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Childhood - The first months

Every parent or carer wants to know how to do what is best for their growing baby and to give them the best start in life.

Feeding your baby

Baby’s immediate needs are to feel safe and secure, and to be able to feed whenever hungry. Holding your baby close to feed and responding to their needs encourages healthy brain connections.

Most of this development will occur within the first two years. Responsive parenting will enable your baby to reach their full potential, to be able to form good relationships and communicate well, giving them the best start in life.

Breastfeeding tips

  1. Hold your baby’s body close with their nose level with your nipple to help them attach correctly.
  2. Let your baby’s head tip back a little so their top lip can brush against your nipple. This should help your baby to make a wide open mouth.
  3. When your baby’s mouth opens wide, their chin is able to touch your breast first, with their head tilted, so their lower lip can make contact with the breast 2cm to 3cm below the nipple.
  4. With their chin firmly touching and their nose clear, their mouth is wide open and there will be much more of the darker skin visible above your baby’s top lip than below their bottom lip. Your baby’s cheeks will look full and rounded as they feed.

There are lots of different positions for breastfeeding. You just need to check the following:

  • Are your baby’s head and body in a straight line? If not, your baby might not be able to swallow easily.
  • Are you holding your baby close to you? Support their neck, shoulders and back. They should be able to tilt their head back easily.

Safety advice and sterilising

  • The cleaning and sterilising instructions are the same, whether you are using expressed breast milk or infant formula milk.
  • All the equipment you use for bottle feeding your baby should be washed in hot soapy water, rinsed and sterilised. You should keep sterilising your feeding equipment until your baby is at least six months old. However, continue to sterilise bottles until your baby is 12 months old.
  • Infections (like gastroenteritis) are rare, but, if they do occur, can be very serious.

Making up a bottle of formula milk

  • Wipe down the work surfaces you are going to use with a clean cloth.
  • Wash your hands with soap and water.
  • Read the instructions on the tin or packet to find out how much water and milk powder you will need.
  • Always fill the kettle with fresh water from the tap. Do not use bottled mineral water or artificially softened water.
  • Boil the kettle and leave it to cool for no longer than 30 minutes. It is important the water is still hot, otherwise any bacteria in the milk powder may not be destroyed. Always take care, as at 70°C water is still hot enough to scald.
  • Always check the temperature before feeding it to your baby.

Health visitor tips

How to tell your baby is having lots of milk:

  • Lots of wet heavy nappies - around six in 24 hours.
  • Dirty nappies, two to three soft stools daily until four to six weeks, after which two to three per week.
  • Baby is content and settled during and after each feed.
  • During a feed, you can hear baby swallowing.
  • Weight gain - checked by your health visitor.

Remember, your milk fulfils all of your baby’s needs for around six months. It also reduces the incidence of sudden infant death syndrome (SIDS). Cow’s milk should not be offered until your baby reaches one year, although it is suitable to use from six months in breakfast cereals.

Being sick

It is common for babies to be sick in the early weeks as they get used to feeding and their bodies develop. Bringing up small amounts of milk is known as possetting. When your baby vomits there will be a much larger amount. It can be frightening for your baby, so they are likely to cry. Lots of things can cause your baby to be sick.

  1. I have a new baby. I have just given my baby a feed.
  2. They always seem to bring up small amounts of milk.
  3. This is known as possetting. As they develop it will stop naturally. Talk to your health visitor.

Health visitor tips

Possetting (when a baby brings up milk) is normal during or after a feed. If this carries on at other times, between feeds it may be a tummy bug. It is important for babies to have plenty of fluids to stop any dehydration.

GP tips

After the first few months, if your baby is suddenly sick it is more likely to be caused by a stomach virus rather than possetting. Gastroenteritis is a tummy bug, which can come with diarrhoea (runny poo).

This is more serious in babies than older children because babies can easily lose too much fluid from their bodies and become dehydrated. If they become dehydrated they may not pass enough urine, lose their appetite and have cold hands and feet.

If your baby is unwell, or if vomiting has green bile stained fluid or has lasted more than a day, get your GP’s advice straight away.

Crying and colic

All babies cry, especially in the first few weeks after birth. Crying is their way of letting you know they need something or are uncomfortable. They may need changing, they may be hungry or just need a cuddle.

If your baby cries suddenly and often, but they otherwise appear to be happy and healthy, they may have colic. Colic is common and although uncomfortable, it is not serious and usually affects babies only in the first few months of their lives.

The most common symptom of colic is continuous crying, which typically occurs in the late afternoon or evening. Other signs include a flushed appearance, drawing their legs to their chest, clenching fists, passing wind and having trouble sleeping.

  1. My baby is crying more than usual.
  2. Have you followed the advice given by your health visitor? Have you thought about what your baby is trying to tell you? It may be something really simple.
  3. If you have tried this and it has not worked, speak to your health visitor, or contact your GP if you are worried.

