Common Questions Parents Ask About Babies Aged 0–12 Months

NBSS Newborn Blood Spot Test

The NHS guidance for the newborn spot test (heel prick test or newborn screening) is as follows:

1. Purpose: The test is performed to identify rare but serious conditions that could affect a newborn's health and development. Early detection allows for early intervention and treatment to reduce the risk of long-term complications.

2. When it's done: The test is usually done between 5 and 8 days of life, ideally after the baby has been feeding well for at least 24 hours. The blood sample is taken from the baby’s heel.

3. Conditions screened: The test screens for a variety of conditions, including:

* Phenylketonuria
* Cystic fibrosis
* Sickle cell disease
* Congenital hypothyroidism
* Medium-chain acyl-CoA dehydrogenase deficiency
* Maple syrup urine disease
* Homocystinuria
* Glutaric aciduria type 1
* Isovaleric acidaemia
* Tyrosinaemia type 1

4. Procedure: A small amount of blood is taken from the heel of the baby using a lancet. This sample is then sent to a laboratory for testing.

5. Results: The results are usually available within a couple of weeks. If the screening indicates a potential concern, the parents will be contacted for further tests. If a condition is detected, early treatment can prevent or reduce the risk of serious complications.

6. Follow-up: In cases where the test results are abnormal, further tests and appointments with specialists will be arranged for further diagnosis and management.

The newborn screening test is a routine part of postnatal care in many healthcare systems and is considered an essential part of ensuring that newborns receive timely interventions for any potentially serious health conditions.

References and Further Reading:
1. NHS Newborn Blood Spot (Heel Prick) Test – Overview
https://www.nhs.uk/conditions/baby/babys-health/tests/newborn-blood-spot-test/
2. NHS Screening Programmes: Newborn Blood Spot
https://www.gov.uk/topic/population-screening-programmes/newborn-blood-spot
3. UK National Screening Committee (UK NSC) – Policy on Newborn Blood Spot Screening
https://www.gov.uk/government/collections/newborn-blood-spot-screening
4. NHS Sickle Cell and Thalassaemia Screening Programme
https://www.gov.uk/topic/population-screening-programmes/sickle-cell-thalassaemia
5. Public Health England – Newborn Screening Standards
https://www.gov.uk/government/publications/newborn-blood-spot-screening-programme-standards

Newborn Hearing Screening

The NHS provides guidance on newborn hearing screening to ensure early identification of any hearing issues, which is crucial for a child's development. Here's a summary of the key points:

* All newborns in the UK are offered hearing screening shortly after birth. This screening typically takes place before the baby leaves the hospital.

* The test is non-invasive, usually conducted using a method called otoacoustic emissions (OAE), which involves a small probe placed in the baby's ear. The probe measures sounds that are produced by the inner ear in response to a gentle click.

* If the first test doesn't give a clear result, a follow-up test will be arranged. This is important as not all babies pass the first screening due to factors like noise or movement.

* If the second test suggests hearing loss, further assessments and support are arranged to confirm the results and provide the necessary interventions.

* Early identification of hearing issues helps with timely intervention, such as speech therapy or hearing aids, which can significantly support the child's communication development.

It’s important for parents to follow through with any recommended follow-up tests and services to ensure the best possible outcomes for their child's hearing and overall development.

References and Further Reading:
1. NHS – Newborn Hearing Screening Overview
https://www.nhs.uk/conditions/baby/babys-hearing/nhs-newborn-hearing-test/
2. GOV.UK – Newborn Hearing Screening Programme (NHSP)
https://www.gov.uk/topic/population-screening-programmes/newborn-hearing
3. Public Health England – Newborn Hearing Screening Standards
https://www.gov.uk/government/publications/newborn-hearing-screening-programme-nhsp-standards
4. NHS – How the Newborn Hearing Test is Done
https://www.nhs.uk/conditions/baby/babys-hearing/nhs-newborn-hearing-test/#how-the-test-is-done
5. UK National Screening Committee – Hearing Screening Policy
https://www.gov.uk/government/collections/newborn-hearing-screening

Newborn Dry, Peeling Skin

It is normal for a newborn's skin to peel.

This usually happens within the first few days to weeks after birth. Peeling skin is a natural process as the baby's skin adjusts to the new environment outside the womb.

Here are some key points to keep in mind:

* Peeling Skin: Common on the hands, feet, and ankles, and can occur all over the body.

* Causes: Peeling is part of the shedding of the outer layer of skin, which was protected by vernix in the womb.

* No Treatment Needed: Typically, no special treatment is needed. Just keep the baby’s skin moisturized with a gentle, fragrance-free lotion if recommended by a healthcare provider.

* Gentle Care: Continue to use plain water for bathing and avoid harsh soaps or cleansers during the first month.

General Your Baby's Skin Care

* Delicate Skin at Birth: Newborns have very thin and easily damaged skin which matures over the first month. Premature babies take longer to develop this natural barrier.

* Vernix: The white, sticky substance on a newborn's skin acts as a natural moisturizer and protects against infection. It should not be removed.

* Bathing: Use plain water only for bathing your baby during the first month. Avoid cleansers, lotions, and medicated wipes.

* Premature Babies: Their skin is even more fragile, and neonatal staff will provide specific skincare advice.

* Overdue Babies: They might have extra dry and cracked skin because the protective vernix was absorbed before birth.

* If you notice any signs of infection, persistent redness, or other unusual skin conditions, consult your GP, Health Visitor or Midwife. Always consult medical professionals GP, Pharmacist, Health Visitor or Midwife for diagnosis and treatment.

