Baby checks
At each postnatal assessment, your midwife will check your baby’s health and wellbeing. The following observations help to build up a complete picture of your baby and your midwife will discuss the findings with you. Please discuss any concerns you may have about your baby with your healthcare team.
Observations: Depending on your baby’s needs, closer monitoring may be carried out during the first 12-24 hours after birth. This may include observing your baby’s breathing rate, temperature, colour, blood glucose levels and how your baby responds. Staff caring for you will explain the reason why this is being done.
Temperature: Your midwife will check how warm your baby feels to the touch; it is a good indication of how appropriate the temperature is around your baby. Your midwife can advise on the amount of clothing and bedding to use, whether in the house, car or pram. The recommended room temperature should be 16-20°C. If there are concerns about your baby’s temperature your midwife will assess using a thermometer.
Weight: Your midwife will weigh your baby at regular intervals and advise you about feeding according to your baby’s weight gain. Your health visitor will give you information about where the local child health clinic is based and where your baby will be weighed. They will continue assessing your baby’s growth.
Tone (muscle tone – activity and reflexes): Your midwife will check to see that your baby can move both arms and legs. IN the early days and weeks your baby will have involuntary movements which are called reflexes. These include the root reflex which begins when the baby’s cheek is stroked or touched. The baby will turn their head and open their mouth to follow and ‘root’ in the direction of the stroking. This helps the baby find the breast or bottle and begin feeding. Babies are born with the ability to suck and during the first few days they learn to coordinate their sucking and their breathing. The startle reflex occurs when a baby is startled by a loud sound or movement. The baby throws back its head, extends out the arms and legs, cries, then pulls the arms and legs back in. A baby’s own cry can startle them and begin this reflex. They can also grasp things like your finger with either hands or feed and they will make stepping movements if they are held upright on a flat surface. All these responses, except sucking, will be lost within a few months and your baby will begin to make controlled movements instead.
Jaundice (yellow colour): This is a common condition in newborn babies, more than half of all babies become slightly jaundiced for a few days. Babies develop a yellow colour to their skin and whites of the eyes (sclera); it is a normal process and does no harm in most cases. However, it is important to check your baby for any yellow colouring particularly during the first week of life. It will normally appear around the face and forehead first then spread to the body, arms and legs. From time to time gently press your baby’s skin to see if you can see a yellow tinge developing. Check the whites of the eyes and when your baby cries, have a look inside their mouth and see if the sides of the gums or roof of the mouth look yellow. Ask your midwife to show you how to check if you are not sure. If you think your baby is jaundiced contact your midwife for advice. If your baby is jaundiced, very sleepy with pale/chalky stools or dark urine, a blood test can be taken to check the level of jaundice (bilirubin). If the level is high, treatment is recommended by using phototherapy. This is done in the hospital environment, under closer supervision. Treatment may last for several days, with regular blood tests being carried out to check the level of bilirubin. You will be advised according to your individual circumstances.
Eyes: your baby’s eyes are observed for any signs of stickiness, redness or discharge. Special cleaning of your baby’s eyes is not required unless your baby develops an infection. This can occur for no apparent reason and appears as a yellow discharge in one or both eyes. If this happens, your midwife may take a swab or arrange for your doctor to prescribe treatment. Your midwife will also show you how to clean the eyes properly. It is common for a newborn to have poor control of its eyes ad appear cross-eyed at times, but this should decrease as the eye muscles strengthen. The eyes usually look blue-grey or brown. In general, your baby’s permanent eye colour will be apparent within six to twelve months.
Mouth: soon after birth, the midwife will examine your baby’s mouth to check their palate and look for any teeth. There is a piece of skin under your baby’s tongue called the frenulum and in a small number of cases this can be right and can affect the way your baby feeds. If you are experiencing feeding issues please let the midwife looking after you know who will complete a feeding assessment. It can be treated; your midwife will give advice about treatment. Occasionally, babies can be born with teeth. If your baby has been born with teeth, treatment will be discussed with you. At each subsequent baby check, the midwife will check your baby’s mouth for thrush. Signs of thrush are redness, white spots or white coating that does not disappear between feeds. Thrush can be avoided by good hygiene. Always wash your hands before preparing bottles and after changing your baby’s nappy. Wash bottles and teats thoroughly and sterilise before use. If your baby develops thrush, it may be necessary to treat with prescribed medicine from your GP.
Cord: after your baby is born the umbilical cord will be clamped and cut. The plastic clamp will stay on the stump of the cord until it drops off, (this usually takes 7-10 days). It usually does not require any special attention, other than careful washing and drying. It is very common for the stump to bleed slightly as it separates, and your midwife will advise you how to care for this. Usually all that is required is to ensure the nappy does not rub on the area. If there is any heavy bleeding, discharge, redness or a bad smell around the cord stump you should contact your midwife or GP for advice.
