Health visiting resources

Drinking during pregnancy

You’re advised to avoid drinking alcohol whilst pregnant or trying to get pregnant.

The National Institute for Health and Clinical Excellence (NICE) advises women to avoid alcohol for the first 3 months of pregnancy due to the risk of miscarriage.

But drinking is also dangerous throughout your pregnancy – alcohol can harm your developing baby.

Your baby’s liver does not mature until the last half of your pregnancy. It’s one of the last organs to fully develop. The alcohol you consume passes from your blood to your baby through the placenta. Your baby’s liver can not process alcohol as
well as your liver can, and it can seriously affect your baby’s development.

Risks of drinking alcohol during pregnancy

If you drink a lot of alcohol during your pregnancy your baby could be at risk of foetal alcohol syndrome. This is a group of problems consisting of facial abnormalities, behavioural and learning difficulties, and restricted growth.

Please speak to your doctor or midwife if you think you might have a problem cutting down the amount of alcohol you drink.

Over the counter and prescribed medicines

You must check with your doctor, midwife or pharmacist before taking any medication as some medicines can harm your baby’s health and development.

You must make sure that your doctor, dentist or other healthcare professional knows that you’re pregnant before they carry out any treatment or prescribe you anything.

The following medicines are generally considered safe:

• paracetamol
• most antibiotics
• nicotine replacement therapy
• some vaccinations for example tetanus, whooping cough, flu
• medications for long term conditions such as diabetes, asthma, epilepsy
• dental treatments including local anaesthetics.

Always check with your doctor, midwife or pharmacist first before taking them when pregnant.

Homeopathic and herbal remedies and aromatherapy

If you chose to use herbal or homeopathic remedies, or aromatherapy whilst
pregnant, you must tell the practitioner that you’re pregnant. You should
also tell your midwife, doctor or pharmacist which remedies you’re using.

Not all natural remedies are safe to have whilst you are pregnant.

Check with the Institute for Complementary Medicine that your practitioner is qualified.

Illegal drugs

Using heroin, cannabis, ecstasy and cocaine during pregnancy can seriously harm your unborn baby. If you use drugs regularly you should seek medical advice about how to stop. If you stop abruptly you may have withdrawal problems or other side effects.

If you think you have a substance misuse problem, it is important to seek help so
that you have support and get the right advice.

Speak to your doctor, midwife, or find drug support services near you.

Useful links

How vaping can help you quit smoking

A guide on how your baby develops in the womb from 12 weeks to when you’re ready to give birth.

12 weeks

By 12 weeks your baby will be fully formed. Even though you won’t be able to
feel it yet, your baby is already moving around.

13-20 weeks

By 17 weeks, your baby will have eyelashes.

By 18 weeks your baby will have between one and two billion basic brain cells.

You’re halfway through your pregnancy by 20 weeks and you’ll see your baby during your second scan.

By this stage you might feel your baby moving around.

21-28 weeks

Now your baby will start to open their eyes and can hear noises outside of the
womb. By week 28, your baby will be fully formed but still very small.

29-36 weeks

Your baby’s nervous system and brain will be fully developed by week 33. Your baby will also be turning around ready for birth.

37-42 weeks

After 37 weeks your baby is ready to be born.

Brain development

Your baby’s brain develops in the womb. By 18 weeks, between 1 and 2
billion basic brain cells will develop although only a small number of these
will form connections to each other before your baby is born.

Before birth, your baby’s hearing and some automatic responses such as searching for food will form connections. It’s why newborns recognise their mother’s voice and can search for a nipple or bottle with their mouth when they’re hungry.

Your baby’s development accelerates at an enormous rate once your baby has been
born.

1-4 weeks

In the first few weeks, your baby likes to look at faces. Your baby will focus on your
face and follow it if you’re close. By 2 weeks your baby will begin to recognise you.

Your baby will also be startled by sudden noises. This is all part of their normal
development.

