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?

HV's can make you complain to their managers when their advice is so crap that it is making you ill have to see them

HV's can also make you say (loudly and slowly) Go Away And Never Darken My Door Again

HV's can make you feel very happy when they do what you say!

If your dd wasn't gaining weight and you were not trying suggestions to improve weight gain then she can contact social services (under neglect).
However, she is still gaining weight slowly, so i would wait and see what the peadiatrician says. If you are planning to wean now, then once she is weaned and most of her calories come from food, not milk you will probably find she puts on more weight. (not initially, but once she is eating 3 meals and puddings iyswim).
The HV herself cannot force you to do anything.
Unless it was found that she was malnourished then SS would have no case to answer.

"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"

I've known babies to go on strike for a week, which is a long time before they will starve themselves or cause irreversible damage. By the end of the week they know that if they're not going to take Mummy's milk, they're not going to get fed and they do restart. A week is quite extreme though, most babies I know got the idea a lot sooner than that.

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

I'm not sure what has happened in Britain and America that our milk supply is so dismal! In Scandinavian countries 98% of women don't have supply issues and the 2% aren't just made up of women with supply issues. It is a myth that women don't always produce milk. For someone who claims to be a BF advocate you don't seem to know much.

I know what you mean, but still they had the milk there, they just didn't have the knowledge given to them to get it. I just hate this idea that some women just don't have enough, when actually they do and it's the rubbish support available to them.

It's not that I feel it's my business how anyone else fed, but I do feel frustrated for them that the help wasn't there when they really wanted to and could have done it with the right support.

Think the HV did exactly the right thing - DD being referred to pedatrician who is impartial, but also will be able assess whether there are any underlying medical issues.

No offence to the breastmilk/formula debate, but it's important to get this ruled out.

agree Tinkers and Starlight. The most seemingly innocent and pervasive bad advice to a woman with a slow weight gain baby who is already insecure about her milk supply is to top up with formula.

My only concern with the Hadeda going to the paediatrician is that this person is not likely to have a deep understanding about bf-ing and will trot out the formula line.

Hadeda, my personal experience - having had to deal with a fair few paediatricians in the case of dd's slow weight gain - is to grill the paediatrician on whether dd is dehydrated or malnourished or not developing in a way (apart from slow weight gain) which is normal. Paediatricians are trained in this area.

Any other advice on bf-ing, weaning or otherwise, a bf-ing counsellor (definitely not HV or GP or paediatrician) or even mn advice, like from Tiktok, is much better. A paediatrician is NOT trained in this area and may spout textbook/media/personal/MIL nonsense, just to appear knowledgeable in this area.

thank god i never went to weigh ins -think i did it once. decided sanctimonious shit wasn't for me.

never went again.

its not compulsory

unless thats changed

blueshoes, my paediatrition was great and said she was doing fine, he got me into the breastfeeding group.

If you would like to find a group near you (can't remember if I posted this on this thread already) try here.

Custardo is right. Weigh-ins are not compulsory.

If the paediatrician gives the all-clear as to your dd's health on Friday, then you might want to consider weighing less frequently and eventually not at all.

My HV says that she really only tends to see first time mothers. By their second, she does not see them for dust until their vaccinations.

If you feel confident in what you are doing, the best thing is to nod and smile at HV's suggestions, don't offer information, and then don't go back for a loooong time. I am like Mona Lisa with my ds, my second.

That is great, tinkers. I like a paediatrician who knows and is happy to admit that bf is not his/her speciality.

agree blueshoes.

dd2 is a low-weight gain baby (well, toddler now - she's 16 months, and 16lb)

she si doing every right, except the weight gain. she was exc bf until 6 months, and then BLW. She eats like a horse, still has 2 bf a day (won't take anymore, as she is more interested in having the same snacks as her sister!) but is still sliding further away form the bottom centile line. we are under the care of a paed, who has suggested formula for no good reason (dd2 is dairy free due to family allergies so this was not viable anyway) and also a dietician, who could find nothing wrong with her diet (despite dairy free) and her only suggestion was to up dd2's caloties by giving hermore biscuits and puddings (I don't mind the odd biscuit or oudding, but no way am I going to have dd2 eating pudding instead of eg curry purely for the wrong type of calories...)

Our paed has referred on for a shed load of tests, but says himself that he will be surprised if any of them come back positive as dd2 is such a cheerful little girl, hitting al her milestones, etc, but just not growing very fast.

