My HV has made me feel like giving up breastfeeding!! Do all HV make you feel useless??!!

[mrsthommo]

My DD is 15wks old today, and yet again my HV has expressed concerns about her weight gain. She was 7lb 8oz at birth and I've been EBM. She's an extremely hungry baby, and I find I rarely have more than 1-2hrs between feeds (even less time recently, due to a growth spurt and the hot weather).

She latches on correctly and always feeds from both breasts (average of 20mins each side). She was gaining weight well for the first few weeks but this has now slowed down (although she has never lost weight). A couple of weeks ago my HV advised me to give her 2 extra feeds per day. I've done this (with great difficulty as there doesn't appear to be any spare time between feeds as it is) but again today when she was weighed (11lbs 8) my HV still wasn't happy.

I've tried expressing so I can see how much she is taking (can only get about 1oz between feeds as she feeds so regularly) and managed to get 9oz over the course of the day. This didn't even seem to touch the sides, and I still had to breastfeed her afterwards for approx 15mins.

I suffer from Coeliacs disease so was worried my gluten free diet meant my milk wasn't filling her, but have been told this is not the case.

On the advice of a few friends I decided last week to add a formula feed (6oz) to the last feed of the day. I breastfeed her first and then give her the bottle (as I find my milk flow slows right down at night and this frustrates my DD). My HV was entirely unimpressed with this!! She has now said that I should come off the mini-pill as it may have slowed down my breast milk supply, and has referred my DD to a dietician!! I'm devastated about this!! She has also told me to try and cram in yet another feed per day and has requested a urine sample from my DD to check for infection (she believes my DD could only be burning off the amount of calories she does if she is ill)!!

My DD seems perfectly healthy to me! She doesn't seem unhappy, or ill and is fitting nicely into her 3-6mth clothes. She is very active, and whenever she is awake (which is most of the day), she is kicking and making attempts to crawl, so I thought this was why she was burning calories.

Although I found the first few weeks of breastfeeding really difficult, now I love it and would hate to have to stop. My HV has just left me feeling utterly useless, and wondering if there is something wrong with my milk (she mentioned that there may not be enough calories in it)! Help!!

uuuuurrrrgh! Health Visitors!

if she's alert and active and having plenty of wet nappies then she's fine.

I had a friend with a HV like this, who was referred to a specialist who took one look at the baby, asked the mum if she had any concerns, and sent them away telling my friend to enjoy her baby.

Expressing won't show you how much milk your dd's having as she is far better at getting milk out than any pump.

Oh dear - I also posted a thread earlier about a very unhelpful HV. Must be the day for it.

I don't know about the implications of being a coeliac but if your DD is happy, gaining weight, lots of wet and dirty nappies etc, then surely she is fine?

15 weeks is a tough time I found and my DD (now 22 weeks) fed a LOT around that time up until around 19 weeks when it started to calm down a bit. Now she feeds every 4 hours pretty much although has been a bit more in the warn weather.

Stick with it - it gets easier I promise and you'll be so glad you did. When I was getting down I would always say to myself "just do one more day then see how you feel." If you just take it one day at a time you can get past the more challenging times.

11lbs 8 sounds like a decent weight. As long as she s gaining weight and seems happy and healthy there really isn't a problem. Is she vaguely following a centile on the dreaded growth charts?

Horrible to feel undermined like this, mrsthommo. Without knowing more, no one can say whether your HV's concerns are justified, but if she is suggesting the calories in your milk are lacking, she is showing poor knowledge of bf....happily, breastmilk's calories are consistent between women, and while breastmilk is not identical at all times, the calorie content works out pretty much the same.

Giving formula can affect the quantity of breastmilk available (because it stretches out the gaps between breastfeeds, and/or reduces the amount of breastmilk the baby takes, and the effect of both of these is to reduce the milk), so if you think you need to increase your milk supply you would need to drop the formula.

Expressing gives no indication of what the baby takes, and I agree - better to feed the baby than feed the pump

It might be a good idea to see the dietitian because if she feels your baby is fine, the HV will have to accept that. Your own assessment of your baby that she's healthy and fine and growing is something to be taken seriously, anyway - most babies whose growth is slow are fine, and they are this way because that is the way they are meant to be!

