12 week old slow weight gain but happy but HV sending me into mental spiral

[Emkitch]

Hi! We are EBF and never had pain but due to slow weight gain had tounge tie assessed and snipped at 8 weeks old. After this we had two good weigh ins as she had put on 160g two weeks in a row. HV due to come back 2 weeks later to weigh and if a good result hopefully discharge (this was today). But she had ‘only’ put on 200g over the two weeks. As a side not she is the most content baby and sleeps amazing with only one feed in the night. Poos usually once a day sometimes more.
so she is on the 9th centile and they did her length today for the first time and this is also on the 9th centile.

I was so excited to be discharged as it’s STRESS having the weigh ins but after today we can’t be because she’s not gained enough and they want us to top up with bottles (which is is literally just point blank refusing!)

looking for some reassurance. My gut says she would be unsettled if she was hungry and not happy but she is so happy- never falls asleep on the boob always pulls herself off. Surely they don’t ALL again within the average gains??! They aren’t robots.

help.

thank you. My first post on here so hope it’s in the right place and some of you can respond

xx

attached image of her weight chart

@StuntNun yeah this makes sense average is very different to normal and ‘not a cause for concern’ that’s a really good point.
this is sticking to the 9th isn’t it… attached a photo. (And the fact that her height centile is the same makes me think she’s just petite)
thank you

Personally I would give it a month and then have baby weighed again, to check she hasn't crossed the 2nd centile line. I'd also offer boob like mad during the day if she's not feeding much at night. That might all change as she has growth spurts anyway but it wouldn't do any harm!

How can an HV discharge you? They are an optional service.

If the baby is happy and growing I'd disengage. If you are at all concerned ask for a referral to a paediatrician for a professional clinical opinion. Pay for it if necessary.

I think that's what my DS did. I'll check his old red book tomorrow. He was totally fine, just small as you say. Now 8 and very average in his year I'd say.

My daughter (now 12) was on the 25th at birth, and was between the 2nd and the 9th by about 8 weeks. She never lost weight but was slow to gain. She’s now an incredibly active kid, while still on the small side, which absolutely tracks with DH’s family.

by 12 weeks she was feeding like your DC at night, and was sleeping 7-7 by 14 weeks. She was EBF until 6 months.

I’m not in healthcare but it does sound like we’d very similar babies!

https://www.rcpch.ac.uk/sites/default/files/Usingthegrowth_charts.pdf

My bff had similar stress from her hv - she was also exclusively pumping as she had difficulties with latch due to nipple probs and tongue tie that they refused to refer for. She was eventually referred to a neonatal dietician who took one look at her and her dh and discharged them - both are VERY slight and she's only weighed more than 8stone when pregnant.

Baby is gaining weight, consistently. I'd keep an eye on the overnight feeds (whilst also being grateful for the one 3am feed) but as pp said, check out the Norwegian chart. The red book chart is the WHO average for majority of babies.

What was the weight at the last measurement? From that chart it doesn't look like there's 200g difference between the last two measures. And they have dropped nearly a full percentile in the last 2 weeks. This will be why they have asked to continue the weigh ins.
To me the chart looks to be 4.4kg at 10 weeks and 4.5kg at 12 weeks. How do these compare with the actual weights. Poor plotting of weights can lead to unnecessary concern! If the latest weight is actually closer to the 9th percentile I would ask to push the appointment back by a couple of weeks to have a 4 week gap. If it is real that between 10 and 12 weeks that they have gone from almost 9th to almost 2nd I think I would still want the next check in 2 weeks time to be honest.
Is there a weigh in clinic that you could go to? Would that feel less pressured than having the weigh in at home?

I had a little person too she was born on the 25th dropped to the 9th. I had the opposite and told don't fret she is just a 9th percentile baby. I'm only 5ft2 and slim build. She wasn't a 9th percentile baby she was a 35th percentile baby with food allergies. Once I started cutting out food she was allergic to she moved up the percentiles. She's nearly 4 and tiny in height (1st-2nd percentile) but always a good weight (25-35th percentile).

Weight a crude stick but can be an indicator of issues. My sister was 6lb13 at birth and by 10 weeks was just 7lb10! She was weaned very early and was had an admission for refeeding. Looking at her with 2020s eyes she had a dairy allergy. 1980s eyes she's just a sickly baby that was slow growing. Now her slow weight gain would have been a huge flag for cmpa.

