you have breastfed" sadly nobody was there when I so needed the support and info in order to continue.

ALLYCO - the UNICEF chart for bf babies can be found and printed off from www.kellymom.com. There are separate ones for girls and boys. If you have trouble finding it, please CAT me and I would be more than happy to email it to you. Also UNICEF have their own website devoted to bf. There is lots of valuable info. there too.

CHANDRA - poor love ! I am so sorry that you were wrongly advised. I feel for all mothers who are told such rubbish about bf.

I have been struggling all alone since my DS was born 7 months ago and doing everything I can to continue bf. I read articles on the internet whenever DS is napping to keep up with bf info. But mothers are busy people and we can get easily depressed by the wrong kind of advice. We shouldn't have to read the internet to get accurate health info. The NHS should be providing this to us.

Amanda3266 - I am so pleased you started this debate. You sound like a wonderful HV who knows what she is on about. Unfortunatley many mothers are given bad advice, especially about bf and weight gain. I wish that most HV's and GP's had better knowledge about bf, as weight gain is such a sensitive and obsessive topic.

Karaj - thaks for that link about the UNICEF ones - am going to download a couple. Our charts have recently been changed to reflect the fact that breastfed babies gain weight at a different rate to bottlefed babies.

Hi Dinny, if she doesn't look overweight to you then I wouldn't be worried. Just concentrate on giving her a balanced diet and plenty of opportunities for activity. I think in the first five years the rate of growth in height and weight can be very variable. Some children can even look podgy for a while and then have a growth spurt. Your DD is actually within normal limits for both height and weight and as she is tall it stands to reason she'll weigh more. I wouldn't worry too much about this.

Mandy

www.kellymom.com

What a fantastic site - so much info on there - thanks for that karaj.

Mandy