When a baby cries, it can be upsetting, it can be easy to get frustrated and you may not be getting much sleep. It is very important to stay calm and don’t be afraid to ask for help.

Never shake your baby - No matter how frustrated you feel, you must never shake your baby. Shaking moves their head violently, and can cause bleeding and brain damage.

If your baby’s crying seems different in any way (such as a very high-pitched cry or a whimper), then seek medical advice. Crying can sometimes be a sign that your baby is unwell. Trust your instincts - you know your baby best.

Health visitor tips

Know your baby. Try to understand what it is they need. Finding out why your baby is crying is often a matter of going through all the possible options. Things to check first are:

  • Does their nappy need changing?
  • Could they be hungry?
  • Could they be too hot?
  • Could they be too cold?
  • Does their cry sound different?
  • Could they be teething?
  • Do they want a cuddle?

These are simple things which could be causing your baby to cry.

Rashes and dry skin

It’s normal for babies to develop rashes early on as their skin adapts to a different environment. If your baby develops a rash and seems unwell, contact your GP. Most rashes are nothing to worry about, but do be aware of the signs of meningitis.

Nappy rash

Nappy rash is very common and can affect lots of babies. It is usually caused when your baby’s skin comes into contact with the wee and poo that collects in their nappy. A nappy rash causes your baby’s skin to become sore.

Most nappy rashes can be treated with a simple skincare routine and by using a cream you can get from the pharmacist. With a mild nappy rash, your baby won’t normally feel too much discomfort.

  1. There is a red, sore rash around the nappy area. Baby is uncomfortable and cries a lot.
  2. Has baby been in a dirty nappy for a long time? Have you followed advice from your health visitor, or spoken to your pharmacist?
  3. Change nappy often. If you are worried, see your GP.

Dry skin

A baby’s skin is thinner and needs extra care. Dry, flaky skin, some blemishes, blotches and slight rashes are normal in newborns and will naturally clear up. If your baby is otherwise well but has a rash and you are worried about it, contact your health visitor or GP.

Health visitor cradle cap tips

This is the name given to the greasy yellow-brown scales and crusting affecting the scalp in newborn babies.

Do not pick the scales as this may increase the risk of infection. It is not a serious condition and is not contagious. It is not usually itchy and will usually clear up within weeks to a few months.

Gently massaging a small amount of baby or vegetable oil (not olive oil) into the scalp at night can help to soften and loosen the scales. In the morning use a soft baby brush or cloth to gently remove any loose skin scales. If any hair comes out with the scales it will grow back. Gently wash the baby’s hair and scalp with a baby shampoo.

Talk to your health visitor if the rash spreads or there is any infection or oozing.

Health visitor nappy rash tips

  • Leave your baby in a warm, safe place with no clothes or a nappy on, to let the air get to their skin.
  • Use a barrier cream.
  • Remember to change and check their nappy often.

Pharmacist tips

Call in and talk to your nearest pharmacist about creams we can provide you with over the counter.

Find your nearest pharmacy (internal link)

There are two types of nappy cream available. One is a barrier cream to keep wee away from your baby’s skin.

The other is a medicated cream that is good for clearing up any soreness, but should only be used when advised by a health professional.

Sleeping

It is normal for a baby at six weeks old not to sleep through the night. Feel confident in yourself to know whether your child is really distressed or just restless. Trust your instincts.

Try to establish a regular sleep routine early on by putting them to bed at a regular time (day and night). Place your newborn baby on their back to sleep, in a cot in your bedroom for the first six months.

Adult beds are not designed for babies and toddlers and do not conform to safety standards. Only breastfeeding babies should ever be fed in bed and should be positioned on the outside of the bed and returned to the cot after the feed.

You can help your baby to sleep safe and sound by keeping the temperature in their room between 16°C to 20°C. A basic room thermometer will help you to keep an eye on the temperature.

  1. I am so tired when my baby wakes up at night it seems easier to share the bed.
  2. The safest place for your baby to sleep is in a cot (by your bedside for at least the first six months). Try to establish a regular sleep routine.
  3. Speak to your health visitor about how to keep your baby safe and get some sleep.

Safe sleeping environment tips

  1. Place your baby in the feet-to-foot position - baby’s feet at the foot of the cot.
  2. Newborn babies sleep in a cot in parents’ bedroom or room where you are during the day.
  3. Make sure baby is not too hot nor too cold. (approximate room temperature of 16°C to 20°C.
  4. Put baby to sleep on their back.
  5. Keep baby’s head uncovered.
  6. Do not smoke and keep the house smokefree.
  7. No pillow, stuffed animals, toys or bumper pad.
  8. No heavy or loose blankets.
  9. If a blanket is used, it must be tucked in and only as high as the baby’s chest.
  10. Crib sheets must fit tightly over the mattress.
  11. Use a clean, firm, well-fitting mattress. Mattresses should carry the BSI number BS-1877-10:1997.
  12. These tips apply to day time and night time sleeps.

