6 months -referred for poor weight gain - I feel cr*p (long, sorry)

[elliott]

Sigh. Ds2 is now just over 6 months and has been on solids since 20 weeks, still bf (about 4-5 times per day), no formula bottles. I'm about to go back to work next week and I'm planning for him to have one bottle and one bf during his nursery day (I've decided not to express as haven't been very successful recently and don't have time to express AND go and feed him).
Anyway. His weight gain has been slow since he was about 8 weeks old, and ground to a halt by the time I started solids (1oz total gain between 16 and 21 weeks). At 21 weeks he'd fallen through enough centiles to merit referral for further investigation, according to the local protocols. Since I'd just started solids, hv agreed to wait a month or so. She came a couple of weeks ago and I was pretty shocked to find that, although he had put some weight on (12oz over 5 weeks) he is still drifting down the chart and is now on the 2nd centile (from 90th at birth and 50th at 8 weeks). So I've agreed to referral to a paediatrician - which hv said would take 6-8 weeks 'since its not urgent'. Needless to say since then I've been on a no holds barred campaign to up his weight....
The appt arrived today - its on Tuesday! I can only imagine that the dr took one look at his growth chart (which I have to admit does look horrendous, taken in isolation) and decided he needs urgent attention!
I feel awful - have I been blase and complacent while ds2 has been horribly neglected? I also feel really embarrassed at the prospect of having to explain and defend what I'm feeding him - I do consider myself pretty well informed on how to feed babies, I put a lot of effort into giving him a good diet, and I feel like I'm going to be told I'm doing it all wrong....
Then of course my other worry is maybe there is something physically wrong? In which case why haven't I spotted it? He's such a calm and happy baby, right from the start he's not demanded a lot of feeding, I've had to take the iniative to offer him feeds. I now feel totally inadequate about my ability to bf - like I've allowed my determination to continue bf to get in the way of his health (although its all been pretty straightforward, I haven't been struggling to feed him or anything)
Sorry for long and rambly message. Not sure what I want people to say, just wanted to say how awful I'm feeling about it, like I can't look after my own baby properly or something.

Honey, you have NOT been neglecting him. It honestly sounds like (a) a drift down that SO many of us (including me, definitely) have experienced (b) the doc had a cancellation or similar clear space to offer.

You haven't been neglecting him. If he genuinely wasn't getting enough and was starving he would be screaming the place down. You've been keeping a close eye on his weight and as soon as you were told that there might be a problem you followed the advice you were given, ie to accept a referral. That certainly doesn't sound like a bad mother to me.

I agree that the appointment was probably a cancellation and not an indication that it's an urgent case.

hugs elliott. Just wanted to say that although I have no advice, I know how you are feeling. Ds1 dropped through the centiles and I had to go see a dietician and a paediatrician to justify myself (or so I felt).

The GP and dietician were very nice, but I did feel like they were on the lookout for signs of neglect rather than being sympathetic.

The paediatrician at the hospital gave him a quick look over, saw that he had dimples in his cheeks and seemed perfectly happy and very respectfully threw us out of his office

Mind you, the whole process was so stressful that I live in fear of every single weighing of ds2.

Lots of hugs. my second child had difficulty putting on weight and was found to have a hernia. I think feeding caused him discomfort so he wasn't eating a lot. As soon as they sorted the hernia, he put on weight. I should try not to worry (difficult I know) but write down everything you want to say and ask before the appointment. Then, if you get stressed you have something to fall back on. As you say, he's a calm and happy baby... by the way, all the charts are based on bottle fed babies in the 1950s (unless they've changed them recently). the main thing is he is putting weight on, and thats the bit to remember. Hugs.

Elliott, I am waiting to see the pead for exactly the same reason, out appointment took 6 weeks to come through and was for 3 months time so I definatley not urgent.

DS3 at his peak was on the 75th centile, at about 8 weeks but by 27 weeks(6 months or so) was between the 2nd and 9th. It seems our Ds's have the same slow weigt gain at almost exactly the same ages. Also very similar about feeding, although bottle fed here and has never been a baby that is ravenously hungry.

Our DS3 is gaining weight now but is still only just above the 9th centile(certainly not half way between the 9th and 25th yet).

At the moment I'm toying with the idea of cancelling my appointment as I would be more worried if he was a great hulking brute when me, DH and his 2 older brothers aren't big by a long shot so he's hardly going to be massive himself. The HV I saw yesterday agreed with me too, about his size and cancelling!

No real advice but just wanted to let you know we're in the same boat.

Oh and YOU ARE NOT NEGLECTING HIM!!!!!!!!!!!