Talking to your baby is a great way to encourage your baby’s learning in these early weeks. Making eye contact whilst holding your baby close and talking to them will help them begin to understand how conversations work. Making baby noises teaches your baby how to listen and take turns in a conversation.

4-6 weeks

Between 4-6 weeks your baby will start to smile.

Your baby can focus on objects that are 6-10 inches away from them. You can help your baby’s development by talking about what you’re doing and what’s
going on around you. You can also make faces and noises. Your baby will respond to the sounds happening around them.

Your baby will try to lift their head when they’re lying on their front, and then move onto wriggling and kicking their legs. Somewhere between 4-12 weeks your baby will be able to roll over front to back or back to front.

You must not leave your baby on their own at this time as they can roll off of beds, sofas and changing tables.

Baby brain development

The first 3 years of a child’s life is a time of rapid brain development. The brain
cells will create more and more connections as your child learns about
themselves and the environment they live in.

Brain development is shaped partly through a child’s genes (nature) and also
through the interactions between a baby and its main carers (nurture). The two work together in developing the baby’s brain.

Breastfeeding is the natural way to feed your baby. Breast milk contains just the right amount of nutrients.

We recommend exclusive breastfeeding  for the first 6 months of your baby’s
life and should continue, whilst weaning your baby onto solid food, as long as desired and ideally at least up to one year old.

Breast milk changes during the feed, quenching your baby’s thirst and satisfying their hunger. As your baby grows, your breast milk changes to meet his needs.

What are the benefits of breastfeeding for your baby?

By breastfeeding you provide your baby with a healthy start in life. These health benefits will continue into adulthood. Breast milk is full of antibodies, hormones and enzymes that help your baby grow, develop and remain healthy.

Your baby will also have a reduced risk of getting infections such as
gastroenteritis, ear infections and chest infections. They’ll be less likely to develop allergies and illnesses such as insulin dependent diabetes and childhood leukaemia.

Health benefits of breastfeeding for parents

These include reduced risks of:

• breast and ovarian cancer
• osteoporosis
• cardiovascular disease
• obesity
• postnatal depression.

Recent studies suggest that breastfeeding enhances the bond between a mother and her baby. Keeping your baby close to you will help you to recognise their feeding cues so that you know when to offer the breast.

Breastfeeding for comfort

You can also put your baby to the breast when they seem unsettled, lonely or just want to be comforted, when your breasts are full or you just want to sit down and have some quiet time with your baby.

Breastfeeds may be long or short. You can not overfeed or spoil your breastfed baby.

Expressing your breast milk

You may need need or wish to express your breast milk because:

• your baby may be unable to feed at the breast if they’re unwell or born prematurely
• your baby can not feed well at the breast and you may need to maintain your milk supply
• you can leave your baby with someone else if you need to be away.

Learning to hand express will help you to remove milk from your breast. Our health visiting team or your midwife can support you with this. They can also provide information on electric or hand held breast pumps.

Local support with breastfeeding

Breastfeeding is a learned skill and requires practice and patience in the early days. It can take a while before you feel confident.

You can ask your midwife or health visitor to help you with breastfeeding and
they can direct you to other support available to you.

If you need more specialist support your midwife or health visitor may suggest that you attend a breastfeeding clinic.

We’re working towards the UNICEF Baby Friendly Initiative accreditation. The programme makes supporting breastfeeding a priority and provides staff with training and skills to support mothers to breastfeed for as long as they wish to.

Useful links for more information

Breastfeeding help and support 

Advice on how to breastfeed and your questions answered

Baby Buddy App 

Association of Breastfeeding Mothers

Breastfeeding is the healthiest way to feed your baby, but where this is not possible or you choose not to, you should use an infant formula instead.
Most infant formula is made from cow’s milk which has been modified to make it suitable for babies.

Breast milk or formula milk should be your baby’s main drink throughout the first year. When your baby is 1, they can start to drink whole cow’s milk.

Find out more about the different types of formula milk.

