Help! Falling off the weight gain chart

[Grapes2]

My dd, (who is my third), is 19 weeks old and has just fallen off those lines on the chart. She is exclusively breast fed, born at 7lbs 14 oz, and now weighs 10lbs 5oz. I would like to hear from anyone whose baby has fallen off the chart. Should I give a bottle? Will it make a difference? She was following just above the 0.4th percentile line and she has had 2 colds in the last month which could cause the lack of weight gain. What happens if she is referred to a pediatrician? I have to say that she is happy, and doing all one might expect for her age. She seems to feed well, and poos and wees etc. Please help me as it is making me very miserable and sad. (I should point out that I exclusively breastfed my dd2 for 14 months. My ds1 I switched to bottles at 11 weeks because his weight gain was slow- although he didn't gain any more and continued on the 25th percentile.)

I have to say that she is happy, and doing all one might expect for her age. She seems to feed well, and poos and wees etc.

There's your answer right there. As long as she is doing well in all of these areas there really shouldn't be cause for concern. If her 'line' was 0.4 to start with anyway, going off the chart is only a small dip. Illnesses definitely have an effect too.

My daughter was 9lbs at birth which is on the 90th-ish percentile and then she dropped to 50th and then 25th. The HVs were giving me hassle and causing me so much stress but I had a great lactation consultant through NCT who helped me realise that they were talking rubbish and convinced me to keep on feeding and to stop worrying so much about the bloody charts (which are based on formula-fed babies in the 70s, anyway, so not much good for present-day breastfed babies). By the time DD was a year old she had 'caught back up' with her peers and retained her previous percentile for weight.

Life doesn't follow a chart, it's only a guide. Hang in there, you're doing great!

Regular mumsnetters in this folder will know what I am going to say about charts Charts in the UK are not based on formula fed babies nor babies from the seventies. They are based on several datasets of babies in the UK whose feeding was not differentiated - many of them will have been ff of course, but in fact, in the first few months bf babies tend to be very slightly heavier than ff babies as we will see when we get new charts next year.

The issue is not the charts - it's the way they are used and interpreted and used as a stick to beat mothers with!

Grapes, it may well be your dd is a little underweight at the moment - in an otherwise healthy baby, NO BIG DEAL - there's an easy explanation for it (she's been a bit poorly) and an easy solution....breastfeed her a little more often, using both breasts (at least) each time. If all she needs is calories, you have the calories, in your breasts

Grapes - my dd2 was born on the 50th percentile, and then at some point, fell off the bottom of the charts altogether. She was exclusively bf. She was just a very small eater, however often I tried to feed her. Most of the babies in the family are very small. It was a bit worrying when she got a nasty tummy bug and lost weight, but apart from that she's a very healthy 3 year old now. I bf her for 19 months.

DS fell off the charts at 21 weeks (actually probably a little earlier as the HVs were plotting the line wrong ) It was explainable as he'd had AntiBs -> diarrhoea but still all hell broke loose. I was told to wean him onto solids, which I did with tears in my eyes as I didn't think he was ready and wanted to wait till 6 months. He took to it very well and he is now a happy and healthy (and large!) 3yo.

I know it's not ideal to wean before 6 months. Another time I just wouldn't get a baby weighed unless I am worried and then I wouldn't have all that hassle

Sorry tiktok, it was my understanding that the charts were old and based on ff babies. Guess it's one of those urban myths that get around.

amitymama I thought that too. Tiktok as ever, you continue to enlighten me (as an about to be 3rd time mother who has read widely on feeding issues). That is really interesting!

Grapes2 - I have just had a look in little Ff's red book, and at 19 weeks she was 10lb1oz. I had no end of hassle from my HV, insisting I took her to be weighed every week, treating me like a moron for 'still' breastfeeding her, and telling me that I should be topping her up with formula, even when I explained that I had plenty of milk, wasn't too tired to feed, and was eating well. She basically accused me of lying on more than one occasion, seeming incredulous that a baby as small as Ff would sleep as well as she did, suggesting that she was sleeping at night because she was too weak to wake up. I came to dread the weekly weigh ins, but had to go, because if I didn't she would turn up at my house. Little Ff used to take a good hour to take a feed, and to try and make her gain weight faster I was expressing milk after each feed so I would have a bottle of EBM to give to her with her last feed at night, as well as an hour at the breast. I honestly felt as though I was doing nothing apart from feeding or expressing.

