4mo checkup and questions about head circumference (LONG)

Mmm79

Warning: I think I ramble a lot here, but have to PNR to pick DH up at the train. 

Today was A's 4 month check up.  It was with a nurse practitioner at the practice rather than his pediatrician (who, so far, we love).  Anyway, it was just a complete let down for me.  The scale at the doctor's office is always off- it was off almost a pound and a half from the electronic one at the hospital at his 2 month appointment- so it says he's only weighing it at just over 11lbs.  Now that is a 3lb 4oz gains (per their scale) from his 2 month check up, but since he's already on the small side, I feel like every oz counts and based on clothing and diaper size, I swear this baby is 12 lbs!  He's also grown 3 inches (yay!), but of course is still below the 5th percentile for his age.  I know he was born early (and small at just 4.9lbs) but I feel kind of deflated hearing that.  yes, he's following an upward curve which is good, but still...and then there's his head.  It was 38cm at 2 months but has now jumped to 42cm, putting it in the 50th percentile.  they measured it 3 times to be sure.  Of course that kind of freaked me out, but they kept assuring me that with "no other factors" they're not worried.  Of course I came home and googled "baby big head" and all this stuff about hydrocephalus popped up which freaked me the f*ck out as my mom was diagnosed with hydrocephalus 2 years ago and has had a rapid decline (at just 64 years old).  Ugh. I called to talk to the pedi and am waiting to hear back. ANyone else with a baby with head cir much bigger in relation to height and weight?

Then, the NP doesn't seem at all interested in A's stellar STTN (7:30pm to 4am), nor his great head control nor the way he firmly plants his feet when you have him stand (all things my pedi usually checks). Nor how amazingly social he has gotten lately with big laughs and tons of smiles and babbling.  She didn't even ask about those things?!  Instead I heard about how A needs more time on his stomach flat on the ground no matter how much it makes him wail (we have been doing TT on DH and with a hoppy- still not something A loves, but in these positions he will tolerate it for short periods).  

Next, even after assuring me his weight gain is good (despite his small overall size), I am asked how big his bottles are at DC.  They're 3oz each which seems to satisfy him and we nurse when he's home. Plus as I understand it, BM increases in calorie count so 3oz now is a lot more dense than it was 4 weeks ago and it will just keep getting richer.  She wants me to bump it up to 4oz per bottle.  I mentioned that I am just getting to pumping 4 3oz bottles while at work (and that doesn't always come easy) and she starts pushing me to add a formula bottle a day.  I mentioned concern about milk supply if I supplement and she was all, "that's not a concern" which goes against everything I have read. Look, A's growth and development are the most important thing and if I have to increase bottle size I will, but I'll definitely turn to my freezer stash first. 

Anyway, feeling really defeated and down right now.  Thanks for letting me vent/whine.

 

martinimomma

Great advice in the prior posts.  Keep in mind, too, that your LO is "really" a month younger than his birth age (from your ticker it looks like he was a month early). So don't stress too much about where he falls on the curve, so long as he is on it. 

My DS' head has always been much higher on the scale than the rest of him - he was and is a skinny man, and had some odd molding to his noggin as he was frank breech for a while before delivery - so his head measurement percentile was always higher than the rest of him.  Now at 21 months, his latest stats are 25th percentile for height and weight, 75th for head. If everything else is on course with your LO, I'd step away from google on this one,as it will scare the bejeezus out of you. Head circ is one area where if the provider is concerned, I'd be concerned, and if not, not. 

((Hugs)) and stay the course, momma! 

ProfessorPedals825

Sorry you had a bad experience. I would definitely call the Pedi back for follow up. Big ((hugs))!

hopefulmom81

I am so sorry you are feeling defeated after your appointment

That NP seems to be a little pushy and misguided.

First of all, my DD is a big baby, but her head hit the 100th percentile quickly even before she started gaining weight and was on the smaller side.  I was totally freaked and googled big baby head and looked at images of hydrocephalus as well.  Totally normal for us moms, however, the nurses and doctors would say something if there was a concern on their end.  They don't keep secrets for many legal reasons.  I have found they are always "better safe than sorry", at least at the clinic I go to.  Do you and/or DH have large heads? 

I am guessing the NP is well-trained on tummy time, so that is something she mentions to every family regardless of the individual families' circumstances.  It sounds like she is just a "one size fits all" type of person.  I have had doctors like that before.  It sucks.

I am at a total loss as to why she wants you to increase bottle size and add formula.  DD was taking 3 4 oz bottles at daycare, so your LO is getting the exact same amount (am I reading that right?).  Why would you overfill your child?  If they are content and satisfied, that seems about what you should be shooting for.

Overall, very confused by the "advice" you were given.  I would follow up with my actual ped this week if I were you. 

Mmm79

Thanks, ladies . I missed the call from my pedi last night, but spoke to a nurse who was helpful and reassuring about the head thing. My pedi should be calling today , too.

On the bottles, I broke into my freezer stash and bumped today's bottles to 3.5 oz. I am definitely stressed about producing enough for A. Pumping at work is a lot harder than I thought it would be. I feel like I am barely getting the minimum 12 oz and some days trying to squeeze in 3 sessions is ridiculously hard. I feel like I am falling behind in my work as an hour and a half if the day is spent attached to a machine in a room w/out a computer. Plus one of my tubes went yesterday so while I wait on a replacement part, I have to pump one side at a time. And I feel like my PISA is not pulling enough milk out. And I have added a before bed pump, but that now cuts into my work catch up time in the evenings.

I appreciate the support. I think I'm having a really difficult time right now :

mork

DD has always had a huge head.  Her head has always been more than 50 percentiles bigger than her length. (That's a dumb sentence, but you get my meaning.)  Her weight is usually a little more than length, but nowhere near her head.  Anyway, around 4mo she was at about 25 for length, and 98 for head. Yikes! Then at 6mo, she was officially off the chart for her head.  Way WAY off the chart.  Her little dot is two inches above the top average curve.  That earned us a head ultrasound and an appointment with the neurologist.

Her ultrasound showed a perfectly "normal," yet large, head and brain.  The neurologist said she is doing and acting just as she should, and he isn't worried, although we will go in for checks about twice a year to keep an eye on it.  Actually, the neurologist said he wouldn't have ordered the u/s (our ped did, and we did it before the neuro appt) because she was doing so well.  Her huge head size is likely genetic.  I have a huge head, as do my brothers, nieces, and nephew.  Plus, my FIL has a huge head, so DD is getting it from both sides!

So, in the end we have a 9mo with a 3yo head.  Yes, her head is bigger than an average 3 year old's head!  The neuro said the only thing to expect is a few delays in the physical department that include holding the head up (crawling, walking, etc.).  Which makes sense, if you think about how they have to hold up and balance an extra big, extra heavy melon to do those things!  He said not to worry if she still isn't crawling at a year, nor walking at 18mo.

That's our experience.  Of course, everyone is different.  If your Mama instincts tell you to check it out, by all means, check it out.  I would also be sure to do so with an MD.  I may get flamed for this, but my personal experience both working in the medical world and personally are that DOs, PAs, NPs, and RNs are typically not as concerned, versed, or knowledgable.  There are exceptions (and there are really crappy MDs too), but for something that concerns you, I would make sure to see an MD.  Just my opinion.