It can be nerve-wracking caring for a newborn. They can’t tell you what they need, or whether something is wrong, and most new parents find this quite daunting. In time you will learn to understand your baby’s feeding cues, and they will develop different cries which can help you to understand what they need.
In the first few weeks and months, it can be really difficult to tell if your baby is unwell, especially if this is your first baby and you’re not sure what’s normal. In this section you’ll find lots of information on common health issues affecting newborns, and when you should seek help.
Jaundice in newborns is common. It causes yellowing of the skin of the face and upper body, and sometimes the whites of the eyes. Jaundice usually appears when the baby is 2-3 days old, although it can also occur later.
Newborns have a high number of red blood cells which are broken down and replaced frequently. This process produces a yellow substance called bilirubin, which is usually broken down by the liver. In many newborns, the liver isn’t quite mature enough to process the bilirubin so it builds up, causing jaundice. This usually improves and resolves by the time they’re around two weeks old, although it can take longer, especially if your baby was premature.
Jaundice usually resolves on its own, but some babies will need to have treatment in hospital.
If you think your baby is jaundiced, it’s important to speak to your midwife. Look out for skin or eyes that look yellow, or pale / white stools. Jaundice can make babies sleepy and reluctant to feed, which can lead to dehydration, so it’s very important that you feed your baby every three hours at least if you think your baby has jaundice.
You should call your general practitioner (GP) or midwife if:
- The jaundice seems to be getting worse
- You are struggling to rouse your baby
- They are refusing to feed
- They have fewer wet and dirty nappies than you think they should
- The whites of their eyes look yellow
- They have pale or white poo
A newborn baby’s skin is very delicate and sensitive. There are lots of things that can cause skin issues or rashes in babies and it can be hard to figure out what’s going on. NHS UK has a useful visual guide to rashes which can help you identify a rash, but if you are at all unsure about the cause or you are concerned about your baby’s health, you should seek advice from your GP or midwife.
Go to Accident and Emergency (A&E) or call 999 if your baby has a rash and the following symptoms:
- They seem more sensitive to light
- They have a high-pitched or weak cry and will not settle
- They feel very hot or very cold to the touch
- They have a fit or convulsion
- The rash doesn’t fade when you press clear glass firmly against the skin
Babies need to be fed regularly to prevent dehydration. If they don’t get enough milk, they can become dehydrated quite quickly.
If your baby experiences any of the following symptoms of dehydration you should seek medical advice from your GP, 111 or go to A&E if you are very concerned:
- The soft spot (fontanelles) on their head is sunken
- Their mouth or lips are very dry
- Their wee is very dark or contains urate crystals
- Their skin looks blotchy or mottled
- Their hands or feet are very cold
- They haven’t had a wet nappy for 12 hours
- They are refusing milk
- They are very lethargic or hard to rouse
If your baby is constipated, it means that they are struggling to poo. Symptoms of constipation in newborns include:
- Lots of grunting and straining, even if there is no po in their nappy afterwards
- Small, hard lumps of poo in their nappy
- Having fewer than three dirty nappies a week if your baby has formula, or less than one dirty nappy a week if breastfeeding
- Very smelly wind and poo
- Loss of appetite
- Their tummy seems swollen and hard
Start4Life has some great tips on treating constipation at home but if things aren’t getting better or you’re concerned, you should get advice from your GP.
It can be hard to tell if your newborn has diarrhoea, as baby poo is generally loose and runny. If your baby has dirty nappies that are more watery than usual, they might have diarrhoea and you should look out for signs of dehydration, blood or mucous in your baby’s poo, or vomiting.
Diarrhoea in babies can be caused by different things, such as:
- A virus, particularly rotavirus
- An allergy such as CMPA (cow’s milk protein allergy) or something in your diet if you are breastfeeding
- Formula that isn’t made up properly
- Food poisoning
- Antibiotics or other medications
- An underlying health issue
Your baby will receive a vaccine against rotavirus at 8 and 12 weeks, as this is the most common cause of diarrhoea and vomiting in babies. Some babies get mild diarrhoea after receiving this vaccine.
If your baby has diarrhoea, it’s important to make sure they have regular fluids to prevent dehydration, so keep feeding them, whether breast milk or formula. If your baby isn’t getting better or is refusing milk, seek advice from your GP or midwife. Don’t give your baby medicine to prevent diarrhoea.
NHS UK has advice on how to treat diarrhoea and when to seek medical advice, but always call your GP or midwife if you are concerned.
