Any HV OR drs about... Baby off the chart!

[LadyMedea]

I am worried about my friends baby. I am mostly worried because he hasn't seen a health professional since he was about 3.5 months old (and not been officially weighed since 10 days) so there is no one who is qualified to comment professionally as to whether his mum (or I) should be worried.

He is 6 months old and approx 15kg. Looking in my red book 10.5kg is 99th centile for 6 months. So he is now nearly 50% heavier than a top weight baby of that age. He has been exclusively breastfed and is only just being slowly introduced to solids so there is no explanation from his diet.

I understand growth charts, they are created from data on healthy babies, so anywhere on the charts is normally fine for a baby. But I know it's worrying when babies fall off the bottom of the charts, so isn't it equally worrying when they head so far off the top of the charts? 15kg is 99th centile for an 18 month old!

My friend is not worried, but I am. What if he is one of those rare babies with a metabolic or endocrine condition? Any medical professionals out there, would you be worried if you saw a baby so far off the charts?

That does sound huge then - she does need a trip to see a hv
My next suggestion would be try a different set of scales though....
(I know my scales at home definitely weigh heavy - no way do I weigh that much )

That's a massively overweight baby. I think the incredulous reaction you're getting here is telling you everything you need to know. If you can get your friend to the HV all well and good, but they'll just send her straight to the GP. She really needs to get him checked out. If she won't, I'm afraid in all fairness to the baby I think you should mention your concerns to the HV yourself.

Never mind health visitor He needs to see a doctor He could have something very wrong with him if he is that big on just breast milk.it really is very important that it's checked properly by a doctor.

By any chance do you have a photo that you could obscure the face and post on here safely?

And do you know what centile he was on when he was born?

And are we right to assume normal pregnancy?

What build are his parents, and extended family members? Any relevant health conditions you are aware of in the family?

I was worried about a large baby about the same age, when his mum came to a stay and play clinic I was working at. Turned out his father was 6'4" and his uncle was 6'7". Cant remember his presenting weight, but same scenario in terms of ebf and a whopper. Mum was petite though, and he was on 25th centile, hence my concern before I got more info from Mum.

How mobile is he? I guess not much when he is that size, but quite often babies go back down centiles around this age due to increased rolling or crawling. But 15kg does seem a lot of centiles to drop.

If I was you, and knew which gp he is registered at, I would contact the health visiting team to express your concerns. They could do a home visit, under the guise of 'we haven't seen you and just want to see if there is any part of our service we can offer you' type thing. He should be due a developmental review at 8 months but I don't think I would leave it that long.

Do you know her hv? Could you have a word and maybe suggest she pops in for a visit?

We don't get any reviews here. Last time my dd2 saw any sort of hcp (excluding the practice nurse for vaccs) was at her post natal check at 6 weeks old. Last time we saw a hv I was 38 weeks pg.

I had a letter at some point inviting me to fill in an internet questionnaire in lieu of a hv check. I didn't bother.

Dd is now 6. So I wouldn't rely on it being picked up at "routine" checks...

I think Bessie may be right in that the hv will only be able to advise her to go to the gp, but calling the hv team would be an easier way of getting the situation recognised and medical intervention for the baby.

How does Mum talk about his size? Is she worried or perhaps quite proud of what a good job she has done breastfeeding him to this size? Quite often cultural or generational/extended family opinion influences can affect what people perceive as a healthy weight.

15kg! Hasn't anything been flagged when he's had his jabs. Why won't his mum take him to the HV. I know it isn't compulsory but it's pretty normal to go every so often.

Your description does indeed seem that his weight is about 15kg. Thanks for clarifying.

Please tell your friend to urgently see her GP. If she won't or is not taking it seriously, tell her in very clear terms that there can be endocrine or genetic causes for this that need investigation. Obesity at that level can put strain on his heart and increase the risk of obstructive sleep apnoea. The baby is EBF so it's likely the GP will want to refer him to a paediatrician for investigation.

If that doesn't work, take matters into your own hands and phone the HV. If there's nothing wrong it won't have done any harm. Perhaps it's become so normal to her she simply can't see the problem, harm and risks.

You're very right to be worried.

Right, I have no recent photos I'm afraid but I've uploaded a photo of him at 9 weeks old to my photos. That is him in a 6-9month sleepsuit (leant by me) If I remember rightly he was heavier at 11 weeks than my DS was at 23 weeks (6.7kg checking my red book). Again approximate weights for this baby as his was done at home.