DT1 is a diddy wee thing. Always has been. I gave up on the weigh ins rather early (bored by them) but the HV was a friend and really relaxed with me. The initial mw was crap so I "sacked" her (told her not to come again). DT1 is still diddy (was on the 0.9centile forever). My milk supply was never an issue. I produce enough to feed a third world country. DT2 grew and grew and was on the 75th percentile having started on the 25th.

Some children are just small. It's been said lots, if the nappies are good then fret not. I don't see the point in popping in formula if you've got breastmilk. Give more breastmilk if she needs to feed more.

I think you're doing a great job! Keep it up.

sorry for bit of a hijack here but wanted to add my bit about bad advice from both mw and hv.

I didn't have a small baby, dd1 was 10lbs 2oz at birth, mw told me that I wouldn't have enough milk to feed her and would need to use formula top up, hv told me I would have to have her weighed weekly to make sure she was gaining weight and she too mentioned formula top ups.

I became slightly paranoid about my abillity to BF [huge understatement emoticon] that for first 12 months, I kept a diary of all her feeds, wet and dirty nappies, just to prove to myself that I wasn't starving her.

We'd moved before dd2 was born thankfully, when hv saw her weight gain, she told me I didn't need to have her weighed every week as they would normally do for bf babies!!!

We all know bf is best for babies so why are mums made to feel guilty about having small babies/low weight gains when you are exclusively BF?

Give 100 people the same food to eat and some will gain weight, some will lose weight, we are all different, it's the same for babies.
The red books do not take into consideration parental weight, height, race, all of which have an influence on how slowly or quickly a baby will gain weight.

We tell parents that the "ideal" weight gain is 3-4oz per week but the best way to tell if a baby is having enough milk is the number of wet and dirty nappies per day, if the baby is settled after feeds, is happy and reaching the appropriate milestones.

as a mum you know your baby the best, trust your instincts,

Oh, I don't know. I think he was looking at what mattered first and then her weight, which actually on the hospital chart (don't know the difference) looked a lot healthier. She was doing everything she should do and her weight looked good. The only reason he got the lady from the group to call me was because he thought she might be able to help with the biggest problem I had - The Health Visitor! He actually said to me "She is doing fine but we need to get the HV off your back because it's not going to help you".

I think the problem with HV's is that the majority of them trained a long time ago. If they have families themselves, their children would probably have grown up in the days when it the norm to bottle feed. They are not used to supporting BF mum's.

Bf is a HV, (have to add a very sensible one too, who I turned to for help and advice with dd1) and where she works, the majority of HV's are due to retire in the next 5 years.

We need younger HV's, who are actually able to support mum's, instead of upsetting them.

I haven't had time to read all of the posts but my dd is also 'underweight' and is on the 4th pecentile at 20 months. Until she was 18 moths she wasn't on the graph at all. We have been to the hospital but nothing really came of it and after a few visits we opted out of it as there was nothing helpful coming of it at all. We also saw a dietician at the hospital but she said we were doing all of the right things. {preen}

My HV was at the time and still is a pain in the arse about the whole thing. She told me to give her custard creams and cheese strings. She told me that she should not be given any milk at all to drink. She has told me to give her complan. She is FURIOUS that I haven't done any of these things and in a way it is a bit scary because she has got some power and could report me or something. However I am not doing what she wants as it does not feel the right thing to do.

savoy
she has remarkably little power actually.
why are you still seeing her?

i never went to weigh ins with my middle child and have hartdly been with this new one. Learnt with my eldest that its best to stress over things that are worth stressing about

If you need your HV for advice, then thats fine but alot of them are jobworths these days

i don't know if there is a stress/confidence element to bm production, but my weensy dd struggled to gain 2-3oz a week until we saw the lovely paed and effectively sacked the hv. she now regularly puts on 6-9oz and has done ever since i relaxed about it and realised how much they were undermining me.

The research is all the other way, Caz - stress has no effect on milk production.

What can have an effect is trying not to feed often because someone has told you not to, or trying to increase the gaps between feeds because of concerns about the baby not really being hungry, or doing other things because of a lack of confidence in the bf. It's not stress per se that has the effect, but the practical impact of not feeding often enough. Don't know if that happened to you, of course.

HV can't make you do anything. she can't make you have your baby weighed, or even make you go and see her. ime i wouldn't ask an HV anything at all. i might go for weigh ins in the early days, but that's it.

i did wonder if it was just coincidence!! that's the thing, i didn't change anything apart from my mindset and dd started piling it on...she possibly just would have anyway!