References and Further Information:
1. NHS – Your Newborn's Appearance (Peeling Skin, Vernix)
https://www.nhs.uk/pregnancy/labour-and-birth/after-the-birth/your-baby-after-birth/
2. NHS – Washing and Bathing Your Baby
https://www.nhs.uk/conditions/baby/caring-for-a-newborn/washing-your-baby/
3. NHS – Dry Skin in Babies
https://www.nhs.uk/conditions/baby/caring-for-a-newborn/dry-skin-in-babies/
4. NICE – Postnatal Care Overview (Skin Care Mentioned Under Physical Assessment)
https://www.nice.org.uk/guidance/ng194

Atopic Eczema

Atopic eczema is a common skin condition, often occurring in childhood, with up to 1 in 5 children estimated to be affected by eczema at some point.

- It typically improves with age, with more than half of children growing out of it by their teens.
- It belongs to a group of related, inherited allergy-related conditions, including asthma and allergic rhinitis.
- Atopic eczema tends to run in families; if one or both parents have eczema, their children are more likely to develop it too.

Atomic Eczema might present:
- Atopic eczema can appear anywhere on the skin, but it often affects joints' creases like elbows and knees, as well as wrists and neck.
- Typically, affected skin shows redness, dryness, and common scratch marks, occasionally leading to bleeding.
- During active phases, eczema may exude moisture, forming small blisters, particularly on hands and feet.
- Persistent scratching can lead to skin thickening (lichenification), exacerbating itchiness.
- Skin pigmentation changes may occur in affected areas, appearing darker or lighter than surrounding skin.

** Consult your GP, Health Visitor or Midwife for an assessment of your baby skin symptoms and discuss and review, possible triggers and treatment plan.

** Consult a GP, call 111, dial 999, or visit the Emergency Department if you are concerned about your baby's presentation, rash, symptoms, and feel that your baby needs a medical review.

Please follow the link bellow https://www.nhs.uk/conditions/atopic-eczema/ for information and guidance on:
- What are the symptoms of atopic eczema?
- What does atopic eczema look like?
- Diagnosing eczema
- Treating eczema
- What factors are likely to exacerbate my child’s eczema?
- What can I do to help my child?

Please click and follow the link below for further up to date information and guidance on atopic eczema. Signposted from BHC, containing public sector information licensed under the Open Government Licence v3.0.

References and Further:
1. NHS – Atopic Eczema (Infant and Childhood)
https://www.nhs.uk/conditions/atopic-eczema/
2. NHS – Treating Eczema in Babies and Children
https://www.nhs.uk/conditions/atopic-eczema/treatment/
3. NICE Clinical Guidelines – Atopic Eczema in Under 12s: Diagnosis and Management
https://www.nice.org.uk/guidance/cg57
4. NICE Evidence Summary – Emollients and Treatment Options
https://cks.nice.org.uk/topics/eczema-atopic/
5. NHS Inform (Scotland) – Childhood Eczema
https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/eczema/childhood-eczema
6. National Eczema Society: https://eczema.org

Cradle Cap

NHS Guidance
The NHS recommends the following steps for managing cradle cap:

* Apply an emollient (moisturiser) to the scalp to soften the scales.
* Gently brush the scalp with a soft baby brush.
* Wash the scalp with a mild baby shampoo.

Avoid:
* Olive oil or peanut oil
* Soap
* Adult shampoos
These may irritate the baby's skin.
🔴 Do not pick at the scales, this can lead to infection.

Seek medical advice if:
* The condition lasts beyond a few weeks
* It spreads to other areas of the body
* There are signs of infection (e.g. swelling, bleeding, or oozing)

NICE Guidance (Clinical Knowledge Summaries)
NICE also notes that cradle cap is self-limiting and typically resolves by 8 to 12 months of age.
Recommended management:

* Apply a bland emollient or petroleum jelly
* Use a soft brush to loosen the scales
* Wash with a mild baby shampoo

If first-line measures are ineffective and the baby is distressed, a prescription may be considered.
💡 However, emollients and cradle cap shampoos are listed in NHS England guidance as items that should not routinely be prescribed in primary care.

Additional Information
* Cradle cap may extend beyond the scalp to eyebrows, face, and nappy area
* It is not infectious and generally painless
* If in doubt, or if symptoms worsen, consult your GP or pharmacist

References and Further Reading
1. National Health Service (NHS). Cradle Cap. Available at: https://www.nhs.uk/conditions/cradle-cap/
2. National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summaries: Seborrhoeic dermatitis (cradle cap). Available at: https://cks.nice.org.uk/seborrhoeic-dermatitis
3. National Institute for Health and Care Excellence (NICE). Prescribing of over-the-counter items in primary care. Available at: https://www.nice.org.uk/guidance/ng58

Oral Thrush (mouth thrush) and Breastfeeding and Thrush

As per NHS (2024) Infant feeding can become very painful due to a fungal infection known as thrush, caused by Candida albicans.

Signs of thrush in the baby include:
• white patches on tongue and mouth
• nappy rash.
• fretful
• windy
• difficult to settle
• reluctant to feed

Treatment for babies:
• DAKTARIN® Miconazole 2% oral gel *** if your baby is under 4 months you will need to see your GP for a prescription.
• apply the gel 4 times/day
• For correct application follow the patient information leaflet.
• Do Not put it to the back of your baby’s mouth as this may cause choking.
• Do Not give DAKTARIN® Gel from a spoon or syringe.
• DAKTARIN® Gel is available for purchase over the counter at a pharmacy for a baby over the age of 4 months.
• It is important to continue the treatment for a whole week after your baby is symptom free.

Breastfeeding and thrush:
Breastfeeding can lead to thrush, causing extreme pain in both breasts simultaneously. It often follows a course of antibiotics. Ensure your midwife or health visitor checks your baby's attachment, as poor attachment can mimic thrush pain.

Signs of thrush in the nursing parent may include:
• Initially healed sore, cracked nipples may lead to sudden painful feeding.
• Nipples may itch/burn, appear pink, shiny, and moist.
• Severe pain may persist after feeding.
• If pain persists despite correct positioning, thrush treatment for both mother and baby is necessary, even without visible signs in the baby.
• Warfarin users should avoid Miconazole cream and consult a GP if thrush is suspected.