I had the same thing happen with my 6 mo. old who had been in 80-90 centile since birth. We went in for our visit, and the dr. thought he had the wrong chart because my son had dropped weight from 4 mo. Dr. was very nice though, and made suggestions. We came back in for a weigh at 7 mo, and he made progress. By 9 mo. visit he was back at 65th centile. We went in for an ear infection yesterday (coming up on 10 mo.) and he was back in the 75th centile. I thought it was my determination to breastfeed (put him on formula after 6 mo. visit), but dr. said that he would be screaming his head off if hungry. I thought I wasn't taking good care of him, either, but I don't think that was the case for me or you.

I have to say that I love your name. It's Colin's middle name.

Gosh elliott, sorry you feel so crap, I can only agree, you're not (crap I mean)! He's happy, you're feeding him, please try not to worry. I bet you get chucked out like GeorginaA, let us know how it goes. In some ways a quick appointment is good (agree, you got a cancellation, doubt they think it's urgent) since it'll all be over soon. Btw, my dd is the same age as your ds and I have no idea what she weighs (though she looks chubby to me) and neither has anyone else: I haven't been to baby clinic etc than at her 10 week check. So now I'm worrying that I wouldn't know if her weight was going down. Eeek. Do other people usually go?

My heart goes out to you. My eldest was always being referred here, there and everywhere for poor weight gain.
He took a few weeks to regain his birth weight and was a very happy breastfed baby. He liked a good early evening feed snd slept through the night from 6 weeks. I always felt under enormous pressure to supplement breastfeeds with formula and refused. I did give in and start solids early which made no difference.
We went to New Zealand when he was 8 months old and found a completely different attitude. He walked at 9 months weighing almost 18lbs. His father was tall and slim and I was 5'6" and 8 stone so we were not big either!
My son is now 14 and still tall and lanky but has never been ill and rarely suffers from even basic colds.
Charts are a guideline. You need to look at the wider picture. The doctors will make sure there is no need to worry.
Enjoy your baby and don't worry if you can. Good Luck

I'm sure all will be fine. DD had her 8 month check last week and her weight was a lot lower than should be. She just said that's what she expec ts with a bf baby.

Mind you she did refer to salt although we have decided to ignore this!

Oh elliott - this is a classic case of HPs being unable to handle a weight question without making the mother feel awful.

You say yourself the reason you have the referral is for 'local protocols' - not because your son as an individual is thought to be at risk.

'Local protocols' are there to check out the babies for whom there is an underlying medical reason for slow or non-existant weight gain; to spot the babies whose mums do deliberately neglect them (a tiny minority, but sadly, they do exist); to spot the babies whose mums don't have much of a clue (and again, a tiny minority, but again, they do exist - any HP has stories of mothers who water down the formula, give their babies unsuitable food and drink and so on).

The local protocols are also there so community health professionals can cover their backsides - understandable, and they don't deserve criticism for this.

The vast majority of referrals for your son's situation need no treatment. Maybe the paed will talk about ways to get a few more calories in to your son, and while I don't suppose he would say 'increase the breastfeeds' this would certainly be a good way for a baby of this age. Your baby's more obvious drift down the centiles began with solids, and shows how solids before 6 mths for a breastfed baby tend not to increase calorie intake (in fact the reverse). Breastmilk is relatively calorie dense and because it can be given little and often, is a useful way of boosting weight gain.

The charts are not based on bottle fed babies in the 50s - that's a myth. The source of the data is in your red book, where it should say the data comes from several data sets, and taken together they give a good indication of the UK infant population's growth. It is, though, more difficult to get a clinical picture of an individual baby's health from these charts which is why they should be interpreted alongside other aspects of growth and health. This is what the paed will be able to do, and almost certainly, reassure you

tiktok - thanks for your message. I do understand the use of growth as a screening tool for underlying problems, and I have to say my hv has been quite reasonable (hasn't been 'making' me feel awful - I take full responsibility for that )
I also take the point about bf and calorie intake - I have been trying quite hard to keep his milk intake up (or at least discourage him from reducing it) but its not that easy - he's at that inquisitive distractible stage and if he's not interested he just pulls off and grins and looks around! I do struggle to get him to take more than 5 feeds in a day. But what you say about the timing in relation to solids isn't actually accurate - his worst weigh in (where he'd ground to a halt) was just a few days after starting solids. The most recent weigh in (with the better, but still not really good enough increase) reflected the first 6 weeks or so of weaning, where it IS quite hard to think of foods with more calories than breast milk, and because of that I'd been holding back on his solids. Now he's hit 6 months I'm able to add in a lot more nutrient dense foods and hopefully this has been doing the trick (I don't think I really need the doc to tell me how to increase his calorie intake).
I have to say I've found this issue (balance between milk and solids) a bit of a conundrum with both ds's, who were both much keener on solids than breastmilk.
Thanks everyone else for your input - its nice to know I'm not the only one! And at least with a quick appt I'll find out soon whether the current strategy is working....
www, yes I've wondered what would have happened if I hadn't got him weighed - would I have done anything different? And if he's healthy, do i NEED to be trying to get him to increase his weight?
Ah well. the main thing I feel sad about is that I don't feel a sense of satisfaction about my bf any more

elliot, if it helps, my mum was in a very similar position 30 years ago with my brother. He's now 6'1" and still disinterested in food!!

