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Peer support session - Beside You Medway

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Free breastfeeding support sessions in Medway. For any support with feeding challenges, we’ve got you covered

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Looking for support? Find your nearest support. We’re right #BesideYou - if you’re struggling, have questions or want to meet other women breastfeeding.

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Get in touch – National Breastfeeding Helpline

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The Oliver Fisher Special Care Baby Trust Charity 

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The Oliver Fisher Special Care Baby Trust Charity 

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With about 1200 babies passing through Oliver Fisher NICU per year, our funds provide vital and extra care beyond NHS funding. This allows support to be given not just to patients, but also their families who are also going through ridiculously stressful times. In addition, we can provide top of the line equipment to deliver better health outcomes for the babies.

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Oliver Fisher Special Care Baby Unit support the Neonatal Intensive Care Unit at Medway Maritime Hospital. Ours is a local charity

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Team Lotus Specialist Mental Health Maternity Team

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Supporting maternal mental health and wellbeing during pregnancy and after birth

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Our systems have detected unusual traffic from your computer network. This page checks to see if it’s really you sending the requests, and not a robot. Why did this happen?

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keeping track of your baby's feeds, sleep and nappies

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Baby newborn activity logger and tracker, breastfeeding timer, sleep timer, diaper log, growth chart, medication, temperature, vaccine

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Statutory Maternity Leave and Pay is meant to help mothers take time off work when they have a baby. If you are eligible, Statutory Maternity Pay is available for 39 weeks.

You apply through your employer and, if you qualify, you receive it through your wage packet. The payment will be taxed, just like income.

If you're not sure whether you want to go back to work, you can still ask for Statutory Maternity Pay.

You do not have to pay it back if you do not return to work and it is the legal minimum amount your employer has to pay. Your employer may offer additional maternity benefits.

Who can claim

You are only entitled to Statutory Maternity Leave and Pay if you are an employee.

You qualify for Statutory Maternity Leave if you give your employer the correct notice. It does not matter how long you have been in your current job or how much you earn.

If you do not qualify for Statutory Maternity Leave, for example because you are self-employed or on a zero hours contract, you must still stop work for 2 weeks after giving birth (4 weeks if you work in a factory).

If your baby is born early (premature) your maternity leave will start straight away.

Whether you qualify for Statutory Maternity Pay depends on how long you have been in your current job. If your wages are low and do not reach the minimum level, you might not qualify.

You can still get Statutory Maternity Leave and Pay if your baby:

is born premature

is stillborn from your 24th week of pregnancy

dies after being born.

If you can't get Statutory Maternity Pay, you still might qualify for Maternity Allowance (see below).

You can get more information from your employer's human resources department or your local trade union.

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If you've had a baby born premature or sick, take a look at our information for families on parental leave and pay.

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Jaundice and phototherapy on NICU

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Find out more about what jaundice is, the signs to look out for in your baby, and the treatment available.

Jaundice (jawn-diss) is the name for yellowing of the skin and the whites of the eyes. It is very common for newborn babies to get jaundice. In most cases it is harmless and goes away without needing treatment by the time your baby is about two weeks old.

Sometimes jaundice can be serious and may be caused by a medical problem. Serious cases of newborn jaundice are more common in babies born premature. Because it can sometimes be serious, your midwife or baby's doctor needs to know if they have jaundice. Your baby can then get any treatment they need quickly.

What causes jaundice?

The yellow colour is caused by a build-up of a substance called bilirubin (billy-roo-bin).

Bilirubin is a normal body chemical, which is produced when red blood cells are broken down and replaced by fresh cells. Bilirubin is then processed by the liver and leaves the body in urine (pee) and stools (poo).

Jaundice is common in newborn babies because the baby's liver is not developed enough in the first few days to process all the bilirubin that is produced. Bilirubin then builds up in the blood, which causes jaundice.

Doctors call this ' physiological jaundice ', which means it is not caused by a medical problem. This is the most common type of jaundice and starts at about two days after birth, but is usually gone by about two weeks.

Other types of jaundice

Other types of jaundice may be caused by serious medical problems. Jaundice that occurs within the first 24 hours of life, which doctors call ' early jaundice', could be caused by conditions such as:

There is also a type of jaundice which causes babies to be jaundiced for longer (after they are around two weeks old). This is called ' prolonged jaundice '. It can also be referred to as 'breastmilk jaundice' because it is much more common in babies who are fed with their mother's milk.

Doctors are not sure why this happens, but it does not harm the baby and will go away without treatment. This type of jaundice can sometimes carry on for up to 12 weeks, but this does not mean that feeding with breast milk should stop.

Prolonged jaundice is usually harmless, but may occasionally be caused by more serious medical problems. Babies with prolonged jaundice will usually have some extra blood tests to look for any medical problems. This is often at a clinic in the hospital or may be done at home by a community midwife in some areas.

In most cases, no medical condition is found and the jaundice gradually goes away without needing treatment, but occasionally important medical problems are picked up by these tests.

Which babies are most likely to get newborn jaundice?

Jaundice in newborn babies is very common, but in most cases is not severe enough to need treatment. There are some things which make a baby more likely to have jaundice that needs treating:

Being born premature (less than 38 weeks) - the earlier a baby is born, the more likely they are to need treatment for jaundice.

Having a low birth weight.

Being male.

Being from an Asian or black family.

Getting jaundice in the first 24 hours after birth.

Having a brother or sister who needed treatment for jaundice after birth.

Being only fed with breastmilk.

Babies born prematurely are more likely to get jaundice. If they have jaundice, it is more likely to be severe and tends to last longer than in full term babies.

After your baby is born, they will be examined, both in hospital and at home. Every time your baby is examined, your care team will be checking for jaundice. You will be encouraged to check your baby too, especially after you take them home. If your baby has jaundice, their skin and the whites of their eyes will appear yellowish.

Signs of jaundice in babies with darker skin tones

It can be more difficult to tell if a baby has jaundice if they have darker skin, because the yellowing may be less obvious. Gently pressing on the tip of their nose or on their forehead can make it easier to see any yellowing.

The whites of the eyes should normally always be white, no matter how dark your baby's skin. So checking your baby's eyes is a good way to look for jaundice. It is best to check your baby in bright light, preferably daylight.

Tell your midwife, health visitor, or GP the same day if you think your baby has jaundice.

Jaundice on the neonatal unit

Jaundice is commonly seen on the neonatal unit, especially with preterm babies. Around 80% of preterm babies develop jaundice. The liver of a preterm baby is still developing, and is not yet able to process bilirubin as easily as term babies.

Preterm babies are also more sensitive to the potential complications of jaundice, so treatment often starts earlier than in babies born at full-term.

Jaundice is also more common in babies who are born at full-term but unwell, for example with an infection, or who have other risk factors. Their care team will know what to look out for and will check your baby's bilirubin level, but if you think your baby looks like they have jaundice, please mention this to them.

If you notice your baby has jaundice

If you think your baby may have jaundice, tell your midwife, health visitor or doctor straight away. Jaundice is not usually a serious problem, but it is best to get your baby checked.

If your baby's jaundice does not go away (prolonged jaundice)

In full-term babies, jaundice usually goes away on its own by the time your baby is two weeks old, or three weeks if they were premature. If the jaundice does not go away, it might mean that there is an underlying medical problem.

If your baby has jaundice for more than two weeks, tell your midwife, health visitor or GP the same day. Prolonged jaundice is usually harmless, but it is important to have your baby checked in case they need treatment for a medical problem.

Pale stools (poo) and dark urine

A newborn baby's stool should be yellowy orange and their urine should normally be colourless or yellow. If they are not, that can be a sign of a problem which needs to be investigated. If your baby has pale (cream or white coloured) stools then you should inform your Community Midwife, GP or Health Visitor immediately, and tests should be arranged that day.

Useful guide to baby stool colour.

When your baby needs immediate medical help

Get immediate medical help by contacting your GP or going to the hospital Accident and Emergency department if your baby:

Has jaundice in the first 24 hours after they are born.

Has jaundice and is unwell, becoming more drowsy or not feeding.

Is becoming more and more yellow.

What tests might my baby have?

To accurately check whether your baby has jaundice, the level of bilirubin in their blood needs to be measured. Your midwife may be able to do this test at home, or you may need to take your baby to the hospital. If you are on a neonatal unit, doctors and nurses will check your baby's bilirubin level regularly.

The two main ways to check your baby's bilirubin level are:

By using a small device called a bilirubinometer (billy-roo-bin-ometer), which shines a light onto your baby's skin.

With a blood test from a heel prick. This may be needed depending on the results of the bilirubinometer test and the age of your baby.

The results of the test are used to see whether your baby needs any treatment. The doctor may also recommend further tests to look for other causes of jaundice. If so, they will explain what these tests involve.

Most babies with newborn jaundice do not need treatment. If your baby does need treatment, this will usually be given in hospital, but sometimes it can be given at home. Some people believe that sunlight is a good treatment for newborn jaundice but this is not correct.

The main treatment for newborn jaundice is called phototherapy. This is where your baby lies in an incubator with a blue light source above them. Some babies may be able to have phototherapy by lying on a special light-up blanket (called a 'biliblanket') instead. The blue light changes the bilirubin into a form that your baby's body can more easily process.

You will usually still be able to feed your baby, change their nappies, and give them a cuddle. Find guidance on how you can be more involved in your baby's care on the unit.

Preterm babies may need multiple treatments over a number of days and sometimes weeks. The more preterm your baby is, the more likely it is they will need phototherapy. Once treatment has stopped, your baby's bilirubin level will be checked again as they may require more phototherapy.

Very occasionally, a baby with jaundice needs a treatment called exchange transfusion. This is where your baby's blood is slowly replaced with blood from a blood donor, to remove the bilirubin. This treatment will happen in a neonatal unit and will only be done if your baby's bilirubin level is very high, or if phototherapy has not worked.

Your baby may need other treatments if they have a medical condition causing their jaundice. You can ask your nurses or doctors to explain what these involve.

Are there any short-term or long-term effects from having newborn jaundice?

Most newborn babies who have jaundice are not ill, and the jaundice goes away on its own in a few weeks without causing any problems.

But high levels of bilirubin can be harmful. That is why some babies need treatment. Fortunately, treatment usually works well to bring down the high level of bilirubin before it causes harm.

In a small number of babies, levels of bilirubin go very high. This can affect the brain and cause a condition called kernicterus (ker-nic-ter-us). Babies with this condition will be very unwell and will need care in the neonatal intensive care unit (NICU). Signs of kernicterus include:

Being overly sleepy

Being irritable

Being floppy, or stiff with an arched back

Having pauses in breathing (apnoea)

Having unusual movements (seizures)

Kernicterus can lead to long-term problems for babies. These include seizures (fits), learning difficulties, and hearing problems. If your baby has had kernicterus, they will have follow up appointments to check their development.

If jaundice is caused by a baby having a different blood type to their mother ( Rhesus disease), this can also cause the baby to develop anaemia (ah-nee-mee-ya), which is when they have less healthy red blood cells.

Where can I get more help and support?

It is natural to feel worried if something seems wrong with your baby. Your midwife, health visitor, or your baby's doctor will be able to talk to you about newborn jaundice. In most cases they will be able to reassure you that your baby's jaundice will get better without causing problems.

If your baby needs treatment, you can talk to the nurses and doctors in the hospital. If you are unsure about any part of your baby's diagnosis, treatment or care, just ask.

If you feel like you are struggling, we have lots of information and tips on how you can look after yourself and find support.

If your baby is found to have an underlying liver problem, you may find it helpful to visit the website of the Children's Liver Disease Foundation. We also have some other links to charities and organisations who can provide support.

If you need someone to talk to, you can contact us on hello@bliss.org.uk or arrange a video call with one of our volunteers.

If you have any feedback about this page, please email: information@bliss.org.uk

Last reviewed: April 2022

Next review date: April 2025

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Find out more about what jaundice is, the signs to look out for in your baby, and the treatment available.

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Your family may be asked to take part in trials and research

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Bliss is an integral member of the research teams for the following projects, currently supporting £8.1 million of research in neonatal care.

DOLFIN

Babies who are born very prematurely, or who suffer poor blood supply or lack of oxygen to the brain before or around the time of birth, are more likely to experience problems with their brain development. This may impact the ability of children to think, learn, communicate, play and interact with their surroundings.

The developing brain is constantly making new connections and nerve cells from specific nutrients and babies may need higher amounts of these nutrients to support brain growth and development.

The DOLFIN trial is investigating whether adding a daily nutrient supplement to the milk or food of babies born prematurely or who suffer poor blood supply or lack of oxygen to the brain around birth can help improve child neurological development.

The trial population will be made up of babies born less than 28 weeks of gestation (preterm group) and babies born at 35 weeks of gestation or more, receiving therapeutic hypothermia for hypoxic-ischaemic encephalopathy (HIE group).

The trial aims to recruit 1,010 babies from around 30 neonatal units across the UK.

Lead Applicant s: Professor Jeremy Parr, Newcastle University. The project is managed by the National Perinatal Epidemiology Unit, Clinical Trials Unit (NPEU CTU) at the University of Oxford and sponsored by The Newcastle upon Tyne Hospitals NHS Foundation Trust.

Funding: NIHR Health Technology Assessment (HTA) Programme, approximately £3,700,000 funding.

Website: https://www.npeu.ox.ac.uk/dolfin

FEED1

A large number of infants admitted to neonatal units are those born prematurely at 30-33 weeks.

