Health visitors over-react to babies at the bottom of the charts more than babies at the top?

[FeelLikeTweedleDee]

Would you say this statement was true: Health visitors over-react to babies at the bottom of the charts more than babies at the top?

Hmmmm difficult.

In my limited experience, I often think mums (particularly first timers) are more concerned about babies at the bottom of the charts. I've had 2 babies both at (and at times off) the top of the charts. I never had any concerns about it - they were just big "healthy" babies. In fact, if anyone made any negative comments (HV included) I was quite shocked and laughed them off

There was a girl in our village who had a baby boy a few days before I had DS. Her DS was very small and right at the bottom of the charts. She would spend ages getting advice from the HV and other mums on "how to make him bigger". She was really paranoid about it. Even now our DS's are 18 months old and clearly both very healthy, albeit very different in size, she's still always asking how much ds eats etc. Her DS has been referred to a dietician but I think more as a response to her concerns as opposed to the HV's really

I would agree. My DS is over the 95th for weight. However he is totally off the scale for height. So actually he looks rather lean.

Our HVs have always been delighted to see him so far up the charts. However, friends we have with babies at the bottom of the centiles have had to have extra check-up and HVs coming over to see them.

But isn't it the case that a big, tall baby/child is generally going to be healthier than a little, low weight baby?????? Not sure about that one but that is my gut instinct.

I wouldn't say a tall baby was healthier than a petite baby. What I found most frustrating was my health visitor's indifference to length. Her whole focus was on weight.

I've had a bottom lurker, he was 0.4% or below for his first year and if I hadn't been an experienced mum i'd probably have bowed to the endless pressure to 'top up' after feeds or stop breastfeeding altogether in favour of that disgusting fortified slop. If you have a small baby expect to be harassed about their size and encouraged to wean them on to absolute shite just so they get bigger.

Fwiw, my titcher is 2.5 now and was ebf till 19 months, never topped up and weaned healthily and is completely normal size wise...The medical professionals led me to believe that was entirely impossible.

I have no idea about having a big baby so can't compare though.

My older daughter was a 2nd centile baby, but perfectly happy and healthy. The GP at the 8 week chech tried to bully me into topping up, but the HV told me to ignore her, as it was obvious that she was fine, just tiny. The HV was an ABM member, which I guess helped, too.

I wrote a whole big post here but hit reply just as MN went into "offline for an upgrade" mode - cheers HQ!

I am a HV and I would agree with the statement. The reason for agreeing is that I all too often see people struggling because they have had bad advice.

Some babies are on the 0.4th centile because that is where they are meant to be - getting some HCPs to realise this is a nightmare, although all HVs trained in the last 10 years should have had training in epidemiology and looked at centile charts as part of this.

My biggest problem is ion the first six weeks when babies are still adjusting to whatever line they will follow - some will go from the 9th - 0.4th and then sit on the 0.4th quite happily while various HCPs go collectively crazy trying to get the baby back to the 9th centile

Poor weight gain is a different kettle of fish and DOES need reviewing. In nine cases out of ten it is down to a feeding problem. If this is the case then sorting out the feeding sorts out the weight gain. In those cases when I pick them iup I start off by making sure it is only me seeing and weighing the baby so you don't get discrepancy with two sets of scales. I find out what the baby is doing with feeding and then advise accordingly. Once the baby is gaining weight again then Mum can go back to clinic for weighing if she wants to - I don't advise it while the weight is an issue though - too much conflicting advice. This works fairly well and I have a good track record in supporting breastfeeding now. Does my self confidence in my ability to support breastfeeding mothers the world of good too.

I always tell student HVs to "look at the baby" and you will often find the answer. Is the baby well otherwise? Has the Mum any concerns?

If the baby is well and happy and just following the 0.4th centile (very occasionally I see them following a line below) then there is not a problem generally.

If the baby is not feeding well then help sort this out

If the Mum thinks her baby is unwell then take her concerns seriously.

Dilly, thanks for that.

Would you say that a lot of the over-reaction of health visitors is down to covering their own backs? An obese baby is not as immediate a health concern as a small baby. By the time the effects of obesity have taken place, the HV will be out of the family's life.

In my experience with DD2 the answer is yes. If HV and GP hadn't made such an issue of the fact that she was a petite baby who gained weight slowly (just like her older sister but we were under a different PCT then) I would probably still be EBF rather than mixed with more formula than breastmilk now at 21 weeks. I was made to feel inadequate and that I should have realised that there was something wrong/she was too thin etc. etc. Thankfully the Paediatrician we were referred to agreed with me and saw no problem - merely saw that DD1, DH and I were all small and short as are our immediate families so it follows that DD2 was likely to be the same, but HV still continued to make little 'digs'. I shan't be bothering to see the HV again until it is time for the 8 month checks.

My experience would support the statement but I can kind of see a logic to it. It is possible (but very unlikely) that a large child is being overfed and this may raise the risk of weight problems later in life. The most probable explanation is that the child is simply programmed to be large and they are perfectly healthy.

