Baby looks starving. Would you mention it?

[spidermama]

This is for a friend who also happens to be a GP. She's worried about her friend's 8-week old baby who looks so skinny and ill. Others have commented.

The baby was over 9lbs at birth, but no looks wan and emaciated and attracts comments. My firend has subtly mentioned it to the mother but it's shurugged off.

She's worried about sticking her nose in and upsetting her friend, but more worried about the baby.

What would you do?

Can she not find out who the health visitor is and have a quiet word?

Well a ruined friendship is awful, but not as bad as a dead baby.

Of course if she has concerns she must act on them, a child's life is at risk!

Suggested that. She's worried about going behind the woman's back. You're right though. Two choices are:
Mention it up front or do it thorugh HV.

blimey, I think the baby matters more than the friendship. Your GP friend should stick her nose right in there and say what she thinks, using the fact that she's a GP to imply her authority to comment. If the mother says the baby weights X which is fine on the charts and HV is happy about it, fair enough, but otherwise...

can your GP friend live with herself if she doesn't say anything and the baby is harmed as a result?

yes, she should mention it. in fact given that friend is a GP, i wonder if she is under any sort of professional obligation to.

I think you're right, she needs to say something. She's just had a baby herself so doesn't really have much energy. It has to be done though eh?

Possibly mts. The hypocratic oath might cover that. She's got to bite the bullet hasn't she?

yes, she does!!! [imho, all that]

Yes fully breastfed. Mum is apparently on the defensive and unwilling to listen so my freind would have to battle a bit.

sounds as tho mum is not using teh best technique for her and baby but does not know what to do being adament not to use a bottle. Think it needs to be tackled perhaps by breast feeding expert (Nct?)

Listen, you don't get more fully supportive of breastfeeding than me (I am the only on MN who doens't mind being called a breastfeeding nazi) -- but

There was a baby a few years ago who died because breastfeeding wasn't working, baby had FTT, young mother (18yo) didn't realise. HV in that case got slated for negligence, and HVs have been a bit pro-active since, but not all HVs will be so clued up. Maybe it would be optimal if someone who is as militant about breastfeeding as me talked to this mother, and everything should be framed in terms of reference of how to fix the breastfeeding rather than to think a bottle is the only solution --

But regardless, it's not unreasonable to say something, and if a GP with her own young baby to compare to is that concerned, I imagine that there really is a problem that needs sorting out asap.

If as a gp she is concerned, then she obviously needs to act.

In her position, I'd have thought it would be relatively easy to find out which health visitor she needs to speak to and then voice her concerns confidentially. Handled properly, there would be no need for her friend to find out that she has said anything.

Agreed dino. But in fairness she's not 'wearing the gp hat' at the moment as has recently given birth herself. I think she will intervene, her dilemma is whether to do it personally, or through a health visitor.

It's a friend, though, dinosaur, you put on a different persona for dealing with patients than you do with your friends.

ah, didn't realise that thru the hv was an option.
That said, I think both GP friend saying something to the mother & to the baby's HV is right way to go. If the baby's weight is fine then that will be very clear very quickly & it will (probably) simply be a ruffle in the friendship.

If baby is not well & mother accepts this, she will forgive GP friend for interfering.

If baby is not well & mother doesn't accept this, HV may have to bear down on the mother, & friendship may not recover, but at least the baby should be ok.

Of course the friend has to say something. She doesn't have a choice, IMHO. She needs to do it tactfully and gently, and directly to the mother. Anything else is not fair to the mother - even speaking to the partner is 'going behind her back'.

Thanks all. I'll pass these on to her. I think she knows it deep down but has got herself in a tizz. Not a pleasant thing to have to do so soon after having a baby.

As a GP, your friend should know that she has a duty to report anything odd that may suggest that a child is malnourished. I honestly can't see how she has even contemplated not mentioning it.

Hmm. B-fed DD plummeted to bottom of charts and looked really thin for about 4 mths. I was very worried by this but would only confide my anxieties to people I knew very well, or trusted (my HV, for instance, who was reassuring and pointed out that DD was alert and well hydrated, if very reflux-y). A woman I did not know particularly well came round, goggled at DD and said, "My God, What percentile is she on?' You can imagine how this made me feel.
So, I would also suggest things may not be quite as straightforward as you assume they are.
The upside is, we never see that witch anymore .

i don't think you can do much just on the fact that the baby "looks skinny and ill"

someone my mum works with had a baby just after i had ds. whereas ds pile don the pounds and got all chubby, her little boy stayed quite skinny looking and quite pale all the tiem... now, at 5 months he is the picture of health.

you don't know what support this lady is getting. what the baby weighs etc etc. I am sure the baby will have been weighed not so long ago and if HV was worried about weight surely s/he would be doing soemthing already

Perhaps your friend should just ask how much the baby weighs now. does it feed often... the kind of questions EVERYONE asks anyway, to get a bit more info on the situation

Senstive, careful, gentle....absolutely. But if a baby looks scrawny to an experienced medic and mother, then someone needs to say something.....because it might not be poor feeding, it might be something else. I can give an example of this. It was the baby of a mother I was supporting breastfeeding, who was really, really skinny, miserable and who clearly was not feeding well (I watched). With my help, she tried to improve positioning and attachment, to no avail, and the baby did not grow. She was in touch with the HV, and the baby's father was a doctor.The baby turned out to have multiple learning diffculties and epilepsy, just not apparent at birth. Co-ordinating her feeding action was not possible for her. Of course most people just assumed the mother's breastmilk supply was 'at fault' - well, of course, it wasn't a good milk supply because the baby wasn't stimuating it. But the baby failed to feed well on the bottle, too.

All this is to underline further the need to be sensitive - the parents may be very worried about something else being wrong.

I knew someone whose baby didn't seem to put on much weight, and was quite quiet. He didn't look skinny, though, just small. Eventually, he caught chicken pox quite badly, and further medical investigation revealed some sort of heart problem. It was fixable, and as far as I know, everything is fine now.