Babies who are born early are currently fed small amounts of milk, 'gradually' through a tube into their stomach, with additional nutrition through a drip into their veins. Babies are fed this way because of concerns about Necrotising Enterocolitis (NEC).

However, research suggests that for premature babies who aren't too poorly, larger milk feeds can be given without increasing the risk of NEC and might also reduce the risk of severe infection.

The FEED1 trial compares whether starting babies (born at 30-33 weeks gestation) on "full milk feeds" rather than "gradual milk feeds" will lead to babies going home from hospital earlier and will affect their later development.

Lead Applicant: Dr Shalini Ojha, University of Nottingham.
The University Hospitals of Derby and Burton NHS Foundation Trust are the sponsor of this study. The study is coordinated by the Nottingham Clinical Trials Unit.
Funding: National Institute for Health Research (NIHR) Health Technology Assessment Programme, approximately £2,000,000 funding.
Website: https://www.feed1.ac.uk/home.aspx
Recruitment end date: September 2024.

CASSAVA

It is not currently known whether a vaginal delivery or a caesarean section is safer for women and their babies with an early birth, or whether both are equally safe.

The CASSAVA study aims to seek the best way to manage the birth of women presenting in preterm labour. The first part of this research is to find out where doctors and women feel that more research on this topic is needed.

Lead Applicant: Professor Jane Norman, The Queen's Medical Research Institute, University of Edinburgh

Funding: NIHR Health Technology Assessment Programme, £309,105.

SurfON

Many late preterm and early term babies have breathing problems after birth, which can be severe. The lungs of healthy full term babies produce surfactant, a substance that makes it easier for them to breathe.

Late preterm or early term babies often do not make enough, or their natural surfactant does not work properly. We can give extra surfactant into the lungs of these babies by putting a tube in the windpipe. However, not all babies need extra surfactant, but it is hard to predict which do and which do not.

SurfON (Surfactant Or Not) aims to investigate whether, in late preterm and early term infants with respiratory distress, giving surfactant early can reduce the number of days that babies with breathing problems need to stay in hospital.

Lead Applicant: Professor Elaine Boyle, Department of Health Sciences, University of Leicester

Funding: NIHR Health Technology Assessment Programme, £1,671,376.

OPTI-PREM

Babies born between 27 and 31 weeks of pregnancy in England and Wales are currently looked after in two different types of settings: Neonatal Intensive Care Units (NICU) and less intensive local neonatal units (LNU).

Both types of unit can provide the care these babies are likely to need, but LNUs tend not to look after the very smallest babies and so are designed and staffed differently. Read more about the different levels of neonatal care.

Optimising Neonatal Service Provision for babies born between 27 and 31 weeks (OPTI-PREM), is a project which aims to look at which type of unit leads to the best outcome for babies at each week of gestation in this range, is most cost effective for families and the NHS, and is the best at taking into consideration the views and needs of parents and families when their baby is being cared for far from home, or being transferred between units. Read more about the OPTI-PREM project.

Lead Applicant: Dr Thillagavathie Pillay, University Hospitals Leicester NHS Trust, and University of Wolverhampton.

Funding: NIHR Health Services and Delivery Research Stream,£924,469.

CuBS

Currently, premature babies are transitioned from tube feeding to oral feeding by a scheduled feeding programme, at set times in the day. This differs from healthy full-term babies who are fed when they show signs of hunger (cue-based feeding).

This study, CUe-Based versus Scheduled feeding (CuBS), aims to help parents and staff in neonatal units to feed premature babies in neonatal units using cue-based feeding instead of scheduled feeding. The plan will include training for staff and educational materials for parents.

Find out more about different ways to feed your premature baby.

Lead Applicant: Dr Alison McFadden, University of Dundee

Funding: NIHR Health Technology Assessment Programme, £343,759.

ToSCiN

Premature babies who undergo surgery due to problems with their bowel often require stomas to be formed temporarily. Forming these stomas can be a life-saving procedure however these stomas need to be closed later on to allow the infant to remain healthy and grow.

The best timing to close a stoma is not currently known and practice varies between centres. The ToSCiN study (Timing of Stoma Closure in Neonates) is looking at whether a trial could help solve this issue and find the best timing for a stoma closure.

Lead applicant: Dr Nick Lansdale, Royal Manchester Children's Hospital

Funding: NIHR Health Technology Assessment Programme, £395,406.

Neonatal Cochrane

Cochrane Reviews are systematic reviews in healthcare research and policy. The Cochrane partnership programme aims to support the development, production, and use of these reviews to inform neonatal care.

This project aims to develop reviews that support key research priorities in neonatal care, for example, preventing and treating infections in babies in neonatal care.

Lead Applicant: Professor William McGuire, University of York

Funding: NIHR Systematic Reviews Programme, £397,034.

NeoEPOCH

Neonatal Electronic health record data for Point Of Care Health research and continuous incremental improvement in neonatal care ( NeoEPOCH) is a collaborative group of neonatal doctors, nurses, researchers and parents whose overall aim is to improve neonatal care through the use of electronic health record data.

Three projects undertaken by this group were supported by Bliss: WHEAT, COIN and BUDs.

Lead Applicant: Dr Chris Gale, Chelsea and Westminster Hospital, Imperial College London

Funding: Medical Research Council Clinical Scientist Fellowship, £1,019,913.

Currently, 1 in 3 neonatal units in the UK stop feeding babies during a blood transfusion to try and reduce the risk of developing necrotising enterocolitis (NEC). However, we do not know how helpful this is.

The WHEAT pilot study (WithHolding Enteral feeds Around packed red cell Transfusion), aimed to determine whether stopping the feeding of a baby during blood transfusion reduces the risk of developing NEC.

Lead Applicant: Dr Chris Gale, Chelsea and Westminster Hospital, Imperial College London

Funding: NIHR Health Technology Assessment Programme, £990,000.

Core Outcomes In Neonatology ( COIN) aimed to identify what outcomes of neonatal care are most important to: parents of babies needing neonatal care, neonatal patients, researchers, and clinicians.

This project identified a core set of outcomes that should be collected during all neonatal research, ensuring that future research involving neonatal babies will collect outcomes that are important to all groups involved. Read the results of the COIN study, published in the BMJ.

Lead Applicant: Dr James Webbe, Chelsea and Westminster Hospital, Imperial College London

Funding: as part of Medical Research Council Clinical Scientist Fellowship (see above).

The Better Use of Data to improve parent Satisfaction project, BUDS, aimed to provide parents with daily updates about their baby, taken directly from the infant electronic patient record system (Badger.Net), during their time on a neonatal unit.

It is hoped that this will eventually be in the form of a mobile phone application which will help parents to feel more involved in their baby's daily care.

Project Lead: Dr Susanna Sakanidou, Chelsea and Westminster Hospital, Imperial College London

Funding: NIHR CLAHRC NWL research driven improvement project grant (£55,749), NIHR doctoral research fellowship (£407,681) and Rosetrees Trust (£15,000). Total funding of £478,430.

Cooling and Feeding

Hypoxic Ischaemic Encephalopathy (HIE), a lack of oxygen to the brain around birth, can lead to long-term brain injury or death. Babies who have moderate to severe HIE are treated with therapeutic hypothermia, where they are cooled a few degrees and then gradually warmed back up again to help protect the brain.

This study aimed to identify the best way to provide nutrition to babies with HIE while they are being cooled. Different neonatal units have different ways of providing nutrients to babies during cooling.

This study compared these different ways, and assessed rates of infection, by using information that is collected every day on neonatal units.

Lead Applicant: Dr Chris Gale, Imperial College London, Chelsea and Westminster Hospital

Funding: NIHR Health Technology Assessment Programme, £92,988.

SPRING

Some children who are born earlier than 32 weeks develop neuropsychiatric disorders such as ADHD and Autism. The SPRING pilot study aimed to identify whether babies who are born very premature have variations in their DNA that have previously been identified to increase the risk of having neuropsychiatric disorders.

In partnership with Bliss, families, clinicians, and researchers, the SPRING study (Study of Preterm Infants and Neurodevelopmental Genes), allowed methods to be established for a future large scale whole-population genetic study.

This will increase the understanding of the link between very premature birth, genetics, and neuropsychiatric disorders.

Chief Investigator: Professor Anita Thapur, Cardiff University

Funding: Medical Research Council, £288,191.

Preterm Birth Programme

The preterm birth programme, published in October 2019, aimed to identify how to improve quality of care and long term health of babies who are born very premature (<32 weeks).

This project aimed to explore ways to provide initial care of premature babies after birth at the bedside, making care more family-centred. Further, the programme aimed to identify gaps in research and priorities in the care of premature babies, to inform future research.

Part of the programme was a randomised trial which investigated the timing of cord clamping in relation to initial stabilisation and resuscitation at birth.

The results from the trial, published in the British Medical Journal in 2017, suggest that cord clamping after 2 minutes, and providing immediate neonatal care with the cord intact, may improve the outcome of these very premature babies.

Lead Applicant: Professor Lelia Duley, University of Leeds

Funding: NIHR Grant for Applied Health Research

INFANT

Interpretation of outputs from continuous electronic fetal heart rate monitoring is difficult. INFANT software has been developed to monitor and highlight abnormalities in fetal heart rate.

A trial was conducted that aimed to assess whether INFANT aided monitoring of fetal heart trace, and therefore reduced the likelihood of poor neonatal outcomes. The results from this trial, published in the Lancet in 2017, concluded that the use of INFANT did not reduce number of poor neonatal outcomes.

Chief Investigator: Professor Peter Brocklehurst, University of Birmingham

Funding: NIHR Health Technology Assessment programme

SIFT

When babies are born too soon they have trouble feeding themselves so are given milk through a tube into their stomach. The volume of milk given starts off slowly, and gradually increases.

The best rate of increasing these feeds to achieve full milk feeds, without causing complications, is not yet known.

This study (SIFT: Speed of Increasing milk Feeds Trial) looked at which speed is generally best for feeding babies, by assessing long and short term health, as well as infection rates.

The results from this trial, published in The New England Journal of Medicine in October 2019, showed that babies could safely be fed at a faster rate (30 ml per kg) with no difference in survival without moderate or severe neurodevelopmental disability at 24 months, and no increased incidence of infection, when compared to a slower rate of feeding (18 ml per kg).

Lead applicant: Dr Jon Dorling, Nottingham University Hospital NHS Trust

Funding: NIHR Health Technology Assessment Programme, £2,403,552.75

ELFIN

Babies who are born very premature or more than 8 weeks early often need specialist hospital care on a neonatal intensive care unit. During their stay, babies can develop serious infections and illnesses.

The ELFIN study was designed to test whether giving lactoferrin, a naturally-occurring milk protein (often used as a food supplement), to babies can help to protect them against infections.

The results from this trial, published in The Lancet in January 2019, concluded that enteral supplementation with bovine lactoferrin does not reduce the incidence of infection, mortality or other morbidity in very preterm infants.

Lead Applicant: Professor William McGuire, University of York

Funding: NIHR Health Technology Assessment Programme, £1,989,890.

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Find out about the latest research projects that Bliss supports.

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What is parenteral nutrition (PN)?

Parenteral nutrition (PN) is nutrition in a liquid form that is given directly into your baby's bloodstream intravenously (through a vein). The solution has nutrients such as vitamins, minerals, carbohydrates, proteins and fats. It is called total parenteral nutrition (TPN) where it is used as the only source of nutrition.

How does PN work?

PN provides food to help your baby grow. An infusion pump is used to deliver the nutrition to your baby. This allows a stream of nutrients to flow into the bloodstream over a period of time. In newborn babies it is common for the vein in the baby's umbilical cord to be used for this.

A doctor or advanced neonatal nurse practitioner will insert a tube (catheter) into your baby's umbilical cord (tummy button). The nutrition passes through this into the bloodstream. After some time, if your baby still needs PN, they will place another tube (called a long line) into one of your baby's veins (usually the arms or legs). They will then remove the tube in the tummy button.

At first, this may be their only source of nutrition.

Why does my baby need to be fed using PN?

Although very premature and sick babies can have milk feeds, these often need to be introduced gradually so their gut can learn to cope with them. Very premature babies are usually fed using PN at first, as they have an immature digestive system that needs time to develop enough so they can tolerate enough milk to meet their nutritional needs. For both very premature and sick babies, PN can be used to make sure they get enough nutrition and can start to grow while they are gradually introduced to feeds.

We understand that seeing your baby being fed using PN can be quite scary. But it will allow your baby to feed without reducing their energy. It also enables them to absorb the nutrients required to grow.

When will my baby stop needing PN?

As your baby begins to grow and becomes stronger, a method called tube feeding will be introduced. This is so your baby can start to have milk. Tube feeding is where breast milk or formula is given through a tube passed into your baby's nose or mouth to their stomach. Milk feeds will be introduced as soon as possible alongside PN.

Once tube feeding has been established, PN will stop. Some babies need PN for a week or two, but others can take longer.

We have more information about tube feeding that you may find helpful.

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Parenteral nutrition, also known as PN, is used to feed extremely premature or very sick babies.

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Your baby is being treated in a neonatal unit because they need some medical care. This will include necessary procedures that may cause them some discomfort or pain. As a parent, you have a unique and amazing ability to comfort your baby through pain and discomfort in a way that no one else can.

This pain and discomfort can be broadly split into two categories:

Acute procedural pain - this is the pain a baby feels for a short time during medical procedures or tests.

Ongoing pain, discomfort, or stress.

Acute procedural p ain can happen during a procedure, for example, when a sample of a baby's blood needs to be taken through a heel prick. Ongoing pain or discomfort can happen for a number of reasons. It could be caused by a medical condition or longer periods of stressful activity, for example, moving to a different neonatal unit.

