What can a HV "make" you do?

[Hadeda]

My DD has slow weight gain issues - I've posted about this before under the name BWMum.

Well, was just at HV to try to talk about weaning (she's 23 weeks). Different HV was there and naturally just wanted to focus on the weight gain issue.

DD is currently 12.3lbs (dropped to just above 0.4th centile but has stayed there for last 2 "weigh - ins"). She is still gaining weight - and actually gained quite a bit for her over the past month. But HV of course first off advised me to top her up with formula. Been there, done that - I said I don't want to do that. So got full lecture about how I must have poor milk supply (no one has ever check if this is actually the case, I just get told it every time - except by the BF counsellor I saw) and that slow weight gain can affect DD's brain development (thank you for the free guilt trip). Then said if she hadn't stayed in that centile "I'd insist you topped her up".

We are seeing the paediatrician on Friday about this issue but I really don't expect him to find anything wrong with DD. She's like so many of the slow weight gain babies here - happy in herself, producing wet and pooey nappies, meeting the milestones but just not meeting that chart. So, unless paediatrician says there is something wrong can the HV really insist I give formula? What would she do if I didn't - refer us to social services or what?

My understanding is that HVs can (and should) use their judgement about referral to other agencies, but there are no rules about what would precipitate this except if the baby was thought to be at risk. It is possible that a baby who was not being nourished would be considered to be at risk - but a baby whose only query is a slow weight gain is not in that category.

I would ask her, 'when you said 'I would insist', are you able to do that, and what would happen if I refused?" Just ask her straight. You have a right to know where you stand.

I think she is bullying you, and from a position of poor information, too...from the info in your post, anyway.

Obviously, successful breastfeeding that leads to healthy growth and a thriving child is what any breasfeeding mother aspires to. However, if breastfeeding is not being successful (and, from your description, your paediatrician may conclude that you are not successfully breastfeeding your baby - through no fault of your own, of course, just bad luck), surely it is better to feed your baby formula and see her thrive than to insist on exclusive breastfeeding and risk damaging her growth?

I'm sure Social Services have more to worry about!

I had this at about 7 weeks, she stayed 6lb 2oz for the next 4 weekly weigh-ins (apart from just after a feed when she was 6lb 4oz and then weed it out!) HV wanted me to give formula top ups which I wasn't happy about, she was getting really worked up about it. Using words like "failure to thrive" (which having a CPSW for a Mum I knew that's not a good phrase) I ended up so upset I called the neonatal team who had visited me before and they got me in with the paediatrician straight away (same day IIRC). They said all was ok and got a wonderful lady to call me who is either a HV or MW (there's two of them and I can never remember which is which) from a BF group. At the group they were happy with her (she was sitting on my knee at 3.5 months, watching everything going on, "taking part" in conversations - they couldn't talk straight to me because she was making them laugh at taking it all in etc) but got her onto a body building diet as I like to call it to appease the HV. I'm really upset even now because it took a week to get her weight up and two months to wean off the formula by which point she was 6 months and ready to start solids.

Are you thinking about BLW? If you are you could always start now, if she's showing signs of being ready, and when HV says anything you can honestly say you have started weaning, even if she's not interested in food

Anna, I disagree. A line on a chart cannot say that a child isn't successfully breastfeeding and is no reason to not carry on. Babies, especially breastfed, gain weight at their own rate and as long as baby is healthy, got good output and doing everything they should then breastfeeding is successful.

BTW, Tink was never on the chart.

I've just checked back in my red book and my ds only weighed one pound more than your dd at that age. He has always been small and skinny - even now at 4.6 - and I had the same issues with HVs. I think they initially told me to look at my own diet, to ensure I was eating enough (I'm 16 stone fgs - I think I was eating enough!) Then I was put on once a week weigh ins. Then they suggested top ups.

Next time round (I'm pg), I'm not even taking my child to the HVs. You don't have to have them weighed at all, and I didn't appreciate much of their advice. I knew my ds was healthy and that nothing was wrong. He was the same frame as both me and DH were when we were babies.

By the way, I never topped up and ds self weaned at 3.9.

Sorry - I can't tell you what powers they have and whether or not they can refer you to any other authorities, but I wanted to reassure you that your dd sounds absolutely fine.

Another thought - do you have a "breaast from birth" chart? The centiles are slightly lower down the weight range than the "traditional" charts. (I may be out of touch here - I'm speaking from when ds was a baby, four years ago - they may have these as standard now).

Anna, if the paed says there is an issue with the baby's growth, then the OP can breastfeed her more often.

If the baby needs more milk to grow satisfactorily, the OP has milk already - in her breasts. Why would she need to give formula?