Treatment of mother:
• Use DAKTARIN® 2% Cream: Apply small amount after each feed, wipe excess before next feed.
• Apply after every breastfeed for 2 weeks.
• Continue treatment for a week after both mother and baby are symptom-free.
• DAKTARIN® Cream is available over the counter at pharmacies.

*** Seek help: Pharmacist or health visitor for non-urgent concerns

*** See a GP urgently if your baby's symptoms worsen and you become concerned. Call 999 or attend the Emergency Department if you feel extremely concerned about your baby's symptoms and they require medical review.

References:
NHS. (2024). Worried about your baby? My baby has thrush. NHS. https://www.what0-18.nhs.uk/worried-your-baby-unwell-under-3-months-2/worried-about-your-baby/my-baby-has-thrush [accessed[accessed 26 May 2024]
NHS. (2024). Oral thrush in babies. NHS. https://www.nhs.uk/conditions/oral-thrush-mouth-thrush/ [accessed 2
NHS. (2024). Thrush while breastfeeding. NHS. https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding-problems/thrush/[accessed 26 May 2024]

Please click and follow the link with up-to-date guidance signposted from BHC, containing public sector information licensed under the Open Government Licence v3.0

Baby Nails

An ingrown nail or toenail in a baby occurs when the corners or edges of the nail grow into the surrounding skin.

Babies get ingrown toenails from sharp nail corners, cutting nails too short, or tight shoes.

If a baby's fingers are red around the skin, it could be due to several reasons:
* Irritation or allergic Reaction to soap, lotion, or fabric.
* Infection: Bacterial or fungal infections can cause redness, swelling, and sometimes pus.
* Sucking or Chewing on their fingers, which can lead to temporary redness and irritation.

It's important to keep the area clean and dry, avoid potential irritants, and monitor for signs of infection (such as increased redness, swelling, or pus).

If the redness persists, spreads, or is accompanied by other symptoms like fever, consult your GP for proper diagnosis and treatment.

You can try some home treatments if there is no pus, excessive redness or fluid and your baby does not have a fever.

* Soak the affected toe in warm, soapy water 2-3 times a day
* Gently massage the toe or fingers to ease the nail out from the skin
* Pat the toe/finger dry without rubbing
* Speak to your pharmacist for an over-the-counter cream to prevent infection
* Check shoes and consult GP if infection signs are present
* Ingrown nails may fix themselves if not infected; otherwise, see GP if redness spreads or fever develops

Preventing recurrence:
* Regularly check your Baby's toes and fingers
* Trim toenails and fingernails straight across
* Ensure your Infant shoes fit well
* Ensure fingers corner skin are not getting stuck in ie : baby hand mitts

** Consult your GP:
* Needs attention if red, swollen, leaking fluid and appears painful
* After a week of home treatment if signs of infection persist (swelling, redness, pus, bleeding)
* See a GP, call 111. immediately if fever develops or redness spreads. Call 999 or attend Emergency Department if you become extremely concerned with you baby’s presentation and symptoms.

Always consult medical professionals for diagnosis and treatment

Guidance as stated in the following sources:
Sources:
https://www.nhs.uk/conditions/baby/caring-for-a-newborn/washing-and-bathing-your-baby/
https://www.nhs.uk/conditions/ingrown-toenail/
https://www.bdct.nhs.uk/wp-content/uploads/2016/12/Babies-and-Childrens-Feet-Leaflet.pdf
https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/ingrown-toenail
https://www.verywellfamily.com/caring-for-baby-toenails-284174

Please click and follow the link below for up to date guidance on caring for your newborn. Signposted from BHC, containing public sector information licensed under the Open Government Licence v3.0.

Jaundice

Jaundice is common in newborns and usually harmless.

It causes a yellowing of the skin and whites of the eyes and typically clears on its own by 2 weeks of age. However, it's important to monitor symptoms and seek help if they worsen.
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Key Symptoms to Watch For
• Yellow skin and eyes (check palms/soles in darker skin tones)
• Dark yellow urine (normal = colorless)
• Pale or chalky stools (normal = yellow or orange)
• When symptoms appear: Usually around 2 days after birth
• When symptoms improve: Usually by 2 weeks
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Examinations & Monitoring
• All newborns are checked within 72 hours after birth.
• Contact a healthcare provider if:
o Jaundice appears after 72 hours
o Symptoms worsen or last beyond expected timeframe
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Why Does It Happen?
• Immature liver not yet efficient at processing bilirubin
• High red blood cell turnover after birth
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How Common Is It?
• Affects 6 in 10 babies
• More frequent in:
o Premature babies (8 in 10)
o Breastfed babies (still encouraged due to benefits)
• Only 1 in 20 babies need treatment
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Treatment Options
• Usually not needed
• If bilirubin levels are high:
o Phototherapy (light treatment)
o Exchange transfusion (in rare, severe cases)
Complication (Rare in the UK)
Severe untreated jaundice can lead to kernicterus—a type of brain damage.
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When to Refer: Prolonged Jaundice Screening
Referral needed if jaundice persists:
• Beyond 14 days in full-term babies (≥37 weeks)
• Beyond 21 days in preterm babies (<37 weeks)
Referral Pathways:
1. Neonatal Registrar
o If jaundice persists 14–21 days (term) or beyond 21 days (preterm)
2. Paediatric Team
o If jaundice lasts beyond 28 days
Urgent Referral Needed If:
• Early onset (<24 hours) – assess within 2 hours
• Unwell appearance + jaundice – immediate A&E assessment
• Visible jaundice in first 24 hours – urgent bilirubin testing
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Urgent Symptoms – Seek Help Immediately
📞 Call NHS 111 or visit A&E if your baby has:
• Deepening yellow/orange skin (spreading to arms/legs)
• Poor or reluctant feeding
• Lethargy or difficulty waking
• High-pitched crying
• Dark yellow or brown urine
• Pale/chalky or white stools
• Arched back or stiff limbs
• Seizures
➡️ These could indicate serious complications like kernicterus. Don't delay.