These pages will focus on how parents and neonatal care teams can work together to comfort babies through acute procedural pain. If you would like information about how you can help manage your baby's ongoing pain, discomfort, and stress, visit our pages about Looking after your baby on the neonatal unit.

We also look at how parents and healthcare professionals can work together to help comfort babies, and we provide suggestions for unit staff about how they can help support you.

Reducing pain and discomfort for babies on neonatal units

Managing a baby's stress and pain is very important for healthcare professionals and parents. How this is done can be different from unit to unit and between different members of staff, but three common approaches are:

Timing and frequency of procedures: Your baby's care team will try to manage the number of procedures your baby experiences in a short space of time. This can help to support their sleep and brain development.

Providing comfort: You can make a big difference to your baby's comfort. How much you can be involved will depend on what is happening to and around your baby.  There are lots of ways you can be involved in your baby's care and help to comfort them around their procedures.

Medication: Your baby's care team will make decisions about medication but sometimes you will be able to help by describing how you think your baby is responding to medication.

In this video Professor Rebeccah Slater explains her research into the role of parents in their baby's medical procedures. This video features a mother, Brenda discussing her experience on the neonatal unit and Dr Maria Cobo, a postdoctoral researcher discussing the importance of this research into the benefits of parental touch for babies in neonatal care.

FAQs and Quick Guide

Don't have time to read through it all?

Visit our FAQs section for links to further information or check out our quick guide.

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Find out about the medical care your baby might receive on the neonatal unit, and how you and healthcare professionals can reduce your baby's pain and discomfort.

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Screening for Newborn baby

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Find out what screening tests your newborn baby will be offered.

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Retinopathy of Prematurity

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What is retinopathy of prematurity?

Retinopathy of prematurity (ROP) is a potentially blinding eye disorder that primarily affects premature infants weighing about 2¾ pounds (1250 grams) or less that are born before 31 weeks of gestation (a full-term pregnancy has a gestation of 38-42 weeks). The smaller a baby is at birth, the more likely that baby is to develop ROP. This disorder - which usually develops in both eyes - is one of the most common causes of visual loss in childhood and can lead to lifelong vision impairment and blindness. ROP was first diagnosed in 1942.

How many infants have retinopathy of prematurity?

Today, with advances in neonatal care, smaller and more premature infants are being saved. These infants are at a much higher risk for ROP. Not all babies who are premature develop ROP. There are approximately 3.9 million infants born in the U.S. each year; of those, about 28,000 weigh 2¾ pounds or less. About 14,000-16,000 of these infants are affected by some degree of ROP. The disease improves and leaves no permanent damage in milder cases of ROP. About 90 percent of all infants with ROP are in the milder category and do not need treatment. However, infants with more severe disease can develop impaired vision or even blindness. About 1,100-1,500 infants annually develop ROP that is severe enough to require medical treatment. About 400-600 infants each year in the US become legally blind from ROP.

Are there different stages of ROP?

Yes. ROP is classified in five stages, ranging from mild (stage I) to severe (stage V):

Stage I - Mildly abnormal blood vessel growth. Many children who develop stage I improve with no treatment and eventually develop normal vision. The disease resolves on its own without further progression.

Stage II - Moderately abnormal blood vessel growth. Many children who develop stage II improve with no treatment and eventually develop normal vision. The disease resolves on its own without further progression.

Stage III - Severely abnormal blood vessel growth. The abnormal blood vessels grow toward the center of the eye instead of following their normal growth pattern along the surface of the retina. Some infants who develop stage III improve with no treatment and eventually develop normal vision. However, when infants have a certain degree of Stage III and "plus disease" develops, treatment is considered. "Plus disease" means that the blood vessels of the retina have become enlarged and twisted, indicating a worsening of the disease. Treatment at this point has a good chance of preventing retinal detachment.

Stage IV - Partially detached retina. Traction from the scar produced by bleeding, abnormal vessels pulls the retina away from the wall of the eye.

Stage V - Completely detached retina and the end stage of the disease. If the eye is left alone at this stage, the baby can have severe visual impairment and even blindness.

Most babies who develop ROP have stages I or II. However, in a small number of babies, ROP worsens, sometimes very rapidly. Untreated ROP threatens to destroy vision.

Can ROP cause other complications?

Yes. Infants with ROP are considered to be at higher risk for developing certain eye problems later in life, such as retinal detachment, myopia (nearsightedness), strabismus (crossed eyes), amblyopia (lazy eye), and glaucoma. In many cases, these eye problems can be treated or controlled.

What causes ROP?

ROP occurs when abnormal blood vessels grow and spread throughout the retina, the tissue that lines the back of the eye. These abnormal blood vessels are fragile and can leak, scarring the retina and pulling it out of position. This causes a retinal detachment. Retinal detachment is the main cause of visual impairment and blindness in ROP.

Several complex factors may be responsible for the development of ROP. The eye starts to develop at about 16 weeks of pregnancy, when the blood vessels of the retina begin to form at the optic nerve in the back of the eye. The blood vessels grow gradually toward the edges of the developing retina, supplying oxygen and nutrients. During the last 12 weeks of a pregnancy, the eye develops rapidly. When a baby is born full-term, the retinal blood vessel growth is mostly complete (the retina usually finishes growing a few weeks to a month after birth). But if a baby is born prematurely, before these blood vessels have reached the edges of the retina, normal vessel growth may stop. The edges of the retina - the periphery - may not get enough oxygen and nutrients.

Scientists believe that the periphery of the retina then sends out signals to other areas of the retina for nourishment. As a result, new abnormal vessels begin to grow. These new blood vessels are fragile and weak and can bleed, leading to retinal scarring. When these scars shrink, they pull on the retina, causing it to detach from the back of the eye.

Are there other risk factors for ROP?

In addition to birth weight and how early a baby is born, other factors contributing to the risk of ROP include anemia, blood transfusions, respiratory distress, breathing difficulties, and the overall health of the infant.

An ROP epidemic occurred in the 1940s and early 1950s when hospital nurseries began using excessively high levels of oxygen in incubators to save the lives of premature infants. During this time, ROP was the leading cause of blindness in children in the US. In 1954, scientists funded by the National Institutes of Health determined that the relatively high levels of oxygen routinely given to premature infants at that time were an important risk factor, and that reducing the level of oxygen given to premature babies reduced the incidence of ROP. With newer technology and methods to monitor the oxygen levels of infants, oxygen use as a risk factor has diminished in importance.

Although it had been suggested as a factor in the development of ROP, researchers supported by the National Eye Institute determined that lighting levels in hospital nurseries has no effect on the development of ROP.

What's the treatment for ROP?

The most effective proven treatments for ROP are laser therapy or cryotherapy. Laser therapy "burns away" the periphery of the retina, which has no normal blood vessels. With cryotherapy, physicians use an instrument that generates freezing temperatures to briefly touch spots on the surface of the eye that overlie the periphery of the retina. Both laser treatment and cryotherapy destroy the peripheral areas of the retina, slowing or reversing the abnormal growth of blood vessels. Unfortunately, the treatments also destroy some side vision. This is done to save the most important part of our sight - the sharp, central vision we need for "straight ahead" activities such as reading, sewing, and driving.

Both laser treatments and cryotherapy are performed only on infants with advanced ROP, particularly stage III with "plus disease." Both treatments are considered invasive surgeries on the eye, and doctors don't know the long-term side effects of each.

In the later stages of ROP, other treatment options include:

Scleral buckle. This involves placing a silicone band around the eye and tightening it. This keeps the vitreous gel from pulling on the scar tissue and allows the retina to flatten back down onto the wall of the eye. Infants who have had a sclera buckle need to have the band removed months or years later, since the eye continues to grow; otherwise they will become nearsighted. Sclera buckles are usually performed on infants with stage IV or V.

Vitrectomy. Vitrectomy involves removing the vitreous and replacing it with a saline solution. After the vitreous has been removed, the scar tissue on the retina can be peeled back or cut away, allowing the retina to relax and lay back down against the eye wall. Vitrectomy is performed only at stage V.

What happens if treatment does not work?

While ROP treatment decreases the chances for vision loss, it does not always prevent it. Not all babies respond to ROP treatment, and the disease may get worse. If treatment for ROP does not work, a retinal detachment may develop. Often, only part of the retina detaches (stage IV). When this happens, no further treatments may be needed, since a partial detachment may remain the same or go away without treatment. However, in some instances, physicians may recommend treatment to try to prevent further advancement of the retinal detachment (stage V). If the center of the retina or the entire retina detaches, central vision is threatened, and surgery may be recommended to reattach the retina.

What's the latest research on ROP?

The NEI-supported clinical studies on ROP include:

The Telemedicine Approaches to Evaluating Acute-phase ROP (e-ROP) study is exploring new strategies to identify babies at greater risk of developing severe ROP, especially those in underserved or remote areas. Currently in the U.S., evaluation of premature babies for severe ROP is performed by an ophthalmologist in the neonatal intensive care unit (NICU). The e-ROP study tested whether it's possible to accurately detect potentially severe ROP by sending retinal images taken in the NICU to an offsite image reading center. In the study, non-physician staff in the NICU were trained to take the photos, which were made available to trained image readers, who evaluated whether the babies needed to be referred for potential treatment. The study found that this telemedicine approach to identifying severe ROP was about as accurate as regular examinations by an ophthalmologist. The approach potentially gives millions of premature babies worldwide greater access to ROP screening.

The Cryotherapy for Retinopathy of Prematurity (CRYO-ROP)-Outcome Study of Cryotherapy for Retinopathy of Prematurity Study examined the safety and effectiveness of cryotherapy (freezing treatment) of the peripheral retina in reducing the risk of blindness in certain low birth-weight infants with ROP. Follow-up results confirm that applying a freezing treatment to the eyes of premature babies with ROP helps save their sight. The follow-up results also give researchers more information about how well the babies can see in the years after cryotherapy.

The Effects of Light Reduction on Retinopathy of Prematurity (Light-ROP) Study evaluated the effect of ambient light reduction on the incidence of ROP. The study determined that light reduction has no effect on the development of a potentially blinding eye disorder in low birth weight infants. The study determined that light reduction in hospital nurseries has no effect on the development of ROP.

The Early Treatment for Retinopathy of Prematurity Study (ETROP) is designed to determine whether earlier treatment in carefully selected cases of ROP will result in an overall better visual outcome than treatment at the conventional disease threshold point used in the CRYO-ROP study.

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Retinopathy of prematurity (ROP) is an eye disorder that occurs mostly in babies who weigh less than 3 pounds or are born before 31 weeks of pregnancy. It is one of the most common causes of vision loss in children. Learn how many infants have ROP, how it is treated, and what ROP research is being done.

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Support with your crying baby

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Babies cry, you can cope When babies cry it can be stressful and overwhelming. Help is out there and all you need to do is ask. Latest news Testimonials

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Building a brighter future for high risk infants

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EiSMART is an evidence based framework to give high risk babies the best start in life. We span all aspects of a child's development: Sensory, Motor, Attention and Regulation, and Relationships. Professionals and parents work Together to support premature and sick infants from birth ( Early I ntervention).

parents

We are here to help. You are the expert on your baby; let us work with you and provide the resources, tools and education that can help fulfil your baby's potential.
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free resources

Our developmental play leaflets suggest activities to support all aspects of a child's development. You can get free access to these resources, plus webinars, posters and more.
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We are committed to supporting your development. We are working to advance knowledge, skills and practice in early intervention.
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Training Courses

Published October 20, 2023

Study Days and Ei SMART Implementation Workshops

The Ei SMART Framework - Foundation Training. This study day provides an in-depth introduction to the Ei SMART framework and is our Foundation level training before progressing to our advanced half days.

Dates for 2024 will be announced soon. Watch this space or subscribe to our newsletter for more information.

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Giving Every High Risk Infant The Best Start In Life

EiSMART is a framework for improving developmental outcomes for high risk infants. It is an approach founded in research, which combines multiple disciplines, to address every aspect of development in premature and sick babies. EiSMART is a uniquely collaborative approach, where professionals and parents work T ogether to provide early and more effective interventions for infants and young children with developmental challenges. Click on the balls to learn more.

How We Help

We provide resources to support child development, and deliver training courses to support professional development. We collaborate on research to advance practice in early intervention, and we influence policy on the care of high risk infants.

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Invaluable For Us & Our Baby

"In the beginning of my NICU journey I cried every day. There is no other outlet for the hurt, the sadness, the fear - especially the fear - of giving birth so early. In NICU, everything about those first weeks is different to how it should be. You emerge from that darkness into an intense, overwhelming, medical world where you feel utterly helpless to do the most natural thing: care for your baby. Stumbling upon EiSMART was like finding fresh air, after a long, dark time under water. It helped me recover purpose; recover focus; recover the ability to care for my baby."
- Parent of baby born at 24 weeks' gestation
DISCOVER MORE OUR APPROACH

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Building A Brighter Future For High Risk Infants: EiSMART is a transdisciplinary approach to early intervention for infants at risk of developmental delays.

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Every baby is offered newborn blood spot screening, also known as the heel prick test, ideally when they're 5 days old.

What is the blood spot test?

Newborn blood spot screening involves taking a blood sample to find out if your baby has 1 of 9 rare but serious health conditions.

Most babies won't have any of these conditions but, for the few who do, the benefits of screening are enormous.

Early treatment can improve their health, and prevent severe disability or even death.

What does the blood spot test involve?

When your baby is 5 days old, a healthcare professional will prick their heel and collect 4 drops of blood on a special card.