The HV has not suggested this, as far as we know, and the only response to the slow weight gain is to suggest the OP has a poor milk supply and to threaten her with 'insisting' on topping her up.

And actually,the answer to your question - is it better to have a faster growth, rather than a slow one, and to give formula for this - is not an easy one at all. It may well be better to be exclusively breastfed and to grow more slowly, rather than to grow faster than would be physiologically normal for this baby and to have formula.

TinkerbellesMum - I didn't say that the criterion for determining whether breastfeeding was successful or not was a line on a chart .

Personally, I think the OP should listen to the paediatrician before deciding what to do.

Malnourishment in infancy does, sadly, affect later development. Just because this is very rare in developed societies (because we have formula to fall back on) does not mean it cannot happen.

NoNickname - the 'breast from birth' charts are not lower at first - the centile lines are actually slightly higher. But beyond about 5-6 mths, the line starts to be a bit lower.

Ah - right - I was actually comparing the two lines at 26 weeks, so I've assumed that they were the same difference all along. Thanks for the info.

tiktok - I know you are a great advocate of breastfeeding... so am I (DD is 3.7 and still going strong ).

But there are times when giving formula is appropriate.

And it would also explain why ds dipped under the 2nd centile at 22 weeks and stayed there for quite a while.

I wouldn't be at all surprised if rapid weight gain caused by inappropriate topping up with formula to force a baby to follow a weight gain unnatural for their physiology might be worse for health. Probably ioncreases risk of obesity & diabetes. Sadly, a lot of health professionals really believe that breast fed babies are often malnourished because they don't get enough milk.

Thanks for the responses - sorry, my original post may have been a bit short on info. I've posted about this before (including a massive rant this pm on the acorns to oaks thread) so was trying to avoid boring everyone with the details again!
DD has had slow weight gain from about 10 weeks, she gained fine to start and then slowed. The (other) HV suggested formula tops ups before and I spent a lot of time looking into that and checking (with BF counsellors at our local Baby Cafe) that my latch was fine and that she was feeding efficiently, long enough to get hind milk and often enough. I've thought long and hard about continuing to BF and had support from the Baby Cafe and from my GP. That is why I straight away said today that I didn't want to top up.
My GP referred us to the paediatrician as we have dropped more than 2 centiles. However, because we had to wait 6 weeks for an appointment, she stressed to me that she thought DD was ok and the referral was probably more of a precaution than anything else.
Of course, if the paediatrician finds there is something wrong with either DD or me (e.g. poor milk supply) then I will give her formula. I just don't want to do it without a valid reason.

Tinkerbellesmum - I have thought of BLW. That's actually why I went to the HV today - DD has insisted on playing with our food for weeks and yesterday grabbed a raw carrot off DH's plate and ate bits of it, so I wanted to ask about weaning but of course got side tracked on the weight gain issue.

But thank you for the responses to my original question - I'm probably just paranoid!

Anna - where and when have I ever said there are no times when giving formula is appropriate? Why would I say that?

In this case the OP has not said anything that rules out feeding the baby more often.

You have clearly not read my post properly!

Starlight - can confirm that this HV succeeded spectacularly today

You may not have said that, but it's the only problem that Hadeda is saying her baby has which you said is a reason her paediatrician may say she should add formula.

Formula does have it's place, but it should be a last resort for a baby who is being breastfed.

BTW, do you know how long it takes a baby to starve to death? Malnourishment is rare because in the time it would take to happen people get help.

Haeda, go with it if she is happy to be munching on solids. If she's not ready for them she won't swallow it, it will just come out again. If she is then she will start eating. BLW is a real no brainer I think (as is all parenting if you don't make an issue out of it!)

Ugh, if you're told baby needs more food by the paeds can you tell them you'll try getting another breast feed into baby?
As tiktok says, there is nothing to say extra food has to be with formula.

TinkerbellesMum - sadly, much irreversible damage can happen long before a baby "starves to death".

And considering how long it takes, long before is a long time! A BF baby isn't going to starve to death or get irreversible damage, it is willful neglect that would get a baby to that state. A baby will starve themselves for a week, but they know by then which side the bread is buttered!

Anna, please respond to the notion that the OP can breastfeed her baby more frequently, as a way of responding to slow growth (if the paed thinks there is a problem). And it would be nice if you could withdraw your implication that I think there are never any circumstances when formula would be appropriate.

Ta!

tiktok

You asked:

"The OP has milk already - why would she need to give formula?"

I replied

"There are times when giving formula is appropriate".

I wasn't implying anything - I was responding to your question.

If the OP is feeding her baby correctly, I am assuming that she is feeding on demand... and that therefore giving the baby more breast milk is unlikely to be an option.