References and Further Reading:
1. NHS: Jaundice in Newborns
https://www.nhs.uk/conditions/jaundice-newborn/ NICE Guidelines
2. NICE Clinical Guideline (CG98): Jaundice in Newborn Babies under 28 Days
https://www.nice.org.uk/guidance/cg98
3. NICE Information for the Public (CG98/IFP)
https://www.nice.org.uk/guidance/cg98/ifp/chapter/About-this-information

"Breast Milk Jaundice"

🍼 Breastfeeding and Jaundice: A Guide for Parents
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Understanding Jaundice in Newborns
Jaundice is a common condition in newborns, typically appearing within the first few days of life. It causes a yellowing of the skin and eyes due to raised levels of bilirubin, a substance in the blood.
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🤱 Breastfeeding and Jaundice: What You Need to Know
• Breastfeeding and Jaundice Risk:
Breastfed babies are more likely to develop jaundice, especially within the first week. However, there’s no need to stop breastfeeding, as it offers significant health benefits and usually helps resolve jaundice.
• Breast Milk Jaundice:
Some breastfed babies may have jaundice that lasts for several weeks, even up to 12 weeks. This is called breast milk jaundice and is typically harmless, resolving on its own over time.
• Feeding Helps:
Regular and effective breastfeeding helps the baby flush out excess bilirubin through urine and stools, which helps in resolving jaundice.
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⚠️ Key Symptoms to Watch For
• Yellowing of skin and eyes (check palms/soles in darker skin tones)
• Dark yellow urine (normal is colorless)
• Pale or chalky stools (normal stools are yellow or orange)
• When symptoms appear: Typically around 2 days after birth.
• When symptoms improve: Usually by 2 weeks of age.
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Treatment Options
• Usually not needed: In most cases, jaundice resolves naturally.
• If bilirubin levels are very high, treatment options may include:
o Phototherapy (light therapy)
o Exchange transfusion (in rare, severe cases)
• Complication (Rare):
Severe untreated jaundice can lead to kernicterus, a type of brain damage.
__________________________

📋 NHS & NICE Guidelines Highlights
• Definition:
Physiological jaundice is common in newborns and generally harmless. Prolonged jaundice should be assessed to exclude other conditions, such as liver disease or infections.
• Monitoring:
Blood tests to check serum bilirubin levels are recommended if:
o Jaundice appears within the first 24 hours of life
o Jaundice persists beyond the typical timeframe
o The baby is preterm or visibly jaundiced
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✅ Managing Jaundice at Home
1. Frequent Feeding:
Offer feeds every 2–3 hours. Waking the baby for feeds may be necessary.
2. Breastfeeding Support:
Seek help with positioning and latch to ensure effective feeding and proper milk transfer.
3. Hydration:
Ensure the baby is well-hydrated with early and regular feeds to help resolve jaundice.
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🔄 When and Where to Refer for Prolonged Jaundice Screening
Referral is required if jaundice persists beyond the following:
Infant Type Duration of Jaundice Action
Term (≥37 weeks) >14–21 days Refer to Neonatal Registrar
Preterm (<37 weeks) >21 days Refer to Neonatal Registrar
All infants >28 days Refer to Paediatric Team
Immediate Actions:
• Early Onset (<24h): Review within 2 hours and measure bilirubin levels.
• Unwell & Jaundiced: Assess urgently in the A&E department.
• Ongoing Monitoring: Repeat bilirubin tests every 6 hours if necessary, until stable or falling.
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🧾 Urgent Symptoms – Seek Help Immediately
📞 Call NHS 111 or visit A&E if your baby shows any of the following:
• Deepening yellow/orange skin (spreading to arms/legs)
• Poor or reluctant feeding
• Lethargy or difficulty waking
• High-pitched crying
• Dark yellow or brown urine
• Pale or chalky stools
• Arched back or stiff limbs
• Seizures
These could indicate serious complications, like kernicterus, which requires urgent medical attention.
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🧾 Summary for Parents
• Jaundice is common in newborns, especially in breastfed babies.
• Continue breastfeeding, frequent feeds can help resolve jaundice.
• Seek medical advice if jaundice persists beyond typical timeframes or if symptoms appear unusually early.
• In cases of prolonged jaundice or if your baby seems unwell, medical checks will ensure there are no underlying causes.
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📚 References and Further Information
1. NHS Jaundice Information: https://www.nhs.uk/conditions/jaundice-in-babies/
2. NICE CG98 - Jaundice in Newborns: https://www.nice.org.uk/guidance/cg98

Prolonged Jaundice Screening

🟡 What Is Prolonged Jaundice?

Prolonged jaundice is defined as jaundice that persists beyond the expected duration in newborns:
• More than 14 days in term infants (≥37 weeks gestation)
• More than 21 days in preterm infants (<37 weeks gestation)
Prolonged jaundice is usually harmless, especially in breastfed babies, but it can sometimes indicate a more serious underlying condition (such as liver disease, biliary atresia, or metabolic disorders), so further assessment is necessary.
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📋 NICE and NHS Guidance on Prolonged Jaundice Screening
🔍 NICE Guideline (CG98) — Key Recommendations:

* Jaundice persisting beyond 14 days in term infants or 21 days in preterm infants is classified as prolonged jaundice.

When to Investigate:
* If jaundice persists beyond the timeframes above or
* If the baby has pale stools, dark urine, poor weight gain, or signs of illness

Recommended Investigations:
* Serum bilirubin (conjugated and unconjugated)
* Full blood count (FBC)
* Liver function tests (LFTs)
* Thyroid function tests
* Urine culture
* Additional tests may be needed based on clinical findings.