Tips on how to bottle feed your baby

If you’re feeding your baby from a bottle it is important to hold your baby close and make eye contact with your baby.

Try to limit the number of people who feed your baby as it can be stressful for babies to adapt to different feeding techniques. This is a lovely time together for you and your baby.

Watch for signs that your baby is hungry and to your baby have some control over
their feeding pattern rather than maintaining a strict 3 to 4 hourly routine.

Let your baby pace the feed. Remove the teat and sit them up to ‘wind’ them when they want a break.

Be guided by your baby’s appetite. They won’t always want to take a full feed.

Useful links

How to sterilise equipment and make up a formula feed

Spending time getting to know your new baby is a very exciting time. It can also be
nerve-racking, especially for first-time parents.

Common conditions your baby may experience

There are some common conditions that your baby may experience. Most are
nothing to worry too much about, but knowing what to expect can help you look after you baby and know when to seek medical attention.

Loose stools (poo)

Most babies have occasional loose stools. Breastfed babies have looser
stools than formula-fed babies. Diarrhoea is when your baby frequently passes
unformed, watery stools.

Sticky umbilicus

Once the umbilical stump detaches, the belly button underneath may become a little sticky with a spot of blood around it. You can clean it with cool boiled water and a fresh piece of cotton wool. Try to stop your baby’s nappy rubbing on it if possible.

Sticky eyes

They’re quite common in babies and easily treated. Clean the eyes from
the nose outward with cotton wool dipped in cooled boiled water, not too wet. Make sure you use a separate piece of cotton wool for each eye.

Speak to your health visitor or GP if you have any concerns about your baby’s eyes.

Enlarged breasts

Some babies develop what appear to be breasts. This is because of hormone levels
in their milk and they should go down in time. If you’re worried, mention it to your health visitor or GP.

Rashes

It’s normal for babies to develop skin rashes from as early as a few days old as their sensitive skin adapts to a different environment. Most rashes are harmless and go away on their own.

However, if your baby develops a rash and seems unwell, or if you’re worried, see your GP.

Cradle cap

They’re yellowish, greasy scaly patches that sometimes appear on the
scalp of young babies. It’s a common, harmless condition that does not usually itch or cause discomfort to the baby.

It usually clears up on its own. Gently washing your baby’s hair and scalp can help
prevent a build-up of scales, and massaging baby oil or natural oil, for example  almond or olive oil, into their scalp at night can help loosen the crust.

Do not pick at the scales as this may cause an infection. Use a soft bristled hairbrush.

Nappy rash

Most babies get nappy rash at some time in the first 18 months. Nappy rash can be
caused by:

• prolonged contact with urine (wee) or stools (poo)
• sensitive skin
• rubbing or chafing
• soap, detergent or bubble bath
• baby wipes
• diarrhoea or other illness.

There may be red patches on your baby’s bottom, or the whole area may be red.
The skin may look sore and feel hot to touch, and there may be spots, pimples or
blisters.

The best way to deal with nappy rash is to prevent your baby getting it in the
first place by:

• changing wet or soiled nappies as soon as possible (10 or 12 times a day for young babies, or 6 to 8 times for older babies)
• cleaning the whole nappy area thoroughly, wiping from front to back. Use plain water or baby wipes
• leaving the nappy off for as long and often as you can to let fresh air get to the skin (lie your baby on a towel)
• using a barrier cream, such as zinc and castor oil, and rub it in well.

If your baby gets nappy rash you can treat it with a nappy rash cream. Ask your
health visitor or pharmacist to recommend one.

If the rash doesn’t go away or your baby develops a persistent bright red, moist rash with white or red pimples, which spreads to the folds of the skin, they may have a thrush infection. You’ll need to use an anti-fungal cream, available either from the pharmacist or on prescription from your GP.

Ask your pharmacist or health visitor for advice.

Milia (milk spots)

About half of all newborns will develop small white spots, called milia, on their face. They’re blocked pores and usually clear within the first 4 weeks of life.

