HV constantly pushing formula. Can I just ignore Her?

[Isabelleforyourbicycle]

So ebf DS, 11 weeks is putting on weight very very slowly. He's dropping through percentiles, but isn't skinny, just small. In all other aspects, he is absolutely spot on, happy, smiling, good sleeper, a very easy content baby.

But because of the PC dropping, the HV is constantly on me to introduce formula. I've been to a bf clinic for some tips on latch, which hasn't seemed to make any difference to his weight gain.

I'm not against formula, but I don't think it is necessary in this case. Can I just ignore her totally and not get him weighed anymore?

Is it possible to go "off grid" with Hv and just trust my instincts?

I feel if I introduce formula it'll be a slippery slope to full ff and I can't be arsed with all the sterilising etc. I fed my DD till 6 months and hoped to do the same with DS.

Has he dropped more than 2 centiles? Might be worth getting a referral to a aped to check all is ok before ignoring the HV! Or ask her for suggestions to improve weight gain without formula?

How about calling her bluff and asking to be referred to a paediatrician? I used this method when my hv told me to use formula to "wash out" some very mild and physiological jaundice.

Are you offering both boons at a feed? If not might be worth offering the second one see if you can get a bit more into him.

Boons? [ hmm]

Sometimes he takes from both boobs, but not always. I've a fast let down and bf is quite quick. Done and dusted in about 15 minutes. My dd was exactly the same (she had no problems with PC)

HV did refer to paed but they only rang me and told me to offer a bottle a day. Not the most scientific response.

It feels like I'm being fobbed off with formula. I don't think there is anything wrong, surely he would be a miserable baby if he wasn't well and thriving?

Maybe I should push harder for paed referral? Even though I think it is unnecessary. I don't really want to waste their time or mine tbh.

Formula is just the easiest thing for them to suggest.

What if you were to tell your HV that formula is a last resort not a first choice for you, so if there is a problem how are you going to fix it without formula? If she doesn't know, who is she going to refer you to?

Put it back on her, tell her formula is not an option so what else is she going to do?

That's what I'm tempted to do quietly

In my county, they encourage regular weigh ins. No other reason.

My hv was like this with dd1, to the point of harassing me (leaving me 5 min long voicemails saying dd was too light despite saying to my face she was fine). I brought dd to the doctor and she said dd was perfectly healthy. Hv backed off then.
Trust your instincts and don't be afraid to seek another opinion.

OK. I had a similar issue with my HV when DD2's weight was dropping and I went and had a chat with the GP. I think it is worth doing that, because my very nice GP explained they do have to worry in case it is 'failure to thrive', and took a urine sample...but she also reassured me that DD2 was doing splendidly, and in the event there was no problem. In fact if there is some other reason for your baby's size, formula isn't going to solve it!

So I'd say go and see the GP.

BTW DD2 is now 11 and is still absolutely tiny, but is also a tough healthy child. I think if anything she was just reaching her overall level where she has stayed. But she is officially 'underweight' (I don't mean she's just a bit skinny, she has visible ribs and pelvis) and I've had to reassure the professionals that there is no eating or digestive issue - I can understand why they get worried!

How big was your baby at birth? My Ds was just over 11lbs. He was a boob monster, but still fell through the centiles until he settled at where he was 'supposed' to be. Midwife suggested formula as it would be impossible to 'maintain' such a big baby with breast milk alone.

I ebf until 6 months, then very slowly weaned him until he was 16 months. He is very average sized now at 4 and very slim, despite everyone telling me he was sure to be huge!

I'd ask for a few more health professional opinions if it was me. The midwife I had when I had dc2 was desperate to give him formula, even asked why you would bf when formula is easier. Makes me feel sick, I had already bf dc1 so stuck to my guns

My first DS did this. He was 7lb 12oz when born, 10lb 3oz at 4 weeks, 10lb 4oz at 5 weeks and there after dropped down the chart and bumped along one of the bottom lines. He did always put weight on, just not very much.

He was rubbish with solids and this completely messed up milk feeds as he wouldn't take bottles or cups and I don't think he was getting much from me. He went on to be a fussy eater but we kept him on as good a diet as we could.

He is 22, 5'11'' and built like a garden cane, never mind bean pole. His does appear to be filling out his trousers a bit better now.

I used to get a lot of tutting from the health visitors, and they were not a lot of help, so I only took the next two occasionally (monthly?) to be weighed, not every week like I did with DS. So it is perfectly possible to bypass them.

I was told by the nurses in SCBU that if the babies are bottle fed, you can stuff a bit extra into them, whilst if they are breast fed, they are in control. So if you wanted to give him some bottles, you could probably get a bit more into him .... or not. Either, he would just give in or just take less from you. Or you could try some of the methods to up your supply and see if that helps (most breast feeding groups have info).

If you genuninely think it is something to worry about, then a referral would be better.

How much has he dropped?

In my experience, babies don't take being hungry in silence. So if it was a supply issue surely you'd know - either from the screaming or from very very frequent feeding? I'd ask for a second (medical) opinion, as "failure to thrive" is indicated by more than just weight afaik.

Also ask your HV if the weigh ins are mandatory. I asked, and mine said no. So I bought luggage scales and I weigh DD myself and update the red book. I just weigh her in the car seat, then subtract the weight of the seat.

There are lots of ways to increase breastmilk intake before reaching for formula. If your little one does need top ups (without studying his weight chart and history I don't know) then the top up could equally be breastmilk in the first instance. A reassuring option might be to find a good IBCLC lactation consultant to sit with you, take a history, look at the charts and the baby, watch a feed, liaise with your HV as needed and make a plan to ensure little one is well fed while protecting breastfeeding. In the mean time check out the ideas in Is My Baby Getting Enough Milk and One Breast or Two and Pumping More Milk I am surprised to hear a referral to a paediatrician could ever be dealt with over the phone. There could be an underlying health issue for poor gain, I agree with others to ask for a second opinion.

I would recommend seeing a private lactation consultant. They will be able to discuss how to improve weight gain by bf alone. Massively helped me.

Is anyone small in your family? DD1 was 6ibs 10 ozs when born and was ebf but didn't put on weight fast enough for the HV. DD is still a small person at 34 yrs old with size 3 shoe!! I just ignored the HV because she was very healthy Also MIL was a small person. I still don't understand why they STILL don't make allowances for small people.

Oh ignore. You would know if there's something wrong with your baby. As long as he's happy and having plenty of wet nappies and poos.
I never went back to my HV after my dd 4week check.