You can ease any distress for your baby by cuddling and feeding them, and making sure they're warm and comfortable.

Occasionally, the sample may need to be taken when your baby is 6, 7 or 8 days old.

Sometimes a second blood spot sample is needed. The reason for this will be explained to you. It doesn't necessarily mean there's something wrong with your baby.

The test doesn't carry any known risks for your baby.

Which conditions is the blood spot test for?

The blood spot test screens for the following 9 rare but serious conditions.

If you, your partner or a family member already has one of these conditions (or a family history of it), tell your healthcare professional straight away.

Sickle cell disease

About 270 babies are born with sickle cell disease in the UK each year. This is a serious inherited blood disease.

Sickle cell disease affects haemoglobin, the iron-rich protein in red blood cells that carries oxygen around the body.

Babies who have this condition will need specialist care throughout their lives.

People with sickle cell disease can have attacks of severe pain and get serious, life-threatening infections. They're usually anaemic because their blood cells have difficulty carrying oxygen.

The blood spot screening test means that babies with sickle cell disease can receive early treatment to help them live healthier lives. This may include vaccinations and antibiotics to prevent serious illnesses.

Pregnant women are also routinely tested for sickle cell disease early in pregnancy.

Read more about sickle cell disease.
GOV.UK also has a factsheet about sickle cell disease
Cystic fibrosis

About 1 in 2,500 babies born in the UK has cystic fibrosis. This inherited condition affects the digestion and lungs.

Babies with cystic fibrosis may not gain weight well and are prone to chest infections.

Babies with the condition can be treated early with a high-energy diet, medicines and physiotherapy.

Although children with cystic fibrosis may still become very ill, early treatment can help them live longer, healthier lives.

Read more about cystic fibrosis.
GOV.UK also has a leaflet for parents whose baby has suspected cystic fibrosis
Congenital hypothyroidism

About 1 in every 2,000 to 3,000 babies born in the UK has congenital hypothyroidism. Babies with congenital hypothyroidism don't have enough of the hormone thyroxine.

Without thyroxine, babies don't grow properly and can develop learning disabilities.

Babies who have the condition can be treated early with thyroxine tablets, and this allows them to develop normally.
The British Thyroid Foundation has more information about congenital hypothyroidism
Inherited metabolic diseases

It's important to let your healthcare professional know if you have a family history of a metabolic disease (a disease that affects your metabolism).

Babies are screened for 6 inherited metabolic diseases. These are:

About 1 in 10,000 babies born in the UK has PKU or MCADD. The other conditions are rarer, occurring in 1 in 100,000 to 150,000 babies.

Without treatment, babies with inherited metabolic diseases can become suddenly and seriously ill. The diseases all have different symptoms.

Depending on which one affects your baby, the condition may be life threatening or cause severe developmental problems.

They can all be treated with a carefully managed diet and, in some cases, medicines as well.

Severe combined immunodeficiency (SCID)

In some areas of England, screening for a condition called severe combined immunodeficiency (SCID) is also being offered as part of the newborn blood spot test. This is to help the NHS decide if screening for SCID should be offered to all babies in England.

SCID causes problems with the immune system. It makes it very hard for a baby to fight off infections like meningitis and pneumonia, which can be life-threatening. About 14 babies born each year in England have SCID.

Ask your midwife if screening for SCID is being offered in your area.
Great Ormond Street Hospital for Children has more information on severe combined immunodeficiency

Does my baby have to have the blood spot test?

The blood spot test is not compulsory, but it's recommended because it could save your baby's life.

You can choose to have screening for sickle cell disease, cystic fibrosis or congenital hypothyroidism individually, but you can only choose to have screening for all 6 inherited metabolic diseases or none at all.

If you don't want your baby to be screened for any of these conditions, discuss it with your midwife.

You should be given information about the blood spot test and the diseases it screens for in advance so you can make an informed decision for your baby.

If you change your mind, babies can be screened up to the age of 12 months for all the conditions except cystic fibrosis. Cystic fibrosis can only be screened for up to 8 weeks of age.

If you have any concerns about the tests, speak to your midwife, health visitor or GP.

When will we get the results?

You should receive the results either by letter or from a healthcare professional by the time your baby is 6 to 8 weeks old.

The results should be recorded in your baby's personal child health record (red book). It's important to keep this safe and take it with you to all your baby's appointments.

If you haven't received your baby's results, speak to your health visitor or GP.

You'll be contacted sooner if your baby screens positive. This means they're more likely to have one of the conditions tested for.

You'll be contacted:

the day the result is available, or the next working day, if your baby is thought to have congenital hypothyroidism (CHT) - you'll be given an appointment to see a specialist

before your baby's 4 weeks old if they're thought to have cystic fibrosis

before your baby's 6 weeks old if they're thought to have sickle cell disease

Screening for cystic fibrosis finds some babies who may be genetic carriers of the condition. These babies may need further testing.

Screening for sickle cell disease also finds babies who are carriers of this or other red blood cell diseases.

Carriers are healthy, although they can experience problems in situations where their bodies aren't getting much oxygen - for example, if they're having an anaesthetic.

Parents of babies who are found to be carriers should be told by the time they're 6 to 8 weeks old.

What do the results mean?

Most babies will have a normal result, which means it's unlikely that they have any of the conditions.

A small number of babies will screen positive for one of the conditions. This doesn't mean they have the condition, but they're more likely to have it. They'll be referred to a specialist for more tests.

It's important to know that screening isn't 100% certain. A baby with a negative screening result may later turn out to have the disease screened for. This is known as a false negative.

Babies with a positive result sometimes turn out not to have the disease - what's known as a false positive.

Occasionally, other medical conditions are picked up by blood spot test screening. For example, babies with beta thalassaemia major, a serious blood disease, will usually be detected. These babies also need to be referred for early treatment.

More information

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Your guide to the newborn blood spot (heel prick) test, including which diseases it screens for and when to expect the results

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PostpartumMen is a place for men with concerns about depression, anxiety or other problems with mood after the birth of a child. It promotes self-help, provides important information for fathers - including a self-assessment for postpartum depression - hosts an online forum for dads to talk to each other, offers resources, gathers new information about men's experiences postpartum, and - most importantly - helps fathers to beat the baby blues.

Yes, men do get postpartum depression. It's a fact that most people - and even many health professionals - don't know. As a result, most men with postpartum depression suffer in isolation. With PostpartumMen, these dads are no longer alone.

こちらは日本の公共放送（NHK）で放送された、 産後うつについての番組です。ぜひご覧ください。
En Espanol, nueva revista historia, "Depresion Posparto Masculina." View Article
PostpartumMen Awarded 5 Stars!
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Remember seeing your baby for the first time? You were probably filled with pride and excitement. That's what you always heard it was like having a child - pure joy. Baby bliss.

Then, reality sets in. Sleepless nights. A screaming infant needing nearly constant care. Fights with your partner. Going to work exhausted.

Then, over time, you've noticed things have gotten worse.

Now, you've lost your sense of humor, and there's not much to look forward to. You've started getting more anxious or panicky. You've had trouble sleeping. And you're miserable a lot of the time.

Or perhaps you've been irritable. You're getting more stressed at work and getting angry with your wife. Maybe you've noticed you're drinking more - or withdrawing from people.

These are all signs of men's depression. You may think you should just "get over it" - and that you must be the only guy who can't. But you're not the only one.

Every day, over 1,000 new dads in the United States become depressed. And according to some studies, that number is as high as 2,700. That's 1 in 10 to as many as 1 in 4 new dads who have postpartum depression. Whatever the exact number, we know that a lot of fathers are suffering from this painful condition.

The truth is, depression, anxiety and other mood disorders are common. In fact, they're just as common - and just as real - as physical problems, like heart disease and diabetes. They can also be as crippling.

Now, contrary to what you might think, admitting you're depressed isn't admitting defeat. It's admitting there's hope. And it's taking charge of your life.

Postpartum depression in dads - or PPND (for Paternal Postnatal Depression) - is a very serious condition. Without effective treatment, it can result in damaging, long-term consequences for a man, his child, and his entire family. But with proper treatment and support, men can fully recover from PPND.

Depression isn't something a guy can simply "get over." It's a health condition that needs to be treated - just like a bad heart or injured knee. PostpartumMen is a place for you to find the strength and courage you need to get your life back on track.

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PostpartumMen is a place for men with concerns about depression, anxiety or other problems with mood after the birth of a child. It promotes self-help, provides important information for fathers - including a self-assessment for postpartum depression - hosts an online forum for dads to talk to each other, offers resources, gathers new information about men's experiences postpartum, and - most importantly - helps fathers to beat the baby blues.

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Postnatal depression (PND) is a type of depression that many parents experience after having a baby. It can affect any parent, regardless of whether they've suffered from a mental health condition before. Postnatal depression is linked directly to giving birth and is a common problem, affecting 1 in 10 women within a year of giving birth.

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We encourage neonatal units and networks to share this animation with parents and disseminate the resource widely.

There is also a QR code that takes you directly to the animation.

The NNAP produces a number of resources specifically for parents and carers. These include:

Your baby's care - the parent and carer guide to the NNAP summary report

Unit posters - these highlight how each unit is performing against a selection of audit measures and what unit's are doing in response to these results

Privacy notices - these outline how the audit collects and uses data on babies and what parents can do if they want to opt out of this data collection process.

Neonatal unit and neonatal network annual NNAP results can be accessed via NNAP Online

Audit results are also available via the interactive NNAP Data Dashboard based on 2023 measure definitions. The dashboard presents results for each of the 10 NNAP performance metrics as annual rolling averages and will be updated quarterly. It can be found here: National Neonatal Audit Programme - Data dashboard | RCPCH

The NNAP publishes an annual summary report as well as an at a glance guide and an extended analysis report.
View NNAP summary report on 2021 data
You can follow the NNAP on Twitter @nnap_rcpch

If you have any questions about the audit, please email: NNAP@rcpch.ac.uk

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What is the National Neonatal Audit Programme?

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The National Neonatal Audit Programme (NNAP) looks at the care babies receive if they are born early or unwell and need to be admitted to a neonatal unit. We have created a short animation designed to introduce the NNAP to parents and carers. The animation outlines how the audit works and what resources it produces.

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Kent and Medway - Bump, Birth and Beyond

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Neonatal :: Kent and Medway - Bump, Birth and Beyond

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“When your child has had such a rough start and then they do start to hit milestones (whatever that might be) it feels incredible.

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Guide to services

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Singing with babies- Demelza

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Support if your baby is born between 22-24 weeks 

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Support if your baby is born between 22-24 weeks 

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Small changes, Big Difference

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Cerebral Palsy support

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Cerebral palsy is a condition that affects muscle control and movement. It affects about 1 in every 400 children in the UK.

It is usually caused by an injury to the brain before, during or after birth, but there may be no obvious single reason. The main causes include:

infection in the early part of pregnancy

lack of oxygen to the brain

abnormal brain development

a genetic link but this is quite rare

Clinical negligence
There is no cure, but physiotherapy and other therapies can often help people become more independent.

Treatments and therapies should reflect individual needs, as CP affects people in different ways.
CP therapies and treatments
Causes of cerebral palsy

The following factors can increase the likelihood of CP:

difficult or premature birth

twins or multiple birth

mother's age below 20 or over 40

father under 20

first child or fifth (or more) child

baby of birth weight less than 2.5 pounds

premature birth, less than 37 weeks

A combination of factors such as low birth weight and being a twin can increase the probability.

Symptoms of cerebral palsy

Symptoms of cerebral palsy normally become noticeable around 18 months to 2 years old. Although sometimes diagnosis is later in childhood. Your child might have problems with movement, co-ordination and development.

Possible signs of CP can include:

delays in reaching development milestones

being too stiff or too floppy

fidgety, jerky or clumsy movements

muscle spasms

walking on tiptoes

Symptoms will vary depending on the severity and type of cerebral palsy.
Cerebral palsy - Symptoms (NHS)
Types of cerebral palsy

There are 3 main types. Many people will have a mixture of these.

The Gross Motor Function Classification System shows how someone's CP might affect them.
Download CanChild's PDF of Gross Motor Function Classification System
Spastic cerebral palsy

Spasticity means the muscle tone is tight and stiff. This reduces a person's range of movement. As the muscle tone is so tight, spasticity can be very painful with muscles often going into spasm. It can affect different areas of the body.

Dyskinetic cerebral palsy

Sometimes called dystonic, athetoid or choreoathetoid cerebral palsy. Dyskinetic CP causes uncontrolled, involuntary, sustained or intermittent muscle contractions. It may be difficult to maintain an upright position. The person may find it difficult to control the tongue, vocal cords and breathing. This may affect speech and language.

Ataxic cerebral palsy

Ataxia is defined as an inability to activate the correct pattern of muscles during movement. This affects balance and spatial awareness. It can make it difficult to judge your body position in relation to things around you. Ataxia can affect the whole body. Most people with ataxia can walk but they will be unsteady with shaky movements. Ataxia can also affect speech and language.

Mixed cerebral palsy

Many people will have a mix of types.

You may also come across terms such as:

hemiplegia (1 side of the body affected)

diplegia (2 limbs affected)

monoplegia (1 limb affected)

quadriplegia (4 limbs affected)

Cerebral palsy: associated conditions

Some people may have associated conditions; while others may not. These can include:

Last reviewed by Scope on:

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Cerebral palsy (CP) | Disability charity Scope UK

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What is cerebral palsy? Including types and causes of cerebral palsy, life expectancy and associated conditions.

