Children's health

The first month

How to build a close and loving relationship from the start

• During pregnancy: You are encouraged to relax and take time to talk to your developing baby. You can help your baby's development by stroking your baby bump, talking to your baby and by playing music. This will help to familiarise them with you and your family member's voices.
• At birth: Where possible, your baby will be dried and placed onto your chest to be held in skin to skin contact for as long as you wish. Remember skin to skin contact can be used at any time to calm and soothe your baby.
• In the early days: Keep your baby close to recognise the signs they are hungry or need a cuddle. Responding to these signs will make your baby feel safe and secure. Responding to your baby and their needs for feeding and comfort will help them feel more secure.

Speech and language development

Communicating with your baby while you are pregnant will help with the development of their brain which starts early in pregnancy. Your baby is able to hear from about 16 weeks and will get used to her mother's voice and can also hear her heart beat. Your baby may also 'jump' at loud noises. Communicating with your unborn baby can help to create a bond that can continue to be strengthened when they are born. Babies communicate from birth; they are equipped to interact with adults and are interested in interacting and engaging. Adult interaction reinforces early communication. Language learning is a natural process that is learnt through everyday interaction during nappy changing, bathing, soothing, cuddling and responding to needs.

Your baby starts to understand speech even before they begin to speak. From a very early age, they will be interested in looking at your face and listening to your voice. At about two to four months, your baby will begin to respond to the different tones that you may use. For example, they may cry if you raise your voice or may laugh or gurgle excitedly if you make a word or sound that they find funny. If your baby makes a certain sound or noise, copy the sound or noise and wait for your baby to make another. In this way, you are having a ‘baby conversation’ and teaching the concept of turn-taking.

Always make sure that you are looking at your baby and try not to interrupt. Make sure you use smiling and facial expressions during your ‘baby conversations’.

Copy what your baby says. Share books with your baby.

Read and show your baby books with large, simple, colourful photographs.

Most importantly, have fun with your baby! Playing and experimenting with speech and language from the beginning of your pregnancy journey lays the foundations of your child's communication skills for life.

• Speech and language development from birth to 12 months.
• Speech and language development from 12 to 24 months.

Primary birth visit

The health visitor usually visits you at around the time that the midwife discharges you and your baby – this is normally when the baby is between 10 and 14 days old. Each time you are seen, your health visitor will concentrate a great deal on you and your partner’s health. She will be concerned to know how both of you are feeling and how you are coping with adapting to parenthood. During the visit from your health visitor, they will:

• review any previous health needs or concerns you may have
• offer support and advice about your baby’s development
• continue your baby’s 0 to 19 health record
• assess your wellbeing, offering appropriate support and advice as needed.
• remember this is your visit and your chance to discuss the things that are important to you

Infant feeding

Whichever way you decide to feed your baby, the children's health team are here to support you to make feeding you're baby a special time where you can build a close and loving relationship ensuring they have the best start in life.

Responsive feeding: is about understanding when your baby is showing signs of being hungry. Look out for cues (for example moving their head and mouth around and sucking on their fingers). Remember a newborn baby's tummy is the size of a cherry so it only holds small amounts of milk. Babies may feed up to 12 times in 24 hours and this is normal. Where possible try and limit the number of people feeding your baby as this is a special time for you to bond with your baby.

It is very dangerous to ‘prop feed’ a baby if you are giving your baby milk via a bottle. If more milk flows into the baby’s mouth than they can swallow they could choke or aspirate milk into their lungs which could affect their ability to breathe and may result in death. Using blankets or any soft material to prop feed could result in suffocation. It is advised that you do not use any type of prop feeding device.

First Steps Nutrition offers unbiased, up to date and evidence-based information on formula milks. They also have a range of resources which are free to access and download.

The department of health's Start for Life website also has a wealth of information however you decide to feed your baby.

Common feeding issues with your baby

Tongue tie

Tongue-tie (ankyloglossia) is where the strip of skin connecting the baby's tongue to the bottom of their mouth is shorter than usual. Some babies who have tongue-tie do not seem to be bothered by it. In others, it can restrict the tongue's movement, making it harder to breastfeed. If you are worried that your child has a tongue tie, or if you need feeding support please contact your Midwife, Health Visitor or G.P.

Find out more about tongue tie on the NHS website.

Colic

Most infant crying is normal, and many babies will experience some abdominal discomfort as they transition to a milk diet from being inside your womb and this will usually subside. Your health professional can advise you on ways to help manage symptoms. If your otherwise healthy baby cries inconsolably for three or more hours a day, at least three days per week (and it's been happening for thee weeks or more) – it could be caused by colic. Symptoms include:

• intense crying, lasting several hours
• clenched fists, arched back, knees being pulled up to tummy
• red or flushed face when crying
• inconsolable – nothing you do seems to make it better

Please speak to your Midwife, Health Visitor or GP if you are worried about your baby.

Find out more about colic on the NHS website.

