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?

Anna, you are being pedantic and picky. Sometimes, babies who are being fed as often as they appear to want to will benefit from being offered more breastfeeds - if this baby needs more milk (as the HV seems to think she does) then the baby does not appear to be asking for it. So the formula top ups are over and above what the baby appears to 'want' - so why not offer breastfeeds over and above what the baby appears to want?

I might add that we have no idea if the OP is feeding 'correctly' or 'on demand'.

Whether she is or not, the first thing to do would be to offer more breastfeeds - an option the uninformed HV does not seem to have considered.

You should remind your health visitor that those charts ARE BASED ON FORMULA FED BABIES!!!!!

Both my babies bottomed out around the lower end of the chart, but they were gaining weight, which is the most important issue.

As far as I'm aware, the health visitor can suggest that you do things, but cannot force you. What does 'insist' mean anyway?

The issue with my DD was also that she was growing lengthwise, and was on the 75th percentile for length and (at the time) 9th for weight.

She is now 75th for height and 25th for weight which is fine.

Have you tried the local la leche league?

tiktok - I wonder how much you really know about the effects of malnourishment on infants?

mom2ava - no, you have it wrong about the charts.

The charts are based on babies whose feeding is not differentiated.

The issue is not the chart. The issue is the uninformed HV. It's quite likely the OP's baby will look even smaller on solely breastfed baby charts, anyway.

A baby will starve themselves for a week, but they know by then which side the bread is buttered!

don't get this comment at all

Who can confirm that these charts are based on BF babies - my HV didn't agree with that at all

Anna - if this baby needs more milk, why can this baby not have more breastmilk?

That way, any issue of underfeeding - if there is one - can be responded to with human milk and not cows milk.

There is no need to risk under-nourishment.

The charts are based on a mix of formula-fed and breastfed babies, actually.

HVs can also 'make' you come on MN and post about how annoying they are ... but then, yours has already done this, I see ...

If I can go back to the OP rather than the benefits of breastfeeding.
The HV cannot make you do anything. And frankly I would not persist in visiting a HV who was bullying and upsetting you.

She could refer any concerns she has on to the appropriate agencies ( ie social services)if she had a reasonable suspicion that your baby was in some danger of neglect or injury because of your actions.

You have a duty of care to your child. You are the person who, with professional advice is responsible for all decisions regarding your childs health.
When a Doctor gives a prescription that is only their recommendation - it is you who choses to give that child the medicine.
Thus with FF or Bf - your child , your choice. She is there to offer support and advice and information. THAT IS IT !

Speak to the Paed and then , with his/her advice you can choose how you wish to proceed.

(Can you spot the person who is miffed at the commonly paraded notion that medical professionals responsible for our childrens health?)

Crush, they are both formula and BF babies.

Crush - charts in use in UK baby clinics come from large data sets of babies whose feeding is not differentiated.

In the first months, they differ very slightly from the newer charts issued by WHO which come from data sets of babies who were solely breastfed.

Because mothers, sadly, do not always produce enough milk for their baby's needs. That is why formula is such a lifeline.

I'm a great advocate of breastfeeding. But if we had no formula at all, many more babies would be malnourished.

Sorry tik tok, I don't have it wrong about the charts!

But do agree that the health visitor is uninformed.

oh I see thanks

I also didn't produce enough milk for DD, was honest to myself when I saw her not thriving or gaining and topped up. Didn't need a HV to tell me this though it was patently obvious she was hungry.

my hv made me cry lots and lots and lots - for the very same reason!

for a short while we "topped up" but with EBM - it was a nightmare, but it did kick start dd's weight gain, not sure why. anyway it kept hv happy cos we could say we'd topped up! i fed at least every 2.5hrs (dd wasn't v hungry/demanding and would have gone much longer) and then gave 2oz ebm after every feed. i know i could have just fed even more frequently but i was fed up with feeding so much and i was worried dd wasn't feeding effectively

anyway, dd is now in the lofty heights of the 25th centile (from 0.4th) and ex-bf at 6mths - you'll get there!

Anna - so the OP (who is only feeding 7 x in 24 hours) is to be assumed, by you, to be among the very small group of women who cannot produce enough breastmilk? And on that basis, she should not even be offered the option of simply feeding more often?

Feeding more often does two things - it gets more milk into the baby and it stimulates more milk to be made.

Formula may not even get more milk in - babies may then adjust their breastmilk intake downwards, and it certainly does not stimulate the body to make more milk.

Of course there are circumstances when formula is needed. But not as a first option with a healthy 23-week old with room in the day and night to have more breastfeeds.

mom2ava - you said the charts were based on formula fed babies. You said it in capital letters You were wrong.

No tiktok - I have made assumptions at all about the OP. I have just said that the paediatrician, upon examination of her baby, may conclude that formula would be the right approach - and if so, there is nothing wrong with that (and it is not the OP's fault).

no assumptions

mom2ava, look here
WHO have new solely breastfed baby, charts, replacing one which were largely based on formula fed babies, not soley.

But Anna, why should formula be used at all if the mother wants to BF?
IF the paed thinks the baby needs more food, then it should be breastmilk, firstly to stimulate more milk production, and secondly, because as tiktok says if you give a baby milk from a bottle, and they are already feeding as much as they want they are likely to decrease their breast intake, and take the amount of milk down to their original intake anyway.

Anna: you said "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?"

It is possible the paed concludes this - we can't see the OP's baby or guess at what a medical consultation will reveal. But whatever it reveals, if its decided the baby needs more milk, the first option should be more breastfeeds, surely (unless the baby is so weak and undernourished there is an emergency - and I don't think the situation is anything like that)? The second option would be to express and give top ups of EBM.

With both options, the breastmilk supply is protected and boosted, the baby gets the breastmilk the mum wants her to have...what's not to like?

If this doesn't work, and the paed and the mum still think there is an issue with the baby's health/growth, then formula (or even solids) would be a consideration.

The problem seems to be a total lack of support!

If you have a problem breast feeding (and I'm not suggesting there is one here) who do you turn to? Most women would discuss it with the health visitor, who may or may not have the requisite knowledge/experience with the knee jerk response of suggesting going down the formula route. Of course there is a role for formula

There is a great book: The Ultimate Breastfeeding Book of Answers. Written by a paediatrician and a La Leche advisor.

Have I missed something here. Didn't Hadeda go to the HV to talk about weaning. This baby is 6 months old. So, surely the baby could have a bit of food for extra calories and stay on breast milk too. Why does formula need to come into it?

But, to answer the OP's original question. The HV can't make you do anything. I'd be far more interested in what the paediatrician has to say anyway. And surely you can arrange the paed appointment to take place in 3 or 4 weeks.