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Help if your child has a disability

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There are a number of benefits and tax credits that you may be entitled to. Some benefits can be paid because your child is disabled while others may be paid to you for other reasons. For example, you may be getting disability living allowance (DLA) for your child and carer's allowance as their carer. However, depending on your income and certain other factors you may also be able to claim benefits such as income support, child tax credit and housing benefit.

Personal Independence Payment (PIP) is the disability benefit for disabled people aged 16 or above. Like DLA, PIP has two types of payment - a mobility component and a daily living component. However, the decision about whether someone qualifies for PIP is based on different rules than DLA and depends on the number of points you score following a medical assessment.

There are a number of organisations that can provide you with information about all the benefits that you may be entitled to:

The national charity for families with disabled children, Contact, has a freephone national helpline on 0808808 3555 and can provide you with a free benefits check service and have a wealth
of information and factsheets on their website:www.contact.org.uk

Your Local Citizens Advice or welfare rights unit can carry out a full benefits check for you. A range of useful information about benefits is available from their country-specific website pages:

The Gov.UK website signposts to independent online benefits calculators to help you to work out what benefits you may be entitled to claim: www.gov.uk/benefits-calculators

Personal Budgets

A personal budget is a sum of money that is made available to someone who needs support. The money comes from their local authority's social care or education department or the NHS and is allocated to the individual or family to spend on help, care and/or support to meet their assessed eligible needs and to achieve agreed outcomes.

Children and young people with an Education, Health and Care Plan (EHCP) and/or with a continuing care package are able to access a personal budget. When the money comes from the NHS it is referred to as a Personal Health Budget.
Click here to download this resource as a PDF.

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Benefits for parents caring for a seriously ill child

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Together for Short Lives factsheet explains what benefits and tax credits that parents caring for a seriously ill child might be entitled to.

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Help to pay your water bills

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What is Healthy Start?

If you're more than 10 weeks pregnant or have a child under 4, you may be entitled to get help to buy healthy food and milk.

If you're eligible, you'll be sent a Healthy Start card with money on it that you can use in some UK shops. We'll add your benefit onto this card every 4 weeks.

You can use your card to buy:

plain liquid cow's milk

fresh, frozen, and tinned fruit and vegetables

fresh, dried, and tinned pulses

infant formula milk based on cow's milk

You can also use your card to collect:

Healthy Start vitamins - these support you during pregnancy and breastfeeding

vitamin drops for babies and young children - these are suitable from birth to 4 years old

If you live in Scotland

You can get help from Best Start Foods (opens in a new tab) instead.

Advice on healthy eating

For more advice on healthy eating, visit:

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If you're more than 10 weeks pregnant or have a child under 4, you may be entitled to get help to buy healthy food and milk. If you're eligible, you'll be sent a Healthy Start card with money on it that you can use in some UK shops.

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Virtual Tour- Kent, Surrey Sussex Transfer Service

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Virtual Tour- Kent, Surrey Sussex Transfer Service

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Kent, Surrey and Sussex Neonatal Transport Service (NTS)

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Neonatal Transport Service- Bump, Birth and Beyond

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Neonatal Transport Service- Bump, Birth and Beyond

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Kent and Medway - Bump, Birth and Beyond

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This website was created with women and expectant families from Kent & Medway. Your maternity care is safest when you understand your choices and can make the right decisions for you and your baby. Bump, birth and beyond gives local, trusted information. Your local midwives and maternity team look forward to meeting you and answering any questions.

This website does not provide specific medical advice.

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Home :: Kent and Medway - Bump, Birth and Beyond

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This website was created with women and expectant families from Kent & Medway. Your maternity care is safest when you understand your choices and can make the right decisions for you and your baby. Bump, birth and beyond gives local, trusted information. Your local midwives and maternity team look forward to meeting you and answering any questions.

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The Royal Society for Blind Children offers a range of services including emotional support and practical advice for families, opportunities for children and young people to build confidence and skills through activities, and a specialist further education college.

What we do

RSBC Dorton College of Further Education

RSBC Dorton College is an independent specialist college in the London Borough of Bromley. We offer a day provision for vision impaired 16-25-year-olds and many of our students have additional needs.

Learn more

Activities

RSBC's wide range of fun online and in-person activities for vision impaired children and young people to reduce isolation, build friendships and teach new life skills.

Book

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Welcome to the Royal Society for Blind Children

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The Royal Society for Blind Children supports blind and partially sighted children and young people, and their families.

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National Deaf Children's Society | Supporting deaf children

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We are the National Deaf Children's Society, the leading charity for deaf children and young people. We're here to support every deaf child who needs us.

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Speech and Language progress checker for babies over 6 months corrected age

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Speech and Language progress checker for babies over 6 months corrected age

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Communicating with babies with visual impairment

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Communicating with babies with visual impairment

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Alys Mathers is a Highly Specialist Speech and Language Therapist and works with children who have a wide range of speech, language and communication needs. Here she talks about how you can support your child's speech and language development if they have a visual impairment...
Babies and children learn using their five senses - they look, listen, touch, taste, and smell, and take it all in. When they're learning to communicate, they link the words they hear to information they get from their senses. So, how can we help children when one of their senses can't be used to learn to talk?

Many children with visual impairment go on to develop communication skills without much extra help, using the information from their other senses to learn to talk.

And there are lots of ways you can support their speech and language development, as well as helping them communicate with you. You know your child's unique needs and interests, so are the best person to 'be their eyes' and help them on their way to confident talking for learning and life.

By talking about what you can see, and giving them experiences which use their other senses, you are helping your child grow and develop.

Simple changes you can make

Language learning starts at home through daily routines and play. Your baby or child will find it easier to understand you, and learn to talk, if you make some simple changes.

Get down to their level so they can hear your voice clearly and know it's your sounds they should listen to.

Turn off background noise, like the TV or radio, to help your child concentrate on your voice.

Say their name to show them you're about to start talking to them. Some children might need a gentle touch to focus their attention before you start talking.

Use your voice to show how you're feeling, as your child may not be able to see your face and gestures clearly.

Talk about what you're doing, using short, simple sentences. For example, you might say 'I'm drinking tea' before taking a drink, to help your child link the drinking (slurping!) sounds they can hear with the word 'drinking', and with your action if they can see this.

Tell your child if someone new comes into the room - 'Hi Ben!' This is particularly important with people they don't know so well, as it helps them link voices to people's names.

Fun games you can play at home

What may feel like fun and games to your child, can also be a great chance for multi-sensory language learning.

Have fun playing with sounds, such as raspberries . Your baby will enjoy the vibration of raspberries on their skin, and this encourages them to play with sounds themselves.

Songs and rhymes build babies and children's awareness of sounds in words. Don't miss out on the actions, even if you're not sure your child can see them. Instead you could make the actions and signs bigger , or put your hands over theirs and show them the hand movements to make. You could also try other actions your child can feel, such as bouncing them on your lap or holding their hands and rowing back and forth in Row, Row, Row Your Boat.

Encourage your child to use their other senses by exploring textures during activities . For example, if you are cooking together, talk about how the ingredients feel (soft, squishy, wet), smell and taste.

Feeling creative? Try making your own sensory space like Jade and Stevie .

Books are more than pictures and words. Make up your own sound effects to the story (creaking doors, the 'woosh' of a rocket), or find toys or household objects from the story. For example, if you're reading Julia Donaldson's Stick Man, you could find a stick for your child to hold and play with while they're listening. Some libraries have story sacks you can borrow, which have a book, CD with sound effects, and toys linked to the story.

Activities when you're out and about

Go on an adventure outside, and you'll find lots of opportunities to keep on using all the senses and boost your child's communication skills.

Go on a listening walk , talking about everything you can hear. Your child may be able to hear the sounds in the world around them, but not spot exactly where they're coming from. So if you pass a building site and hear banging... turn them towards the direction of the noise, and explain what it is.

You could go on a treasure hunt to find the nicest - and the nastiest - smell, and have fun going 'urghh!' when you find a nasty smell.

Where to find help

Your child's eyesight develops gradually with age - the world to a newborn baby will be blurred. If you are concerned about your child's vision as they get older, speak to your GP or health visitor. Eye tests can be carried out even with very young babies , and are recommended before children start school.

If you find your child has a visual impairment, there are lots of organisations out there providing extra information, advice and support. Seeability and the are good places to start. Gracie's mum Kazmin also recommends finding a support group, either locally or on social media.

The best thing you can do to help your child is to spend time learning about their individual strengths and needs, then use their skills and interests to help them learn. With your help, they can learn to talk, learn all about the world around them, and you can all have fun at the same time.

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Communicating with your baby and child if they have a visual impairment

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Speech and Language Therapist Alys Mathers talks about how you can support your child's speech and language development if they have a visual impairment.

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Communicating with your deaf baby or child

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Emma Fraser from the National Deaf Children’s Society shares her advice for parents raising a Deaf child. Find out how you can support your child’s communication skills and language development if they are deaf.

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Help to pay travel costs to be with your baby in hospital

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If you’re referred to hospital or other NHS premises for specialist NHS treatment or diagnostic tests by a doctor, dentist or another primary care health professional, you may be able to claim a refund of reasonable travel costs under the Healthcare Travel Costs Scheme (HTCS).

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Benefits and financial support for families

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Help if you look after children or plan to have or adopt a child. Includes Child Benefit.

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Find out how using an NHS stop smoking service can improve your chances of quitting smoking. Plus, how to contact a stop smoking adviser and what sessions involve.

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Going home from the neonatal unit | Bliss

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You may have a lot to think about when you go home from the neonatal unit with your premature or sick baby. Find out more about preparing to go home, and what support is avaliable.

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Babies who are born prematurely (before 37 weeks) or of low birth weight (under 2.5kgs) are particularly vulnerable and it is important that all the safe sleep advice is followed. Premature babies are sometimes slept on their front in hospital for special medical reasons. When they are getting ready to go home these babies should always sleep on their back to reduce the risk of sudden infant death.

Download our Safer Sleep Advice for Premature Babies guide below for further information on reducing the risk of SIDS.

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Babies who are born prematurely (before 37 weeks) or of low birth weight (under 2.5kgs) are particularly vulnerable and it is important that all the safe sleep advice is followed. Premature babies are sometimes slept on their front in hospital for special medical reasons. When they are getting ready to go home these babies should [...]

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One gift, twice the impact

From now until midday on Tuesday 5th December, donations to The Lullaby Trust made via the Big Give will be DOUBLED at no extra cost to you. Please donate today if you can. One gift will make twice the difference to babies living in crisis situations.

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How to reduce the risk of SIDS

Our safer sleep advice gives simple steps for how you can sleep your baby to reduce the risk of sudden infant death syndrome (SIDS) which is commonly known as cot death. It can give you the peace of mind to enjoy this special time.

Our advice is based on strong scientific evidence and should be followed for all sleep periods, not just at night.

If you have any questions about SIDS or safer sleep, please call our information line on 0808 802 6869 (lines open Monday-Friday 10am-2pm).

Watch our free presentations on how to sleep your baby safely and reduce the risk of SIDS

Things you can do

Always place your baby on their back to sleep

Keep your baby smoke free during pregnancy and after birth

Place your baby to sleep in a separate cot or Moses basket in the same room as you for the first 6 months

Breastfeed your baby

Use a firm, flat, waterproof mattress in good condition

Things to avoid

Never sleep on a sofa or in an armchair with your baby

Don't sleep in the same bed as your baby if you smoke, drink or take drugs or are extremely tired, if your baby was born prematurely or was of low birth-weight

Avoid letting your baby get too hot

Don't cover your baby's face or head while sleeping or use loose bedding

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Reduce the risk of sudden infant death syndrome (SIDS) for your baby by following our safer sleep advice. The advice is based on strong scientific evidence.

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Learning to feed: responsive bottle feeding pathway in NICU 

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Learning to feed: responsive bottle feeding pathway in NICU 

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What is Healthy Start?

If you're more than 10 weeks pregnant or have a child under 4, you may be entitled to get help to buy healthy food and milk.

If you're eligible, you'll be sent a Healthy Start card with money on it that you can use in some UK shops. We'll add your benefit onto this card every 4 weeks.

You can use your card to buy:

plain liquid cow's milk

fresh, frozen, and tinned fruit and vegetables

fresh, dried, and tinned pulses

infant formula milk based on cow's milk

You can also use your card to collect:

Healthy Start vitamins - these support you during pregnancy and breastfeeding

vitamin drops for babies and young children - these are suitable from birth to 4 years old

If you live in Scotland

You can get help from Best Start Foods (opens in a new tab) instead.

Advice on healthy eating

For more advice on healthy eating, visit:

# data[].attributes.attachment_link.description
If you're more than 10 weeks pregnant or have a child under 4, you may be entitled to get help to buy healthy food and milk. If you're eligible, you'll be sent a Healthy Start card with money on it that you can use in some UK shops.

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Infant milks for parents & carers — First Steps Nutrition Trust

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First Steps Nutrition Trust is a charity which provides clear, evidence-based and independent information and support for good nutrition from pre-conception to five years of age.

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Start for life breastfeeding information 

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Start for life breastfeeding information 

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Breastfeeding is a skill that takes time to get the hang of. Lots of mums wonder if their baby's feeding well and getting enough - especially in the first few days.

But once you've mastered it, you'll probably find it's the easiest and most satisfying way to feed your baby.

We're here to provide lots of helpful information and advice on breastfeeding.

If you have any breastfeeding worries or concerns, the best thing to do is speak to your midwife or health visitor, or join a local breastfeeding support group.

