DS on 9th centile and "may need topping up" - help, confused

[Moorhen]

Just been to see consultant with 6-week-old DS to follow up blood tests (I'm rhesus neg). All fine, but junior doctor we saw disappeared for half an hour to check w/ consultant, and then came back to say we'd need to come back in 2 months as she was concerned for DS's weight.

He's gaining 4ozs a week and is 8lbs 6, I said. Have been told this is normal.

Yes, she said, but is not fantastic and he's on the 9th centile.

She did not explain what this meant. She also said I should feed him every 3 hours (I am) and wake him up during the night (he's starting sleeping 5hrs between 11pm and 4am, only reason I am compos mentis enough to care for him!) to feed.

If I do this, she said, we won't need to talk about formula just yet.

I don't want to talk about it at all, tbh!

DS looks perfectly healthy and everyone says how alert and bright he seems.

Should I be worried? At the moment I am feeling very stressed.

The issue is not the charts.

It's how they are used and interpreted.

I have said this so many times on mumsnet- but even hvs and midwives don't know the correct provenance of them.

Charts in the UK are based on several data sets of UK babies. The way the babies were fed was not differentiated. It is likely that few of them were fully breastfed - that's 'cos we know not many babies in the UK are fully bf.

But it is not true that breastfed babies grow more slowly than ff babies - at least not at first. The charts from the WHO are from babies who were solely or mostly breastfed six months, from various countries in the world, and they show what we already know: breastfed babies tend to grow faster than formula fed babies until about 4 mths, and then after about 6-7 months, the formula fed babies grow faster.

Telling mothers of any babies under the age of about 4 mths that their slowly growing bf babies should be graphed on a different chart is pointless, because the baby will look even smaller!

The issue is not the chart! Babies can be perfectly healthy and be all over the chart.

agree tehre tiktok...
I think, well...people should just actually look at the individual baby and if they are gaining and doing well...that is fine then...
MY es and ys were both chubby Baby's, whereas my ms is rather petite...dispite them all starting out the same way, being breastfed. Thing is my es is the one I breastfed the shortest time and ys is the one I breastfed for 13 month (of which 6 month exclusively and well, he didn't really eat many solids until past a year), es was my lightest Baby at Birth, ys the heaviest...they are completely the smae build ....ms started of in the middle and then dropped a centile or 2 but is sticking to that...he is just completely differntly build...(as you can see on the pictures in my profile)

That's really interesting Tiktok, I really had no idea about that . I feel so passionately angry when I read posts like that of the OP, so I feel a bit stupid for posting incorrect info. Women who want to BF have a difficult enough time as it is in the UK and when mums like the OP come so far and are doing fine only to have their confidence shaken by some bumbling health offical who is supposed to be there to help them - I don't know.

Just to let you know my dd1 was born on the 50th centile, quickly dropped to the 9th and stayed there (for whenever I could be bothered weighing her ). She was fully breastfed and no problems with her health/weight at all.

DD3 was born on the 50th, dropped to the 2nd and recently had to get her weighed at a hospital appointment and she's now on the 9th and still fully breastfed. My opinion is that some of these babies have to be there and it just so happens to be mine!

My dd3 was re-admitted with weight loss and I have to say all the consultants were brilliant and when I said I wanted to breastfeed her they just agreed and never once mentioned formula. Maybe it was because he was a junior doctor.

Please persevere and most importantly have confidence in yourself!

Moorhen - just read your message. I too have had lots of struggles with my little one's weight. She was 6lbs at birth - was exclusively breastfed for 6 months (well, apart from one week when she was about 3-4 weeks old when I was told to top up with formula - basically gave a bottle of formula after my last milk feed of the day, before the night feeds). The following week she started putting on some more weight but I was sure it was all down to just the formula - so I went back to 100% bf and she kept putting a little on some weeks and not others. Basically she has followed the lowest line on the chart all the time (except falling below if ill which does worry me but she does seem to come back to the line after a while). I have worried so much but accept now she is just small - loads of energy etc but small. She is now 13 months and in 3-6 month clothing. I saw a consultant a while ago about something else and they said don't worry about her weight, she is just a petite baby. Hope this helps. BTW, I am still bfing currently, just a.m. and p.m. She is on 3 meals a day now obviously, eats loads but is still tiny but doing great! It's normal to compare but, as one of the other notes said, some babies are smaller and ours are those babies! As long as they are healthy and small it doenst matter. Good luck x

Dear Moorhen, I hope that this can help relax you.

I had something similar with DD, she was born on the 98th centile and then just failed to put on any weight - looking at the charts, she pretty much flatlined and was soon under the 9th centile. I was bf, ff, all kinds of feeding, anything to try and get her to put on weight. Leaving longer between feeds, shorter between feeds - everything. I was driven to crazy stress and antidepressants with the worry of it all. After a particularly horrible consultants meeting where they did lots of tests to her, I got cross, went to tescos and bought stacks of organic veg, went home and pureed my socks off. She was 5m old then. She has wolfed down everything I have given her, and at 2 years old now, is small but healthy bright and happy, and when I look at her racing around and eating twice as much as her 4yrd old bro, I cant believe I was ever worried. They reckon I just grow fat babies (1st baby was a biffer too) but this one was meant to be petite. She didn't gain weight until she found her level.

