Anyone with a small or slowly growing baby being bothered by HV/GP, read this NOW

[welliemum]

J Pediatr Gastroenterol Nutr. 2006 Oct;43(4):428-32.

Rapid growth in infancy: balancing the interests of the child.

Weaver LT. Division of Developmental Medicine, University of Glasgow, and Royal Hospital for Sick Children, Glasgow, Scotland. [email protected]

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Low birth weight is associated with a number of immediate adverse consequences, and it has been assumed that "catch-up" growth is a "good thing" because "better" nutritional status is associated with greater childhood health and survival. The same thinking applies to infants who suffer malnutrition and growth faltering during weaning.

Recent studies suggest that the rapid postnatal growth of babies is associated with an enhanced risk for obesity, diabetes, hypertension, cardiovascular disease and osteopenia in later life.

If this is true, it has implications for our recommendations for infant feeding. Insights from evolutionary biology, life cycle theory, animal husbandry, epidemiology and comparative zoology suggest that the energetic feeding of underweight infants should be considered in the context of the whole life cycle and balance the interests of the child with its likely fortunes in adulthood.

Before we revise our current recommendations, we must consider the meaning of catch-up growth, what it involves in terms of tissues gained (fat, muscle and bone) and to what degree association represents causation.

In the meantime, it will be prudent to balance the short- and long-term interests of the child by endeavoring to (1) optimize maternal nutrition and health, to avoid low birth weight, (2) breast-feed ideally, (3) consider birth weight, gestation and future "nutritional environment" when making decisions about infant feeding, (4) use appropriate growth charts, (5) avoid excessive postnatal weight gain, (6) think about the whole life span and (7) extrapolate from animal studies cautiously.

So is this different from the ones they use today in red books?
I've just checked it against the one I was given for DS 19 years ago & it's almost identical.

I think there is a difference - ds2 is on the 9th centile at 6 months in his red book, but sits comfortably on the 50th centile on that WHO chart.

DD is just about the same on both charts, hovering just above the 25th centile..she has dropped from the 50th at birth, but has followed a curve of her own for a while now....HV is happy with her....she is also petite height wise, so that is the way she is built, her head is small too ! Like mine !

i am used to it now, especially as i have stopped comparing her chart to DSs

she is an active girl, however much food goes in, it is burnt off !!

just thank god my HV is a star !! last time i took DD to be weighed, she had put on a pound in 3 months, and she laughed and told me not to bring her back for 6 months !!

she is happy,bright, alert, healthy and doing what she should, she is just petite !

c'est la vie !

Rusty Bear - these are the very latest from WHO. Please see the WHO website, it explains better than I can how they were put together. I think these SHOULD be readily available at GP/HV surgery to bf mums, but apparently the NHS has no obligation to hand them out if requested to do so

When you say 19 years ago, are you talking about the WHO chart of 19 years ago, or the Red Book ones ? I would be very surprised if it is identical to the Red Book now or then.

My ds has followed a similar pattern on both the WHO chart and Red Book. Very little difference in terms of ds growth, but makes a huge difference to some babies as purpleturtle points out.

I mean the one in DS's book of 19 years ago (not that it was red, DS's was blue & DD's pink) - compiled by 'The Society of Nurse Advisers' apparently.

I meant to say almost identical for the first year - Looking at the 3rd centile, (which DS spent most of his toddlerhood on or under) they are the same for most of the first year, except for between 3-7 months, when the WHO ones are actually heavier (by between 0.3 & 0.5 kg)After 12 months the WHO ones are lighter - though even by the WHO standards, DS would still have been well below the 3rd centile at 18 months.

I read in kellymom.com that fully bf babies 0 - 6 months gain weight more rapidly than fully ff ones. So the WHO chart 0 - 6 months would reflect that.