Baby acne

Pimples sometimes develop on a baby’s cheeks and nose. These tend to get worse
before clearing up completely after around 6 weeks.

Oral thrush

Symptoms can include one or more white spots or patches in and around the baby’s mouth. These may look yellow or cream-coloured, like curd or cottage cheese. They can also join together to make larger plaques.

You may see patches on your baby’s gums, on the roof of their mouth or inside their cheeks. The patches may not seem to bother your baby but if they’re sore, your baby may be reluctant to feed.

Other signs and symptoms of oral thrush in babies include a whitish sheen to their
saliva, fussiness feeding or refusing the breast, clicking sounds during feeding, poor weight gain and nappy rash. Some babies may dribble more saliva than normal if they have an oral thrush infection.

Most cases clear up on their own. Your GP or health visitor may prescribe an antifungal treatment called Nystatin which is a liquid applied directly onto the thrush using a dropper. Most babies accept this treatment without any problems.

Colds and snuffly nose

Colds are common and most frequently caused by a variety of viruses. Gradually,
children build up immunity and get fewer colds. Most colds get better in five to seven days.
If your child has a cold, increase the amount of fluid they drink. Encourage the whole family to wash their hands regularly to help stop the cold spreading.

Because colds are caused by viruses, not bacteria, antibiotics don’t help.

A warm, moist atmosphere can ease breathing if your child has a blocked nose.
Take them into the bathroom and run a hot bath or shower or use a vaporiser to
humidify the air.

Saline nose drops can help loosen dried nasal secretions and relieve a stuffy nose.
Ask your pharmacist, GP or health visitor about them.

Fever

A fever is a temperature above 38˚C and usually caused by a virus which the body
is dealing with. For children under 4 weeks old, use a digital thermometer under
the armpit to take their temperature. Over 4 weeks old, use a digital ear
thermometer.

Ensure the baby is dressed appropriately for the room. Make sure the environment itself is not too warm. Cold sponging a baby to treat a fever is not effective and only causes distress.

Medicines to treat a fever can only be given over 8 weeks of age. Paracetamol at 8
weeks of age or ibuprofen at 3 months. If giving any medication before 12 weeks,
please check with a health professional

Follow the dosing instructions on the box for the amount and how often it can be
given. Use the syringe that comes with the medicine – wash it out and use again.

Own brands work just as well as named brands.

You do not need to give paracetamol/ibuprofen before vaccinations. It may even reduce the effectiveness of the vaccine. Over 8 weeks of age, paracetamol
can be given if your baby becomes very irritable or develops a temperature over
38˚c.

Please check with your practice nurse for advice after vaccination.

Diarrhoea and vomiting

Infections can cause diarrhoea with or without vomiting. This is called gastroenteritis (a stomach bug). Stomach bugs are more common in formula-fed than breastfed babies.

Contact your GP or health visitor urgently for advice if your child passesd 6 or
more diarrhoeal stools in the past 24 hours or if your child has vomited 3 times or
more in the past 24 hours.

If other family members or people your baby comes into contact with have a stomach bug, ask them to wash their hands frequently using liquid soap in warm running water and drying their hands carefully.

Keep toilets clean and wash towels frequently. With formula-fed babies, make sure bottles are sterilised thoroughly.

Babies are more at risk of becoming dehydrated due to vomiting or diarrhoea than
older children. Symptoms of dehydration include:

• lethargy or irritability
• a dry mouth
• loose, pale or mottled skin
• cold hands and feet
• sunken eyes and fontanelle.

A dehydrated baby may pass very little urine and feed poorly, but it may be
difficult to tell how much urine they pass when they have diarrhoea.

In general, for mild diarrhoea, give extra fluids. Use cooled boiled water. Don’t stop breastfeeding and give the extra fluid in addition to breast or formula milk.

For more severe diarrhoea, or diarrhoea with vomiting, don’t stop breastfeeding. Get expert advice. Speak to your GP – they may suggest oral rehydration fluids.