To answer procrastinators questions.

Mum is maybe 5ft 8, dad about 5ft 10. Both normal build. I've met one set of grandparents and a sister, none particularly out of the ordinary. Normal pregnancy as far as I know. Was a home birth. I don't know how much he weighed at birth but when I first met him he looked like an average newborn, then by about 5 weeks, after a gap of about 10 days in seeing him, he suddenly had five chins and had busted out of his newborn sleepsuits and was filling his 0-3 months.

He is just sitting but still toppling over. I've barely seen him move. Not really even his arms. I gave him some toy links today and he could move them about a bit. But obviously his movement is highly restricted by the size of his limbs.

I've been worried for a while, but had hoped that his weight gain would slow down naturally as he got older. And it's a really, really difficult thing to discuss with her. I openly asked her if she was worried today and she said not as she knew other big babies who had grown out of it. The thing his he would not have to gain weight for a year to bring him back to the 99th centile line.

She is a lovely mum, very intelligent but not very knowledgeable about things baby, and not interested in finding out. I have no idea why she hasn't had him weighed but she is quite anti-establishment generally. I mentioned my concerns to the hv when I had Ds weighed but I think I'm going to have to go to them properly.

I think your first step should really be to lay out to the mum that his weight is extreme, he could be ill, and you are seriously worried.

It's sad if he can't move his arms etc well. I think more formal 'mentioning' to a HV wouldn't be a bad plan.

I think I've been in denial. Until she told me what he weighed today (I was guessing around 12kg which was enough to worry me) and looked in the red book and saw how far out he is I just wanted to pretend it wasn't as bad as it was.

Everyone I've introduced to her has come to me afterwards and asked me about it.

She is very strong minded but I'm going to ask her if she'll cone to baby clinic with me. She'll probably say no and if that's the case I'll call the HV team.

I can't understand how this has been missed. Does she not vaccinate either? Does her DS never get sick and need to see a GP?

That sounds like a good plan Lady, given your answers to my questions.
I can't see your photos, haven't played around with the new format enough yet, I think.

Could you entice her to go for reason other than getting him weighed, if you don't feel able to broach the subject. Eg to meet other mums if she has previously mentioned that she doesn't know many or to get her out of the house etc. I would probably even invent a really weird person who goes every week, in a come along and see what I am on about kind of way.

Ultimately, there is something clearly amiss, and while it may be an awkward conversation, or even potentially feel a bit wrong to contact hv, you could be doing something to save this little boys life, due to the potential causes and consequences of his unexplained weight gain. She may not thank you now, but perhaps one day she will.

An update on the outcome would be really appreciated if you got the chance.

I was frankly amazed that it wasn't mentioned at his jabs or when he last saw the dr at about 16 weeks (he had spectacular nappies for a while). But then I guess they'd assumed he was being weighed at clinic, I've also found HPs can focus on the job at hand rather than necessarily looking at the whole picture (they are ridiculously busy after all). He hasn't had any contact at all since 16 weeks. I think there is also the assumption that as he is breastfed it must be ok.

You are right to be taking action. I hope it is accepted in the spirt intended

Allisgood,
I do vaccination clinics. We have five mins for each child during which we have to draw up the imms and go through the child's records on the computer for relevant information before the patient comes into the room. Once in the room we have inform the (usually) parent about which imms are being given, the possible side effects, go through a consent form and administer the imms. Obviously it is polite to say hello, how is it all going etc, all this needs to be done in five mins. Most parents also want to ask a question about something else while in the room, ranging from a rash, to teething, sleep, etc. Only sometimes is it appropriate to say not now, eg, I would never not check a rash. We also look out for maternal mental health during these appts. And quite often, a quick chat can save an hour appt to do a home visit. Staff shortages in my team mean every hour counts. My most common reaction to chunky thighs is 'ooh I love a rugby player type thigh for imms' I love the bustle of an imms clinic, a huge sense of achievement at the end, but it only takes one 'quick query' or an unclear history of imms, to upset the while flow of the clinic, leading to frustrated parents complaing about how late the clinic is running. However, they feel they are entitled to ask 10 questions during their appt. I am not moaning, but I had my babies before I did this job and had no idea of the time pressure during an imms clinic. I honestly thought it was an opportunity to also ask any questions i may have and generally have other people admire my beautiful precious 1st, 2nd, and 3rd born.