Again the most probable explanation for a baby being at the small end of the chart is that they are meant to be small and are perfectly healthy. But the alternative explanations are much more sinister and include problems with feeding which may deteriorate over time, neglect by the parents, physical deformities in the bowels and genetic illness. All of these things are rare but they need addressing PDQ if present.

The difficulty is that by not wanting to use scary phrases like 'failure to thrive' HV's often fall back on 'just keeping an eye on things' and advocate frequent weighing. For a concerned and anxious parent this can be agonising. I think with hindsight I would have preferred an urgent referral to a paediatrician to check DD than out 4m of fortnightly weighing by our monumentally unhelpful HV.

DD was on the 0.4th centile for weight for 12 months and we had monthly visits from our health visitor for four months. I refused a paediatric referal as I felt dd was fine. Once her weight was plotted on the breastfeeding chart she moved up to the second centile. She was weighed last week and now is on the 9th centile at 26 months.

Other than the primary visit I only got dd weighed twice in her first year and she fell from the 50th centile to the 0.4th between two weighings. She was weighed at 2 weeks (primary visit), 6 months and a year. (Poor dd is a negleted second born) It was hard to get to clinic as I was back at work.

Having a small baby/ toddler can cause a lot of anxiety. Health visitors are there look after the health of the mother as well as the child.

Hmm! Unsure exactly, I think it's more a case of them not being savvy enough to think of looking at the baby beyond the chart. I am a big believe in this because even if you DO have a baby falling through centiles and not thriving the underlying cause is often feeding. I have seen babies like this who otherwise look the picture of health and it just takes a bit of good support with breastfeeding.

The ONE occasion I can recall where that was not the case was with a baby who was not gaining weight well and who turned out to have a heart problem. In that particular case her Mum said as soon as I'd got in the door "I don't think my baby is right" - and she was correct. The weight chart was just a guide to the underlying problem and tbh I didn't need it to see her baby was unwell. More to the point the Mum did not need to do so either.

I think some of the anxiety comes from poor practices and training. It's also because breastfeeding is badly supported on the whole. Most HVs still have scant training in breastfeeding support and faced with a baby not feeding well do not know where to go except via the GP who has often had even less training in breastfeeding.

I think there needs to be much better training in breastfeeding support and also in the in terpretation of centile charts. I see a baby on the 0.4th centile and see a healthy baby beyond it. Some still sadly see 0.4th centile and attempt to get the Mum overfeeding to push the baby up to whatever centile line he/she was born on.

My bottom line in all of it though is LOOK AT THE BABY and NOT THE CHART.

Dillydaydreaming, Thanks for your post, its an interesting insight.

My health visitor is fanastic, although I found that other health visitors were less good. I don't think the issue with breastfeeding is training as all health professionals in my area have had training on breastfeeding. Breastfeeding support is much better than in the past. There is a breastfeeding support group where the staff really know their area.

I think the issue is that some health professionals fundermentally disagree with what is taught on the breastfeeding course. For exampe I had row with a health visitor at the baby clinic who told me that breastfeeding beyond 12 months was against the governant guidelines and I HAD TO STOP. I was very pissed off as felt she was masacrading her parenting opinons as professional advice.

The stupid cow even had the cheek to phone my GP and tell him I had gone bonkers. How on earth a health visitor that I had never met before could assess my mental health in three minutes flat is crazy.

Definitely true for me. Both DSs have plunged through the centiles, and nobody cared with DS, despite my constant questions, because he was born on the 98th. DS2 was born just below the 50th and we are on a paed referral after a similar proportional fall down the centiles. When HV told me it was 'policy' to refer you to the GP if they fell more than two centiles I made a face and enquired whether this had been policy 3 years ago. Apparently it was

I am because DS2 is waaay healthier than DS1 was - DS1 had latch issues, gut issues etc. DS2 is (I think) just a tiddler.

That advice about stopping at 12 months is utterly appalling.

It is SO important to ask a Mum how SHE feels things are. If that had been done for you Hopefully then better support could (or should) have been given.

I had a HUGE baby and my stupid HV could still only bang on about dropping too may centiles. DD was born right up above the 99.6th centile and as DP and I are both only average I never expected her to stay that way. She dropped to the 75th and HV started suggesting top ups, bedtime bottles and weekly weighings. DD is 8 months now and still around the 75th but the 98th for length just like her brother.

I agree about the obsession with weight and not length/height. My lovely friend gave up BF as she received crap HV advice to top up all the time and never really got her supply going. Her boy is now a complete whopper ad they gave her a really hard time about his weight (98th centile I think, born at 50th). She had to really hassle them to go all the way over to the cupboard to get that yellow thing and measure his length and lo and behold his length was on the 98th centile too so he is the totally in proportion child of tall athletic parents.

Dillydaydreaming, I got amazingly good support in the end. There are good health visitors in my area. Prehaps one of the advantages of corporate working is that you aren't stuck with a health visitor that you don't relate well to.

I have an outstandingly good health visitor. She has 25 years of experience and knows to look at the baby and not the charts. She got old of a copy of the WHO charts for me and it turned out although my dd was tiny, she was a health breastfed baby.

She did a two year check the other day and I feel truely devestated that it is unlikely that I will ever have professional contact with her again.