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Your baby’s development

Your baby’s development

Smiling mother holds baby in outdoor setting Babies are learning from adults as soon as they are born. At this age, your baby will love when you chat, play, sing and read to them, even when they are too young to understand everything.

Chat

Your baby starts trying to communicate with you from day one. You can practise communicating together to build your bond and help them develop. Your baby loves the sound of your voice, so little chats throughout the day will make them happy.

Play

Your baby starts exploring the world straightaway through movement, sights and sounds. Playing helps your baby get stronger, become more coordinated and learn new things.

Sing

Babies who are exposed to and engage in music, singing and rhyming regularly with parents and carers learn to speak more easily. They have more words to express themselves and are more confident and creative. Babies like hearing songs and rhymes over and over again.

Read

Reading to your baby has many benefits long before they can read or understand words. Your voice stimulates their brain and your voice is soothing to them.

What to expect at six months

Babies develop at different rates. However, understanding what is typical ccan help you identify speech and language problems early. By six months, children will usually:
  • Turn towards a sound/voice when they hear it.
  • Be startled by loud noises.
  • Watch your face when you talk to them.
  • Recognise your voice.
  • Smile and laugh when other people smile and laugh.
  • Make sounds to themselves, like cooing, gurgling and babbling.
  • Make noises, like coos and squeaks, to get your attention.
  • Have different cries for different needs. For example, one cry for hunger, another when they are tired.
Small talk Hungry Little Minds national campaign Talking equals brain power NSPCC brain-building tips Developing between 0-6 months Reducing screen time Baby harp nursery rhymes
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Fatigue

Fatigue

Tired-looking woman holds her baby in her arms It is not uncommon to feel very tired after the birth of your baby. Plenty of rest and a balanced diet can help you on the road to recovery:
Diet
Also remember to eat foods that are rich in dietary iron (see related link below). If exhaustion persists for more than a few days speak to your midwife or GP.
Sleep and tiredness Foods rich in iron
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Transition to motherhood

Transition to motherhood

Woman holds her naked baby in her arms

The myth of motherhood

Having a baby is supposed to be one of the most exciting and happy experiences you’ll ever have. Women are expected to ‘blossom’ during their pregnancy and immediately fall in love with their baby. Society views childbirth as a time for celebration, fulfilment and hope. A woman is therefore under great pressure to act and feel in this way.

The truth about motherhood

Often the reality is quite different and you may be surprised to experience feelings you hadn’t expected. Childbirth can leave you feeling exhausted and anxious, as well as shocked by the sudden changes in your life as a result of becoming a mother. Instead of the expected happiness, many women struggle with the new set of demands a baby brings, the lack of independence and routine, together with the long hours of work within the home.

The transition to motherhood

Transition to motherhood involves adapting to physical, emotional and social changes and there is little support or preparation for this in our society. Therefore: Most mothers experience difficulties adjusting to their new role and may feel overwhelmed by the demands. Myths about motherhood can create unrealistic expectations. Therefore: Unrealistic expectations lead to feelings of failure when problems occur. “I remember wishing someone had warned me how hard it was going to be at first, but then I realised that even if they had it wouldn’t have prepared me.”
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Baby’s oral health

Baby’s oral health

Older baby holds baby toothbrush in their mouth

Brushing

  • Start brushing your baby’s teeth as soon as they come through the gum – usually at around 6 months old.
  • Use a baby toothbrush and a tiny smear of family or baby toothpaste, containing at least 1000ppm fluoride.
  • Don’t rinse your baby’s mouth after brushing.
  • Brush your baby’s teeth twice a day – once at night and once during the day, usually in the morning.
NHS Oral health guidance for babies
Brushing for 0 to 3 year olds with Dr Ranj

Sugar

  • Too much sugar can harm your baby’s new teeth.
  • Only give water or milk to your baby to drink. Fresh fruit and vegetables provide your baby with all the sugar they need.
  • Try not to give any food containing extra sugar – if you do, makde sure it is with a meal and not as a snack.
  • Fresh fruit and vegetables are tooth-friendly snacks just like cheese, rice cakes, breadsticks and plain yogurt.
Baby food advice from NHS Start4life

Dentist

National guidance advises that all babies should visit the dentist for the first time by their first birthday.
Baby dental check by first birthday
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Commonly used medicines after birth

Commonly used medicines after birth

Pills spilling out of the neck of a medicine bottle onto a table top

1. Analgesics (pain killers)

a) Paracetamol (500mg tablets)

What is it used for? Paracetamol works by relieving pain and lowering high temperature. It can provide effective reliefnfrom mild to moderate pain, including headache, toothache, sore throat, symptomatic relief of rheumatic aches and pains, influenza symptoms and fever. How do I take it? Paracetamol can be taken regularly or when required for pain. Dosage: Adults and young persons aged 12 and over: take 2 tablets up to 4 times per day, as required. The tablets should be taken with water. Take only as much as you need to relieve symptom and leave at least 4 hours between each dose. Do not take more than 8 tablets in 23 hours. What are the side effects? Paracetamol is generally well-tolerated in most people. Is it safe to use while breastfeeding? Paracetamol is commonly used during breastfeeding.

b) Co-dydramol

What is it used for? Co-dydramol (10/500 10mg dihydrocodeine and 500mg paracetamol) is a combination of paracetamol and dihydrocodeine. Dihydrocodeine is stronger than paracetamol and is used for the relief of mild to moderate pain. If you have had a caesarean section or moderate pain post-delivery, then you may be given a box of 30 tablets of co-dydramol on discharge from hospital. How do I take it? Dosage: Co-dydramol 1 to 2 tablets every 6 hours when required up to a maximum of 4 times per day. Do not take more than 8 tablets in 24 hours. We recommend that you step down pain relief and substitute these tablets for paracetamol as soon as possible which is usually after 3-4 days. Since these tablets contain paracetamol you should not take any other paracetamol tablets at the same time. Do not drink alcohol whilst taking co-dydramol. What are the side effects? The most common side effects of dihydrocodeine are drowsiness, constipation, feeling sick or dry mouth. You may be advised to take a gentle laxative if you experience constipation whilst taking co-dydramol. Is it safe to use during while breastfeeding? Dihydrocodeine can be used during breastfeeding as a pain killer where paracetamol has not been effective. Use the minimum effective does for the least amount of time. IMPORTANT: Although there is a small dose of dihydrocodeine in these co-dydramol tablets, if you are breastfeeding whilst taking it, inform your midwife immediately if your baby is showing signs of increased drowsiness, difficulty feeding, breathing problems or anything else unusual. Research has shown that some babies may be more susceptible than others to these side effects. If you would like any further information regarding the use of dihydrocodeine while breastfeeding, please discuss it with your midwife/doctor.

c) Ibuprofen

What is it used for? Ibuprofen is anti-inflammatory drug used to treat inflammation in a variety of conditions. It is commonly used after birth to help ease pain and inflammation. How do I take it? Swallow tablets whole, with a glass of water. Take the tablets with, or after, food. Dosage: Adults: 400mg three times a day, 8 hours apart, is often prescribed after a procedure. If you have been given a diclofenac suppository after birth or a procedure, you cannot start ibuprofen until 18 hours later. The dose can be reduced to 200mg three times a day when the pain improves. Who should not use ibuprofen? Women with any of the following conditions should consult a doctor, midwife, or pharmacist before taking ibuprofen if there is history of:
  • asthma or breathing problems
  • previous stomach ulcer
  • previous reaction to aspirin, diclofenac and other non-steroidal anti-inflammatory drugs (NSAIDs)
  • other medical conditions, e.g. kidney disease, heart disease, blood clotting disorders, liver disease.
What are the side effects? Common side effects include headache, dizziness, feeling sick and diarrhoea. IMPORTANT: Stop taking the medicine and seek immediate help if you:
  • pass blood in your faeces (stools/motions)
  • pass black tarry stools
  • vomit blood or dark particles that look like coffee grounds
  • suffer any allergic reaction such as itching, drowsiness, swelling of the face, lips, tongue, mouth or throat, which may in turn cause shortness of breath or difficult swallowing.
Ibuprofen is considered as a suitable treatment option whilst breastfeeding.

2. Ferrous Sulphate (Iron supplements)

What is it used for? Iron supplements are used to treat iron deficiency anaemia. When the body does not get enough iron, it cannot produce the number of normal red blood cells needed to keep you in good health. It is common for women who are pregnant or who have just given birth to have this condition. These medicines work by replacing body iron. Iron is a mineral that the body needs to produce red blood cells. How should I take it? Swallow the tablets who with water. Although iron preparations are best absorbed on an empty stomach, they may be taken after food to reduce the effects on the stomach. Iron supplements should not be taken within one hour before or two hours after eating or drinking the following products: tea, coffee, milk, eggs and wholegrains. These products can reduce the absorption of iron. Dosage: Ferrous sulphate 200 mg tablets Treatment of iron deficiency anaemia: 1 tablet 2-3 times a day. Prevention of iron deficiency anaemia: 1 tablet per day. What are the side effects? Like all medicines, ferrous sulphate tablets may cause side effects, the most common of which are constipation, diarrhoea, stomach pain, feeling sick and blackened stools (faeces). Is it safe to use during breastfeeding? Ferrous sulphate tablets are commonly used safely while breastfeeding. Ensure that you do not take more than the recommended dose. If you cannot tolerate ferrous sulphate tablets, an alternative is available called ferrous fumarate. This is available as a liquid or tablets. The same side effect and safety information applies as above for ferrous sulphate.

3. Laxatives

What are they used for? Laxatives are used to treat constipation. What else can I do to prevent becoming constipated? The following hints are helpful in maintaining regular bowel habits:
  • Eat fibre-containing foods, e.g. wholegrain bread, fruit and vegetables.
  • Drink sufficient liquid, preferably water.
  • Take regular exercise.
Laxatives may be prescribed after birth. If you think that you need a laxative discuss with your midwife or doctor. What are the side effects? Common side effects of laxative include feeling bloated, increased wind (gas) and mild abdominal pain. Commonly used laxatives in pregnancy/after birth:

a) Lactulose

Lactulose is a liquid laxative used to treat and prevent constipation. Lactulose can take 2-3 days to have an effect; it is generally considered to be a gentle laxative. Dosage: Usually 10 mls twice daily. It must be taken regularly to have an effect.

b) Fybogel (Ispaghula husk)

Fybogel is a high fibre drink that works to increase the fibre in your diet. Increased fibre in the diet helps to gently relieve constipation. Fybogel is considered to be a gentle laxative. It is important to maintain an adequate intake of fluid whilst using Fybogel. Dosage: The usual dose is one sachet mixed with a glass of water, up to twice daily. Is it safe to use Lactulose or Fybogel after birth? Lactulose and Fybogel are not absorbed into the blood and only have a local effect on the gut. Both drugs are generally considered safe to use while breastfeeding, under the advice of a midwife or doctor.

4. Blood clot prevention

Enoxaparin (also known as Clexane) is used to prevent blood clots. Blood clots usually present as deep vein thrombosis (DVT) usually in a leg vein, or pulmonary embolism (PE), a blood clot in the lung. Blood clots are more common during pregnancy and some women will be more at risk of blood clots than others. As well as prevention, enoxaparin is also used at higher doses for treatment of DVT and PE. Is it safe to use during breastfeeding? Enoxaparin is given as an injection just beneath the skin (subcutaneous). It is usually injected into a skin fold in your abdomen (stomach) or the upper part of your thigh. If this is not suitable, you may be advised to inject into an alternative site. It should not be injected into your muscles. It may be given either once or twice daily. You should adminster the dose at the time recommended by your doctor. How is exonaparin used after birth/caesarean section? If you have, or develop risk factors at the time of the birth, you may be started on enoxaparin. Examples of possible risk factors would be having a caesarean section or infection. If you were on enoxaparin during pregnancy, your doctor will want you to stay on the same treatment after the birth. They will inform you how long to continue this treatment. How to inject Enoxaparin (Clexane) You will be able to inject enoxaparin once you have been shown how to do so by your doctor or midwife, or by following the instruction leaflet that will be given to you upon discharge. It is a simple process and one that you can do at home. Follow these steps:
  • Wash and dry your hands.
  • Clean the injection site. If someone else is doing it for you it is advisable that they wear gloves.
  • Choose the injection site either on the outer aspect of your left or right thigh or your stomach if advised to do so. It is important that you change the site each time. If there is any oozing of blood at the injection site, apply gentle pressure. Do not rub as this may cause bruising.
  • Dispose of the syringe in the yellow sharps box provided. This box should be kept out of the reach of other people.
Commonly used medicines during pregnancy
Produced by pharmacists at Chelsea and Westminster Hospital NHS Foundation Trust and used with permission.
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Heart health after giving birth

Heart health after giving birth

Graphic of red heart with a jigsaw shaped piece missing Chest pain in pregnancy and/or after your baby’s birth should never be ignored. Some chest pain can be serious and can head to a heart attack, heart failure, cardiac arrest or even death. Most women do not suffer from these conditions during or after pregnancy but it is important to recognise the symptoms and, if you have any of them, to seek treatment quickly.

Pre-exisiting heart conditions

If you have a known heart condition, were born with a congenial heart defect or have been diagnosed with heart disease, your midwife/GP/cardiologist will monitor your heart health before, during and after pregnancy.

Symptoms of a heart attack can include:

  • central chest pain
  • arm pain or numbness
  • pain in the jaw, back or shoulders
  • nausea
  • sweating/clamminess
  • breathing difficulties
Some people experience indigestion-like chest or throat pain that does not respond to indigestion remedies.

When should I contact the midwife or doctor?

If you feel unwell, contact your midwife or GP for guidance. If you experience some/all of the above symptoms, dial 999 and ask for an ambulance as yoru heart health needs to be investigated quickly. An ECG monitor and a troponin blood test should be carried out to find out if you have had a heart attack.

When am I more likely to have a heart attack?

You are more likely to have a heart attack if you:
  • have a family history of heart problems
  • have high blood pressure
  • have high cholesterol
  • smoke
  • drink excessively
  • are obese
Rarely, women with no risk factors or history of heart disease in their family will experience heart attack symptoms. Heart attack symptoms are pregnancy should never been ignored. Contact your midwife or GP for further advice.
Pregnancy and heart conditions Misdiagnosis of heart attacks in women Heart disease in pregnancy More on heart disease in pregnancy Heart disease symptoms
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Keeping your baby warm after birth

Keeping your baby warm after birth

Baby wearing a sleep suit and a baby beanie hat

Why is this important?

If a baby becomes cold after the birth, the baby can be at risk of developing hypothermia. Hypothermia is a condition where the body temperature drops to a dangerously low level. In a newborn, this occurs when the baby’s temperature drops below 36.5°C. A baby with hypothermia may have problems breathing regularly and maintaining their blood sugar and may result in admission to the Neonatal Intensive Care Unit (NICU) for treatment. Leaving the warmth of the womb at birth, the wet newborn baby comes into a much colder environment and immediately starts to lose heat. Most of this heat loss occurs within the first few minutes after birth and if not kept warm in the first 10-20 minutes, the baby may lose enough heat for their body temperature to fall to a very low level. Some babies are more at risk of getting cold, these include:
  • Preterm babies born at less than 37 weeks’ gestation
  • Babies with low birth weight
  • Babies of mothers who are diabetic
  • Babies who need to be resuscitated at birth
  • Babies where the mother has an infection in labour
However, all babies are susceptible to hypothermia in the first few hours after the birth, so it is important to take simple measures after the birth to keep your baby warm.