Referral:
* Babies with conjugated (direct) hyperbilirubinaemia should be urgently referred to a specialist.
* If the baby is clinically unwell, has pale stools, or dark urine, refer immediately for assessment.
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🏥 NHS Guidance Summary:
Source: https://www.nhs.uk/conditions/jaundice-in-babies/

* Persistent jaundice is common in breastfed babies and is often due to breast milk jaundice, which is usually harmless.
* However, prolonged jaundice can also be a sign of more serious conditions (e.g. biliary atresia, infections, hypothyroidism).
* The NHS recommends testing if jaundice lasts more than:
o 14 days in term babies
o 21 days in preterm babies
• Babies are typically referred to a prolonged jaundice clinic where blood and urine tests will be done.
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📝 In Summary
Criteria to Investigate for prolonged jaundice

* Jaundice >14 days (term baby)
* Jaundice >21 days (preterm baby)
* Unwell baby, pale stools, or dark urine Urgent referral to paediatric team
Conjugated hyperbilirubinaemia Immediate referral to paediatric hepatology
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🧾 Urgent Symptoms – Seek Help Immediately
📞 Call NHS 111 or visit A&E if your baby shows any of the following:
• Deepening yellow/orange skin (spreading to arms/legs)
• Poor or reluctant feeding
• Lethargy or difficulty waking
• High-pitched crying
• Dark yellow or brown urine
• Pale or chalky stools
• Arched back or stiff limbs
• Seizures

📚 References and Further Information
1.https://www.nice.org.uk/guidance/cg98
2.https://www.nhs.uk/conditions/jaundice-in-babies/

Nevus simplex "Angels Kisses"

Nevus simplex: also known as “salmon patches”is the most common type of vascular birthmark in newborns. These harmless, flat, pink or red patches occur due to the dilation of capillaries (small blood vessels) near the skin’s surface.

Two well-known types of nevus simplex are “stork bites” and “angel kisses”.

Types of Nevus Simplex:
1. Stork Bites: These appear on the back of the neck, often in a V-shape.
2. Angel Kisses: Found on the forehead, eyelids, upper lip, or between the eyebrows.

How They Form:
- Cause: Nevus simplex is formed due to dilation of small blood vessels in certain areas of the skin during fetal development.
- These blood vessels, located close to the skin’s surface, expand (dilate) more than usual, creating the pinkish or reddish color of the birthmark.
- The exact cause of why these capillaries dilate is not fully understood, but it is a benign and natural variation in fetal development.

Appearance:
- Flat, pink to reddish patches on the skin.
- The color may intensify when the baby is crying, upset, or when there is a temperature change.
- They are most commonly found on the forehead, eyelids, upper lip, or back of the neck but can appear elsewhere.

Do They Fade?
- Yes, in most cases, nevus simplex birthmarks fade over time, usually by the age of 1 to 2 years.
- Angel kisses on the face typically disappear faster, often within the first year.
- Stork bites on the back of the neck may take longer to fade, and in some cases, they may persist into adulthood, but less noticeable.

Are They Harmful?
- No, nevus simplex birthmarks are completely harmless and pose no medical risks.
- They are purely cosmetic
- No association with underlying health conditions.

Treatment:
- In most cases, no treatment is needed because the birthmarks tend to fade naturally.
- If they persist and are cosmetically concerning, especially on visible areas like the face, laser treatments can be an option, but this is rarely necessary.

Summary:
Nevus simplex birthmarks are common, harmless vascular birthmarks caused by dilated capillaries during fetal development. They usually fade as the child grows and do not require any treatment.

As stated in the NHS. (2023). Birthmarks. Retrieved from https://www.nhs.uk/conditions/birthmarks/ [Link at the bottom of the page]

Birthmarks are colored marks on the skin present at birth or shortly thereafter. Most are harmless and fade without treatment, though some may need medical intervention. Types include salmon patches, strawberry marks, port wine stains, café-au-lait spots, blue-grey spots, and congenital moles. Each type has specific characteristics and treatment options, which may include medication, laser therapy, or surgery for those affecting health or causing complications.

See a GP if:
- you're worried about a birthmark
- a birthmark is close to the eye, nose, or mouth
- a birthmark has got bigger, darker or lumpier
- a birthmark is sore or painful
- your child has 6 or more cafe-au-lait spots
- you or your child has a large congenital mole

The GP may ask you to check the birthmark for changes, or they may refer you to a skin specialist (dermatologist).

Please click and follow the link below for up to date guidance. Signposted from BHC, containing public sector information licensed under the Open Government Licence v3.0.

Nevus simplex "Stork Bites"

Infantile Haemangioma - Raised red lumps or Strawberry Marks)

Understanding Infantile Haemangiomas (Strawberry Marks)

What is a Haemangioma?
* A haemangioma (pronounced hee-man-gee-oh-ma) is a benign (non-cancerous) tumour of blood vessels.
* Often called a "strawberry mark" because of its bright red, raised appearance.
* Typically appears within the first few weeks of life.

What Happens Over Time?
* Grows rapidly during the first few months (called the “proliferative phase”).
* Then slowly shrinks and fades over several years (called the “involution phase”).
* Most are gone by age 7–10, though some children may have faint skin changes left behind.

🔎 When Should You Be Concerned?
* Seek medical advice if the haemangioma:
* Is near the eye, nose, mouth, or airway (could affect vision, breathing, or feeding).
* Becomes ulcerated (develops an open sore).
* Grows very quickly or is very large.
* Appears in multiple places (could indicate internal haemangiomas).
* Causes distress or affects your baby’s appearance significantly.

Treatment Options. Most haemangiomas do not need treatment. However, if intervention is needed:
* Oral Propranolol
A safe and effective beta-blocker medication. Helps shrink large or problematic haemangiomas. Usually given as a liquid by mouth daily.
* Treatment can last several months to over a year. Your child will be monitored regularly during treatment.
* Topical Timolol (Eye Drop Gel). A non-invasive treatment used on small, superficial haemangiomas.
* Other Treatments (less common) Laser treatment or surgery may be considered in special cases.