Reflux

Reflux is the medical term for when some of the stomach contents comes back up from the stomach and travels up the oesophagus (tube from the stomach to the mouth). The stomach contents are acidic which can cause irritation and discomfort. This can make your baby vomit or regurgitate milk - they may cry for long periods, arch their backs and refuse feeds. Babies take in large volumes of milk as they are growing rapidly. They have small stomachs and a short oesophagus, meaning that the stomach contents can overspill easily. This is normal and, if a baby is happy, healthy and thriving, they should not require any further intervention other than keeping them upright after feeds.

• baby reflux affects at least four in ten babies and it isn’t usually cause for concern
• usually no tests or treatments are needed
• it tends to start before the baby is eight weeks old
• it can happen a lot – some babies bring up milk six or more times a day
• it normally happens less often as the baby gets older
• it gets better on its own in most babies (nine out of ten) by the time they are one year old.

Please speak to your midwife, health visitor or GP if you are worried about your baby.

Find out more about reflux.

Vitamins for baby and mother

Vitamin D is found in certain foods (including oily fish like salmon, sardines, and mackerel; red meat; and some breakfast cereals) but it's hard to get enough from food alone. If you're pregnant or breastfeeding, you should consider taking a vitamin D supplement (containing 10mcg). If your baby is only having breast milk, or less than 500mls formula a day, you should give them a daily vitamin D supplement of 8.5 to 10mcg. It's worth checking if you're entitled to Healthy Start food and vitamin vouchers. If you're not, ask your GP or health visitor where to buy them.

Vaccinations

Vaccinations are the most effective way to prevent infectious diseases and have been saving babies, children's and adults lives for many years.  They help to protect people against harmful diseases before they come into contact with them. It is advisable to discuss the different vaccinations offered to you and your child, and their possible side effects, with a health professional such as a health visitor, midwife, practice nurse or GP. Remember that anti-vaccine stories are spread online through social media and are often not based on scientific evidence. Always take advice from your health professional.

Find out more about vaccinations.

Minor illnesses specific to newborns

Jaundice

Jaundice is a common condition in newborn babies at around two to three days old. It is caused by a build-up of bilirubin in the blood. It can improve without treatment in the first two weeks as a baby's liver becomes more effective at processing bilirubin. However, some babies do require treatment in the first days and weeks of their lives, and some may have prolonged jaundice lasting longer than 14 to 21 days. Your health visitor may notice prolonged jaundice when checking your baby over and could refer you to hospital for further investigation in order to have this treated.

Find out more about jaundice.

Cradle cap

Cradle cap (Infantile Seborrheic Dermatitis) is a harmless skin condition that’s common in babies. It usually clears up on its own. It often presents itself as greasy, yellow-brown scales and crusting affecting the scalp of new born babies. There may also be a skin rash with redness and scaling. It is not caused by infection, allergy or poor hygiene and is thought to be related to mother’s hormones still in the baby’s circulation. These hormones result in overactive sebaceous glands which release a greasy substance (sebum). This excess sebum causes the old skin cells to stick to the scalp, instead of drying up and falling off. Cradle cap is usually mild and treatment is not usually needed. Try:

• gently wash the baby’s hair and scalp with a baby shampoo
• use a soft brush to loosen and remove the loose skin flakes
• do not pick the scales as this may increase the risk of infection
• soften the scales with baby or vegetable oil (not olive oil) overnight
• if any hair comes out with the scales it will grow back
• after softening the scales overnight, use a soft brush or cloth and gently remove any loose scales and wash the hair with a baby shampoo

If the response to these simple measures is ineffective or there is any doubt about it being cradle cap, or the rash appears to be spreading or infected and has signs such   as oozing, crusting, bleeding, then seek medical advice.

Find out more about cradle cap.

Oral thrush

Oral thrush (Pseudomembranous oral candidiasis) affects about 5% of new born babies and increases to 14% at around four weeks old, before decreasing thereafter. Premature babies and those who have had antibiotics or steroid treatments are at an increased risk of an overgrowth of this normally harmless micro-organism. Oral thrush can also be caused by poor hygiene practices when cleaning and sterilising feeding equipment and soothers incorrectly.  Many cases of oral thrush are self-limiting and clear up in a few days without the need for treatment.

If thrush is visible but not causing symptoms, an antifungal treatment is not required. However, affected infants who also have symptoms such as fussiness or discomfort, feeding difficulties or weight loss should be prescribed a medicine called an 'antifungal'. If you are breastfeeding your baby, and either you notice your baby has oral thrush or you have symptoms that may show you have thrush in your breasts please speak to your Midwife, Health Visitor or GP or if you are worried you or your baby may have thrush.

Sticky eyes

This is a very common condition in newborn babies and, most of the time, it will look like a discharge from one or both eyes, which may not be due to an infection. If your baby’s whites of the eye remain clear of any redness, but there is a discharge, it is likely to be due to blocked tear ducts. Approximately one in five babies are born with tear ducts that have not fully developed, affecting one or both eyes. It can last for several months. You will normally be advised by your health visitor to just wait and see if the sticky eye improves over time.

