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 --- This email is free from viruses and malware because avast! Antivirus protection is active. http://www.avast.com *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome