Caring for baby

During pregnancy, your baby’s brain is growing very quickly and you can help this growth by taking some time out to relax and talk to baby, to stroke your bump and maybe play music. Encourage other close family members to do the same.

New babies have a strong need to be close to their parents, as this helps them to feel secure and loved. When babies feel secure they release a hormone called oxytocin, which acts like a fertiliser for their growing brain, helping them to be happy babies and more confident children and adults.

Holding, smiling and talking to your baby also releases oxytocin in you, which helps you to feel calm and happy. We cannot spoil babies by giving them too much attention, when babies’ needs for love and comfort are met; they will be calmer and grow up to be more confident. Babies don’t benefit from lots of toys, looking at your face is the best way for babies to learn. Talking, listening and smiling triggers oxytocin and helps your baby’s brain to grow.

After your baby is born, hold him against your skin as soon as possible, and for as long as you want. Skin to skin contact reduces baby’s stress level by 75%. This will calm him and give you both the chance to rest, keep warm and get to know each other. If you want to breastfeed, this is a great time to start as your baby might move towards the breast and work out the best way to suckle for himself. Breastfeeding also releases lots of oxytocin in baby and mother, which will help you to feel close and connected. If you choose to bottle feed, giving the first feed in skin contact while holding your baby close and looking into his eyes will also help you bond.

Newborn sleep needs

Most newborn babies are asleep more than they are awake. Their total daily sleep varies, but can be from 8 hours up to 16 or 18 hours. Babies will wake during the night because they need to be fed. Being too hot or too cold can also disturb their sleep.

Babies need frequent nappy changes, but how often they need changing depends on how sensitive their skin is.

Some babies have very delicate skin and need changing as soon as they wet themselves, otherwise their skin becomes sore and red. Other babies can wait to be changed until before or after every feed.

All babies need changing as soon as possible when they have done a poo (stool) to prevent nappy rash.

Young babies need changing as many as 10 or 12 times a day, while older babies need to be changed at least 6 to 8 times.

You don’t need to bathe your baby every day. You may prefer to wash their face, neck, hands and bottom carefully instead. This is often called “topping and tailing”.

Choose a time when your baby is awake and content. Make sure the room is warm. Get everything ready beforehand. You’ll need a bowl of warm water, a towel, cotton wool, a fresh nappy and, if necessary, clean clothes.

You will need various items for your baby including – clothes, nappies, pram, car seat, carrier, bot bedding.

The sudden and unexpected death of a baby is usually referred to by professionals as ‘sudden unexpected death in infancy’ (SUDI) or ‘sudden unexpected death in childhood’ (SUDC), if the baby was over 12 months old. The death of a baby which is unexpected is also sometimes referred to as ‘sudden infant death’. While SIDS is rare, it can still happen and there are steps you can take to help reduce the risk for your baby.

While SIDS cannot be completely prevented, you can reduce the risks of it occurring considerably by following our safer sleep advice. For example:

• Sleep your baby on their back for all sleeps – day and night – as this can reduce the risk of SIDS by six times compared to sleeping them on their front.
• Share a room with your baby for the first six months – this can halve the risk of SIDS.
• Keep your baby smoke-free during pregnancy and after birth – this is one of the most protective things you can do for your baby. Around 60% of sudden infant deaths could be avoided if no baby was exposed to smoke during pregnancy or around the home.
• Never sleep on a sofa or armchair with your baby as this can increase the risk of SIDS by 50 times.
• Do not co-sleep with your baby if you or your partner has been drinking, is a smoker, has been taking drugs or is extremely tired; these factors can put babies at an extremely high risk of SIDS when co-sleeping. One study found that the risk of SIDS when co-sleeping is six times higher in smokers than in non-smokers.

You have lots of decisions to make during pregnancy, in labour and when you have had your baby. In order to make informed decisions about your care you can use a decision making tool like the BRAIN tool.

B Benefits. What are the benefits?

R Risks. What are the risks and considerations?

A Alternatives. What are the alternatives, and what are the risks and benefits of those?

I Intuition / information. How do you feel? Do you need more information?

N Nothing / not now. Do I need to decide now? What if I do nothing?

Hygiene advice for new mothers

Hand washing before and after you use the toilet or change your maternity pads is very important for all women in helping to reduce your risk of developing an infection. If you have a wound or stitches we have a wound care information leaflet that gives you additional advice on how to keep these areas clean and reduce the chance of infection.

Vaginal bleeding

It is normal to experience blood loss for up to six weeks following the birth of your baby. It is heavier than a period but will reduce gradually over a few days after birth. Breastfeeding and being active may increase your blood loss. It should reduce again when you rest.

