Dear wise colleagues

I have permission to post.  I was asked to do a weight assessment by
the parents of a baby girl who had failed to thrive on exclusive
breastfeeding and then been placed on the child protection register
at 6 months of age. This is the worst case of FTT I've ever had
anything to do with.  But the parents had been diligent about
weighing her for her first 2 months and had been reassured that the
baby was fine and that breastfeeding was going well.  Based on this
reassurance the baby was not weighed again until 6 months of age,
when she was hospitalized suffering from marasmus.  There seems to be
a culture of infrequent weighing here in England, and parents are
actively discouraged from weighing often, so it's not hard to imagine
how this could have happened.  Also, I've found when working with
babies who are failing to thrive that often the parents, who are with
the baby every day, don't notice the baby becoming too thin.

It seems to me that the baby was _not_ doing well right from the
beginning, and that her inadequate weight gain seemed to have been
missed by all of the 5-6 HCPs who checked her during her first two
months of life.

The key weights are as follows:

birth          3940g      91st percentile on UK-WHO and WHO charts
5 days       3500       Lost 11% of birthweight
20 days     3850       Baby still under birthweight at 20 days, cause
for concern and investigation
31 days     3950       Baby 10g > birthweight at one month, ie now
only 88% of  normal weight for her age.
41 days     4060       Further low gain, ie now only 77% of
normal
67 days     4460       Baby now only 520g over birthweight, ie only
76% of normal weight for age.
6 mo         4250       Baby should now weigh at least 8890g. Now
weighs 47% of normal weight for age.

Everyone agrees that this baby was severely malnourished at 6
months.  But it seems clear to me from a close observation of this
baby's chart that she was already struggling almost from the
beginning.  At a recent CPS conference, however, the NHS
paediatrician disagreed with my conclusions that this baby was
already failing to thrive, ie dropping down the centiles (from 91st
at birth to 25th by 9 weeks and that an intervention in the early
weeks would have been appropriate.. He contends that she was gaining
sufficient weight.  So I'm looking for more back-up from any journal
articles or scholarly texts (or even your own professional opinions)
that I can share with the parents as they struggle to prove to CPS
that they had their daughter's best interests at heart and did not
deliberately neglect her.

What do you think?  Can you share with me any refs that would support
the opinion that she was gaining inadequate weight even in the early weeks?

Many thanks if you can help.

Pamela Morrison IBCLC
Rustington, England


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