If you’re formula feeding, stop. Instead, give small amounts of oral rehydration fluids every 10 minutes or so. Keep doing this even if your baby is still vomiting.

Most of the fluid will stay in, even if it doesn’t seem that way. Restart normal formula feeds after 3 to 4 hours. Your GP will give you advice.

Constipation

For babies with constipation who have not yet been weaned, give them extra water
between their normal feeds. Do not try to dilute formula milk, continue to make it as directed on the packet.

You can try carefully massaging your baby’s tummy and cycling their legs to stimulate their bowels.

Reflux

It’s similar to heartburn and caused by a back-flow of milk leaving the
stomach and entering the food pipe. It will be partially digested and slightly acidic.

Reflux happens because the valve at the top of the stomach is under developed.
Symptoms include crying during feeds or refusing to feed, arching their backs,
irritability, coughing at night, weight loss or poor weight gain. Babies may vomit
varying amounts.

When to get urgent medical help

The following symptoms in a baby should always be treated as serious:

• an unusual high-pitched, weak or continuous cry
• lack of responsiveness, reduction in activity or increased floppiness
• bulging fontanelle (the soft spot on a baby’s head)
• neck stiffness
• not drinking for more than 8 hours (taking solid food is not as important)
• temperature of over 38°C for a baby less than 3 months old, or over 39°C
  for a baby aged 3 to 6 months old
• a high temperature coupled with cold feet and hands or quietness and
  listlessness
• fits, convulsions or seizures
• turning blue, very pale, mottled or ashen
• difficulty breathing, fast breathing, grunting while breathing, or if your child works hard to breathe, for example, sucking their stomach in under their ribs
• unusually drowsiness, is hard to wake up or your baby doesn’t seem to know you
• unable to stay awake even when you wake them
• a spotty, purple-red rash anywhere on the body
• repeated vomiting or bile-stained (green) vomiting.

Call 999 if your baby:

• stops breathing
• struggles for breath (you may notice a sucking in under the ribcage)
• is unconscious or seem unaware of what’s going on
• won’t wake up
• is having a fit for the first time, even if they seem to recover.

Take your child to Accident and Emergency (A&E) if they have:

• a fever and persistently lethargy despite taking paracetamol or ibuprofen
• difficulty breathing (breathing fast or panting, or very wheezy)
• severe abdominal pain
• a cut that won’t stop bleeding or is gaping open
• a leg or arm injury that means they can’t use the limb
• swallowed a poison or tablets.

Pregnancy to 6 weeks

Vitamin D in pregnancy, breastfeeding and children under 5

Having a baby and managing your money

Your baby’s first solid foods

Activities for kids for newborn to age 5

Buckinghamshire Family Information Service

1 to 2 years

Dealing with child behaviour problems

Children’s teeth

Fussy eaters

Keeping your baby and toddler safe

How to potty train

Sleep problems in young children

Information and guidance about specific conditions:

View a list of children and young people patient information 

This free, live webinar provides information on how you can support your child’s toileting.
From about 18 months – 2 years, children start to show signs they are ready for toilet training.

Preparation helps toilet training to go smoothly. Before you start, it’s good to learn more about how toilet training works, how to get started and what to expect during the process. It’s also good to think about practical things like potties and accidents.

In this webinar, we’ll explain how to:

• Tell when your child is ready for toilet training
• Get organised for toilet training
• Prepare your child for toilet training
• Start toilet training

If you have a child aged 1-4 years this webinar is suitable for you. It is also suitable if your child is younger and you want to be ready when the time comes to start toilet training.

This free, live webinar provides information on when and how to introduce solids.

Evidence based guidance recommends the introduction of solids when your baby is around 6 months of age.

Encouraging good eating habits from the start is the best foundation for future healthy eating behaviour. It is good to learn how to get started and what to expect.

If you have a baby aged between 4 and 6 months old this webinar is suitable for you. It is also suitable if your baby is younger and you want to be ready when the time comes to start introducing solids.