Some babies are born with an allergy to cow’s milk. This isn’t the same as lactose intolerance, which is very rare in babies. It mostly affects formula-fed babies, although in some cases it can affect breastfed babies if you eat dairy products as part of your diet.
CMPA is the most common allergy in babies, but they can also be allergic to soy, or other allergens that pass into breastmilk.
Allergy symptoms can range from mild to severe, and include:
- Diarrhoea
- Vomiting
- Green or mucous-filled poo
- Eczema and other rashes
- Severe nappy rash
- Reflux
- Breathing issues
These symptoms do not mean that your baby has an allergy, but if you are concerned you should see your GP. They may advise you to try an exclusion diet if you are breastfeeding, or a trial of a special formula if you are bottle feeding, or refer you for allergy testing.
Read more about CMPA.
As adults, it’s miserable when you have a cold or blocked nose, but it’s even harder for babies. Babies can’t blow their noses or choose to breathe through their mouths, and it’s also much harder for babies to feed and sleep when their noses are blocked.
Blocked noses in babies are usually caused by colds, but can also be caused by allergies, enlarged adenoids or other issues.
There are several things that you can do to help your baby if their nose is blocked:
- Saline nasal sprays or drops can help to loosen dried secretions in the nose
- A nasal aspirator can help clear snot from your baby’s nose
- Steam can ease congestion – running a hot shower and sitting with your baby in the bathroom can help
- If your baby is over 2 months old and they have a temperature or seem to be in pain, you can give infant paracetamol (ask the pharmacist for advice and always follow the dosage for your baby’s age on the packaging)
Never give your baby cough or cold medicine. There are menthol and vaporiser products available from pharmacies, but you must always check the packaging as some are not suitable for small babies.
In most cases, the congestion will pass, but if your baby has any of the following symptoms you should get advice from your GP, midwife or 111:
- Your baby is having to work hard to breathe – look out for movement in your baby’s tummy when breathing, nostrils flaring, or the skin around their ribs and at the base of their throat pulling in
- Your baby feels very hot or cold to the touch
- Your baby doesn’t want to, or is unable to, feed
- Your baby has fewer wet or dirty nappies than usual
- Your baby is wheezing or grunting when breathing
- Your baby has a fit or convulsion
- Your baby doesn’t seem to be getting better
- Your baby has a blocked nose / breathing issues all the time, even when otherwise well
Bronchiolitis is a common lower respiratory tract infection that affects babies and young children under 2 years old.
Most cases are mild and clear up within 2 to 3 weeks without the need for treatment, although some children have severe symptoms and need hospital treatment.
The early symptoms of bronchiolitis are similar to those of a common cold, such as a runny nose and a cough.
Further symptoms then usually develop over the next few days, including:
- a slight high temperature (fever)
- a dry and persistent cough
- difficulty feeding
- rapid or noisy breathing (wheezing)
Most cases of bronchiolitis are not serious, but see your GP or call NHS 111 if:
- you’re worried about your child
- your child has taken less than half their usual amount during the last 2 or 3 feeds, or they have had a dry nappy for 12 hours or more
- your child has a persistent high temperature of 38C or above
- your child seems very tired or irritable
Dial 999 for an ambulance if:
- your baby is having difficulty breathing
- your baby’s tongue or lips are blue
- there are long pauses in your baby’s breathing
What causes bronchiolitis?
Bronchiolitis is caused by a virus known as the respiratory syncytial virus (RSV), which is spread through tiny droplets of liquid from the coughs or sneezes of someone who’s infected.
The infection causes the smallest airways in the lungs (the bronchioles) to become infected and inflamed.
The inflammation reduces the amount of air entering the lungs, making it difficult to breathe.
Treating bronchiolitis
There’s no medication to kill the virus that causes bronchiolitis, but the infection usually clears up within 2 weeks without the need for treatment.
Most children can be cared for at home in the same way that you’d treat a cold.
Make sure your child gets enough fluid to avoid dehydration. You can give infants paracetamol or ibuprofen to bring down their temperature if the fever is upsetting them.
About 2 to 3% of babies who develop bronchiolitis during the first year of life will need to be admitted to hospital because they develop more serious symptoms, such as breathing difficulties.
This is more common in premature babies (born before week 37 of pregnancy) and those born with a heart or lung condition.
Preventing bronchiolitis
It’s very difficult to prevent bronchiolitis, but there are steps you can take to reduce your child’s risk of catching it and help prevent the virus spreading.