I also agree with www, with ds (2nd child) I just haven't had him weighed and I've been so much happier and more relaxed because if it.

I didnt get dd weighed for months- 5 i think.

Elliot, don't worry. Weight seems to be a total obsession with health professionals, regardless of whether it's appropriate. My DS who is 5, is skinny as a rake and I'm always being persecuted about it. As his father was 5ft 11 and 9st, and permanently looked as if he'd been on hunger strike for a month, I am not remotely surprised that DS is skinny, but it always seems to shock HPs. They can't seem to grasp that an average is made up of people who are average, below average and above average, and therefore, those who are either above or below are bound to exist! You'd probably have noticed if there was an underlying cause for DS being light, but if I were you I'd take Tuesday's appointment as a useful opportunity to bring up all those niggling little worries that you normally don't like to waste HP's time with.

Hi Elliott - I am having the same probs with ds. He is on 9th percenile (just) and although he feeds well he is not gaining enough weight. Hy hv advised to give him proteins like lentil/chicken. I am now obsessed with stuffing the poor wee mite with food. He has 3 good meals per day and about 21 oz formula milk. Saw paediatrician a few weeks ago as he has had a fairly persistent cough really since birth and he has prescribed high steroid inhaler. Ds is is very happy and very active but I still worry and imagine all sorts of things being wrong with him. Let us know how you get on with the doc on Tuesday. I am planning to get ds weighed on monday and hoping he has put on something. Ironic really as Monday is my Weightwatchers weigh-in - trying to lose weight !

Oh and meant ot add my hv said that she had a similar case where baby was not putting on weight so the mum fed him fullfat cream and that worked...eh?

grommit, and emmatmg, I have to say your posts have made me feel better - somehow I can't shake off a feeling that ds2's basic problem is that I'm not producing enough milk, and that if he were bottle fed he'd be gaining weight fine....I keep assuming that his milk intake must be way below the 20oz level, so I'm relieved to see it can also happen in bottle feeders who ARE getting their regulation milk quota!
But it does make me wonder - if these babes are all fine, all eating well and getting enough milk, why are we trying to stuff them up so that they follow a line on a centile chart that indicates the weight gain for a POPULATION of babies, not the optimum line that any individual baby will follow.....
That's what I'd really like to ask the paed - wonder if I'll manage it?
grommit, ds2 is getting either chicken or fish or lentils every day, plus greek yoghurt, ricotta cheese, etc etc....he has the same amount for breakfast as ds1....if he's not gaining on this diet I'll eat my hat (or make him, perhaps )

elliott, glad you are feeling able to crack a few jokes about hat-eating. There are heaps of us on here who have been made to feel (or have made ourselves feel, my HV is nice too!) that our babes are too thin and undernourished. Dd is still "worryingly" underweight for her height (tall string bean) apparently and I am astounded at how bad it keeps making me feel. This despite the fact that she can do a good impression of John Prescott in drag and has thighs like tugboats.
Also agree you've bagged yourself a cancellation appointment. His diet sounds fine, you sound as though you've done a fab job with b/f, I am sure it will all go fine and you will be given your cards by the paed within minutes. Good luck.

Elliott, Ds3 not only has 3 good meals a day, huge brekkie and 1.5 to 2 jars at lunch and dinner as he refuses home cooked(note to self try him again though ) but around 30 oz of milk and at his peak it was 36oz with all that food. So all that and he was still sliding down the centiles.
For us I think the reason he's started gaining weight is because since he could sit really well I've left him on the floor for as long as he'd let me playing after food, which is ages if he's in the garden so he's not burning up the calories running around in the walker. The walker is my life line/sanity giver as before he wanted to be carried everywhere by me ond only me. He just follows me around now

Grommit, How strange? My Hv told me to feed him starchy food to help gain weight. Lots of potato, rice, pasta and all that. Seems they all have no bloody idea.

Elliot, I wanted to send you big hugs.....need a hug emoticon!