🏥 Who Will Care for My Child?
* Start by speaking with your GP or health visitor.
* If needed, they will refer you to a paediatric dermatologist or vascular anomalies team.
* Some children are managed at specialist centres like Great Ormond Street Hospital.

❤️ Reassurance for Parents
* Most haemangiomas do not cause any problems and disappear on their own.
* They are not caused by anything you did during pregnancy or birth.
* Treatment is available if needed, and outcomes are usually very good.

📚 References and Further Information
1. NICE – Topical Timolol for Superficial Infantile Haemangiomas
o Evidence summary for off-label use.
ohttps://www.nice.org.uk/advice/esuom47
2. Great Ormond Street Hospital (GOSH) – Haemangiomas in Children
o Parent-friendly information on types, causes, and treatment.
ohttps://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/haemangiomas/
3. Great Ormond Street Hospital – Using Propranolol for Haemangiomas
o Detailed patient leaflet about propranolol treatment.
ohttps://www.gosh.nhs.uk/conditions-and-treatments/medicines-information/treating-haemangiomas-propranolol/
4. Oxford University Hospitals – Timolol for Infantile Haemangiomas (Parent Leaflet PDF)
o Clear guidance on how and when to use timolol topically.
ohttps://www.ouh.nhs.uk/patient-guide/leaflets/files/102368timolol.pdf
5. NHS – Birthmarks Overview
o General information about types of birthmarks, including haemangiomas.
ohttps://www.nhs.uk/conditions/birthmarks/

Mongolian Blue Spots (Congenital Dermal Melanocytosis

Areas of blue-grey pigmentation.

Commonly in non-Caucasian children.
- Usually over back/buttocks/wrists/ feet/ shoulders/ arms, it can be extensive.
- Usually fade over first year of life but can take longer.

- Documentation is crucial at time of postnatal check and ensure this is communicated to Community Midwifery staff. The reason for proper documentation is due to appear similar to a bruise and can be mistaken for Non-Accident Injury. If a professional is unsure it is normal to ask advise to senior staff.

The leaflet attached provides information about congenital dermal melanocytotic, previously known as Mongolian blue spot.

Advice to Parents:
- It is a harmless, pigmented birthmark usually seen at birth or shortly after, often fading by age 1-6.
- Caused by melanocytes remaining in the dermis, producing melanin which appears blue-grey through the skin.
- It may have an inherited component, particularly in children of Asian, African, Middle Eastern, or Mediterranean descent.
- The condition has no physical symptoms and typically appears as flat, blue-grey patches on the lower back and buttocks, occasionally on other body parts.
- Diagnosed by appearance but must be noted correctly to avoid misdiagnosis as bruising.
- No treatment is necessary as the patches often fade; skin camouflage can be used if needed.

Please refer to leaflet attached.

Babies Sleep Patterns and Guidance

Sleep patterns and recommendations provided are generally in line with NHS and NICE guidelines, although they are based on typical developmental stages and general expert advice rather than being direct quotes or specific excerpts from those documents. Both NHS and NICE focus on evidence-based practices and developmental milestones, which align with the outlined sleep behaviours and growth spurts.

1. Newborn Sleep Patterns: NHS guidelines recommend that newborns (0-2 months) sleep about 16-18 hours per day, with irregular sleep patterns, and this is aligned with the information shared. The sleep-wake cycle is not well-developed in this stage, and babies wake frequently to feed.

2. Sleep Duration at Different Stages: The NHS and NICE recommend that babies gradually begin sleeping longer at night as they approach 3-6 months of age. This is consistent with the information provided about the typical sleep duration and patterns.

3. Growth Spurts: Both NHS and NICE guidelines recognize that growth spurts can temporarily disrupt a baby’s sleep. For instance, growth spurts often occur at 3 weeks, 6 weeks, 3 months, and 6 months, which are times when babies may feed more often or wake more at night.

4. Sleep Regressions: Both NHS and NICE mention sleep regressions, especially around 4 months, 6 months, and 9 months, and explain that these are common during periods of growth and developmental milestones.

5. Tips for Parents: NHS and NICE both suggest creating a consistent sleep routine, offering comfort during growth spurts, and remaining patient during these challenging phases.
These are consistent with recommendations for helping babies settle into better sleep patterns.

References:
• NHS. (n.d.). Baby sleep. National Health Service. Retrieved May 11, 2025, from https://www.nhs.uk/conditions/pregnancy-and-baby/baby-sleep/
• NICE. (2006). Postnatal care: Routine postnatal care of women and their babies. National Institute for Health and Care Excellence. Retrieved May 11, 2025, from https://www.nice.org.uk/guidance/cg37
• NHS. (n.d.). Growth spurts in babies. National Health Service. Retrieved May 11, 2025, from https://www.nhs.uk/conditions/pregnancy-and-baby/growth-spurts-in-babies/
• NICE. (2021). Infant and young child feeding. National Institute for Health and Care Excellence. Retrieved May 11, 2025, from https://www.nice.org.uk/guidance/ng151

Tongue Tie

What is Tongue-Tie?

Tongue-tie (ankyloglossia) is a condition present at birth where the strip of skin (frenulum) connecting the baby's tongue to the floor of the mouth is shorter or tighter than usual. This can restrict tongue movement and may affect feeding.