What will my maternity team do to ensure that my baby is keep warm?

  • Ensure the temperature of the birth room is at least 24°C
  • Check the air conditioning and fans in the birth room are turned off or facing away from the baby
  • Keep windows closed
  • Turn on heaters if appropriate
  • After the birth, your baby will be dried immediately and a hat will be put on your baby’s head.
If there are additional risk factors, then a hat will be placed on your baby’s head to alert all team members that your baby is more at risk of getting cold. Once your baby is dried, the wet towel used to dry your baby will be removed and replaced with a blanket. During skin to skin contact, your baby will be covered with blankets. You will be encouraged to feed your baby or express your breast milk and give your baby within an hour of birth. Bathing your baby should wait until the baby has adjusted to the environment and maintains its temperature. The baby’s temperature will be checked shortly after the birth to ensure that this is within the normal range.

How can you help your baby?

As parents, you can help the maternity team in ensuring that your baby is kept warm. There are many things you can do to help:
  • Tell a midwife or support worker if the birth room is not warm enough. This is very important just before and in the hours after the birth.
  • This may mean reminding a midwife or support worker to close windows and turn off the air conditioning/fans, or turn up the heaters.
  • Ensure that during skin-to-skin contact your baby is covered with blankets.
  • Ensure tht your baby keeps the hat on for the first 12 hours; as much as 25% of heat loss will be from the baby’s head if it is not covered.
  • If a hat has been put on your baby’s head then please keep this in place for 12 hours. You can usually then remove the hat and replace it with one of your own baby hats.
  • When dressing your baby for the time, warm the clothes and blankets beforehand. You can do this by placing the baby clothes against your skin or under your clothes.
  • When in the cot, ensure that your baby is adequately covered. Babies usually need one or two more layers of clothing or bedding than adults.
  • Tell a midwife or support worker if you think your baby’s breathing is not normal.
  • If you notice that your baby is breathing very fast for a continuous period (more than 60 breaths per minute), or seems to be struggling to breathe, with nostrils flaring or making noises wih each breath, then please tell a member of your maternity team.
  • Babies use up energy to keep themselves warm, there you will be encouraged to feed your baby regularly and will be supported in doing so. Some babies may need more frequent feeds. However, a well baby will need to have feeds at least every three hours for the first few days of life.

How long should I take these measures for?

If kept warm, once the baby is around six hours old, then will then usually be able to maintain their temperature at a normal level. The observation of your baby’s temperature will continue for at least 12 hours. Some babies that are unwell or vulnerable at the time of birth (for example, a baby with a low birth weight) may need support to keep warm for a longer period of time. If you have any questions, please ask one of the midwives or support workers.
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Handling your newborn baby

Handling your newborn baby

Close up of baby wrapped securely in a blanket being held in the mother's arms Babies like being held securely and gently. They need to have their heads and necks carefully supported as their neck muscles are not strong enough to hold their head up yet Babies find touch soothing; an upset baby can be comforted by a gentle cuddle or rhythmic rocking in a parent’s arms. It may often help to wrap your baby up securely in a blanket, although it’s very important not to allow your baby to become overheated. Very occasionally babies are accidentally dropped, particularly when a parent falls asleep holding a baby; or when holding the baby they slip, trip or fall. Here are some things you can do to stop your baby being injured:
  • Return your baby to its cot when settled
  • Change your baby’s nappy on a changing mat on the floor
  • Do not leave your baby unattended on a bed, sofa or changing table, even for a second, as they could roll off
  • Always keep bouncing cradles or baby car seats on the floor, rather than on a table or kitchen worktop, as your baby’s wriggling could tip it over the edge
  • Hold on to the handrail when carrying your baby up and down stairs, in case you trip. Make sure the stairs are free of toys and other trip hazards.
  • Watch where you’re putting your feet while carrying your baby. It’s easy to trip over something like a toy.
Handle with care guide on how to keep your baby safe