@Superscientist thsnk you so much for taking the time to reply. So I thought maybe it was plotted a bit low too… so he weight at 10 weeks was 4.380 and her weight at 12 weeks is 4.580 so that’s 200g in 2 weeks. I’ve just phoned the doctors to hopefully get booked in for another opinion

thanks

I've just plotted them on my daughters book using a ruler to measure and I think they have plotted the 10week one slightly high and the 12 week one slightly low which has made it look like weight gain is slowing as they have moved from the top of the 2nd-9th percentile to the bottom in 2 weeks.
Each box is 5mm so the 4.38kg is 3.8 mm up from the 4kg line and 4.58kg is 0.8mm up from the 4.5kg line. For me this places both in the middle of the 2nd-9th box.
You can see as well that she isn't much lower than my daughter. She was 4.7kg at 10 weeks but the 10week marker is actually at 4.9kg! I think HVers need to go back to year 9 and have some more lessons on plotting graphs!

On the rcpch website you can get the charts for neonates and slow growths. They have the graphs on a different scale and lines every 0.1kg rather than 0.5kg. I would download or print a copy and put all of the weights on that so you get a truer picture of how the weight on the charts is going

www.rcpch.ac.uk/resources/uk-who-growth-charts-neonatal-infant-close-monitoring-nicm

@Superscientist thank you so so much I’m going to do this now thank you

@Superscientist so I’ve print screened it and plotted her weights on up to yesterday let me know what you think… looks good to me…

The slightly off plot of yesterdays measure I think has sent the HV to panic stations. A baby dropping below the 2nd usually is a cause for concern but it looks like yours is just about hold the middle of 2nd-9th percentile. It probably warrants some continued monitoring to make sure they keep on this line but I would keep doing what you are doing and if you want to push the window towards 3-4 weeks checks I would do that to reduce the stress on you. Getting a once over by the GP wouldn't hurt but it does look they are small and following a line nicely

I questioned a paed friend on something similar when my son was little. Apparently birth weight is determined by nutrition in utero, but once the cord is cut and babies begin to feed then genetics takes over. So based on this, the fact that you are small and her growth chart, I wouldn't say there's an immediate concern if your gut is telling you she's fine.

It definitely can't hurt to have the GP have a look, and I'd be inclined to have a weigh in every month or so. But it could very easily just be her normal.

I was told that as well @UnravellingTheWorld my oldest was born on the 50th percentile but then dropped to just under the 9th and stayed there. He's 21 years old and 5'8" now so a couple of inches below the average height, just as you would expect.

I haven't read all the replies here but just wanted to say this was me this time last year.
we dropped down just over 2 centiles so automatically referred to paediatrician.
GP wasn't worried and said to carry on what I was doing (EBF) but I was so confused and felt like something was going wrong somewhere, should I introduce co- feeding etc. it took all my mental space for a few weeks and was upsetting! Lots of people commenting how small she was for age which added to the stress.
i decided to carry on EBF (I am small myself and my mum said I had similar comments as a baby)
had our appointment and she wasn't concerned at all, she was meeting all her milestones and happy & healthy which is a much better indicator overall than the centile charts.
Then we started weaning and a few months after had a follow up appointment. We had started to go back up the centiles up to the 50th! So discharged. She's still pretty diddy and gets comments about being petite but feel this is just how she is supposed to be for now. she was born on the 75th centile though so a big ish baby however this is just my placenta that makes bigger babies (3rd baby other two a good weight too) but it doesn't mean as a person she will continue being on the 75th, if that makes sense!!

sorry that was probably a little bit waffley but I have recently been thinking if I only I could go back and tell myself not to stress and all would be fine! Also still breast feeding at 17 months now! X

Thank you so much for your reply @Ilikeblueberries07 this is super reassuring. They are still wanting weekly weigh ins because she’s still in between centiles (9th and 2nd) born on the 25th. But she is SO content all the good nappies. The weigh ins are really getting me down and they keep telling me to do top ups but she won’t accept bottle anyway!! And I don’t want my supply affected. They have told me to do SNS feeding tube when feeding her. Did the HV’s just discharge you eventually because you got referred to the doctor? It’s been 9 weekly weigh ins now and I’m so done, she’s so content and still just put on 180g in 10 days.

This makes a lot of sense @UnravellingTheWorld shes just been weighed 2 weeks later and still on the same line. They are still pushing the weigh ins the top ups the pumping. I don’t think they’re going to stop tbh. I don’t know how long this can go on for. She’s gained 180g in 10 days which for a little baby is a good amount I think. She has all the right nappies. Feeds 2hourly all day and 3/4hourly at night. They’ve now told me to try an SNS feeding tube at my feeds because she won’t accept the bottle. I’m going to request fortnightly weigh ins because it’s just too much.

