Are health visitors not allowed to give nuanced advice?

[TeaAndMuffins]

I've noticed that when you ask HVs for any advice around sleep or feeding, they just repeat the same official blanket advice. I.e. feed on demand, sleep on demand. No sleep training in any form until age 1. And when I ask anything about timing feeds to facilitate better naps, or sleeping better at night, or encourage more efficient feeds with longer gaps in between, they just say something like "babies like to eat like us - sometimes they want a snack, sometimes a big meal". Every single time. I can't get any nuanced advice out of them at all. They just parrot the official NHS advice and refuse to tailor it in any way to your situation.
Was health visiting always like this? I have relatives who were HVs in the 80s and they always give me a really wide variety of in-depth, nuanced advice. But HVs now just sound like they're reading from a script. It's like they're just aiming the advice at the lowest common denominator of intelligence and are scared that any nuance runs the risk of babies being starved or neglected.

My dc were all born between 2000 and 2010. The vast majority of HVs have generic advice. It felt like lowest common denominator advice: one thing that can be said to all mothers, with no consideration of individual circumstances, knowledge, experience or intelligence. You're right - no nuance.

With the exception of one HV. She was absolutely amazing. An experienced nurse, and a mother herself. When dc2 approached 4m she started talking about weaning. I told her I was planning to do BLW at 6m. HV was sceptical, but went and researched it, and then contacted me to thank me for keeping her up-to-date on latest research.

I've had some clangers from HVs over the years but I think feed and sleep on demand is good advice.

When I had my DCs in the 90s the advice I got from HVs was bizarre....
Don't breastfeed - I won't know how much milk they're getting
She has to get used to sleeping on her own - move the cot to her own room (6 weeks)
Baby rice with a bit of milk and sugar at 12 weeks
Brown sugar in water will help constipation (breast fed baby only pooed once a week- wasn't constipated)

Maybe it's a good thing they stick to guidelines now!

If you have questions you are better asking parents with similar aged children either in real life or here. If you asked what I did with my teens when they were babies I would only have a fuzzy recollection. Health visitors also do have to tow the party line in general.

I don't think it's neglectful to try and time a baby's naps and feeds so that they go down well in the evenings - I make sure my baby has napped enough during the day so that they can stay awake between 5pm and 7pm, and therefore have a proper bedtime that gives me a free evening. This isn't "sleep on demand", but it doesn't feel cruel or neglectful at all. Everyone, the baby included, is happier for it. Why can't a HV give advice such as that?

People often think they're seeing a HV, but qualified HVs are in short supply and most of the routine work is done by support workers, staff nurses and nursery nurses. HV's have to manage the team and focus on child protection.
This isn't always made clear and I wonder if it's deliberate so people will assume they're fully qualified. A friend had a baby recently and she was phoned by someone who announced herself as "xxxx from health visiting at xxx clinic" an appointment was made for the first visit. Name badge just gave her name and Health Visiting Team.
Took a while for friend to find out that this person was a health care support worker, as she wasn't a trained HV she'd have been "working from a script" and only able to help with the basics.

I think 'naunced advice' can range hugely and get them into trouble if they're found out to be telling people essentially their own opinions rather than what's supported by the NHS. E.g - one MW might personally recommend CIO and another cosleeping.

I'm sure some HVs don't care and will give this kind of advice but most won't.

I wonder why there can't just be a wider pool of official advice. It feels like all their training on sleep training is simply "don't do it". Surely it's better to have some proper advice about the pros and cons of different methods rather than a blanket "don't do it under any circumstances".

My DDs each had a different health visitor, plus I saw two that used to run a breastfeeding group pretty regularly, and they all did give individual, more nuanced advice if asked. However, I'm in Scotland, so possibly the guidelines are a bit different. I've also noted that whoever does the hiring locally seems to value pragmatism, which no doubt helps!

My experience a few years back was that there didn't seem to be any consistency to their advice and I would have welcomed the newer approach.

The lowest common denominator thing definitely put me off too. Having a new baby is hard enough without everyone then speaking to you as if you are a simpleton

In my personal experience, the HV advice was basically just what they thought worked for them. There didn’t seem to be a standard approach. Our HV team was generally pro safe co-sleeping. That was a Trust policy though. Our red books had a whole co-sleeping section they had developed. Otherwise, it was pretty much just their opinion and how evidence based it actually was varied tremendously depending on who you got on a given day.

It sounds like what you’re actually asking is why couldn’t the HV say you should do the things that you think worked for you. I think the answer to that is that there is no one approach that works well for everyone. There are definitely bad, dangerous, neglectful things that no one should be recommending.

But then there are approaches like you are describing that are quite regimented. Great it worked for you. But they can’t recommend it as a blanket approach because it wouldn’t work for everyone. My babies would not have suited a strict routine, they all slept in wraps on me as I went about my day, literally ate and slept when they wanted, and I had no trouble getting them to bed and having the evening to myself.

But HV’s aren’t sleep consultants or nutritionists or any other sort of expert. They are primarily there to support infant and early years development and flag safeguarding concerns. If you want parenting advice, you have to find it for free online or pay someone to provide it, like sleep consultants or night nurses or similar sorts. It’s just outside the scope of what they are able to do. They are mostly about keeping babies and children safe and healthy, not supporting parents.

I agree OP. My brain doesn't compute feed on demand / sleep on demand and it twisted my head when HCP would trot that out at me. It irritated me they couldn't answer a direct question! Heaven forbid you as for FF advice too as it was always BF by default which I would love to have done however my milk didn't come in.

After a lot of self research which was challenging when trying to navigate being a new mum and also health issues following pregnancy (physical and mental) I found taking Cara babies useful as a guide for feed / sleep routine - didn't pay for the paid content just used the guides that are free.

We also loosely took into account the 2,3,4 routine in younger days when DD was on 2 naps.

Must be doing something right for DD as she's thriving and in a good routine 🤞🏻

Currently in the trenches with food stage and that's frying my head off my shoulders!!

They're public health nurses, they give health advice not parenting advice.

You're not going to get bespoke professional parenting advice unless you pay for it.

You'd be better off asking friends, parenting sites or reading books if you want opinions about naps and feeding routines.

I agree in a way OP. As a first time mum I was overwhelmed by all the online information about wake windows/sleep training/schedules, and when all the HV said was feed and sleep on demand, that didn't translate to my problems, which were how to know if I needed to make up a bottle, bearing in mind I was exclusively pumping so had to organise that to be at the same time, and how to get my baby to sleep. He didn't fall asleep feeding, he didn't fall asleep rocking, he actually wanted to be put down and left alone. Until 7 months, when he didn't, and suddenly needed the opposite of intense support. I was totally shell shocked and didn't know where to turn, and all the online blogs, Instagram, and websites told me their method was the answer. Because I heard nothing to the contrary, I followed it. Then months later when I'd realised bed sharing and going with the flow actually worked much better, I finally understood what the official HV line of on demand meant. It meant what I did with my second, which was to let go of the control and worry less about what baby did when, trusting it would all work out ok. It did. But why oh why couldn't the HV have explained all that to me? I try to share my learning with struggling new mums at baby groups etc, only if they ask of course, because I feel so annoyed that I had to learn the hard way.

I would rather the HV relays the evidence based NHS guidance than their own individual opinion; I had plenty of contradictory advice from medical professionals when my son was born, but at least the HV were in agreement about the rules for safe sleeping / feeding etc

I’d agree they seem to be parrotting from a script though and not in any way ‘reading the room’. Our HV asked us if we were aware of female genital mutilation and that it was illegal/reportable… despite knowing we are an atheist British family, my husband is a police officer, and we were having a boy.