LOL Welliemum, you are sooo right! Its what DP said, head size does not equal brain size!

this is a very interesting study at york university which relates to bf babies in the uk and the charts will make you feel better

this has put my mind at reast. My b/f baby was dropping centiles from 50th - 9th, and I was under pressure to put him on formula. His weight has stabilised since I began solids BUT I had his head measured yesterday and he's only on the 0.4th centile! I'm terrified, but his development seems normal - 8 mths old - sitting, rolling and trying to crawl, as well as eating finger foods very well. Can anyone reassure me? I'm terrified I starved him in the early days as my milk supply wasn't brilliant

kel - who is measuring your baby's head? This is done very rarely in the UK, because it's not very accurate a way of assessing health or growth. A baby who is doing all the things your baby is doing is showing every sign of being just fine!

Correction: some babies' heads are measured at birth and maybe once at a subsequent routine check, but routine or frequent head measurements in otherwise normally developing babies are no longer done in most places in the UK.

It was measured at his 8 mth check by the HV. I shall no longer worry - thanks. As you say, his development is spot on!!

Sorry my link was no good before here we go again This is the study done at Glasgow not york university and the charts are very interesting. It's the Gatehead Millenium Baby Study. Bf mums who are worried about their babies weight gain should read it.

Dear all - logged on with interest and looking for threads for low weight babies - my little girls is 12lbs 12 and just over 7 months - she appears to be fine developmentally - eg sits up (but support her a little), rolls over, good hand eye co-ord now, but she is diddy! The HV is great but did say last time that she would like to see her gain weight. Since weaning she has dropped off the centile (however she has only ever followed the very bottom line anyway). She was exclusively BF until 6 months. Unfortunately just returned from hosp with her after a gastro bug (vomitting) - she had to stay a night but is better now. I do stress that I can't seem to get her to put weight on but have been advised to give her more fattening foods, advocados, cheese sauce etc. Great to read other messages, reassuring. I feel bad that she isn't 'conforming' in some ways, however I know that I do all I can - BF (still BFing after 6 months), I make all my own food for her and as far as me and my hubbie are concerned she is a really active, healthy baby girl. If I hadn't gone to get her weighed I wouldn't have been worried! Keep the messages going on the thread - it really picks me us all up when we get worried! (Particularly when you get so many comments, how old is she? really!) Our little ones are gorgeous, just little, but perfect.

just read it back, sorry for typos - long day!!!!

After having my third, felt confident with breastfeeding. M/W and H/V both urged'breast is best'. At six weeks my son was sleeping all the time, which was great as my other two were under three and very demanding. My dad pointed out that his colour really wasn't normal. He hadn't been putting on weight and was dropping from 50th centile. Was told 'no mixed feeds - keep breastfeeding'. What tosh, he finally dropped off the chart. Started bottle feeding and never looked back. My instincts were telling me to do this earlier, but not my health visitor.!

Smiley, glad you got this sorted - your son's poor feeding should have been spotted and corrected long before he dropped off the chart. No good telling mothers to bf at all costs, if the knowledge is not there to fix it if all is not well

This is reassuring, my DS (4 months) is putting weight on slowly, but he is JUST on the charts at 3%.

He had a weigh-in last Friday and the HV wants to see him this Friday, but this morning he picked up a vomitting bug that the rest of the family had so now I am worried that he will actually have lost weight by this Friday....

But hopefully she'll take that into account....

I think I need to do some research on improving my milk supply (both quality and quantity...)

Nothing you can do about quality - it's always good stuff whatever your diet. Quantity is mostly affected by the frequency and effectiveness with which milk is removed.
So for more milk, feed more often

Tiktok, thanks, but what if the baby is sicky? I don't mean just with reflux, or spitup, I mean real vomit.

We've all had it in our house from Friday and over the weekend, and now DS2 has it.

The GP told me to feed little and often, but if he is happy sucking away do I really need to pull him off to give his stomach time to "settle"?

Or do I wait for him to ask to be fed?

Just don't know what to do with him, it seems like there's been something wrong with him since he was born....

Breastfeeding ad lib is the right treatment for vomiting - no need to restrict it at all. He needs the fluid and should be allowed to feed as often as he wants - very important, this, in fact.
The advice might differ if he was formula fed, but don't quote me on that.