If you pass large blood clots (bigger than a 50 pence coin) or have an unpleasant looking or smelling vaginal discharge contact your midwife or GP immediately. We do not advise the use of tampons as this can contribute to infection; continue to use maternity pads until you have your first period.

Pain

It is common to have pain soon after giving birth. Resting and simple pain relief (paracetamol or Ibruprofen, if you are not asthmatic) may resolve this. We do not provide simple forms of pain relief to take home; they can be bought  over the counter from a pharmacy. You must avoid taking codeine, especially if you are breastfeeding. Evidence suggests codeine can pass through into breastmilk and has caused sedation and respiratory distress in some newborn babies.  If you have any concerns speak to your midwife or GP for further advice.

Constipation

You may not have had your bowels opened following the birth of your baby for several days. However, this is normal. To prevent constipation drink plenty of fluids and include fruit and vegetables in your diet. If you have any concerns speak to your midwife or GP for further advice.

Emotional wellbeing

In the days after your baby is born, it is normal to feel tearful, anxious or mildly depressed. Post-birth hormonal changes, adjusting to a new baby, tiredness and discomfort can all contribute to these feelings. It is important to take care of yourself, rest, eat well and seek support from your family and friends until these feelings have passed.

If these feelings continue beyond a few days or you feel your symptoms are very severe, please speak to your midwife, GP or Public Health Specialist Nurse (previously known as Health Visitor).

Recognising potentially serious health conditions in women (NICE 2015)

Symptoms to watch out for	What this could mean	What you should do
Sudden or very heavy blood loss and signs of shock, including faintness, dizziness, palpitations or tachycardia (when you become aware of your heart beating very fast)	Haemorrhage	Get emergency medical attention
If there are no signs of haemorrhage but your abdomen feels sore and tender you should be checked for other possible causes	Haemorrhage or infection	Get emergency medical attention
Fever (high temperature), shivering, abdominal pain or unpleasant vaginal discharge. Your temperature should be taken, and if it’s above 38°C, it should be taken again in 4–6 hours. If your temperature is still high, or there are other signs of infection, you should be checked further	Infection	Get emergency medical attention
Headache and/or changes in your vision/nausea/vomiting in the first 72 hours after giving birth. You should also have your blood pressure measured. If it’s higher than expected and you have other signs of pre-eclampsia or eclampsia, get emergency medical attention. If there are no other obvious signs, it should be measured again within 4 hours. If it is still high, you should have further tests.	Pre-eclampsia or eclampsia	Get emergency medical attention
Pain, swelling or redness in the calf muscle of one of your legs	Blood clot (deep vein thrombosis)	Get emergency medical attention
Difficulty breathing, feeling short of breath or chest pain	Blood clot (pulmonary embolism)	Get emergency medical attention

Trust your instincts

It can be difficult to tell when a baby or toddler is seriously ill, but the main thing is to trust your instincts.

You know better than anyone else what your child is usually like, so you’ll know when something is seriously wrong.

Here’s a checklist of warning signs that might indicate your baby or toddler is seriously ill and requires medical help.

Temperature

• a high temperature, but cold feet and hands
• a high temperature that does not come down with paracetamol or ibuprofen (do not give paracetamol to a baby under 2 months and do not give ibuprofen to a baby under 3 months or under 5kg, unless prescribed by a doctor)
• a very high or low temperature
• your child feels hot or cold to touch, or is shivering
• your child is quiet and listless, even when their temperature is not high
• a high temperature in a baby less than 2 months old

Find out more about high temperature (fever) in children and what to do

Breathing

• rapid breathing or panting
• a throaty noise while breathing
• your child is finding it hard to get their breath and is sucking their stomach in under their ribs

Other signs

• blue, pale, blotchy, or ashen (grey) skin – on brown or black skin, this may be easier to see on the palms of the hands or soles of the feet
• your child is hard to wake up, or appears disoriented or confused
• your child is crying constantly and you cannot console or distract them, or the cry does not sound like their normal cry
• green vomit
• your child is not feeding normally and you’re worried
• nappies that are drier than usual – this is a sign of dehydration

Where to get help for a seriously ill child

If your child has any of signs of serious illness, get medical help as soon as possible:

• during the day from Monday to Friday – it’s best to call your GP surgery
• evenings and weekends – call NHS 111
• if your baby is under 6 months old it’s hard for a doctor or nurse to assess them over the phone – you can go to an urgent treatment centre or, if you’re very worried, take them to A&E

When to call an ambulance

Call 999 for an ambulance if your child:

• stops breathing
• will not wake up
• has a spotty, purple or red rash anywhere on their body that does not fade when you press a glass against it, as this could be a sign of sepsis – on brown or black skin, this may be easier to see on the palms of the hands or soles of the feet
• is under 8 weeks old and you’re very worried about them
• has a febrile seizure (fit) for the first time, even if they seem to recover
• has a severe allergic reaction (anaphylaxis)
• may have been seriously injured by you or someone else

Trust your instincts. You know what’s different or worrying behaviour in your child.