My DS is 6.5 months and is on the 9th centile. Occasionally a bit above it but never as much as the 25th. His friends of a similar age look like Michelin Babies compared with him and although I'm mainly feeling that that's how DS is meant to be (DH and I used to both be very skinny - when I met him DH was 5'10 and 9 stone although he isn't any more )

DS is totally bf and I worry that he doesn't get enough or it isn't full fat enough etc etc. He also has three meals a day and sometimes eats so much I think he'll go bang! But he is really active - always kicking legs, waving arms etc and comparing him with his friends he IS more active. They are nearly all bottle fed now and their mums are talking about cutting down milk. Sometimes I'm glad I don't know how much DS has; other times I'd love to know. My baby is the oldest of his set of 7 babies and also the lightest (one who is 2 months younger has overtaken him now). Doesn't help that DS is longer than average as well - looks like a piece of string!

Poor you having this happen when the return to work is near; really not what you need.

I know I haven't got anything useful to add but I wanted to let you know that you're not alone in feeling you have a DS who "should" weigh more. I wish I had the courage to not have Benjamin weighed so often - it's been nearly 3 weeks now which is the longest I've managed.

We both have lovely 6 month and a bit babies who are just a bit thinner than some babies.

Elliot - please do not feel bad about your breastfeeding - that is not the cause of this 'problem'. Some babies do not gain weight quickly at all. The classic example of a baby losing weight is one that was born too heavy in the first place!! There are babies that have been 'overweight' if you like in the womb and once born, they shed weight till they get to the ideal place on the centile chart for them. They appear to have weight gain problems because indeed they are losing it by nature's own intention. It is a strange phenomenon. Once they get to their weight, they then start to gain. That may indeed be a slow gain for the rest of their lives.

Do not believe that your baby will have gained any more weight on the bottle - a friend of mine had problems B/F and switched to bottle. Both babies gained very slowly. That gave her reassurance with her third baby whose weight gain pattern was the same - she continued to breastfeed him.

I have 4 children as you know - the first 3 are boys. All breastfed.

DS1 and DS" are really tall - DS3 is alittle midget . His height and weight is being monitored by the GP (he's 13yrs old) and the conclusion is that he is just small!

It is correct that your baby is reviewed if there is a concern because there are underlying causes to poor weight gain that are not related to milk intake. Howver, it is most likely that you will get reassurance in the end but it is a shame that you have this worry.

Be proud of your breastfeeding - you have given your baby enormous health advantages by doing so. It is not all about ounces on the scales. Well done

Elliott - my ds was an example of what mears desribes: a baby who was born "too big" (91st centile) and floated down the centiles until he was trundling along just underneath the bottom one! Bu then, both dh and I are small and (were!) skinny as children.

He took 7 weeks to regain birthweight and by 3 or 4 months was back to about about the 9th, where he stayed for a while before creeping up to the 25th - and then I don't know, as I stopped weighing him. At one stage I was even having to wake him to feed him (which was what the EBM was great for - it gave me the confidence that he WAS getting enough, so I did evetually stop the waking at night routine )

Throughout this he was manifestly happy, healthy and alert - he did have a few problems initially with latching, but even once that was sorted (and I was giving him LOADS of EBM), it still didn't change is rate of weight gain.

The miwdives who ran the b/f support group that I went to (actually AT the maternity hospital) did refer him on, just to cover themselves - but the consultant paediatrician took one look at this happy, healthy and alert child, told me not to worry and to stop the faff of expressing (I didn't, as it happened to be helpful, as i was going back to work when ds was 4 months old) and asked what my dad (an ex-colleague) was up to!

I know you've only recently had concenrs about his weight, but all I am trying (longwindedly!) to say is that babies follwo thier OWN growth charts. If you hadn't weighed him, would you have been worried? No. Would he have been referred then? Of course not!

Go along on Tuesday and allow yourself to be reassured by the doctor. You're NOT a bad mum - on the contrary, you are a fantastic mum.

FWIW, ds is now a happy, healthy 3.9 year old, who I THINK is about the 50th centile for both weight and height - I haven't checked recently. I'd like him to eat some more vegetables and fruit, but what mum wouldn't ?! He fills up on yoghurts, cornflakes, croissants, crackers and cheese - supplemented with the odd bag of crisps and chocolate buttons. I don't really care - he is obviously extremely happy, healthy and full of energy.

PS And I breast fed him for 13 months!

Just had ds weighted and he has not gained weight again. He seems healthy and happy and eats OK - he is below the 9th percentile. Hv told me to give him butter. I have decided I am not going to stress about this and just not take him to get weighed again for a while. His sister is really petite and both dh and I were very small kids so I am just putting it down to that