20wo baby happy but tiny! Dropping centiles - HV said nothing, is this right?

[BrianButterfield]

DD is 20wo today. As a neglected second child she has been weighed infrequently and I am not a worrier about weight. However, everyone has been commenting on how small she is and at baby massage this morning it was clear she was much skinnier than babies the same age so I took her to be weighed and she has dropped on the chart again!

She started on the 50th centile, was 25th by 6 weeks, just below 9th at 11 weeks and now between 2 and 0.4. The HV didn't even comment on it - is this OK? She is EBF, feeds every two hours or so in the day and sometimes sleeps through but sometimes has anywhere from 1-3 night feeds - she is in a bedside cot with the side off so totally on demand. I have never made an attempt to space or time her feeds either.

I didn't actually see the chart until I left otherwise I would have brought it up. She's happy, active and all the rest of it but in 9 weeks she's put on 1lb!

Just bumping for evening readers!

I wonder if it's worth ringing the HV and talking it through.
1lb in 9 weeks is not even a gain of 2oz a week which does seem unusual, but might not indicate a problem.

As you say, she's happy, feeds a lot and has milk overnight but she has dropped a lot of centiles which personally I would consider getting checked out.

I understood that if they dropped more than two centiles they should be referred to a doctor. I'd want to speak to the HV again and have her checked out.

That is quite slow weight gain. I would see the HV or the GP just to get her checked over for peace of mind.

My dd was born on 25th and fell to 2nd at one point. They got all up in arms about it! If they fall more than 2 ventures, it is a big deal. They said if she fell any further I would need to be referred. Anyway, she is still very petite but not skinny. I think its a bit negligent of hv to be honest, they should investigate even if all is fine.

Ventures = centiles

normally a drop of more then 2 cr is an automatic referral to a pedatritrtion. Not that there is necessary anything wrong most babies they see are happy slow gainers but it should be checked.
I'd be taking her to the GP at least to get them to check her over. How are her nappies, does she have lots of wet nappies during the day. it's she otherwise happy have awake and content periods? Is she meeting developmental milestones. These are all things that will be look at to see if she's doing ok.

She's generally a really easy going, content baby. She sleeps well, has proper naps and enjoys games and just observing the world when she's awake - she loves to interact with everyone! She isn't rolling yet but is strong - will support her weight on her legs, excellent neck strength on her front and is starting to sit. So no worries there, I don't think. In fact everyone who sees her comments on how smily she is and how alert and interested in the world she is.

Oh, and nappies too, seem fine to me. 5-6 a day or so.

That is a very slow weight gain and I'm surprised the HV hasn't picked up on it. I would contact them and talk it through.

I read that it is normal for ebf babies'weight gain to slow at 4 months, them again at 7-8 months.
I also heard something about a WHO ebf weight chart which is different to the one we use in the red book, which is both formula and ebf. Is this true??
Although I may be wrong as read this in LLL's book so might be Americanised

Think it's this...www.who.int/childgrowth/standards/cht_wfa_girls_p_0_6.pdf?ua=1
Sorry can't link

Brian, would there be any other indicators that she may just be small? I have 3 children and they are all very slim (despite consuming vast amounts of fat and sugar!). My husband is Asian, and the children in his family plus pictures of himself all show very slim children. Dd's cousin (who she is the spitting image of!) is also very small. I was very petite as a child too, so I was never too worried about any of my kids being 'small', or my dd when she dropped the 2 centiles, which is why they probably were ok with not referring me unless it became more. I imagine dd would still be on the 2nd (judging by her class!) but she is 5 now, so it will be interesting when she has her weight checked this term. My older ds1 is 50th for height and 25th for weight.

She is just small but it's the dropping that worries me rather than where she is on the charts. I called my HV (yesterday I was just at the drop in clinic) and she said it had been mentioned to her and she'll come and weigh DD tomorrow and have a chat. She did say DD is probably just small but I'll feel better when she's been weighed again as it was a brand new set of scales last timw!

Sometimes babies are born bigger. Maybe it has something to do with how well your placenta functions!! All my kids were born higher on the centiles than they are (or I suspect they are) now! Ds1 (8) was born on the 75th.

It's good that you are going to talk things through with the HV BrianB, let us know how you get on.

That is quite a slow weight gain and I think it needs looking into.

How long does she feed for?
It may be that she's not getting enough of the hind milk which has all the calories in?

Just to update - HV came round and weighed DD - she had put on 4oz but importantly HV was happy with her appearance, activity level, alertness etc. She also looked at me and commented that as I'm small framed it doesn't seem out of place DD would be. She said it's common for EBF babies to have a bit of a slowdown at 20 weeks and to go back in a month.

I then got DD weighed at the children's centre this week, so 22 weeks old (as I happened to be there and there was nobody waiting!). She had put on another 8oz which brings her just below the 2nd centile line.

She is still feeding a lot both day and night. My SIL has poked her nose in and claims it's because I'm losing weight and I should express and bottle feed as that's better (??). I am losing weight but v sensibly - mostly from upping exercise and cutting out junk food. I eat three good meals a day and am having lots of full fat dairy, avocado, oily fish, olive oil etc. It's more the sugar/biscuits/sweets I have cut out so I wouldn't think this would be an issue? I'm not on a diet.

I think if you're eating sensibly, your breast milk will still contain everything for healthy baby growth. Even if your consumption of some nutrients is low, your body will take from its own stores to ensure the breast milk contains everything. ....that means if your not getting enough calcium/iron etc it is you that will suffer, not thebaby (uunless you become very malnourished).

Even if you weren't eating well, your BM would still have everything your baby needs. Not so great for you tho', so glad you are eating well for your sake. Your HV sounds fab...... your SIL possibly has a wee bit of baggage around infant feeding??

I would keep an eye on her weight...our LO was born on the 25th, dropped to 9th, 2nd, 0.4th and was put on high calorie formula at my insistence as his intake is so low (obviously you can't measure i take with BF...). Pead and now a paediatric referral have been instigated, although he has gone up to the 2nd centile and seems to be hovering there. He's happy, alert, meeting all his milestones and has plenty of wet and pooey nappies, he just doesn't like eating!

I only say to keep an eye on this, as it could be that she's just naturally small and finding her centile, but also there can be a number of causes of poor weight gain, such as latch issues, tongue tie, supply issues, intolerances and metabolic issues so by keeping an eye on things you can act if anything does cause further concern.

Your diet is more important for your health, as I'm sure if you do a bit of research, your diet doesn't influence your breastmilk much.

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