In this scenario I would def have a discrete look at his centile chart and query it with mum. But if she has brushed it aside there really isn't much we could do. It is also possible that at four months he would have been chunky rather than seriously concerning, ( he would not have been seen at imms clinic since 4 months of age,) OP said he has grown exponentially so it may not have been quite so obvious or alarming at 4 months.

Sorry, cross post and so many typos...time for bed. Good luck op, and I agree with Isabeller, I really hope it is accepted with good grace.

I've had a look at your photo OP and it is difficult to tell at that age, but if that is a 6-9 month baby grow then that baby looks to be the same size as my 5.5 month old who is also filling 6-9 month clothes and is over 8kg (75th centile).

Your friend could find herself in trouble with social services if she's not careful. She's ignoring the signs that her baby has a problem and is not engaging with health care professionals. That is very worrying.

My 16 month DS is quite a hefty fellow. Every who meets him comments on his size. He's currently 12.5 kg. But his dad is 6 ft 3 so he was never going to be a tiny tot. Even so I still take him to get weighed regularly for proper monitoring because i know he's pushing the limits.

My 6 month old is around 8kg at between the 50th and 75th percentile and I worry about if he's eating too much! At that age he should be able to do a lot, and it sounds really worrying he can't really move his arms. Sleep appnia (I know that's spelt wrong!) must definitely be a real possibility.

I think you really need to have an honest conversation with her about the whole thing, she could be in denial and that's why she's not going to the clinic. If she refuses to discuss it or go to the health visitor, you need to call them yourself. If anything happened to him, you would never forgive yourself.

Decided to email my friend....

Dear Xxx,

This is a bit of a tricky email to write, but I really, really care a lot about you and Xxx so I'm going to write it anyway. I really hope you take this as coming from a place of love and immense respect for you.

I think you do a marvellous job looking after Xxx and I can see you love him more than anything. I know you aren't worried about his weight, but I need to be honest - I really am worried.

When I got home on Thursday I checked the growth charts in the red book. They are based on normal growth in healthy breastfed babies. If the scales you used are right and he is now around 15kg that puts him completely off the charts. A 99th centile baby boy at 6 months is 10.5kg. So he is nearly 50% heavier than the biggest healthy babies of his age. For Xxx to get back on the charts he would have to gain no weight between now and 18 months (15kg is 99th centile for an 18 month old).

I really, really hope there is nothing wrong. But the only way to know for sure is to get professional advice. I really want to encourage you to get him weighed and ask the health visitors about it at a baby clinic. I've been to the ones at Xxxxx which are Tuesday and Thursday afternoons 2.15pm to 4pm. You just turn up and take a number. If you want company, I'll be there with you.

Now I've written this, I promise I won't mention it again unless you bring it up.

I hope we can carry on being friends as I've so enjoyed spending time with you these last few months.

Lots of love,

Fingers crossed. Meep!

Does sound large especially as he isn't tall and so definitely worth getting it checked out. You are a good friend and I thought your email lovely, I hope your friend will take it well and see that you want to do the best for them both.

For info, and to provide another perspective about a large baby, both my two boys have been off the chart huge in weight - although not as large as your friend's baby. My DS1 was 12.6kg on the day he turned 7 months which put him 1.5kg above the 99.6th centile. We actually had him weighed in hospital that day (admitted as an emergency with croup) and saw lots of healthcare professionals as I did go regularly to get him weighed at HV. Everyone just congratulated me on a big baby (again, he was EBF) and said you couldn't overfeed a breastfed baby. BUT in my case both boys were also on or above 99.6th centile for height. Ds1 in particular was like a little sumo wrestler with 3 double chins and rolls of fat everywhere, so I can imagine that your friend's baby does look like a little ball. Neither DH nor I are huge (DH is 5'11) so not sure why both boys have been so large .

Hope all checks out OK. If no underlying issues are found, and I sincerely hope there won't be, he will probably start slowing down soon. My DS1 peaked at 13kg at 9 months just before he started to crawl, and his weight stayed as a steady line till at least 18 months, he gradually dropped down the centiles for weight and is now between 75th and 91st (18kg at nearly 4). However he was a PITA to wean onto solids as he was not remotely hungry and he survived on a couple of breastfeeds a day till well after one, refusing all attempts to introduce solids, only trying everything once (for novelty and to show that he could) and then not eating it ever again.

Delurking to say well done that's a lovely email and really well written. Fingers crossed she takes it as it is intended