Yes, HV problems here too.

It might not seem like the weather for it, but have you tried trying to get her to wait for a bit longer between feeds? If she feeds less often she should get a more satisfying feed. You could give her a little water in between if she really needs it, but a really good feed every few hours might be better than smaller ones more often.
Having said that, I'm not a health visitor so what would I know?(!)

Thanks everyone!!

Yes, she was nicely following a pattern just above the 50th centile until approx 6wks, when she dropped to the 25th centile. She has now dropped to just above the 9th centile.

My HV seems to think that this pattern is linked to when I began taking the mini-pill, which is why she has told me to come off it. I really don't want to do this!!!

I've tried making her wait a bit longer between feeds by taking her out for walks, etc in an attempt to distract her, but she screams bloody murder!!! she obviously has her dad's appetite!!

She seemed to be getting into quite a nice routine just over a month ago where she was feeding almost like clockwork (0800, 1200, 1600, 2000, 0400) but this went out the window as soon as she hit 3mths!

I'll definitely try giving her cool boiled water, though!! Thanks

Well accourding to my WHO brestfeeding chart your DD has drop one centile since birth. But to be honist I didn't think they normaly worried unless they droped two or more. I'd make sure you have the brestfeeding growth charts in your red book.
www.who.int/childgrowth/standards/chts_wfa_girls_p/en/index.html

Go to the dieatition to keep your health visitor happy. If she's not concered then stop going to get her weighted it's not compusary, or if you can go to a different health visitor clinic do.

Drop the bottle feed it wount help your milk supply at all. Your DD is almost 4 months and coming up for a huge growth spurt, she will feed all the time and hopefully seatl down in a few weeks.

Going longer between feeds means the baby feeds less - it's the opposite of what a baby should be doing and how milk should be offered. The idea that waiting means a more satisfying feed is a huge myth - and no to water!

Sorry to be so dogmatic about this, but it's really important to get this right!

I am an NCT bfc and we hear these ideas a lot. Water is not good for a baby whose weight and milk intake have caused concerns (justifiable or not). Breastfed babies rarely need water and as a technique to make them grow or feed better it makes no sense.

Many feeds given responsively, even if they are short (and 40 mins is not v. short....which is what you say you are doing), are better than fewer longer feeds.

I can see the HV is concerned because of the fall of 2 centiles. This is still within normal, of course, but she prob is watching her back by suggesting a referral.

Never heard that water was good for them, that won't help her gain any weight surely? (or I must stop drinking water!)
Reading your OP, my thoughts were to consider not thinking about it as fitting another feed in, and just keep feeding her whenever she shows signs of wanting it. If I could do one thing differently myself it would be forgetting all about when the last feed was, how many there were in the day and just feeding on demand.

The charts will make no difference to the discussion - breastfed charts are virtually identical to the older charts until babies get to about 5-6 mths when they start to diverge.

definitely forget about timing the feeds, just feed her every time she shows any sign of being interested.

Until she was about 5months I seemed to feed DD all the time! if we were going out I fed her before we left, when we got there, while we were there (more than once if more than a couple of hours) just before we left and then when we go home again!

it's an intense time and seems to go on forever when you're in the middle of it, but it does get easier soon!

She's talking bollocks, feed on demand and all will be fine if your baby is bright, active and doing plenty of poos etc - which sounds like she is. HVs like yours dont understnad breast fed babies - they make you feel inadequate first time around because you aren't cramming your baby full of formula and chunking them out when in fact you are probably avoiding many obesity-related problems in later life. My ds1 was constantly hovering between the 6th and 2nd percentile after being 5oth at birth, HV went on and on, started talking about failure to thrive, must give formula, my vegetarian diet etc. I took him to see a pead consultany privately who actually used the WHO breastfeeding charts, he examined him, did a full scan and developmental check and told me to ignore the HV. He is now a bright and extremely active (and slim) 5 year old!

Ds2 I never took to see the HV ...... (and neither will you if you have more children).