If the tear duct is still blocked and continuing to cause a sticky eye by about 12 months of age, see your GP who may refer your baby to an eye specialist. It’s not necessary to go to your local casualty department (Accident and Emergency or A&E) with sticky or watery eyes. Babies can also suffer from conjunctivitis. This is inflammation of the thin layer of tissue that covers the front of the eye. The symptoms are similar to a sticky eye, but the whites of your baby’s eye will be pink or red.

Conjunctivitis in your new born baby can be caused by a blocked tear duct or a bacterial or viral infection - this is known as conjunctivitis. If your child is experiencing any symptoms of discharge, redness or swelling of the eye, please contact your midwife, health visitor or GP.

Basic care

Changing nappies

When changing your baby's nappy remember that as they get older babies begin to turn over and move about more so ensure they are on a safe surface where they cannot fall or are strapped in if using changing facilities in public. Make sure you have everything to hand so that you do not have to leave your baby unattended. You can use disposable nappies or reusable nappies, cotton wool and warm water or a damp cloth, nappy sacks to dispose of dirty nappies and cotton wool and a barrier cream to prevent nappy rash.

Firstly, wash your hands! Try to keep the room warm as your baby will be undressed at least from the waist down. Undo baby's vest and tuck it up under their back, then remove the soiled nappy and place in a nappy sack. Gently wipe with cotton wool soaked in lukewarm water and when the skin is clean pat it dry. If your baby is a girl, you should wipe from front to back to ensure no germs contaminate the vagina. If your baby is a boy take care to clean around the penis and testicles. Ensure you clean in all babies creases around the legs and groin. You may apply a barrier cream if you wish although only use a liberal amount if doing so. Lift up baby's feet and slide a clean nappy underneath them. Close the front of the nappy onto baby’s tummy and fasten with the tabs at the side. Make sure it is tight enough to prevent leaks but not so tight to be uncomfortable - you should be able to fit a finger between the nappy and baby's tummy. Make sure baby is in a safe place and dispose of the nappy in a bin and wash your hands.     

Care of the umbilicus 

The umbilical cord will naturally dry up and fall off usually within around 1-2 weeks and your midwife will check it when they routinely check baby. As it dries up it will become hard and turn black. It is okay to bath baby while it is still attached if you ensure it can dry afterwards - simply pat it dry with a clean towel. If you wish to clean around the area you should use cotton wool soaked in lukewarm water and gently pat the area to clean and pat again to dry with a clean towel. It is a good idea to fold baby's nappy down under it to allow air to get to the stump to dry it out and ensure urine does not get onto it from a wet nappy.

As you start to see the cord separate you should leave it to detach by itself and do not pull it. If you are concerned it smells offensive, is bleeding, the base of the cord looks red or inflamed or the cord has not separated by three weeks it is important to seek advice from your health visitor, midwife or GP.

Find out more about caring for the umbilicus.

Sleep – baby

Every day your baby will move through different states of wakefulness and sleepiness. Every baby does this in their own way but learning to recognise your own baby’s pattern will help you to give your baby what they need in a way that helps them to feel cared for and understood by you. Babies’ sleep cycles are much shorter, so they often wake, feel distressed and need comfort from a parent. This can be a very exhausting time for parents. Research shows that infants whose parents respond promptly to their crying learn to settle more quickly in the long term because they feel secure in knowing that their needs will be met.

Find out more about helping your baby to sleep.

Lack of sleep and coping mechanisms

Coping with sleep deprivation as a new parent can be very challenging. It might seem like everyone else’s babies sleep more than yours or you may worry that you are doing something wrong. All babies are different but it is normal for healthy babies to wake during the night in their first few months of life. New-born babies have very small stomachs and will wake at least every two hours to feed.

Find out more about how babies sleep.

Find out more about sleep deprivation.

Crying and baby states

There are six baby states: three awake states (quiet alert, unsettled and crying) and three sleep states (deep sleep, light sleep and drowsy sleep).  Babies move from one state to another very quickly and not always in the same order.

Crying:

Irritable:

Quiet alert:

Drowsy: 

Light sleep:

All babies cry, and some more than others. Crying is your baby's way of telling you they need comfort and care. Sometimes it's easy to work out what they want, and sometimes it's not. Infant crying is normal and it will stop! Babies start to cry more frequently from around two weeks of age. Comfort methods can sometimes soothe the baby and the crying will stop. Is the baby hungry, tired or in need of a nappy change? It's okay to walk away if you have checked the baby is safe and the crying is getting to you. After a few minutes when you are feeling calm, go back and check on the baby. Never, ever shake or hurt a baby. It can cause lasting brain damage and death.

Find out more about getting to know your baby.

Parents and self-care

Although having a baby is a joyful occasion, it is also life changing and parents need to take care of themselves in order to be in the best health to care for their family. If you feel you or your partner may need help or support with their mental health, there are many health professionals or organisations you can seek help from.