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Breastfeeding can take practice - read our guides on breastfeeding to find out what works best for you

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Published by the Department of Health and the Baby Friendly Initiative, this leaflet provides mothers and health professionals with key information about introducing solid foods to babies.

The leaflet is intended to be used as a teaching aid when health professionals are discussing when and how to introduce solid food to babies.

For free printed copies please contact the Department of Health. Please note that printed copies are not available from UNICEF UK.

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Introducing solid foods leaflet - Baby Friendly Initiative

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The leaflet is intended to be used as a teaching aid when health professionals are discussing when and how to introduce solid food to babies. For free printed copies please contact the Department of Health. Please note that printed copies are not available from UNICEF UK.

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Transcript of 'Breastfeeding: Mini Parenting Master Class' video

"Did you know that your nipples have good bacteria? So you don't need to wash them before breastfeeding.

My name is Dr. Michele Griswald, and this is my Mini Parenting Master Class on breastfeeding."

Is breastfeeding easy?

"Sometimes mothers get messages that breastfeeding is natural and it's easy. Sometimes breastfeeding can be easy with the first baby, and hard with the second baby for the same mother. So it really just depends."

> Read: 14 myths about breastfeeding

Does breastfeeding hurt?

"You shouldn't stop breastfeeding if your nipples hurt. You should keep breastfeeding but you should get help to see why it's hurting."

> Read: Common breastfeeding challenges

How much should my baby eat?

"They should see signs of hunger about 8 to 12 times in 24 hours. Newborn babies need to eat a lot because they're growing rapidly. They double their birth weight in the first six months of life, or before. So you can imagine how much you would need to eat if you had to double your weight."

Should I wash my nipples before breastfeeding?

"It's not necessary to wash your nipples before you breastfeed, because the breasts and the skin around the nipple actually produces good bacteria. And it's that good bacteria that helps to prevent infections on the mother's breast."

When should I start breastfeeding?

"The first hour after birth is a very important time for the mother and the baby. Breastfeeding is a very organized, neurological behavior. And so right after birth, keeping them against the mother's skin can help them to be calm enough to start to seek the breast. And if we do just leave mothers and babies like that after birth, then they will usually start to go towards the breast on their own. Within about 30 minutes to one hour."

What should I eat while breastfeeding?

"Most mothers can eat anything they want when they breastfeed. They can follow their normal diet. And the interesting thing is whatever they eat, the babies will taste through their milk and start to get them ready for table foods when they're about 6 months old."

Will I have to stop breastfeeding my baby when I got back to work?

"We would hope that mothers who return to work do not have to wean their babies. Mothers need time and they need support to continue to breastfeed their babies. They need the support of their family, they need the support of their workplace, their employers, they need the support of their entire community.

Breastfeeding is not just about food. It's part a nurturing care package that helps children to grow and thrive throughout their entire life."

[UNICEF and WHO recommend that infants are breastfed exclusively for 6 months, starting from the first hour of life. From the age of 6 months, children should be provided with complementary foods, while continuing to be breastfed for up to 2 years or beyond.]
UNICEF Mini Parenting Master Class with Dr. Michele Griswold PhD, MPH, RN, IBCLC. Dr Griswold is a lactation consultant, registered nurse, breastfeeding researcher and advocate. She represents the International Lactation Consultant Association to the WHO/UNICEF Global Breastfeeding Collective, which calls on governments and society as a whole to provide mothers the support they need to breastfeed.

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Breastfeeding: Mini Parenting Master Class

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A lactation expert answers some of the most common breastfeeding questions

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This leaflet for mothers on expressing and storing breastmilk is based on the latest evidence about safe storage and is available courtesy of the Breastfeeding Network.

You can download the leaflet for free. Printed copies are available via The Breastfeeding Network - for latest order details please visit their website.

The cost is £25 (includes p&p) per 50 leaflets (single copies free on receipt of an SAE). Cheques should be made to The Breastfeeding Network and sent to PO Box 11126, Paisley PA2 8YB. Order forms are available on request.

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Expressing and storing breastmilk (BfN) leaflet - Baby Friendly Initiative

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This leaflet for mothers on expressing and storing breastmilk is based on the latest evidence about safe storage.

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This checklist can be used to ensure that mothers are expressing their breastmilk effectively and to address any issues or concerns mothers may have.

For sick and preterm babies the importance of breastmilk cannot be overestimated. Breastmilk supports growth and provides protection from infection, with evidence suggesting that its use decreases the incidence and severity of the life-threatening disease necrotising entercolitis.

By providing breastmilk, a mother can be assured that she is uniquely contributing to the wellbeing and development of her baby. However, expressing breastmilk over a long period of time is extremely demanding and if a mother is to succeed she needs the support from those involved with caring for her and her baby.

Assessment of breastmilk expression checklist

Assessment of breastmilk expression - staff guidance

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Assessment of breastmilk expression checklist - Baby Friendly Initiative

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This checklist ensures that mothers are expressing their breastmilk effectively and to address any issues or concerns mothers may have.

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Skip to main content

This parent-facing leaflet provides information on expressing breastmilk and includes a helpful chart to record how expressing is going

The breastmilk you produce for your baby is unique. Research shows that the earlier you start and the more often you express, the more milk you will produce for your baby. This is really important, especially in the early days and weeks after birth.

Parents are invited to use this leaflet produced by Healthier Scotland and UNICEF UK to learn more about the value of breastmilk and kangaroo care (or skin-to-skin) for a preterm or unwell baby. It also includes detailed instructions on how to hand express, as well as important information on using a breast pump.

LEARN MORE

A workbook for neonatal nurses

Read more

Read more

Neonatal care resources

Read more

Read more

Neonatal National Infant Feeding Network

Read more

Read more

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Expressing milk for your baby on the neonatal unit - Baby Friendly Initiative

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This parent-facing leaflet provides information on expressing breastmilk and includes a helpful chart to record how expressing is going

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Breastfeeding and relationship building early days

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Breastfeeding and relationship building early days

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This video looks at both the theory and practice of relationship building and responsive breastfeeding, supporting families to get their relationship with their baby off to the best start.

Hear mothers and professionals give tips and advice on what it can mean to have a close and loving relationship with your new baby.

Find more relationship building resources

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Breastfeeding and relationships in the early days video - Baby Friendly Initiative

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Baby Friendly's video on breastfeeding and relationship building covers views and tips from both mothers and health professionals.

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In this video, a breastfeeding counsellor helps a mother with her positioning and attachment whilst breastfeeding.

Key to achieving the Baby Friendly standards is a workforce able to support mothers to breastfeed effectively. This video provides some guidance on this.

You can see more of the 'From Bump to Breastfeeding' DVD on the Best Beginnings website.

Video not working? Contact us

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Positioning and attachment video - Baby Friendly Initiativ

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In this video, a breastfeeding counsellor helps a mother with her positioning and attachment whilst breastfeeding. Watch to learn more.

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Getting your baby positioned and attached comfortably at the breast is an art-mothers often say it takes a little while for breastfeeding to feel entirely comfortable and natural, even if they've breastfed before. In the past girls grew up learning about breastfeeding by watching mothers in their families and communities. These days many of us become mothers having never seen a baby breastfeed.
But breastfeeding has worked for mothers and babies for thousands of years and it can work for you too.
Many babies can find their way to the breast by themselves, especially if they haven't been too affected by birth interventions. Other mums and babies need a little longer to work it out with maybe some help from a skilled breastfeeding supporter such as an LLL Leader.

When all is going well, specific holds and positions don't really matter because you and your baby will work out what suits you best. However if you are finding it awkward, uncomfortable or downright painful then the following information is designed to help you think about where you can make adjustments and get breastfeeding working comfortably for you.

Good positioning and attachment is important for maintaining milk production. A baby who attaches deeply at the breast is able to remove milk effectively. This is important for maintaining milk production. Well-drained breasts make milk quickly. If there is any concern about how much milk you are making, working on improving positioning and attachment is an important first step.

There's no 'right' or 'wrong'. If you are comfortable, your baby is producing plenty of dirty nappies and is gaining weight after the first few days, then breastfeeding is going well for you. There are no rules-but there are a few principles that can help you work out what to do if things aren't going well: see Latching on - getting a good attachment.

Positioning describes how you sit or lie and how you support your baby as he takes the breast. How you hold your baby can make a big difference to how well he can breastfeed. Even small adjustments can be significant. Attachment describes the way he latches onto the breast.

Tips for getting started
The laid-back approach
Latching on - getting a good attachment
Different breastfeeding positions
As time goes by

Tips for getting started

If it hurts then make changes

If it doesn't feel right to you, then it isn't fine, whatever anyone says. Pain is your body's way of letting you know something is wrong. Start by trying to improve positioning and attachment. A few quick adjustments to how you are sitting or lying or how your baby comes towards the breast may be all that are needed.

Sometimes it can take a little longer. You may need to work with one or more skilled breastfeeding supporters over a period of time to get to the point where everything falls into place and breastfeeding starts feeling natural.

Each mother and baby pair is different and what works well for one mother and baby may not work for you. This is one reason why you may hear different suggestions from different helpers. You are the best judge of what is helpful so don't be afraid to use what feels right for you and discard the rest.

Your baby needs to be calm

You can offer the breast at any time when you are both calm. You may even find it easier if your baby isn't obviously hungry. Feed your baby before he needs to cry. Early cues for wanting to eat include suckingtheir hand, smacking their lips, turning their head towards you, or fussing. They won't latch well if they are distressed. If your baby is upset take time to soothe them. Hold them upright against you, stroke them and talk to them. A little expressed colostrum or breastmilk given on a spoon can help to calm them if they are desperately hungry.

Your baby needs full body contact

When your baby is held in full body contact against you, they will feel stable and be better able to coordinate their movements. Laid back positions ensure full body contact. If you're sitting up, you'll need to hug your baby in as tightly as if you were standing up holding them against you. Babies who don't feel stable tend to wave their arms around, which can make latching more difficult. Pillows can get in the way and aren't always necessary. So wait until after your baby's latched on, and then tuck them in only if you need them for support.

Some babies need time

Some babies find it difficult to latch on, or simply nurse ineffectively at the breast. Often a difficult birth or interventions during labour or birth are the cause. Giving a baby time to recover, and using laid-back breastfeeding positions with skin-to-skin contact can maximise your baby's natural instinct to breastfeed. If your baby isn't latching or feeding well seek help from an LLL Leader and read our page My Baby Won't Breastfeed. With time and patience, most babies will breastfeed. In the meantime express your milk for your baby to maintain milk production and give you both the time to work it out.

Laid-back breastfeeding

Many people assume you have to sit up to breastfeed. Not so. In fact evidence suggests humans evolved to breastfeed in laid-back positions with our babies upright against our chests. You may have experienced this type of position when you had your first feed, soon after your baby's birth. There is more and more evidence that laid-back breastfeeding positions (also called Biological Nurturing) help babies breastfeed more effectively and are more comfortable for mothers, especially in the early days and weeks.

Laid back breastfeeding is really useful for those first few days and weeks when you want to rest and recover and your baby needs to be in close contact with you to get breastfeeding established. It can be done skin-to-skin or with you both lightly dressed. You don't have to be in bed; the sofa or a reclining chair is a comfortable alternative.

You can also use laid-back breastfeeding principles when sitting in an upright chair by shifting your weight back onto your tail bone and reclining your body back a little, to open up a space for your baby. This allows more of their weight to be supported by your body and less by your arms. It isn't safe to sleep with your baby on a chair or sofa.

Sleepy babies

If your baby is sleepy, perhaps because of birth interventions, then using laid-back positions with skin-to-skin contact can encourage your baby's interest in feeding. In laid-back positions babies often attach and feed when in light sleep so it helps to spend substantial periods of time with your sleepy baby against you. When you notice the little movements that indicate your baby is moving into a light period of sleep you can encourage them to latch.

How laid back breastfeeding works

You lay back in a comfortable, supported semi-reclining position (not flat) that opens up your body, creating space for your baby.

Your baby lies against you, their whole front against your body, vertically or at any comfortable angle.

Your baby feels stable and secure and their instinctive feeding reflexes are triggered, prompting them to bob their head and seek out the breast.

Gravity helps them latch deeply and stay latched, rather than hindering the process.

Your hands are free to support and caress your baby and help them attach.

Your body releases the hormones that stimulate milk production and make you experience loving feelings towards your baby.

There are no rules-you and your baby are free to work it out between yourselves.

Latching on - getting a good attachment

Your baby needs to tip their head back and reach forward with their lower jaw. As your baby tips their head back their jaw drops and their mouth opens wide, so they can anchor their chin and lower lip firmly against your breast. If they have to tuck their chin in to reach the nipple they won't be able to open their mouth so wide. Tipping their head back also makes a deep latch possible, swallowing easier, and frees up their nose for comfortable breathing. In laid-back positions lay your baby with their head between your breasts. If you are sitting up, keep your supporting hand away from the back of their head. Babies tend to creep forward, so try shifting them so that their eyes and nose are opposite the nipple to encourage them to reach forward and anchor their chin first. In sitting or side lying positions a little push between the shoulder blades with your supporting hand or arm as they latch brings their chest in closer and helps their head tip back.

Their lower jaw needs a clear space to anchor. Think about how you might take a mouthful from a big sandwich by placing your lower jaw first then opening your mouth to accommodate the top of the sandwich-the principle is the same. Your baby's lower jaw needs to be deeply placed on your breast well away from the nipple. Keep the fingers of your supporting hand away from the place where their chin and lower jaw need to be so their lower lip and chin can sink into your breast. Your baby's chin needs to stay firmly in contact with your breast.