🔍 Symptoms of Tongue-Tie in Babies

In Breastfed babies:
* Difficulty latching or staying latched
* Clicking sounds while feeding
* Prolonged feeding times
* Poor weight gain
* Fussiness during feeds
* Sore or damaged nipples for the mother
* Low milk supply due to ineffective milk removal

In Bottle-fed babies:
* Dribbling milk
* Clicking sounds or noisy feeding
* Long feeding times
* Gagging or choking during feeds
* Trouble keeping a consistent latch on the teat
* Excessive wind or colic-like symptoms

👩‍⚕️ Who to Contact for Help If you suspect tongue-tie:
**Midwife or Health Visitor. Often your first point of contact. They can assess and refer.
**GP (General Practitioner) Can assess and refer to a tongue-tie clinic or specialist.
* Infant Feeding Specialist / Lactation Consultant (IBCLC) Can assess latch and feeding.
*Tongue-Tie Clinic (NHS or private) For assessment and treatment (e.g., frenotomy).

🏥 Treatment: What is a Frenotomy?
* A frenotomy is a quick, low-risk procedure to snip the tight frenulum.
* Often done without anesthesia in newborns.
* Feeding is usually improved shortly after.

📘 Guidance from:

NHS (UK National Health Service)
* A tongue-tie assessment is offered if feeding issues are present.
* If diagnosed and causing feeding problems, **treatment (frenotomy)** may be offered.
* Not all NHS Trusts provide this service directly; some refer to regional services or private options.

NICE (National Institute for Health and Care Excellence)
* Supports frenotomy as a safe, effective procedure for infants with feeding difficulties due to tongue-tie.
* Recommends that treatment decisions involve shared decision-making with parents.

UNICEF Baby Friendly UK
* Promotes early assessment of feeding and support for breastfeeding.
* Advocates for thorough feeding assessments by trained professionals.
* Encourages avoiding unnecessary separation of mother and baby and supporting breastfeeding post-procedure.

✅ Summary for Parents
* If Baby struggling to feed or poor weight gain | Speak to your midwife, health visitor, or GP * Want to check for tongue-tie, ask for an assessment or referral to a specialist
* Need help with breastfeeding, contact a lactation consultant (IBCLC) or infant feeding team |
* Considering treatment , ask about NHS or local private tongue-tie clinics

📚 References and Further Information
1. NHS (UK National Health Service) – Tongue-tie Overview
https://www.nhs.uk/conditions/tongue-tie/
o General information, symptoms, diagnosis, and treatment options.
2. NICE (National Institute for Health and Care Excellence) – Guidance on Frenotomy
https://www.nice.org.uk/guidance/ipg149
o Interventional procedure guidance on division of ankyloglossia (tongue-tie) for breastfeeding.
3. UNICEF UK Baby Friendly – Statement on Tongue-Tie
https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/advocacy/tongue-tie/
o Baby Friendly UK’s position on tongue-tie and infant feeding.
4. Association of Tongue-tie Practitioners (UK Directory & Resources)
https://www.tongue-tie.org.uk/
o Provides a UK directory of trained practitioners and information for parents.
5. La Leche League GB – Tongue-tie and Breastfeeding
https://www.laleche.org.uk/tongue-tie/
o Breastfeeding-focused advice on how tongue-tie may impact latch and milk supply.
6. NHS Inform Scotland – Tongue-tie
https://www.nhsinform.scot/illnesses-and-conditions/mouth/tongue-tie
o Information for Scottish parents on signs, diagnosis, and treatment.

Lip Tie

A lip tie occurs when the frenulum, a small piece of tissue connecting the upper lip to the gums, is too thick or tight, restricting the movement of the upper lip. In babies, this can affect feeding and cause various challenges, especially with breastfeeding.

Symptoms of Lip-Tie in Babies

In Breastfed Babies:
* Difficulty flanging (turning out) the upper lip during feeding
* Repeated slipping off the nipple or clicking sounds
* Long or frequent feeding sessions
* Poor milk transfer leading to slow weight gain
* Nipple pain or damage for the mother
*Baby swallowing air, causing gas or fussiness

In Bottle-fed Babies:
*Milk leaking from the sides of the mouth
* Clicking or noisy feeding due to poor suction
* Gagging, choking, or coughing while feeding
* Taking a long time to finish a bottle
* Excessive wind or colic-like symptoms

2. Impact on Breastfeeding:
- Painful nipples for mothers: A poor latch can lead to sore or cracked nipples.
- Mastitis: Blocked milk ducts or infection may occur due to ineffective feeding.
- Inadequate milk intake for the baby: Poor latch can lead to the baby not getting enough milk, which affects milk supply.
- Prolonged or inefficient nursing sessions: The baby may take longer to feed or may not feed efficiently, causing frustration for both mother and baby.

3. Diagnosis and Treatment:
- A paediatrician or lactation consultant can diagnose a lip tie during a physical examination.
- Treatment options may include a frenectomy, a minor procedure to release the frenulum if the lip tie significantly affects feeding.

If a parent has concerns regarding their baby having a lip tie, they should seek advice from their family GP, midwife, or health visitor for a review, access breastfeeding/feeding support, and referral to the relevant paediatric team to assess the lip and consider possible division.

*** Consult your GP or call 111 if you have concerns about your baby's condition. If you are extremely worried about your baby's health, symptoms, and believe they need urgent medical attention, dial 999 or visit the emergency department.

📚 References and Further Information
1. La Leche League GB – Lip-Tie and Breastfeeding
https://www.laleche.org.uk/lip-tie-and-breastfeeding/
Guidance on lip-tie signs and feeding challenges.
2. NHS (general feeding support)
https://www.nhs.uk/start4life/baby/feeding/
NHS Start4Life offers support and information on infant feeding.
3. UNICEF Baby Friendly UK – Breastfeeding and Feeding Assessment
https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfeeding-resources/
Focus on responsive feeding and early problem identification.
4. Association of Tongue-tie Practitioners (UK)
https://www.tongue-tie.org.uk
Lists practitioners who assess both tongue- and lip-ties.

