Centile Charts and Weight are Being Used Against Babies with Reflux

If you work in the area of health and wellbeing looking after babies and kids in your community, look away now! I hate infant centile charts. There, I said it. Based on my experience, allow me to make a sweeping generalisation: Centile charts are not the be-all and end-all.

If there is one message to parents, especially new parents, that I’d like you to take away from me, it is this:

Trust yourself.

One of the biggest complaints I often hear about is that if the baby is putting on weight, the baby is fine, or the baby cannot have reflux. Centile charts are used to beat parents into submission, to tell parents that they are paranoid and to undermine their gut instincts.

In addition, centile charts are used to scare parents into not trusting themselves. If the baby's centile line switches, health visitors raise an eyebrow. This was my personal experience; they told me I should be prepared to supplement my daughter with formula because she dropped a centile line.

My Issue with Using Centile Charts in Supporting Babies with Reflux

The problem I have with centile charts is not about measuring a baby's weight, progress or health; it’s about health visitors and parents' confidence.

I trust that the health visitor believes they are acting in the baby's best interests, but they are generally following a ”rulebook” and applying rules where none (or at least simpler ones) should apply.

But NO BABY has EVER followed a "RULE".

In reverse, if a baby is gaining weight, parents are told by health visitors, public health nurses, doctors and paediatricians that "baby cannot have reflux because they are gaining weight".

WRONG.

I don’t think that health professionals comprehend the severe impact their words have on parents at the most vulnerable time of their lives. This is gaslighting, and I believe it is unintentional.

Parents are not allowed to trust their own instincts that their screaming, unhappy baby is in pain.

Not only are parents exhausted and unable to get a good night’s sleep, but they are also solely responsible for the life and sustenance of another human being!

Let me say once and for all. (And I apologise for shouting, but I feel it needs to be heard.)

BABIES ARE NOT SUPPOSED TO FOLLOW A CENTILE LINE! Up or Down.

Feels good to shout once in a while.

How do I know this? Well, I'm an engineer by training, and I understand statistics.

Here’s my take...

The growth centile charts are a graphical representation of the growth of thousands of babies as a group.

How this works in practice is:

If you look at the charts and take 2.75kg at 7 days old, the charts inform us that 7.5% of babies of this age were on or below this weight. And for the same age, 80.2% of babies were 4.2kg or less.

If we jump along the timeline to 3 months of age, we will see that 2.1% of all babies (in this large representation group) weigh 5kg or less, that 50% of babies weigh 6.4kg or less, and 96% of babies weigh 8.7kg or less.

Importantly, what these charts do not tell us is the growth trajectory of any individual baby or what their growth should be. And in that regard, every baby is different. No two children will grow at the same rate and have the same ratio of length to weight to head circumference.

What these charts do tell us usefully is that babies should always be gaining weight and physically growing. If this is not happening, or if the baby lies outside the <2% and >98% marks, we might want to keep an eye on them. If the baby loses weight, this is cause for concern.

If the baby gains excessively (or is way above the 98% mark), then we also need to understand more. Remember, a little baby could do a poo the hour they’re weighed that literally weighs 200g (1/2lb!) and resultantly could drop two centiles just because of the timing of their bowel movements!

Trust Your Gut

Over the last 100 years, Western culture has beaten instinct, intuition and gut feeling out of us, so much so that we sometimes trust what certain people (like highly qualified consultants in a fancy hospital office) say about giving birth more than the women in our lives who have actually done it, or supported it, such as our mothers, our friends, other mothers, midwives and doulas.

We have become so used to trusting our “doctor” that we forget to trust ourselves, our observations, and our gut instincts.

Ask yourself this. If you wanted to know what the new restaurant in town was like, would you ask and trust your best friend who had been there several times or a stranger in a town 100 miles away whose only knowledge of the restaurant is from the website?

Why do I suggest trusting your intuition over your baby’s numbers?

Because your baby is much more than numbers, I hear of far too often that many babies are truly suffering and in pain and being ignored by their doctor because they are gaining weight.

Just because a baby is gaining weight does not mean there is no reflux, colic, allergy or intolerance problem. No amount of suffering is acceptable. Being brushed off as a ‘neurotic parent’ is not okay.

If your doctor or paediatrician tells you your baby does not have reflux because they are putting on weight, call them out on their BULLSHIT.

The centile charts can be useful to see if the baby is gaining too much weight over several periods (for instance, comfort-feeding due to pain of reflux), losing weight, or on a trajectory that indicates less-than-ideal health. The sooner babies who need support can be identified, the better, so we must use the tools available effectively.

We should not use the tools as a way to beat up parents.

On the other hand, I disagree with medicals telling parents that because their baby is gaining weight and on a good centile line, everything is okay.

If the baby is suffering with ongoing discomfort and pain, regardless of weight progression, this should be given fair and due attention.

You are the expert on your baby.

How is Reflux Connected To Weight?

Reflux can cause pain and discomfort of stomach acid burning and irritating the oesophagus. Babies learn very quickly that milk washes this acid back into the stomach, so some will ask for more milk to soothe the pain.⁠ These babies may end up over-eating, and so gaining weight quicker, jumping the centile curves.

For babies who vomit a lot of their milk, this could be that they don’t keep sufficient milk in their bodies to gain weight properly, and so are classed as “failure to thrive”, or they may even lose weight.

There is another group who vomits a lot AND over-feed, leaving them following a “normal” curve on the centile growth charts.

The important thing here is that weight on its own is NOT a reliable indication of reflux or not. We can use it to understand more about the baby and their discomfort and as a guide of what we could do to support them, but only in conjunction with everything else that is going on for them.

So, What is the Answer to Reflux And Weight?

⁠When a baby is experiencing reflux, the answer lies in understanding WHY the baby is uncomfortable and what is causing this discomfort. When we resolve the discomfort at the root cause, your baby won't need to ease the discomfort because it won't be there! Then, they will more consistently ask for milk on a hunger rather than a comfort basis.

Your doctors do not apply this approach because the NICE guidelines do not tell them to 🤦⁠ ****⁠

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Head to the links below for similar suggested blog titles:

• My Baby is Gaining Weight: Can they have Reflux?
• What To Do if Reflux Flares When Starting Solids
• What Doctors Won't Tell You About Baby Reflux and Colic