Your baby needs a big mouthful. When a baby chews on a nipple, this compresses the milk ducts, prevents milk flowing and hurts. When a baby has a good big mouthful of breast beyond the nipple, breastfeeding is comfortable and milk can flow. Some women like (or need) to hold their breast when nursing. They flatten their breast as they would a big sandwich they were offering to the baby, matching it to the oval of his mouth. This can help their baby grasp more breast tissue. It doesn't matter if fingers are closer to the upper jaw but try to keep the "lower jaw fingers" out of your baby's way. Biological Nurturing™ positions make use of gravity to help a baby get a bigger mouthful.

The exaggerated latch. To get an even deeper latch you could try this optional extra. Place your thumb or finger near the base of the nipple where the middle of your baby's upper lip will be, lined up with their nose. If you press, your nipple will tilt away from your baby, presenting them with your breast rather than your nipple. Avoid pressing your nipple into their mouth. As they open wide, snuggle them in close and use your thumb or finger to tuck the breast into their mouth. Your nipple will be taken in last and unroll in their mouth. You can then slip your finger out.

Our own video below demonstrates flipple technique (aka exaggerated latch), it can be very helpful for getting an effective pain free latch:

Let your breast rest at its natural level. It can be tempting to lift your breast and move it towards your baby's mouth. If you do this, your baby probably won't get a full mouthful, and after a while your hand will get tired and the breast will drop and slip out of their mouth. Breastfeeding pillows can get in the way too because they lift a baby up too high and prevent you tucking them in against your tummy. See where your breasts naturally rest and hold your baby accordingly. If you need them, tuck pillows in after they are well attached.

Bring baby to breast, not breast to baby. Since breasts are attached to you and you baby is moveable it makes much more sense to bring your baby to the breast, not the other way round! And it works better too. With their body tucked firmly against you (or laid on top of your body), your baby will feel more stable and have better head control, and you'll feel a lot more comfortable too.

It's easier to latch onto a softer breast. It's much easier to get a deep mouthful if the breast is soft so breastfeed frequently to avoid engorgement. When your baby bobs their head and licks the nipple, it naturally makes it easier to latch on. If your breast is full and hard, you can use reverse pressure softening to move fluids away from the nipple area so your baby can latch on well. Apply gentle steady pressure with your fingertips on the areola around your nipple for about a minute. You can also press with the sides of your thumbs or fingers. Denting the breast at the edge of the areola with a finger and placing your baby's chin in the dent may also help. Gently hand express a little milk too if needed.

Your baby needs to choose his own timing. Your baby will probably do best if they pick the moment to latch on. You can help by supporting them in a position that lets them do this when they are ready. To encourage your baby to gape hold them close against you, close enough to the breast so they know the nipple is there, but where they can't quite reach it. Be prepared for your baby to lick and nuzzle for several minutes before they are ready to open wide.

The natural or laid-back breastfeeding positions shown in the following videos can be a great help in encouraging your baby to latch on well, as well as being comfortable for you. You can recline comfortably with your baby on top of you with their whole front against you and their body completely supported by yours.

Best Beginnings' video demonstrates clearly how to make sure your baby is attaching well to the breast, you can view it here.

This video from Global Health Media demonstrates how to enable your baby to latch deeply on to your breast so that breastfeeding is comfortable for you and means your baby get enough milk:

This video from Raising Children.net.au shows how to attach your baby well, and shows a variety of comfortable breastfeeding positions:

Using different breastfeeding positions

The cradle hold

Although the cradle hold is one of the most common nursing positions it can be a challenge for new mothers to learn. You need to hold your baby's body firmly against you to give them stability because their weight is supported mainly by your arms. Shifting so you are sitting on your tailbone, rather than upright can help stability and reduce the strain on your arms (see picture right). It can be difficult to control a baby's head and to keep them high enough and close enough to your breast. A small baby may tend to curl up in a ball in this position if not pulled in closely enough against your body. It may not be the best choice at first if you're experiencing any problems with latch-on, milk transfer or if you have sore nipples. Once you're more confident with breastfeeding, you may find you use a version of the cradle hold much of the time, especially when out and about.

Your baby's whole front is against your tummy, their hip resting on or near your thigh, tucked around you like a comma. Their chest will be snuggled into the breast and your nipple near their nose.

Their head is resting on your forearm and/ or wrist (not the crook of the elbow).

As your baby opens their mouth to take the breast, pull their body in firmly against you.

Once your baby is attached, settle back a little for your own comfort and so that more of their weight is taken by your body.

Laid back breastfeeding

Remember that Biological Nurturing™ positions aren't just for the first week or two. They can be really useful later on when you want to relax, and especially if you are breastfeeding more than one baby or if your baby is fussy or unwell.

The cross-cradle hold

The cross-cradle position can be useful in the early days because it gives you more control in guiding your baby to the breast. It can be uncomfortable to maintain without good support under your arms, especially with larger babies, so once your baby is attached, switch arms as shown in the picture below. After the first few weeks and as your baby grows longer and heavier, you may prefer to use other comfortable holds. Avoid touching the top or back of your baby's head because it often causes a baby to pull back from the breast. Forcing a baby onto the breast by firmly holding the back of the head usually has the opposite effect and can put a baby off breastfeeding.

Cross cradle

Tuck their whole front against your tummy, their hip near or resting on your thigh.

Your hand supports their neck (not the back of the head) with your palm between their shoulder blades.

Your other hand is free to shape or stabilise your breast if needed.

Make sure your baby isn't too far round the front-line them up so their eyes and nose are near the nipple.

As your baby opens their mouth, give a little push with the palm of your hand to bring their chest in close against you.

This will help their head tip back and let them plant their chin deeply against your breast.

Once your baby is attached you can bring your other arm round to support your baby's body and settle back a little for your own comfort and so that more of his weight is taken by your body. Hold your baby with the arm opposite to the breast he's going to latch onto.

The underarm (clutch or rugby) hold

The underarm hold is useful if you have had a caesarean birth. It helps keep the weight of your baby off your incision. It is also a good position for mothers with flat or inverted nipples and for babies with latch-on or sucking problems because it offers you a good view of baby and breast and control of your baby's head. You can also feed two babies at once in this position. For larger, longer babies you may need extra cushions behind your back to bring you further forward and allow space for your baby's length.

Your baby's front is close against your side, with your hand under their shoulders and neck.

Your elbow keeps them tucked closely against your body.

Your baby approaches your breast from below. This can work well if you have large breasts. If you have smaller breasts you may need to bring your baby into a semi-sitting position.

Make sure your baby isn't too far round the front. You may need a cushion between your back and the chair back to allow room for your baby's length and prevent them pushing themselves forward with his feet.

Side lying

This side-lying position is helpful if you are recovering from a caesarean birth or an episiotomy and invaluable for nursing in bed during the night.
It can take a while to get the knack but it's well worth persisting because it can make night feeds so much easier.
Some mothers decide to sleep with their baby alongside them. Others choose to move their baby back onto a separate sleep surface.
Safe Sleep and the Breastfed Baby will help you decide on the safest sleep arrangements for your family, based on your own individual circumstances.

* Lie on your side, with your knees bent up and a pillow under your head.
* Place your baby on their side facing you so that their body and your body form a V-shape, meeting at your hips, with your nipple level with their nose or eyes.
* You can put your arm under your baby's head as shown, or up by the pillow with your baby lying on the bed.
* As your baby latches, give a little push between their shoulder blades to bring their chest in closer and help their head to tip back and their mouth to
open wide.
* You may find it helpful to tuck a small pillow or rolled blanket behind the small of your back and/or between your knees.

Standing up

At some feeds babies just do better if you stand up. You can sway or bounce gently to help calm your baby, and the lack of a lap can be helpful. As always keep your baby nice and stable and let them lead the way. Try angling their legs down instead of holding them horizontal, and see what happens. Or try starting with them against your shoulder, supporting them as he moves down to the breast. Even when using other positions, sometimes just standing up and sitting down again straight away helps everything settle into a comfortable position.

As time goes by

Whether you choose to breastfeed sitting up, reclining or lying on your side, you will need to adjust how you support your baby as he grows in length and weight. Use the principles shown here as you experiment with different positions. Sometimes there are physical or medical causes for pain or discomfort such as tongue tie or a thrush infection. If you are still finding it difficult to get comfortable, do persist with seeking further and continued support. There is almost always a breastfeeding solution to breastfeeding problems. You can contact an LLL Leader by calling our Helpline. You can also find support and encouragement from breastfeeding mothers in your local LLL group.

Written by Sue Upstone, Karen Butler and mothers of LLLGB

Further Reading

The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.

Mastitis
Beginning Breastfeeding
Breastfeeding Your Baby - easy read
Caesarean Birth & Breastfeeding
Comfortable Breastfeeding - easy read
Skin-to-Skin
Engorged Breasts - Avoiding & Treating
Hand Expression of Breastmilk
Inverted Nipples
My Baby Needs More Milk
My Baby Won't Breastfeed
Nipple Confusion?
Nipple Pain
Nipple Shields
Nursing Supplementers
Safe Sleep & the Breastfed Baby
Sleepy Baby - Why & What To Do
Tongue Tie
Too Much Milk & Oversupply

LLLI Resources
Position to breastfeed

Other resources
How to do Biological Nurturing: www.biologicalnurturing.com/video/bn3clip.html
Best Beginnings videos to watch online: www.bestbeginnings.org.uk/watch-fbtb

References
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010.
Biological Nurturing: Laid-back breastfeeding for mothers (DVD). Colson, S. et al. 2012.
An Introduction to Biological Nurturing; New angles on breastfeeding, Colson S. Amarillo, TX: Hale Publishing, 2010.
Supporting Sucking Skills, Watson Genna, C. Burlington, MA: Jones & Bartlett, 2012.

This information is available to buy in printed form form the LLLGB Shop.
It is also available in kindle edition.

Information, references and links on this page are taken from La Leche League resources, unless stated otherwise. Please note that LLLGB does not endorse information from outside sources, extra information is provided for you to consider. Information supplied is not intended as advice, and you are in the best position to make a decision as to how the information offered will affect you and your baby.

Copyright LLLGB 2016

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Positioning & Attachment - La Leche League GB

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Good positioning and attachment is important for maintaining milk production. A baby who attaches deeply at the breast is able to remove milk effectively.

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The Kent, Surrey, Sussex Neonatal Network (other hospitals links) 

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The Kent, Surrey, Sussex Neonatal Network (other hospitals links) 

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Click on the hospitals below to find out more about the units within our network and to view each unit's individual website. To find out more about where each unit is situated across our region, you can also visit our interactive map.

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Unit Information - Neonatal Network South East

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Click on the hospitals below to find out more about the units within our network and to view each unit's individual website. To find out more about where each unit is situated across our region, you can also visit our interactive map.

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Explore Medway Hospital Oliver Fisher NICU in 3D

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Milk as Medicine- Colostrum use on the NICU 

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Milk as Medicine- Colostrum use on the NICU 

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This video guides mothers on how to hand express and talks about the times when hand expression might be useful.

See the Breastfeeding Network website for FAQs and a leaflet all about expressing and storing breastmilk.

Problems viewing this video? Contact us.

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Hand expression video - Baby Friendly Initiative

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This video guides you through how to hand express, and talks about the times when hand expression might be useful for you.

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Research on the links between breastfeeding and cognitive development
Human milk: From complex tailored nutrition to bioactive impact on child cognition and behaviour
This narrative review presents a complex picture of the current state of knowledge on the role of human milk and its components in the development of neurological processes and cognitive performance in infants. It offers practical and theoretical recommendations to advance research in this field, including innovative directions for future studies on cost implications and current support structures with the aim of inspiring social and political support for improvements in breastfeeding opportunities.
Weerth, C. et al. (2022). Human milk: From complex tailored nutrition to bioactive impact on child cognition and behaviour. https://doi.org/10.1080/10408398.2022.2053058. To what extent does confounding explain the association between breastfeeding duration and cognitive development up to age 14? Findings from the UK Millennium Cohort Study
This study evaluates whether the association between breastfeeding duration and improved childhood cognitive development can be explained by socioeconomic position (SEP) and maternal cognitive ability. The study uses multivariable linear mixed-effects models to compare verbal and spatial cognitive scores at ages 5, 7, 11, and 14 with reported breastfeeding durations. At all ages, longer breastfeeding durations were associated with higher cognitive scores after accounting for the child's own characteristics, however the effect was modest. Adjustment for SEP approximately halved the effect sizes.
Pereyra-Elias, R., Quigley, M., Carson, C. (2022). To what extent does confounding explain the association between breastfeeding duration and cognitive development up to age 14? Findings from the UK Millennium Cohort Study. https://doi.org/10.1371/journal.pone.0267326 Preterm nutrition and neurodevelopmental outcomes
Whilst survival of preterm infants has been steadily improving due to advances in perinatal and neonatal medicine, it does not reach the ideal target level of the normal fetus of the same gestational age. Postnatal weight gain is also often not achieved because extrauterine growth has higher energy requirements than intrauterine growth, due to the intensive care environment, illness and inadequate nutrition. This review focuses on the role of nutrition in preterm neurodevelopment, including the primordial importance of human milk and oligosaccharides and how these help to prevent neonatal complications and contribute to increased preterm survival.