Try not to worry. you will know if there is anything wrong with your baby.

Oh now I see your problem form what you've just said you have the FF growth chart in your red book. She's being measured against the wrong base line information.

Do what I did print out the right growth chart stick it in your red book and make sure the HV plots her on that not the FF one. It's criminal they are supposed to have changed all the red books to BF charts by now.

She's not growing as fast as the norm, but no one is completly in line with the growth lines. They are afterall only guids. If she's producing lots of wet nappies allert and happy then there really should be no worries.

Somthing to think about is you and your DH are you pertite? are there small member of your family.

mrsthommo's concern will be unaffected by charts.

It does not matter what chart you use for the first few months - I mean, it's good to stick to one, and certainly the chart that shows normal, physiological growth is the one issued last year (May 2009) and which every baby should be measured on by now.

But the old 'UK 1990' chart and the more recent UK charts (based on data from WHO/UNICEF) are virtually the same, with the same centiles, for the first months...except to show a v. slightly faster growth. A baby gaining slowly on the old charts will look as if he is gaining slightly more slowly on the new ones.

This does not matter because the issue is not the charts but the way they are used and interpreted. If the HV is unable to see beyond the charts to the whole baby or to assess whether there is anything wrong, then mothers will be made to worry, inappropriately.

However, we can't tell this mum to ignore the HV or to tell her she is being told rubbish - all we can do here is to support her and suggest she asks more questions and challenges, where necessary. We can't see the baby. We may not know the full story. We're not even qualified HCPs, most of us.

Chances are, this baby is fine - because most babies who gain slowly and who are fed responsively and who appear healthy and happy are fine. But we don't know that applies here!

And the issue is not the charts - or have I said that already ?

mrsthommo - my friend's baby had similar weight gain issues with breastfeeding, although he seemed to feed often, it turned out that he has a tounguetie, and she has a forceful let down, so he was getting predominantly foremilk (or something like that - she wasn't 100% sure of the reasoning anyway). He is now mix- fed and growing much much better. He did have a slightly swifter acceleration down the charts (was born on 50th and dropped to 0.4th by 10 weeks - he's now 15 weeks and back on the 9th I think, and gaining).

She found the referral to a paediatrician very useful - a second opinion which contradicted her HV helped her a lot. She hadn't noticed how thin her DS looked, but other people had, so having 2 people tell her he did need to bulk up a bit was good, although the HV had told her just to BF more, the paed was the one who recommended formula additions - and she now says she looks back at early pictures of DS and cries as he was so obviously thin. If your DD has dropped 2 centiles, no matter what chart is being used, it is standard to follow it up (I believe), so to put your mind at rest, it may be worth seeking a 2nd opinion from someone. Also, if you or your DP are petite, she may just be growing like you - the size a baby is at birth is not indicative of the size they will end up (I think)!

(I should also say here that my DS dropped a centile suddenly at 8 months, throwing me into a panic. Friends told me he was gaunt and ill looking, DP told me that going back to work had obviously stressed him, I was in tears thinking I'd harmed my baby. My HV told me to ditch the friends, give DP a slap, and just carry on as I was, as DS is clearly totally healthy, burning calories by crawling and cruising and getting suddenly longer, nothing for me to worry about. So not all HVs are bad!)

My dd started on the 50th (7lb 9) and at 16 weeks when she was last weighed (11lb 4) she had dropped to the 9th. That period around 4 months was very intense and she had a prolonged growth spurt. I just fed her whenever she squeaked.

She's now nearly 24 weeks and is doing really well. She's bulked out (not loads but people have stopped telling me how small she is and have started commenting on her belly). My doctor told me at 6 weeks that she was a beautiful healthy little baby and as long as she had wet nappies, was alert, sleeping etc to not worry and not get her weighed all the time. I weighed her at 16 weeks and I'm going back at 26, it has been very liberating!

Having said that dd2 was very slow gaining weight and by 4 months had dropped off the bottom of the charts, but with hindsight I didn't feed her on demand, I followed the advice of my bottle feeding peers and spaced her feeds out more. I look back at her photos at around that age and she looks awful, so this time I asked a very close friend (who had successfully breastfed) to tell me if dd3 showed any of those signs.