I eventually took her to the GP, not because I had any concerns about her, but to shut the HV up. He referred little Ff to a paediatrician (after telling me I should get over myself with my obsession with breastfeeding, because formula milk nowadays is exactly the same as breastmilk) and we had to take her to the hospital for three separate appointments, not because they found anything wrong with her, but 'just in case'. At the second appointment they insisted on taking blood to check her for anaemia...again, not because she seemed ill, but because she looked pale skinned. (I have red hair, my husband has red hair...neither of us is exactly olive skinned!) At the third appointment, the paed finally conceded that they could find nothing the matter with her. She is small, that's all.

I've never been concerned about her. She is a happy, bubbly little baby, full of energy and always on the go. She eats an extraordinary amount for such a small person, and eats and sleeps like clockwork. I haven't had a broken night with her since she was four months old.

She will be 40 weeks old tomorrow, and is still in size three nappies, and is just wearing 6-9 month clothes. I say you should trust your instincts - you would know if your baby was unhappy and hungry, and would do your best to solve the problem. It sounds as though she's fine. Enjoy having a little one - you get much more time with a 'baby', IYSWIM. I don't take her to be weighed anymore, and if the HV EVER comes to my house again she will be getting the sharp edge of my tongue. I am considering making an official complaint about the way that I was treated, and hate to think how that sort of pressure might make someone who wasn't as bolshy and arrogant self-confident and well supported as I am feel. If you are happy with exclusively breastfeeding, then stick with it, and feel free to sout at me for a chat if it starts to get to you.

Grapes2 - I have just had a look in little Ff's red book, and at 19 weeks she was 10lb1oz. I had no end of hassle from my HV, insisting I took her to be weighed every week, treating me like a moron for 'still' breastfeeding her, and telling me that I should be topping her up with formula, even when I explained that I had plenty of milk, wasn't too tired to feed, and was eating well. She basically accused me of lying on more than one occasion, seeming incredulous that a baby as small as Ff would sleep as well as she did, suggesting that she was sleeping at night because she was too weak to wake up. I came to dread the weekly weigh ins, but had to go, because if I didn't she would turn up at my house. Little Ff used to take a good hour to take a feed, and to try and make her gain weight faster I was expressing milk after each feed so I would have a bottle of EBM to give to her with her last feed at night, as well as an hour at the breast. I honestly felt as though I was doing nothing apart from feeding or expressing.

I eventually took her to the GP, not because I had any concerns about her, but to shut the HV up. He referred little Ff to a paediatrician (after telling me I should get over myself with my obsession with breastfeeding, because formula milk nowadays is exactly the same as breastmilk) and we had to take her to the hospital for three separate appointments, not because they found anything wrong with her, but 'just in case'. At the second appointment they insisted on taking blood to check her for anaemia...again, not because she seemed ill, but because she looked pale skinned. (I have red hair, my husband has red hair...neither of us is exactly olive skinned!) At the third appointment, the paed finally conceded that they could find nothing the matter with her. She is small, that's all.

I've never been concerned about her. She is a happy, bubbly little baby, full of energy and always on the go. She eats an extraordinary amount for such a small person, and eats and sleeps like clockwork. I haven't had a broken night with her since she was four months old.

She will be 40 weeks old tomorrow, and is still in size three nappies, and is just wearing 6-9 month clothes. I say you should trust your instincts - you would know if your baby was unhappy and hungry, and would do your best to solve the problem. It sounds as though she's fine. Enjoy having a little one - you get much more time with a 'baby', IYSWIM. I don't take her to be weighed anymore, and if the HV EVER comes to my house again she will be getting the sharp edge of my tongue. I am considering making an official complaint about the way that I was treated, and hate to think how that sort of pressure might make someone who wasn't as bolshy and arrogant self-confident and well supported as I am feel. If you are happy with exclusively breastfeeding, then stick with it, and feel free to shout at me for a chat if it starts to get to you.

Thank you all so much for your supportive messages. All really useful especially 1. to remind me that it is a small dip in her chart as obviously is following around the bottom lines, 2. reminds me not to worry about the clothes, 3. reminds me that am doing the best I can. (Ff I too feel I am doing nothing but feeding- and can't believe you had such a bad experience with both HV and GP . I am lucky in that my HV is supportive. I need all the support I can get- It helps because people keep asking me if she was premature and constently suggest I just give her one bottle in the evening! She isn't quite as settled as Ff's baby which adds to my anxiety and because she is my third I fear that it is hard for her to get into a routine- so the doubts sometimes creep in. I hate the thought that I am in some way malnourishing her...I'm sure it is not supposed to be this hard.