You should:
- wash your hands and your child’s hands frequently
- wash or wipe toys and surfaces regularly
- keep infected children at home until their symptoms have improved
- keep newborn babies away from people with colds or flu
- avoid smoking around your child, and do not let others smoke around them
Some children who are at high risk of developing severe bronchiolitis may have monthly antibody injections, which help limit the severity of the infection.
Check if your baby has reflux
Reflux usually starts before a baby is 8 weeks old and gets better by the time they’re 1.
Symptoms of reflux in babies include:
- bringing up milk or being sick during or shortly after feeding
- coughing or hiccupping when feeding
- being unsettled during feeding
- swallowing or gulping after burping or feeding
- crying and not settling
- not gaining weight as they’re not keeping enough food down
Causes of reflux
Reflux happens because muscles at the base of your baby’s food pipe have not fully developed, so milk can come back up easily.
Your baby’s muscles will develop as they get older and they should grow out of it.
Things you can try to ease reflux in babies
Your baby does not usually need to see a doctor if they have reflux, as long as they’re happy, healthy and gaining weight.
Do
- ask a health visitor for advice and support
- get advice about your baby’s breastfeeding position or how to bottle feed your baby
- hold your baby upright during feeding and for as long as possible after feeding
- give formula-fed babies smaller feeds more often
- make sure your baby sleeps flat on their back (they should not sleep on their side or front)
Don’t
- do not change your diet if you’re breastfeeding
- do not raise the head of their cot or Moses basket
Non-urgent advice: See a GP if your baby:
- is not improving after 2 weeks of trying things to ease reflux
- gets reflux for the first time after they’re 6 months old
- is older than 1 and still has reflux
- is not gaining weight or is losing weight
- has sick that’s green or yellow, or has blood in it
- has blood in their poo
- has a swollen or tender tummy
- has a very high temperature or they feel hot or shivery
- keeps being sick and cannot keep fluid down
- has diarrhoea that lasts for over a week
- will not stop crying and is very distressed
- is refusing to feed
If a GP thinks something else is making your baby sick, they may send your baby for tests in hospital with a specialist.
Treatment for reflux in babies
A GP or specialist may recommend some treatments for reflux.
If your baby is formula-fed, you may be given:
- a powder that’s mixed with formula to thicken it
- a pre-thickened formula milk
If the thickening powder does not help or your baby is breastfed, a GP or specialist might recommend medicines that stop your baby’s stomach producing as much acid.
When your baby is born, their skull won’t be completely fused together. Their head will have two fontanelles (also known as soft spots) – one larger diamond-shaped spot near the front of the head, and a smaller one near the back of the head. These will gradually get smaller as your baby grows and the skull fuses, and will usually disappear by your baby’s first birthday.
If your baby’s soft spot is sunken or bulging, it’s important to see your GP right away as this can be a sign of illness.
If your baby is disabled, talk to people about how you feel, as well as about your baby’s health and future.
Your GP, a doctor for newborn babies (neonatologist), a children’s doctor (paediatrician) or your health visitor can all help you.
The organisations listed here can offer help and advice:
- Bliss – offer advice for parents of premature and sick babies, including looking after your mental health
- Contact a Family – for families with disabled children
- Living made easy – for advice on all types of daily living equipment for disabled adults and children
- Genetic Alliance UK – supporting those affected by a genetic disorder
- Group B Strep Support – preventing group B strep infection in newborn babies
- Mind – for better mental health
Hospital staff should explain what kind of treatment your baby is being given and why. If they do not tell you, ask them.
It’s important that you understand what’s happening so you can work together to make sure your baby gets the best possible care.
Some treatments need your consent to go ahead, and the doctors will discuss this with you.
It’s natural to feel anxious if your baby needs special care. Talk over any fears or worries with the hospital staff. Hospitals often have their own counselling or support services, and a number of charities run support and advice services.
You would have been asked to bring your baby in for an ultrasound scan (USS) of their hips within the first 4-6 weeks of their birth. An USS is used to determine the ‘maturity’ of an infant’s hip joints. Hip joints are a ‘ball and socket’ joint. The socket, ideally, is cup-shaped. An immature hip joint will not have a cup-shaped socket; it is more shallow, so the joint is less stable/secure. An immature hip is described as dysplastic and the condition is called Developmental Dysplasia of Hips (DDH).
Your baby has been examined by a paediatric doctor or specialist practitioner and no abnormality was felt and their hips appear stable, although this examination does not detect all levels of immature hips. There are a few other factors which increase your baby’s risk of being born with a degree of DDH. These are:-
· Breech presentation
· Birth weight over 4.5 kg
· Family history of DDH
· Presence of talipes
· Moulded babies
If your baby has any of these risk factors, you will have been told about them and an explanation given.