Please go and see your GP and ask for advice. You do not have to put up with this bullying by the HV. If your GP is happy - you can tell the HV that you no longer consent to visits or contact. If your GP is not happy - you then be referred. Either way, you will no longer have to see the HV.

Wow, some of the advice on this post is absolutely crazy and extremely judgement of health visitors in general when their role is to assess health and development in children and support mothers.
It sounds like some of you have had a bad experience with health visitors, but it doesn't mean they're all the same.
They're well experienced qualified nurses/midwives that have gone on to do extra training to be able to give advice in areas such as growth and breastfeeding, way more so than GP's unfortunately.

It is an optional service unless there's safeguarding reasons.
OP I would ask for a different HV if yours isn't able to relieve your anxieties or explain their reasoning for checking in on little one. You could make a plan together which may help you feel more comfortable.
Weight loss can be an indicator of many things such as cardiac issues or genetic problems and even safeguarding concerns but it can also be that baby is going naturally to their own centile where they will stay (hopefully your little one) but this is why weekly/fortnightly/monthly weights are sometimes needed.

I hope this helps to explain things a little better from where they may be coming from and why there's faltering growth pathways that need to be followed and I'm sorry a lot of you have had negative experiences with HV's.

@munchies30 interesting you say hv's are "well experienced". Mine was 23 so neither "well experienced" nor even experienced.

I was never persuaded that an HV with a nursing qual, very little nursing experience and a year's HV course, was more experienced than my GP. A Cambridge educated lady with full clinical training behind her, followed by 15 years in General Practice and three daughters. There was a significant difference in the quality of the advice from her lips than from those of my hv.

@Emkitch have you sought the advice of a doctor? You are under no obligation to keep going to the hv clinic for weighing . Have you actually asked your hv why she expects you to weigh weekly and what her actual concerns are? It sounds v stressful and 180gm doesn't sound bad either.

Also there can be a wide variation in weight if you have just fed your baby than if they are due a feed and have just filled a nappy with both wee and poo. It's worth thinking about.

Finally @Emkitch it shouldn't be about where the hv may be coming from. It should be about clear clinical reasons shared openly in a conversation that allows for discussion. If that is absent there is a problem and rather than being facilitated the op is dealing with opaque information that sounds close to gaslighting.

The NHS breastfeeding helpline were such a help to me when my HV sent me into a spin over something that was just a smidgen away from the average (I don't know what she thinks an average is).

Trust your instincts - if your baby is alert, happy, healthy, growing etc. then all is likely to be well. BUT the NHS breastfeeding helpline saved my sanity when I started doubting myself after an unfortunate HV visit. Their advice was so supportive and practical.

It was like my HV was trying to force me onto the bottle even though that wasn't the right path for me or DS. So glad I trusted my gut!

Trust your gut. You’re the expert on YOUR baby.

And regarding HV, my DD was born over the 99th percentile. After a couple of months she dropped to just over the 91st which was a ‘concern’. I did ask the HV when she would be expected to go down the percentiles as I wasn’t expecting a 6’4ft 200lb+ adult daughter when myself and DH are small + slim. She recommended going to the doctor.

I didn’t want to waste the NHS time with taking in a couple month old baby that looked like a sumo wrestler that was born wearing 3 month plus clothing.

The doctor eyeballed so hard at her check up due to HV ‘not able to use common sense’ and didn’t bother weighing her as she could see a happy baby.

Your baby wouldn’t be sleeping if she was hungry.

@RosesAndHellebores Not sure why you feel the need to pick at my post when all I was trying to do was inform op and others why there's sometimes clinical need for growth monitoring.
It's extremely rare to have a 23 year old HV when 4 years are needed at uni but obviously is doable. There will be others that have seen a GP for CMPA (GP no children of their own and newly qualified as a GP) be fobbed off and will get further assessment, support, advice and referral to a dietitian from a HV of 20 years. Again, just informing others of many cases I have heard of and not just 1 experience.
Also I am definitely under no illusion the huge qualification difference between a HV and a GP, there's no comparison in that. I was merely saying that with everything the GPs are asked to do, many are unable to attend breastfeeding courses and that it should be the bread and butter of health visiting support as WHO, breastfeeding network, NHS evidence, healthy child programme etc are so clear on the value of breastmilk.
I know the professional relationships in our area between GPs and HVs are very strong and they definitely respect that the guidance works both ways.