Your baby IS putting on weight, is happy and looks healthy. You have nothing to worry about and if they start telling you what to do tell them to pee off. I think if I hadnt started the formula etc she woudl have gotten used to bf and I wouldnt have got that stressed.
Sorry this is so long. Hope it helps, please dont get stressed like I did - altho she is 2, I have only just kicked the anti-depressants in teh last few weeks.

I am still cross with the HV and DRs that went on and on, resulting in me giving up bf earlier than planned. Once I started bf, and getting seriously stessed, my milk started to dry up - with first child I was daisy the cow, squirting everywhere inconveniently, so I put this down to the stress and bottles.

Don't let anyone bully you into anything. You are the mum and you know best. Don't let anyone tell you different. Some kids are just 9th centile kids.

When I had my 3rd child, 6 years after the first I noticed that the charts had been revised - upwards! So my firstborn, who was born on the 50th and went down to the 9th, would have been off the chart! my HV said it was because babies were being born bigger these days; not necessarily a good thing. My 3rd, the smallest at birth of the 3, I didn't hardly take to clinic at all, too scared after the treatment I got with my 1st. He's now 8 and the chubbiest (not saying much, the others are like bits of string with knots in) and the tallest at the same age.

Dont worry about it too much my DD is currently off the scale! She is below the 0.4th centile she has made her own little line to follow! She is 17 weeks old rolling over smiling laughing gooing etc. Overall she seems happy even though tiny at 9lbs 1 oz. I was a little paniciked about her growth but didnt give in to the silly suggestion that I try solids or top ups HV have now decided to leave me alone and I feel I have relaxed and she is exclusively b/f since birth I'm just gonna go with the flow and leave her for solids etc till she tells me she wants it. Thanks to Tiktok and others here I got over my weak moment and continued to b/f.

Another 0.4th centile healthy baby here just to show it is normal. DD was 5lb 4oz at birth and we were forced to give formula in hospital told she was growth restricted but since getting home she has been excl BF with support from our HV who is really good and never suggested topping up.No idea why she is so small ( DH and I are average height and weight) but she is bright and smily and doing all the stuff she should be so I refuse to worry. I don't think health profs realise how their throwaway comments undermine you when you're a new mum. I wasted so much time at the start worrying if it was my fault she was small so please don't let this person stop you enjoying your baby and having confidence in yourself.

I agree with your posters - DD was born 5.5lbs at 38 weeks and I left hospital feeling like I'd committed a crime. She has always been between the 5th and 9th centile, and our HV took the view that as long as she didn't suddenly dive down to the 2nd, things should be left alone. She was BF exclusively until about 6 months; weaning revealed she's a fussy eater. She always looked ok, chubby legs, bright eyes, so I decided not to obsess too much (difficult, I know). She's now aged 5 and yes, she's the smallest in her class, but so what? She's always been healthy, she just happens to be petite. There's no explanation for her size really, except that there are petite people on both sides of the family. Some of us are just not average, well, great!

Hi all, thanks for all the support! To update:

HV came today for DS's six-week check. He has grown by 2cm and 3ozs since Thursday, which seems pretty good to me although at the moment he's still hovering on the 9th centile.

HV thinks he looks perfectly healthy and is just long and skinny. Also rubbished idea of waking him up halfway through his long sleep at night for a feed, on grounds that (a) he won't want it and (b) is better for me to be rested and better equipped to cope with days.

She added "some of these doctors live in cloud cuckoo-land".

Nice to get some sensible advice in RL as well as on Mumsnet!

Pleased your HV was more sensible than yoiur Dr.Just read this thread after returning from a weigh in...where I heard the dreaded words "How is she feeding?" after they weighed her.

She is a tidgey bit under the 25th centile -the line she has been on since birth -at 10lb 13oz. But the HV still says she now has to go back every week to be weighed, that I have to rest up,forgoe housework, drink 3 litres of water a day and try giving a bottle of expressed milk at night to get her weight back on!Came away feeling quite scared that I was starving her and was about to cancel all plans for the week to sit on the sofa and feed her up instead.

After reading this post I feel quite relieved. Might still forgoe the housework though. Just to be on the safe side....

beckmo, the advice your HV is giving you shows she does not understand about breastfeeding, how to support it and how breastmilk is made.

In particular, the 3 litres of water a day is daft. The evidence we have about water is that artificially drinking beyond thirst is bad for milk supply.

Thanks Tiktok...it's funny but all my own instincts and knowledge seems to go out of the window at these weigh ins and I come away thinking I'm failing at bf. Once I'm home and I have a good look at my healthy baby feeding away I get some sense back but it would be easy to panic and reach for the formula thinking she wasn't getting enough or that I was doing something wrong.