It's a very common, though incorrect, idea that charts in use in the UK are somehow very old or only use formula fed babies - the charts we use are called UK 1990, and are different from the charts used in, for example, the USA. Anyone who's interested can google UK 1990 charts and find out what data they are based on. In fact, I think there may be a reference to the data in the red book, too.

tiktok - so is it not true that there are separate bf baby charts?

Yes, there are separate 'bf baby charts' but they are not really in proper use yet. The new UK charts - to be issued next year - are based on the WHO 'breastfed charts' which shows normal, physiological growth ie the growth of babies wholly or predominantly breastfed for the first months of life.

There are other 'bf from birth charts' knocking around, but the WHO ones are the best and based on the largest sample. I am not sure if these new ones will be used for all babies.

The main problem with any charts, whatever they are, is that too many HVs and others don't know how to use them properly and to use them as part of an assessment of a baby's health and well-being.

For the first four or five months, breastfed babies are slightly heavier on the new charts compared with UK 1990, but only slightly. After six months the gap gets wider, and by a year, breastfed babies are quite a bit lighter.

It is no use trying to reassure mothers of lightweight babies (under 6 mths) 'oh, the chart's all wrong, breastfed babies don't gain weight fast' - using a different chart would make these lightweights even lighter!

(Of course, many of these babies are fine anyway)

I simply stopped going for dd1 to be weighed. I looked at the WHO charts, some other's that were knocking about in research etc, and I looked at the blooming red book - then I just looked at the child and thought - y'know what, I think you're doing OK overall, and we'll make up some ground when you/I are over the cold/stress/runs/whatever. Figured that a few weeks less gain balenced against a few weeks gaining balenced a few staying put etc etc.

Absolutley no point trying to make human beings conform to lines on charts. Least of all baba's who are a law unto themselves!!

That's only my opinion mind, can't say it's based in any knowledge or research.

tiktok - if the charts are based on so many babies whose feeding was not deferentiated - will they not be mostly FF by definition as most babies in the UK are FF?

You're a big pot of knowledge!! Fab!

Grapes - She is not malnurished, nor is she over nurished, she is perfectly nurished. By the perfect milk in your breasts.

Your doing great and the geenie on your shoulder whispering nasties in your ear is nothing more than a geenie. Bless you!

I remember having all these problems with my HV too. I took Tink to the hospital to see her consultant because I was in tears all the time from the HV going on about formula. He marked her on a different chart which had all their measurements in from her whole time in the NNU to every appointment she had been to. I was amazed at this chart, it made her look normal! It was a chart for premature breastfed babies (not sure if it was even more specific than that, I couldn't see well enough) and she was right there in the middle of it, following all the places where it was flat and when it went up.

Just imagine if we were this obsessed with our own weight!

SO true TinkerBellesMum!! I think this whole chart weighing thing came in with the NHS post war as there were serious issues with child health and lack of nutrition. Maybe they just need to go away now! Except where concerns are raised and THEN they could be started for a child.

Times have changed, instead of being underfed and undernurished dc's are now more likely to be OVERfed and undernurished!!

Weight is weight, surely there is also immune system, skin condition, hair condition etc etc all the things that look 'off' when you see a child in challenging conditions ie neglect or famine.

Am no expert in child health though, so would hat eto suggest something actually dangerous for the dc's.

treedelivery - of course most of the babies on the UK standard chart (UK 1990) are likely to have had formula; some will have had early solids. The chart is a picture of what babies actually are, not necessarily what they should be, physiologically. The data is a mix of longitudinal data (following the same babies over a period of time) and cross-sectional data (a series of 'snapshots' of different babies at different ages). I can't remember off the top of my head how many babies it represents, but prob many thousands.

But feeding style is not differentiated in any of the datasets, and we just dont know how many would have been breastfed and for how long; all we can do is infer from what we know of UK feeding practices.

The point being that UK 1990 is very, very similar to the WHO chart in the first months, and that far too many HCPs have not been trained in use and interpretation of weight gain and charts.