Fortunately due to my determination to feed her - all the time - she is a little chubby boob monster who is now showing interest in solids! It's really hard to know what to do for the best and really easy to slag off hv. They are not all bad, but there are some out there who are obsessed with charts and weights and don't see passed them.

It sounds like you are doing a fantastic job, my only advice to you would be to feed as often as your dc wants, your can't overfeed but you can underfeed. Having tried expressing I would say knock it on the head, it adds extra pressure and it's easier and more effective to bf. Offering a bottle may fill your dd up but it won't help your supply so you need to make your own decision on that one. There's nothing wrong with mix feeding, but don't do it just because someone else has told you to. If you feel like your supply is low in the evening the best way to boost it is to feed not miss a feed.

4 months is a quite intense time, but it's well worth the effort in my experience. Good luck xxx

My DD is similar to yours Hiccups - she was born at 7lbs 10, around about the 50th I think, and now at 3 months, she is quite small and following the 9th. The HVs haven't bothered me about it at all and seem to think it's perfectly all right. She's breastfed on demand but is very chilled out so perhaps doesn't ask quite enough?

Kveta, don't know how old yours is now so this might be moot, but my ebf baby did the same thing at 8-9 months (I think; wasn't weighed between 6 and 12, but you can see in the photos, she suddenly had cheekbones) when she started crawling. Happens very commonly when ebf babies get mobile. At her 12 month checkup she'd gone from 50% to 25%ile.

She's just had her 18 mo checkup and is back up to the 50%, despite seemingly living on air. So in case you were still worried, don't be!

HVs are dementors who suck your confidence. My baby was low on the charts - even the BF one, but then bucked up at around 4 months. And then I stopped getting her weighed! Best thing I ever did.

tiktok - I wasn't trying to impluy she should ignore her HV, I did sujest in my orginal post that if the dieatition was happy then maybe she should see a different HV.

I did find a difference with the groth charts with DD and was happy I had the WHO's version in my red book. It help keep my HV happy she still sujested early weaning though. This is only my experance of couse.

I had different advice from almost every HV I sour which was way why in the end I stoped going. It could be that some of them where giving really good advice but how was I supposed to know that. If they can't all sing from the same hym sheet then how do they expect us to have confidance in the advice they give. It could be the policy they have in our area doesn't help you just go to clinic and see which ever health visitors are there not a specific one each time. I only sour my assigned HV for specific age checks.

I think I'd seek a seconed opoin from another health prefersional if I was worried. Maybe talking to your GP about your contraception would be a good idea, there are other options you can try that are compatiable with BF.

But you do sound like your doing a great job and feeding on demand is deffiantly the best way to go.

tortoise - he's 9 months, got a checkup next week - I've stopped worrying about his calorie intake as he is CONSTANTLY on the go, and is even crawling in his sleep now (very cute until he hits the end of the cot with a 'thunk' and wakes himself up). His dad was tall and slim as a child, so we kind of expect the same from DS!!

thanks

The biggest indicator as to your child's health is that they seem well to you. I've been in the situation of worrying over comments made by one health visitor, and then different ones made by another, especially with my first child. All this 'good advice' really gets in the way of enjoying your baby.

If you think your baby's fine, that is the best indicator. You are feeding on demand. You think you are doing well. So go with that.

Less is more as far as advice is concerned. That's my advice anyway. Good luck to you and your baby.

tiktok I did notice a slight difference in the charts. DS was born on the 91st centile, then dropped down to 50th. THen he seemed to be hovering midway between 25th and 50th. When they started plotting his weight on the bf chart he showed as smack dab on the 50th. I think he weighed so much because of being very overdue, and the fact is DP and I are both small, so it's no surprise that DS dropped down the centiles. THey didn't take into account how overdue he was either when talking all this.

mrsthommo: kellymom, which I think is pretty good for advice, says that there might be something to the idea of the minipill affecting milk supply:
www.kellymom.com/health/meds/birthcontrol.html