7month old dropped off the growth chart - what happens next?

[iloveteacakes]

DD was only 5lb 2 when she was born so has never been big. She at one point reached the 2nd centile but has generally bumped along the bottom of the graph.

About 7 weeks ago she fell off the bottom and has stayed there, still gaining but slightly underneath the graph. The first health visitor said not to worry and come back in three weeks. The second one (three weeks later) said the same. Then, today, the third health visitor said to make an appointment with my own health visitor and that they would probably refer us to dietician or a paediatrician.

Has anyone else had this experience? What happened? I am going to see my health visitor on Thursday so I want to be prepared. Are there any questions I should ask?

I expect that if DD is gaining weight steadily, active and looks well, then they'll prob just keep an eye on her.

Thats not much of a dip- different if she was on say the 25th and dropped down 2 or 3 centiles.

HV may ask about feeding and solids. May offer some info on higher calorie snacks.They may offer referral to dietician.

I would think your DD is probably going through a phase of being more active, sitting and moving more. Very common in her age group for weight gain to even out. It just happens that she has very slightly gone under the charts- she will probably move back up again, just needs an eye kept out for further drifting away from the centile.

I agree with Fleegle above. Am a HV and tbh if I saw a baby who had just dipped under the lowest line but was otherwise following it (even beneath) I wouldn't be overly concerned unless the Mum had other worries about her baby.

Often we refer because our protocol says we have to if a baby drops below a certain line but we can use common sense about it too. No sense in referring a baby to a dietitican for high cals food lists if the baby is happily just below the 0.4th centile. Why force a baby onto a line she doesn't want to follow?

im so glad that sum1 else has asked this question, my little girl was tiny at birth (5pounds 8ounces) she is nearly six months old now but have just been fretting about her weight. thing is, she is putting weight on steadily, she is very active so would say do not worry too much as every baby is different and these charts do not take that into account. if baby seems happy, putting on weight steadily on the whole then as 'fleegle' rightly says keep an eye try not to obsess, i have kinda learnt that as mine will generally be smaller than these charts suggest she should be. hope this helps.

I had very similar to this with DD. This is what happened to me, if you don't mind me saying.

DD was born weighing 5lbs. She was perfectly healthy, happy, nothing at all wrong. Just small. She was just on the bottom centile of a 1960s based formula fed baby chart. She dropped a little, and was off the charts. Teh HV raised concerns about this. At around 4 months, despite us attempting to top DD up with formula at the insistence of the HV, DD continued to stay just under the line, refused a bottle. She met all her milestones, she rolled early at just over 3 months, she was a very happy and content baby. Guidelines then were to wean at 6months and HV said we had to stick to that (new parents did what we were told, at that point). At just over 4 months, she was under the chart and had dropped a slight amount, and the HV told us she was 'failing to thrive' and that we had to give it 2 weeks, then to the gp for referral to a dietician.

We said we would not wait for 2 weeks if our baby was failing to thrive and we went to see the gp the following morning. He checked DD over thoroughly and said, even before checking her, he was not concerned at all, the HV was being overly cautious and in his opinion there was nothing to worry about. he only checked her over as in her belly etc to satisfy to us she was ok.

We saw a different HV who was a locum the following week and she said to me 'pavlov, do not stress about this, your DD is growing wonderfully, she is a small baby, with small parents and she will grow up to be a small child and a small adult. Worrying and force feeding her bottles will not change her'. I stopped going to the HV after that (as the locum was not there after that week).

We weaned DD at 5.5 months and she ate like a horse, and still does. But she never went up her charts any faster. At her 8 month check the only time we saw the HV again, her weight was still under the charts, and we were not bothered at all. At 19 months she weighed 21lb. She is now 3.8, pretty much on target weight wise, with size 3-4 tops and 2-3 bottoms as she has short legs. She is skinny and eats tons.

I never felt like such a shit parent than when the HV told us she was failing to thrive. And it was so not true, and completey unfounded and unnecessary.

Sorry, that did not answer your question about what to ask, but i just thought you might like to hear that it is not always something bad, just is how your LO is, a petite baby.

Thank you for all the responses. DD does seem happy and healthy, just little. Pavlov, 'failure to thrive' is such a horrible term, isn't it? Your experience sounds like ours until now. Let's hope the HV and GP are as reassuring!

I think the best thing I can say is whatever happens and is said or suggested do not for one second think it is anything you are doing wrong. I felt that it was all my fault, my milk was blamed, the fact she was not taking formula topups was blamed and it was in fact nothing to do with my milk whatsoever and we spend endless nights trying to get her to take a bottle, so stressful. And do not get pushed into doing something you feel is not right. If you do get referred to a paed, make sure it is known that you do not think there is a problem, although I think we would have taken DD if the GP told us we should, just to satisfy us and them that we were doing all we could and she was actually ok.

Also, a close friend of mine has a DD aged 18 months who is only 18lb, just. She was formula fed, and loves her food, she is walking, just about to talk (been walking since just over a year) and has dropped rapidly from her place on 25th centile to under the charts. She did see the paed as her mother is diabetic so they needed to make sure there were no underlying reasons and all was fine. Then recently she had not put on weight for a while (2lb in 6 months) and they said two weeks and if nothing, back to paed, she put on 1lb so they have said they won't refer. Friend is not concerned at all now, as paeds have done the full tests to make sure there is nothing serious and so she knows her DD is developing fine. She is small, and gorgeous! Just thought I would give you another positive story.

