Friends baby 0.4th centile at 3months old and advised to top up with formula!?

[Inrockuptible]

My friends little boy was three weeks early and has always been very petite.
She has just called me in tears as the health visitor has told her she has to top up her feeds with formula and to consider introducing solids from four months.
Firstly I don't understand why they are plotting his weight from a normal due date even though he was early. Lets not go into the arguement about these bloody charts anyway as I could go on forever.
My friend has been told she now has to take him to be weighed weekly and that forumla twice a day might be a good idea. They also told her to read up on weaning onto solids as they will advise it as soon as he is 18 weeks.
What makes me furious is they said something along the lines of 'we must keep an eye on babies this small as it is a good indicator of neglect'.
Has anyone else been treated this way, or do you have any positive stories so I can try to reassure her? I was lucky in having a really supportive non judgmental health team, and I feel so sorry that they have upset her in this way.

My DS was two weeks late and only 5lb 9 - its obvious now by his shape/frame etc etc that he is just meant to be petite. We went down the route of top ups but that was because we were so stressed about him not gaining etc etc but it was the start of the decline of the bf. I hadn't found MN then but if I had I would have kept going with the bf - if I could taking to the sofa for a few days and doing nothing else. Also if he seems happy in himself thats a good sign. The whole thing was horribly stressful - both dh and I spent a lot of time crying so I feel really sorry for your friend - the 'neglect' comment I think was really unecessary if someone had said that to us I think both dh and I would have gone into melt down/complete depression and been completely useless as parents. Our HV may not have been 100% perfect in that she didn't offer much help with the bf but she always made sure that we were to a degree in control of the situation and was sensitive to our distress and gave us some extra support in terms of just listening and being there. Hope things improve for your friend.

If your friend's DS has always been small why is the 0.4th centile a problem? Some babies are on that centile because that is where they are meant to be. Unless he looks like he isn't thriving your friend just needs to continue feeding as she is.
As an ex HV I can tell you that it is very apparent when a baby isn't thriving - they actually look underweight. That isn't the same as a baby who is happily sitting on the 0.4th centile - and lets not forget that these charts are based on white, bottlefed babies.

aka, you are wrong about the charts.

The ones in the UK are based on UK babies, whose feeding methods are not differentiated and whose ethnicity is not differentiated.

Many of them - probably the majority - were probably white and bottle fed, but that's because of the nature of the samples.

Ethnicity does not appear to have an effect on the growth of infants, however, as the newer WHO charts (which are based on breastfed babies) confirms.

Oh dear, I am very for your friend.

Why oh why is the knee jerk reaction to strt formula when there are so many things that this could be.

If it's a problem with breast feeding, then a bfc would be useful to make sure Lo was getting enough milk. If there is genuine failure to thrive then a paediatrician would need to rule out any medical causes. Or, it may just be normal weight for her and c'est la vie!

For any of these scenarios...how is adding formula going to help?

I stand corrected - have been out of health visiting for a while so obvioulsy things have changed for the better then.

I don't know about 'better' - charts can be a bit of a tyranny whatever they are like....the charts in use at the moment date from 1990 and are called 'UK90' but they were not used everywhere until a bit later than that.