Hi all,

Just to update you - got DS weighed today and he's 8lbs 12, so has put on 2ozs in last week. Even tho I've been feeding him every 2-2.5 hours during the day.

HV said I should consider topping up with EBM, expressing in the morning and feeding in the evening. But I already feed him until he wants to stop!

She said this would make him less lethargic, which he ISN'T. Mind you, she also said he would be bigger on a BF babies-only chart, which I know is cobblers so am not sure how much to rely on her.

Am now worrying that I'm not making enough milk, or the wrong sort, or overdoing it or eating the wrong things, or something. HV very insistent I should eat well (which I do).

We're nudging the 'failure to thrive' zone. Advice please, even if it's to tell me to stop worrying!

Moorhen, your baby is healthy, not lethargic and gaining weight. Your lifestyle will have very little impact on your bf.

If you want him to gain weight more quickly to satisfy the HV , then you can easily do so by feeding him more often, especially at night.

The HV is another one who is under-informed, so you may want to consider her advice in that light....OTOH, if you are happy to offer him more feeds at night, then do so

Stop getting him weighted! Simple!

No, I know it's not as simple as that - but it really is.

Use your own sense looking at your ds. Is he happy, healthy and alert. from what you are saying he is. If you hadn't had him weighed, would you be worried?

Going back to the OP - the junior doctor needs to be taught the basics about statistics. Someone (in fact quite a few, given the size of the data set) needs to be on the 9% centile. it does not in itself mean there is anything unhealthy about it.

In fact, I was talking to dh about the childhood weight ranges: the fact that we are claiming that there is an obesity epidemic means that the average weight is going to articfically inflated (or should I say "fattedn up" ). SO to be on the 50th centile may not be something to be complacent about after all, even if the child is matching on the height chart!

Just goes to show how charts need to be seen in context.

Fore the record, ds started on the 91st, and like Missingmysleep's dd, he essentially flatlined and eventually dropped out of the charts, following just under the curves. However, he was not a "Non Failure to Thrive" baby, a fact fortunately supported by both the breastfeeding counsellor miwdives iwas seeing on a weekly basis at the support group (yes, it still took me 4 months to break the addiction to weighing, evne in a supportive environmanet) and the consutlant paediatrican and my dad (consultant paediatric radiologist - first grandchild - so he wasn't going to stand by if he had any concerns ). I avoided HVs though! All of these people told me to look at the baby and ignore the charts.

I should just stop going to the bloody clinic, I know.

Trouble is (a) watching the scales is addictive, as prettybird says, and (b)as we drop from the 25th, to the 9th, to the 2nd and now the dreaded blue FTT zone, I am losing the confidence to say 's*d the charts, he's fine'.

Will try to adopt that as a mantra and repeat it often. Urgh.

I haven't read the whole thread but just wanted to say my DD started between 9th & 25th centlile and soon dropped to between 2nd and 9th. She eats like a horse now at 9mths and has loads of breastmilk too. Some babies are not destined to be big.

As long as happy, healthy etc. Then dont worry.

Moorhen if YOU are worried then you could ask to be referred to a consultant paed who supports and has experience of helping babies who are fully BF. Insist that because of previous poor advice you are not prepared to see anyone who does not fit the above description.

If you really want to keep going, just go less often. You get a much better impression of overall weight gain if you go once a month than once a week or once every two weeks. Those growth curves are 'best fit' so actually growth wiggles around them all the time (am prepared to be debunked here if i'm wrong).

And anyway if your baby is healthy and developing normally it really doesn't matter. The whole point of an 'average' or a 'centile' is that it represents a huge range. It is mathematically impossible for everyone to be 'average' and I don't know why so many HVs Drs etc think everyone should strive for it. Makes them feel as though they are doing something constructive I guess.

(I have a long waffle prepared about how if all efforts to get low weight babies to increase their weight worked then the magical averages/centiles just increase anyway, hence the next batch of babies have a higher average to reach and people perpetually get fatter and fatter and fatter.... But I won't go into that, lol )

If you can, (not possible for lots of people, I know) try spending a day or two in bed with the remote control, lots of nice food and drink, some good books ant the baby. Let her feed all day if she will. You get a rest, lots of cuddles - the baby bets lots of milk and I bet she'll put on some weight!

I am really glad I read this thread.
DS is my 2nd baby, I have been fairly relaxed about things in general, in fact it has been 2 months since I last had him weighed.
Went to clinic this morning to find that he has dropped from 25th centile at 9 weeks to 9th centile at 17 weeks. HV not unduely concerned, but told me to come back in a couple of weeks just to see how he was progressing.

I have been panicking all day, worrying that I am not making enough milk, that his possetting is really reflux and I have left it too long without being treated, etc, etc.

I have tried offering him the breast more, but he just brings it all back up again.

Now I am convinced he is just a petite little lad and will grow in his own good time.

thank you all!