Skin: your baby’s skin is very sensitive in the early weeks. Your midwife will check your baby’s skin for any spots, rashes or dryness. After your baby is born, they may have small amounts of vernix left in the skin folds, such as under the arms. This is the white creamy substance that protects the baby’s skin inside your womb. It is not harmful to your baby to your baby and will disappear over the next few days, there is no need to try and remove it. Some babies have dry skin in the first few days after birth; this is common if your baby was born after their due date. It’s best to bath your baby with plain water only for at least the first month. If you need to, you can also use some mild, non-perfumed soap. Avoid skin lotions, medicated wipes, or adding cleaners to your baby’s bath water. After washing pat your baby’s skin dry, pay special attention to skin creases. You may wish to rub some oil onto your baby’s skin, ask your midwife for more information.
Urine and nappy rash: your baby should have at least two wet nappies per day in the first two days, increasing to six or more per day by seven days. Urates are tiny orange/pink crystals that look like brick dust that may appear in the nappy, but with regular feeding will disappear. The skin on a baby’s bottom is sensitive and prolonged contact with urine or stools can cause burning or reddening of the skin. Nappies should be changed frequently, either before or after feeds to prevent this. If the skin does become sore, it is better to use warm water and cotton wool rather than wipes or lotions and apply a barrier cream.
Bowels (stools): the first stools are sticky, greenish-black and are called meconium. As the baby takes milk feeds, the stools become a mustard colour and sometimes have a seedy appearance. Breastfed babies will have soft, yellow stools that do not smell, while a formula fed baby will have stools that are more formed, darker and smellier. All babies should pass at least two soft stools per day for the first six weeks regardless of feeding method. If you have any concerns, ask your midwife, health visitor or GP for advice.
Colic: a baby who cries excessively and inconsolably and either draws up their knees or arches their back, especially in an evening, may have colic. You should tell your midwife so that an assessment can be made to rule out other causes. Your midwife will then advise you according to your individual circumstances.
The fontanelle: On the top of your baby’s head near the front is a diamond shaped patch where the skull bones have not year fused together. This is called the fontanelle. It will probably be a year or more before the bones close over it. You may notice it moving as your baby breathes. Don’t worry about touching it as there is a tough layer of membrane under the skin.
Bumps and bruises: it is quite common for a newborn baby to have some swelling (caput) and bruises on their head, and perhaps to have bloodshot eyes. This is the result of squeezing and pushing that is part of being born and will soon disappear. A cephalhaematoma is a bump, on one or both sides of the head. This is due to friction during the birth, which can last for weeks but will resolve naturally and usually no treatment is needed.
Breasts and genitals: quite often a newborn baby’s breasts are a little swollen and may ooze some milk, whether the baby is a boy or a girl. Girls also sometimes bleed slightly or have a cloudy discharge from their vagina. This is a result of hormones passing from the mother to the baby before birth and is no cause for concern. The genitals of newborn babies often appear rather swollen but will look in proportion with their bodies in a few weeks.
Birthmarks and spots: marks or spots that you notice mainly on the head and face of your baby usually fade away eventually. Most common are the little pink or red marks some people call ‘storm marks’. These ‘v’ shaped marks on the forehead, upper eyelids and nape of the baby’s neck gradually fade, though it may be some months before they disappear. Strawberry marks are also very common. They are dark red and slightly raised, appearing a few days after the birth, sometimes getting bigger. These too will disappear eventually.
Early development: newborn babies can use all their senses. From birth your baby will focus on and follow your face when you are close in front of them. They will enjoy gentle touch and the sound of a soothing voice and will react to bright light and be startled by sudden, loud noises. By two weeks of age, babies begin to recognise their parents and by 4 to 6 weeks start to smile. Interacting with your baby through talking, smiling and singing to them, are all ways of helping your baby feel loved and secure.
Excessive crying: all babies cry but some babies cry a lot. Crying is your baby’s way of telling you they need comfort and care. This can be very stressful and there may be times when you feel unable to cope. This happens to lost of parents and is nothing to be ashamed of. Ask your family and friends to help and talk to your midwife, health visitor or GP. It is okay to walk away if you have checked the baby is safe and their crying is getting to you. After a few minutes when you are feeling calm, go back and check on your baby. NEVER shake or hurt your baby. This can cause lasting brain damage and death. There is an organisation called CRY-SIS who can put you in touch with other parents who have been in the same situation. You can get further information via: www.cry-sis.org.uk/ or helpline number: 08451 228 669. You can also find information about ways you can cope with a baby crying via: www.iconcope.org/. If your baby is crying and the cry does not sound like their normal cry and they cannot be comforted it could be a sign that they are ill. If you think there is something wrong, always follow your instincts.
Last Modified: 11:17am 03/01/2024