There are some simple ways of caring for your baby which can help protect their hips from long term immaturity and promote normal development of the ball and socket. Good positioning and time increases the chance that your baby’s hips will mature correctly.
Positioning Do’s and Don’ts
Do –place your baby on their back for sleep. Their legs should naturally bend at the knees and ‘fall’ outwards.
Do – carry your baby so that their legs are apart, again knees bent and outwards.
Do – dress your baby in loose fitting clothes so their legs are freely able to move outwards.
Do – place your baby on their tummy when they are awake.
Do – change your baby’s nappy by raising their bottom by lifting under their lower back.
Do not – swaddle your baby with their legs together.
Do not – position your baby on their side to sleep.
Do not – change your baby’s nappy by lifting them with their foot. This will pull the hip joint on that side into an unfavourable position.
When to seek advice from your Health Visitor or GP
If your baby shows any of these signs, do seek advice:
· restricted movement in 1or both legs when you change their nappy
· 1 leg dragging behind the other when they crawl
· 1 leg appearing longer than the other
· uneven skin folds in the buttocks or thighs
· a limp, walking on toes or developing an abnormal “waddling” walk
· failure to weight-bear when you would normally expect this
Babies should be active throughout the day, every day, in a variety of ways including interactive floor-based activity.
Tummy time is a great way to help your baby to strengthen the muscles they need for sitting, rolling and crawling, but make sure that you do it when you are both totally awake and you can keep close watch. Babies should not sleep on their tummies.
Try to build up to include at least 30 minutes of tummy time spread throughout the day, but you might start off by giving your baby very short stretches of tummy time. Tummy time may be unfamiliar to babies at first, but can be increased gradually, starting from a minute or two at a time, as your baby becomes used to it.
Encourage your baby to be physically active by reaching and grasping, pulling and pushing themselves independently, moving their head, body and limbs during daily routines, and during supervised floor play.
Every baby develops at different stages. If your baby is not ready for some of the activities, that’s okay. You can revisit another time.
Once your baby can move around, encourage them to be as active as possible in a safe and supervised play environment. Toddlers (1-2 years) should spend at least 3 hours throughout the day being active in a variety of ways, but more is better to support their health and development. This can include light activity such as standing up, moving around, rolling and playing, as well as more energetic activity like skipping, hopping, running and jumping.
Once your child reaches pre-school age (3-4 years), the 180 minutes of activity should include at least 60 minutes at a moderate to vigorous intensity.
Children under 5 years should not be inactive for long periods, except when they are asleep. It is important to avoid spending long periods watching TV, travelling by car, bus or train, or being strapped into a buggy to ensure the best chance of good health and development.
If you feel concerned, it’s best to get your baby checked out. If you see any of these symptoms in your baby, you should contact your midwife, GP or 111 right away:
- Your baby isn’t interested in feeding, or is having difficulty feeding
- Your baby is lethargic and it’s quite difficult to wake them
- Your baby has a temperature above 37.5C or below 36.5C
- Your baby is grunting, breathing very quickly or their breathing is laboured (you might see the skin pulling in around their ribs, their nostrils flaring or their stomach sucking in when they breathe)
- There are long pauses in your baby’s breathing, when they’re awake or asleep
- Your baby has a high-pitched cry, a weak cry or you cannot settle them at all
- Your baby becomes jaundiced (internal link) within 24 hours of birth
- Your baby’s jaundice becomes worse (jaundice can cause lethargy, yellowing of the eyes, reluctance to feed, fewer wet or dirty nappies, and pale or white stools)
- Your baby has not passed meconium (baby’s first poo which is very dark and tar-like) within 24 hours of birth
- Your baby has not had a wet nappy for 12 hours
- Your baby develops a rash all over their body
- Your baby’s soft spot on their head is sunken or bulging
You should call 999 or go to A&E if your baby has any of the following symptoms:
- Your baby is floppy and unresponsive
- You cannot wake your baby
- Your baby is very sensitive to light
- Your baby has a blue tinge to their lips or around their mouth
- Your baby has a pinprick rash which does not fade when a clear glass is pressed firmly against the skin
- Your baby feels abnormally cold to the touch
- Your baby’s skin is mottled or blue
- Your baby has a fit or convulsion
Vaccinations
Vaccinations for your baby are usually given at 8, 12 and 16 weeks, and at 12 months of age. If you have any concerns about vaccinating your baby, it’s important to speak to your midwife or GP so that they can discuss them with you.
Here is a full breakdown of childhood vaccinations, including when they are given and why.