I really hope you get something positive from the visit from now and onwards.

The story Pavlov has written is very similar to that with my own ds2.

Born on 9th centile, grew nicely till 4 months (bf), then stopped gaining weight. Gained only 3 oz in the following 8 weeks and dropped to the 0.4th centile. Took him to the GP and got referral to dietician and paediatrician (which took a further 8 weeks to come through! . The paediatrician did all the standard tests, nothing showed up. Dietician was as much use as a chocolate teapot. Anyway, he is now 22 months and just under 21 lbs. We are starting to worry a bit again now as he has only gained 1 lb in the last 6 months or so and has started to develop what I can only describe as most probably a food-phobia. I blame how the whole thing was handled and the pressure to get him to eat on his current attitude towards food.

I should also add that our HV blamed his lack of weight gain on the fact that he wasn't eating 3 meals per day at 26 weeks old . That along with comments like "if I've ever seen a baby who could use a few more calories, he is it".

So, anyway, what I wanted to say is try not to let it stress you too much. Unfortunately for us (and ds2), the whole episode has affected the health of the whole family in terms of stress etc and has ultimately overshadowed our enjoyment of his babyhood.

I should also add, I recently plotted ds2's weight gain on the new breastfed baby charts (which were not used when he was born). Although he has dropped on those charts, he never dropped anywhere near as much as on the old charts (he went from the 9th to the 2nd centile on the new charts). I wish we had seen his growth on these charts at the time. It might have caused us much less stress and created far fewer problems now.

Good luck to your appointment.

Unseen I second that about the BF charts for BF babies. My HV said they did not exist, the locum HV said they did and that DD would be well within the chart for a BF baby. She also said that many babies drop weight as they grow, as they often fill the space provided by mum in the womb rather than the size they will 'become' so big babies can slow down in weight, and small babies can put on weight at a much greater weight, and all the variations in between. I would not worry much about slow gowth at this age. Your little boy is going to be very active at 22 months, and will be using lots and lots of calories developing his walking skills (or learning to walk skills), and mental development, working on speech and understanding. After 8 months, I never saw a HV again until DS now, and he is 4 months, I only go once a month just for my own curiosity. Also lots of children go through not wanting to eat any food stages, he might just be too busy to eat? Things to do? Do you feed him, or let him feed himself? Might be wort putting down some simple food on a plate and just offering it and let him do what he wants with it? children rarely starve themselves so try not to worry (easier said than done).

Pavlov, thanks.

Very similar experience to Unseen. Ds1 was 6 lbs born at 35 weeks, but consistently failed to put on much weight, and we generally bumped along the bottom of the centiles (o.2 rings a bell).

Got referred to a paediatrician who did bugger all tbh. Dietician was pleasant but her advice (things like add full fat cream to his food) just meant he ate less of the same food. So it was either one whole yoghurt eaten, or add cream and he'd only eat half! The only food he ever really enjoyed were his breastfeeds (carried on for 18m).

In the end, after some fairly sinister talk from the paed about growth hormones (no thanks) we just gave up on the worry and left him to it.

He's now 7 and while still on the small side he's slowly crept up and is now on the 9th centile. What's more, you couldn't meet a healthier child - he's got a cough at the minute, but barely ever ill. He still has little interest in food, but is perfectly healthy, and we've reached the view that there are worse things in life than being petite!

We had a big celebration today because DT2, at 27 weeks, finally crossed the 0.4 centile line!!

He was 5lbs 6 at birth, has been bumping along under the 0.4th (off the bottom of the chart) since birth. Thanks to a brill bf supporter and HV, I didn't panic (though I felt like it, at times) (though now I admit to being chuffed he has finally started going up the chart a bit).

But what I'm trying to say is - some babies will be under the 0.4th line (3 in 1000, I guess). As long as the drop isn't drastic or sustained, try not to worry - you just have a small baby.

DD was born on about the 25th centile and gradually wavered down until she was at about the 2nd percentile by the time she was 8 months. HVs went crazy, I kept saying 'But I wasn't anywhere near the 2nd percentile on any of those charts (they go up to age 20) until I was heavily pregnant! And her father weighs 9 stone and he's a man! And anyway, just look at her. She's fine.' etc etc.

Was threatened with paediatrician, dietician etc, and started to worry although in my heart of hearts I really thought she was all right. Eventually I took her to our very sensible GP who talked to her, examined her and said 'she's perfectly okay, she just takes after you and is a bit skinny'. So I stopped worrying and never went back to the HV, not even for developmental checks. She's now 3 and a half and way off the bottom of the charts (she weighs about 26lb) but she's fine. She's healthy and full of energy and wears me out every day with her bouncing. The only downside to it all is that she is bloody hard to buy clothes for as she has the leg length of a four year old and the waist measurement of about a one year old. I'm getting good at altering trousers.

A quick update- we went along to the HV who weighed and measured dd and agreed that although small, dd seems absolutely fine. I am going back again in a month but that is for me as much as anything. Thank you again for all the replies- it helped me feel more confident going into the HV which meant we had a much more useful appointment as I didn't just feel on the defensive. So I will just see how her weight goes and enjoy having such a cute lo!

Good news