Breastfeeding

Please click and follow the link below for Guidance on:

How to Breastfeed:
• Knowing it's time to feed
• Step-by-step guide
• Video: Latching on animation
• Frequency of feeds
• Cluster feeding
• Breastfeeding Friend from Start for Life
• National Breastfeeding Helpline
• Breastfeeding positions
• When should I burp my baby?
• What's the best position to burp my baby?
• What if my baby won't burp?
Expressing breast milk
• Expressing by hand
• Expressing with a pump
Feeding advice and breastfeeding challenges
• Colic
• Constipation
• Mastitis
• Milk supply
• Reflux
• Sore nipples
• Thrush
• Tongue-tie

*** Consult Health Visitor, Midwife, Feeding Support Group on advice and support.

*** Consult your GP if you have concerns about your baby’s presentation and symptoms, or call 111, 999, or attend the Emergency Department if you are extremely concerned about your baby’s health.

Please click and follow the link with up-to-date guidance signposted from BHC, containing public sector information licensed under the Open Government Licence v3.0

Step-by-step guide to Breastfeeding Latching On

Please click the link below for Step-by-Step guide https://www.nhs.uk/start-for-life/baby/feeding-your-baby/breastfeeding/how-to-breastfeed/latching-on/

Step-by-Step Guide to Latch Your Baby to the Breast
(Based on NHS & UNICEF Baby Friendly Initiative)
* Get Comfortable and Support Your Baby
* Sit in a comfortable position with back support.
* Hold your baby close, tummy-to-tummy, facing you.
* Support Your Breast
* Use your hand to support your breast in a “C” shape (thumb on top, fingers underneath) well behind the areola.
* Encourage a Wide Open Mouth
* Gently tickle your baby’s lips or chin with your nipple to stimulate them to open their mouth wide (like a big yawn).
* Bring Baby Quickly to Your Breast
* When your baby’s mouth is wide open, bring them quickly to your breast aiming the nipple toward the roof of their mouth (the hard palate).
* Ensure Baby Takes a Large Mouthful of Breast
* Baby’s lips should be flanged outward (like “fish lips”).
* More of the areola should be visible above baby’s top lip than below their bottom lip.
* Baby’s chin should be pressed into the breast.

Check Baby’s Position
* Baby’s head and body should be in line (no twisting).
* Baby’s nose should be free to breathe.
* Look and Listen for Effective Feeding
* You should feel a gentle tugging, not pain.
* Baby will suck deeply and slowly with occasional pauses.
* You may hear or see swallowing.
* Baby’s cheeks remain rounded, not sucked in.

Break the Suction Before Removing
* To unlatch, gently insert your finger into the corner of baby’s mouth to break suction before removing the breast.

Helpful Links:
* NHS How to Breastfeed (Latching On)
https://www.nhs.uk/start-for-life/baby/feeding-your-baby/breastfeeding/how-to-breastfeed/latching-on/
* UNICEF Baby Friendly Initiative: Breastfeeding Support
https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfeeding-resources/

📚 References and Further Information
Breastfeeding Helplines
• National Breastfeeding Helpline: 0300 100 0212
• Association of Breastfeeding Mothers: 0300 330 5453
• La Leche League: 0345 120 2918
• National Childbirth Trust (NCT): 0300 330 0700
• The Breastfeeding Network supporter line in Bengali and Sylheti: 0300 456 2421
__________________________

Breastfeeding Websites
• Bliss (special-care baby charity): https://www.bliss.org.uk/
• The Breastfeeding Network (support & info): https://www.breastfeedingnetwork.org.uk/
• La Leche League (1-to-1 breastfeeding support): https://www.laleche.org.uk/
• Lactation Consultants of Great Britain (find consultants): https://www.lcgb.org/
• Twins Trust (feeding twins & triplets): https://twinstrust.org/
• National Childbirth Trust (NCT) (pregnancy, birth & breastfeeding): https://www.nct.org.uk/
• UK Association for Milk Banking (donated breast milk info): https://ukamb.org/
Additional Breastfeeding Support
• Start4Life Breastfeeding Friend chatbot (Amazon Alexa, Facebook Messenger, Google Home) - NHS trusted advice (no direct URL, available via those platforms)
• Breastfeeding Help and Support Page: https://www.breastfeedinghelp.info/

Vitamin D for Breastfed Babies from Birth

Importance of Vitamin D Supplementation for Breastfed Babies:

- Health experts recommend that all breastfed infants be given a daily supplement of vitamin D in the range of 8.5 to 10 micrograms (mcg).
- However, if a baby is consuming more than 500 millilitres (about a pint) of first infant formula per day, an additional vitamin D supplement is not necessary.

From birth, it is crucial to ensure that breastfed babies receive adequate amounts of vitamin D.

This recommendation stems from the recognition that breast milk, while being the optimal source of nutrition for infants, does not provide sufficient levels of vitamin D on its own.

Vitamin D plays a vital role in the healthy development of infants. It is essential for the absorption of calcium and phosphorus, which are necessary for building strong bones and teeth. A deficiency in vitamin D can lead to rickets, a condition characterized by softening and weakening of the bones, which can result in skeletal deformities and growth disturbances.

Vitamin D is crucial for:
1. Bone Health: It helps in the proper formation and maintenance of bones by facilitating the absorption of calcium and phosphorus.
2. Immune Function: It supports the immune system, helping to ward off infections and diseases.
3. Muscle Function: It plays a role in muscle function, helping to prevent muscle weakness.
4. Cell Growth: It is involved in cell growth and differentiation, which is important for overall growth and development.

Infants have a limited ability to produce vitamin D through sun exposure, particularly in areas with low sunlight or during the winter months. Additionally, their delicate skin needs to be protected from direct sunlight to prevent burns and damage, further limiting their natural production of vitamin D.

Therefore, ensuring that breastfed babies receive a vitamin D supplement is essential for their overall health and development.

Please click and follow the link below for up-to-date guidance. Signposted from BHC, containing public sector information licensed under the Open Government Licence v3.0.

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