It can be difficult to tell when your baby has an infection or if your baby is unwell as they can cause lots of different signs and symptoms. You know your baby best, so trust your instincts and, if you feel that something’s not quite right, contact your midwife, health visitor, GP or NHS 111. If you’re very worried, go to an emergency department.

• They are difficult to wake
• The appear floppy
• They are irritable and wont settle
• They have mottled or blotchy appearance
• They have difficulty breathing
• They have a rash, sores or blisters
• They have a temperature
• They have a high pitched or abnormal cry
• If they have had fewer than 2-3 wet nappies in 24 hours

What to tell your health professional

If you think your baby might have an infection, it’s important to tell your health professional anything they might need to know – even if they don’t ask. Being open will help them diagnose and treat your baby. Let them know anything during pregnancy or after birth that might be relevant, including the following.

If the person who gave birth:

• Had any illnesses during pregnancy, such as flu-like symptoms.
• Missed any routine vaccinations in pregnancy, such as COVID-19, RSV, influenza or pertussis vaccines.
• Had chicken pox seven days before or after baby’s birth.
• Has blisters or a rash on their breast/nipple (if breastfeeding).
• Has ever had a genital herpes infection, even if they don’t have symptoms at the moment.
• Had sexual contact with a new partner during pregnancy, particularly in the third trimester.
• Had symptoms of sexually transmitted disease during pregnancy.
• Travelled overseas during pregnancy.

If you or your baby:

• Have tested positive for Group B Strep.

If your baby has had contact with anyone who:

• Had chicken pox.
• Had an active cold sore.

Vitamin K is recommended for all newborn babies in the UK, to prevent a rare but potentially serious condition called vitamin K deficiency bleeding (VKDB). It is recommended that expectant parents read this information leaflet before their baby is born, so they are fully informed and have the time to make a decision prior to the birth.

The full information leaflet is available to read and download here.

Why do newborns need vitamin k?

Our bodies need vitamin K in order to form blood clots and to stop bleeding. We get enough vitamin K from the food we eat but also some vitamin K can be made by the bacteria that live in our gut. Babies are born with very low levels of vitamin K stored in their bodies as it does not easily transfer from the mother’s body and the bacteria that produce vitamin K are not yet present in the newborn’s intestines, so at birth they can be deficient.

What is vitamin K deficiency bleeding?

Vitamin K deficiency bleeding (VKDB) occurs when babies cannot stop bleeding because their blood does not have enough vitamin K to form a clot. The bleeding can occur anywhere on the inside or outside of the body. When the bleeding occurs inside the body, it can be difficult to notice and there may be minimal warning signs.

Is my baby at risk of vitamin K deficiency bleeding?

Babies are at risk of VKDB for up to a year after birth if they do not receive vitamin K. Some babies only experience mild bruising. However, VKBD can cause bleeding from the mouth, tummy button (umbilicus) or back passage. If not treated, babies can be at risk of bleeding in the brain, which can cause permanent brain damage or death.

About 1 in 2,000 babies are at risk of VKBD within a week of birth. About 1 in 11,000 are at risk of getting VKBD later than this and more than half of these babies have bleeding in the brain. The risk of VKBD in babies treated with vitamin K is reduced to very low levels of around 1 in 100,000, meaning that VKDB is almost completely prevented. This is why the treatment is recommended.

Unfortunately, some parents have been deciding not to give their baby vitamin K, after finding comments about a possible connection with cancer when looking for information on the internet. These comments stem from a single small study carried out over 30 years ago which suggested that children who received vitamin K might have an increased risk of blood cancer. However, many more studies around the world have been conducted since then and have found no evidence of any link.

How is vitamin K given and when?

Vitamin K is usually given as an injection into a leg muscle soon after birth. However, some babies may have vitamin K given in the form of mouth drops that the parents administer through multiple doses.

It is recommended that expectant parents read this information leaflet before their baby is born, so they are fully informed and have the time and space to make a decision.