Bed sharing

Bed sharing with your baby is never completely safe. It is particularly dangerous for your baby to sleep in your bed if you (or your partner):

  • Are a smoker (even if you never smoke in bed or at home).
  • Have been drinking alcohol or taken any drugs.
  • Have taken any medication that makes you drowsy.

Also, it is dangerous for your baby to sleep in your bed if:

  • Your baby was premature (born before 37 weeks).
  • Your baby was low birth weight (less than 2.5kg).
  • You or your partner are overweight.

It is very dangerous to fall asleep together on a sofa, armchair or settee. Also, it is risky to allow a baby to sleep alone in an adult bed.

Sticky eyes and eye care

‘Sticky eyes’ are common in newborn babies and young children while their tear ducts are developing. You may see some sticky stuff in the corner of the eyes or their eyelashes may be stuck together.

It normally clears up on its own, but you may have to clean your baby's eyes regularly with damp cotton wool. Use clean, cooled boiled water.

Wipe each eye from the corner by the nose outwards. Use a clean piece of cotton wool for each wipe. Remember to wash your hands before and afterwards and avoid sharing towels to prevent spreading infection.

  1. Is there discharge in the corner of your baby’s eye and do their eyelashes appear to be stuck together?
  2. Sticky eyes is a common condition that affects most babies, speak to your health visitor.
  3. Use cooled boiled water on a clean piece of cotton wool for each wipe.

Conjunctivitis

The signs of ‘sticky eyes’ can sometimes be confused with an infection called ‘conjunctivitis’.

With conjunctivitis the white of the eyes become red and there is more yellow or green sticky goo which comes back regularly. If you notice this and it continues for more than 24 hours, contact your health visitor or GP.

This can be passed on easily, so wash your hands and use a separate towel for your baby.

Eye tests and checks

It is important to look out for any signs of problems with your baby’s eyes. Routine eye tests are offered to newborn babies and children to identify any problems early on in their development.

It's quite normal for the eyes of newborn babies to ‘cross’ occasionally, particularly when they're tired. However, speak to your GP if you notice this happening to your child after three months of age. Left untreated, lazy eye can develop.

Although serious vision problems during childhood are rare, early testing ensures any problems are picked up and managed as early as possible.

Health visitor tips

Some babies have watering eyes. Massaging the tear ducts helps to dislodge tears that have collected in the upper part of your baby’s tear duct, as well as encouraging the tear duct to develop.

This can be done by applying light pressure with your clean, index finger and massaging from the outer corner of your baby’s eye towards their nose. Repeat several times a day for a couple of months.

If this persists past one year, your baby should be referred to an eye specialist for treatment.

Teething trouble

The time when babies get their first primary teeth (milk teeth) varies. A few are born with a tooth already, whilst others have no teeth at one year. Teeth generally start to show when a child is four to nine months old, although every baby develops at their own pace. This is known as teething.

Some babies show few signs while others find it more uncomfortable. Some teeth grow with no pain or discomfort at all. At other times you may notice the gum is sore and red where the tooth is coming through, or that one cheek is flushed. Your baby may dribble, gnaw and chew a lot, or just be fretful.

  1. My baby has red cheeks and seems a bit frustrated and grumpy.
  2. Have you asked your health visitor about teething? Have you discussed options with your pharmacist?
  3. Try some of the gels or sugar-free baby paracetamol. If you are worried and things do not feel right, contact your health visitor or GP.

Think about your child’s tooth care routine. You can brush their teeth with a soft baby toothbrush and a smear of family toothpaste. Make sure you see your dentist regularly and discuss your child’s oral health with them.

Dentists tooth care tips

  1. Clean teeth twice a day, for two minutes, especially at night.
  2. Reduce sugars to meal times only.
  3. Visit the dentist every six months.
  4. Don’t give juice drinks in a bottle. Your baby may still like using a bottle as a comforter and suck away on it for hours, giving sugar and acid plenty of time to damage teeth.

For help accessing an NHS dentist, call NHS 111 or find your local dentist (internal link)

Health visitor tips

It can help to give your baby something hard to chew on, such as a teething ring. Teething rings give your baby something to safely chew on, which may help to ease their discomfort or pain. Some teething rings can be cooled first in the fridge.

All sorts of things are put down to teething - rashes, crying, bad temper, runny nose and extra dirty nappies. Be careful not to explain away what might be the signs of illness by assuming it’s just teething.

Pharmacist tips

If your baby is uncomfortable, you can buy some medicine from your local pharmacy. These medicines contain a small dose of painkiller, such as paracetamol, to help ease any discomfort.

The medicine should be sugar-free. Make sure you read all instructions and the product is suitable for the age of your child. You can try sugar-free teething gel rubbed on the gum. Ask your health visitor about free oral health packs given at regular health checks.

Who to contact for help

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