TinkerBellesMum, yes, there are specialist charts for prems, and there are also overlays for charts called 'thrive lines' which give a more accurate assessment - why more HCPs don't use these instead of scaring the bejabers out of mothers, I don't know. What a waste of time, blood sweat and tears to be sending mothers and babies to specialists and clinics all the time

I am going through the same thing - I managed to get my 7 week old DD back onto exclusive breast feeding after being told to mix feed as she lost weight early on, and now she has only put on 1/2 in a week and has been diagnosed with mild reflux, the HV and doctor are insisting I add formular back to her diet - the doctor wanted me to feed her with aq bottle six times a day to make giving her gaviscon easier, and when I protested that would basicallly end my milk supply, just gave me a blank smile! I have decided to give her three bottles, and although I find I can't express much, try and make one at least ebm; my DD tends to be a bit of a snacky feeder but she is the picture of health otherwise - I wanted to at least have some aknowlegement that I had got her back onto BF but all I got was grief! The HV then went on to have a go at me about carrying her in a baby sling and letting her go to sleep in it before putting her in her bed - she said it was bad for her because 'it was too nice!!!!!' I was so angry I found a site for patents with reflux/colicicy babies and there they recomend baby wearing until at least 4 months to help with both conditions, and have found out that the HV's in Brighton actually recommend buying a sling and not a parm until babies are 4 months +! Sorry, I am ranting, and hijacking you post, but I think what you need is support and ackowlagment that your DD is just suffering the after effects of being ill - they can hardly think someone with three healthy babies dosn't know what they are doing, or would willfully put them at risk!

Hi Grapes. I've been where you are and I do understand the anxiety you are feeling. My dd plunged off the charts, and we saw paediatricians, BF counsellors, HVs GPs...the whole merrygoround. You can search some of my old threads under my posting name verylittlecarrot.

At 26 weeks dd weighed less than 10lb. I had a constant crisis of confidence and was very worried about what the HCPs would 'make' me do.

What it boiled down to in the end was this. My dd wasn't ill. She wasn't malnourished. She wasn't underdeveloped. She was happy and bright and well. Just very, very slow gaining. And I kept asking myself if I trusted that the various HCPs KNEW about BF, and nutrition. Ultimately, I decided that they knew lots about illness, diseases and how to remedy them. If dd had been ill, they would have been the people I turned to. But when faced with a normal but tiny baby they were NOT informed enough to recognise when to leave things alone. And their very purpose was to interfere to try to make the situation look more like what they were familiar with, ie chubby ff baby is preferable to skinny bf baby.

My responsibility as mother was not to make them feel comfortable. It was to do what I believed was best for my baby. And so I carried on bf, and introduced solids at 6 months.

BTW, her weight took off with solids and she is now on a line on a chart again. I'm still breastfeeding her at 16 months.

My advice is this:
First, reassure yourself that your dd is healthy. Consult the HCPs if you have any reason to suspect she is unwell.
Second, assuming you are satisfied that she is well, remove yourself from unwanted feeding advice. It will make you anxious and damage your confidence. Get your knowledge of infant feeding using sources you trust.

Keep us posted on your progress!

VLC - did your dd ever lose weight. i think i seem to remember she stayed the same quite a few weeks (correct me if i'm wrong about that though) but can't remember if you said she actually lost weight.

Grapes if possible stop taking her to get weighed! Some babies/children/adult have to be small for their to be averages IYSWIM.

Thank you vlc. Your posting is really encouraging. My second daughter's weight, although being born at 10lbs 1oz (!), also took off after 6 months with the introduction of solids. So probably, dd3 may do the same. Do you have any other children? Have their patterns been similar? I have to say that actually, my HV is very good. She doesn't feel that DD3 should see a pediatrican. She believes she is healthy and bright and happy. She is more keen to monitor her for a bit now she has dropped off the line, but she does trust me to know myself if I feel dd3 is in difficulties. Fortunatley she knows me from dd2 so knows what I am like. It is just that those charts do make you feel like a failure. I think mothers should not be given them! I gave up feeding ds1 because of them and HV who suggested formula. What a sorry picture this is- robbing mothers of their self- believe to provide for their babies and sucking all the enjoyment out of parenting. Hurrah for networks of mums who support each other!

grapes has she just fallen off the 1990 charts or the who babies breastfed chart aswell?

She has fallen off the red book normal charts...not the breastfed chart. However, judging from the comments on this thread, I would guess that her slow weight gain from the start would actually look worse on the breastfed chart. (?)