Preterm infants are at increased risk of alterations in brain structure and connectivity and subsequent neurocognitive impairment. This study explores the extent to which breastmilk exposure is associated with improved markers of brain development and connectivity in preterm infants at term equivalent age. Findings from an analysis of data on 47 preterm infants' neonatal breastmilk exposure and brain MRI suggests that breastmilk feeding in the weeks after preterm birth is associated with improved structural connectivity of developing networks and greater fractional anisotropy in major white matter fasciculi.
Blesa M, Sullivan G, Anblagan D, Telford EJ, Quigley AJ, Sparrow SA, Serag A, Semple SI, Bastin ME, Boardman JP. Early breast milk exposure modifies brain connectivity in preterm infants. Neuroimage. 2019 Jan 1;184:431-439. doi: 10.1016/j.neuroimage.2018.09.045. Epub 2018 Sep 18. PMID: 30240903.

Impact of breastfeeding on intelligence, educational attainment and income at 30 years of age in Brazil
Victora et al (2015). Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil. Lancet Glob Health, 3: e199-205 Horta, B. L. et al (2015). Breastfeeding and intelligence: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 14-19.

Impact of Baby Friendly accreditation on breastfeeding rates, cognitive outcomes and maternal mental health
Del Bono E, Rabe B. Breastfeeding and child cognitive outcomes: Evidence from a hospital-based breastfeeding support policy. ISER Working Paper Series: 2012-29

Breastfeeding and child development outcomes
Huang, J., Vaughn, M.G. & Kremer, K.P. (2015). Breastfeeding and child development outcomes: an investigation of the nurturing hypothesis. Maternal and Child Nutrition, DOI: 10.1111/mcn.12200

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Research on Brain and Cognitive Development - Baby Friendly Initiative

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The latest infant health studies that we have found to be most pertinent about brain and cognitive development.

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The story behind grow my brain

The idea for grow my brain came to midwife Jo Maynard one night when she was lying in bed and couldn't get to sleep.

Jo started thinking about how best she could support the families that she meets every day as part of her job as Lead Midwife for Infant Feeding at Medway Maritime Hospital.

She shared her idea with another midwife called Trude, who in her spare time is a very talented illustrator. Together they created the beautiful illustrations and words that are at the heart of the grow my brain campaign.

Grow my brain is supported by the Medway NHS Foundation Trust, Medway Community Healthcare and the council. It was launched on Valentine's Day 2019.

The science behind grow my brain

The first 1,000 days of your baby's life (the time between when you get pregnant and your baby's second birthday) are really important for the human brain.

Your baby's brain is developing really quickly, the quickest that it will grow during their lifetime.

Advances in science mean that we know a baby's brain develops better if they feel safe and secure. This is true when a baby is still inside their mother's tummy and once they are born.

Simple actions like singing to your baby, stroking or talking to your bump, helps your little one to feel loved and safe.

Scientific research has revealed that when unborn babies and young children feel stressed they release a hormone called cortisol, which prevents healthy brain development.

UNICEF have reported that the right side of a baby's brain develops best when they enjoy a strong bond with their parents or carers. This brain development is really important as it's the right side of the brain that is responsible for our emotions and how well we communicate.

So the development of your baby's brain can affect what sort of adult they will grow up to be, from how well they are able to manage their feelings to whether they can form positive relationships.

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Find out how to help your baby's brain development with our short videos as part of our Grow My Brain campaign.

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In this video, we look at the importance of developing close and loving relationships with babies in their early days and weeks.

Responding to babies' needs for comfort and food is hugely beneficial for brain development and makes for more confident toddlers. Parents should be supported in breastfeeding responsively and keeping their babies close to help them become happy, healthy and secure children and adults.

For more information:

Find more relationship building resources

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The Importance of relationship building video - Baby Friendly Initiative

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This video looks at the importance of developing close, loving relationships with babies in their early days and weeks.

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Respiratory syncytial virus ( RSV) is an enveloped RNA virus, in the same family as the human parainfluenza viruses and mumps and measles viruses. RSV is one of the common viruses that cause coughs and colds in winter.

Transmission

RSV is transmitted by large droplets and by secretions from contact with an infected person. The virus can survive on surfaces or objects for about 4 to 7 hours.

The incubation period - the delay between infection and the appearance of symptoms - is short at about 3 to 5 days.

When RSV circulates

In temperate climates such as the UK, RSV occurs regularly each year. Epidemics generally start in October and last for 4 to 5 months, peaking in December. The sharp winter peak varies little in timing or magnitude, in contrast to influenza virus infection which is much less predictable in its timing.

Risks of RSV infections

For most people, RSV infection causes a mild respiratory illness. For a small number of people who are at risk of more severe respiratory disease, RSV infection might cause pneumonia or even death.

RSV is the most common cause of bronchiolitis in infants. Over 60% of children have been infected by their first birthday, and over 80% by 2 years of age. The antibodies that develop following early childhood infection do not prevent further RSV infections throughout life. The full extent to which adults are affected by RSV remains unknown.

The NHS website has more information on RSV bronchiolitis and when to seek help.

High-risk groups

The very young (under 1 year of age) and the elderly are at the greatest risk. While most RSV infections usually cause mild illness, infants aged less than 6 months frequently develop the most severe disease such as bronchiolitis and pneumonia, which may result in hospitalisation. Children born prematurely, or with underlying chronic lung disease, and the elderly with chronic disease are also at increased risk of developing severe disease.

Only a minority of adult infections are diagnosed, as RSV is not widely recognised as a cause of respiratory infections in adults. Elderly patients are frequently not investigated microbiologically, as there are fewer viruses present in their respiratory secretions compared with children. This results in the number of adult infections being underestimated.

Symptoms and diagnosis

RSV infection causes symptoms similar to a cold, including rhinitis (runny nose, sneezing or nasal congestion), cough, and sometimes fever. Ear infections and croup (a barking cough caused by inflammation of the upper airways) can also occur in children. RSV is the leading cause of bronchiolitis, an infection of the small airways in the lung, in babies and infants which make breathing harder and cause difficulty feeding.

During the RSV season a laboratory diagnosis is not always necessary as infection can be managed. Specific laboratory tests to confirm RSV require a sample to be taken from the nose and throat.

The Respiratory virus unit (RVU) provides laboratory services for respiratory virus infections including RSV.

Treatment

There's no specific treatment suitable for general use, and treatment is therefore aimed at supporting the patient and relieving symptoms. Ribavirin is an anti-viral drug licensed for treatment of RSV infection which is sometimes used in the management of severe illness. Its effectiveness is not established, and it may be associated with toxicity.

Prevention

Transmission can be reduced through standard infection control practices such as respiratory hygiene, hand washing with soap and warm water, and cleaning of surfaces. Ideally, people with colds should avoid close contact with newborn babies, infants born prematurely (before 37 weeks), children under 2 born with heart or lung conditions, and those with weakened immune systems. Smoking around young children is a risk factor for severe RSV infection.

Immunisation

See the chapter about RSV immunisation in Immunisation against infectious disease: the Green Book.

Palivizumab, a monclonal antibody therapy, is licensed in the UK for the prevention of serious lower respiratory tract infection caused by RSV in infants at high risk of infection.

Human metapneumovirus ( hMPV) is a respiratory pathogen closely related to RSV. It is associated with a range of illnesses from mild infection to severe bronchiolitis and pneumonia. Symptoms may include a runny nose, cough, temperature, sore throat, and wheezing. Like RSV, hMPV is thought to be a seasonal virus occurring mostly during the winter months. However, the number of people which suffer from hMPV each year is still to be determined.

HMPV infection occurs in infants and young children with studies suggesting that nearly everyone has had hMPV infection by the age of 5 years old. However, hMPV has also been found in older children and adults suggesting re-infection may occur later on in life.

UK Health Security Agency (UKHSA) activity

Information about levels of RSV activity in the UK is reported by the UKHSA throughout the winter period.

Read the latest respiratory reports.

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Respiratory syncytial virus (RSV): symptoms, transmission, prevention, treatment

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Respiratory syncytial virus ( RSV) is an enveloped RNA virus, in the same family as the human parainfluenza viruses and mumps and measles viruses. RSV is one of the common viruses that cause coughs and colds in winter. RSV is transmitted by large droplets and by secretions from contact with an infected person.

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Signs to look for in your baby

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Symptoms of meningitis can appear in any order. Some may not appear at all. In the early stages, there may not be a rash, or the rash may fade when pressure is applied.
You should get medical help immediately if you're concerned about yourself or your child.

Trust your instincts and do not wait for all the symptoms to appear or until a rash develops.

Symptoms of meningitis and sepsis include:

a high temperature

cold hands and feet

vomiting

confusion

breathing quickly

muscle and joint pain

pale, mottled or blotchy skin (this may be harder to see on brown or black skin)

spots or a rash (this may be harder to see on brown or black skin)

headache

a stiff neck

a dislike of bright lights

being very sleepy or difficult to wake

fits (seizures)

Babies may also:

refuse feeds

be irritable

have a high-pitched cry

have a stiff body or be floppy or unresponsive

have a bulging soft spot on the top of their head

Someone with meningitis or sepsis can get a lot worse very quickly.

Call 999 for an ambulance or go to your nearest A&E immediately if you think you or someone you look after could have meningitis or sepsis.

Call NHS 111 for advice if you're not sure if it's anything serious.

If you've had medical advice and are still worried or any symptoms get worse, get medical help again.

Meningitis rash

If a rash does not fade under a glass, it can be a sign of sepsis (sometimes called septicaemia or blood poisoning) caused by meningitis and you should call 999 straight away.

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Page last reviewed: 25 October 2022
Next review due: 25 October 2025

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Read about the main symptoms of meningitis, including the meningitis rash, and find out when and where to get medical advice if you have any concerns.

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Meet NOAH team

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Bliss: 'Look at me - I'm talking to you' 

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Bliss: 'Look at me - I'm talking to you' 

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A free downloadable resource to support caregivers in reading preterm baby behaviours

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We hope that the information in this section will be useful to you at this very difficult time, and will help you and your family get through the coming days, weeks and months.

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Sands - Saving babies' lives. Supporting bereaved families.

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Sands | Saving babies' lives. Supporting bereaved families.

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Sands works to support anyone affected by the death of a baby; improve the care bereaved parents receive; and create a world where fewer babies die.

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Peeps HIE Charity | HIE Awareness & Support

Welcome to Peeps HIE

We provide support to parents, families & friends of those affected by HIE (Hypoxic-Ischaemic Encephalopathy), raising awareness of HIE.

Some of the things we do include:

Provide information about HIE

Buddy/peer support

Counselling and therapy

Funding for equipment

Find out more about what we do...

Our Family stories

We pride ourselves on the support we can give to families experiencing the challenges of day-to-day life with children affected by HIE.

Read our Family Stories

Peeps on Twitter

Our information leaflets are written by families, with families, for families.
They can be downloaded from our website, or printed copies sent out - please get in touch if we can help support.

https://www.peeps-hie.org/resources-downloads/

#HeardOfHIE

2

If you'd like to find out more about our new book club, starting in 2024, and register an interest, please check out our website:

It will be online, peer-led, from the comfort of your own home, and just for H.I.E. parents/grandparents/carers.
Suggestions...

We recognise that each H.I.E. journey can be unique; we aim to provide support and guidance tailored to the diverse needs of our community.

Inclusion matters and is an agenda item on every meeting we have with Trustees and employees.

From informational resources to emotional...

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Peeps HIE Charity | HIE Awareness & Support

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Peeps is a UK charity, dedicated to supporting those affected by HIE (hypoxic-ischaemic encephalopathy). We provide emotional, practical and financial support.

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Baby newborn activity logger and tracker, breastfeeding timer, sleep timer, diaper log, growth chart, medication, temperature, vaccine

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All adults, children and babies experience illnesses. We become protected from infections by either catching them or through vaccination.

Babies and young children get more colds than adults as their resistance to infections builds up over time. For babies born premature or sick, the risk of complications can be higher.

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All adults, children and babies experience illnesses. We become protected from infections by either catching them or through vaccination. Babies and young children get more colds than adults as their resistance to infections builds up over time. For babies born premature or sick, the risk of...

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Help to decide if your unwell baby needs to see a doctor

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Baby Check App

Baby Check features 19 simple checks that parents can do if their baby is showing signs of illness. Each check tests for a different symptom and when completed, a score is calculated that tells parents or carers how ill their baby is. The app then lets parents know whether their baby needs to see a doctor or health professional.

Download for FREE from Google Play or the App Store.

Buy posters, business cards and other materials to help promote Baby Check to your clients and patients

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The Baby Check App helps parents decide if their baby needs to see a doctor or health professional

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Routine childhood immunisations from February 2022 (born on or after 1 January 2020)

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Before you leave the neonatal unit, a trained doctor or nurse will show you how to resuscitate your baby if they stop breathing.

The thought of having to resuscitate your baby can be very scary, and is something that no parent or carer ever wants to have to do or think about. But the training is designed to help you be as prepared as possible.

Research suggests that learning how to resuscitate your baby could help increase your confidence and reduce any anxiety you may have.

If your baby stops breathing, it is important to stay calm and call 999; the emergency call handler will help. If you need to perform CPR on your baby, the call handler will talk you through the process until the ambulance arrives.

We have more information on what to do if you think your baby is becoming unwell.

We are currently reviewing our resuscitation video and will upload the new version later this year. Until then, our friends at the St John's Ambulance have an instructional video about what to do if your baby stops breathing.

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Having resuscitation training can help you be more prepared to care for your premature or sick baby after leaving the neonatal unit.

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Positive touch is a way of communicating your love and reassurance to your baby and hearing your baby's needs in return. Babies do communicate, and by watching and listening to your baby you can learn what kind of touch to use and when it is appropriate, safe and pleasurable for your baby.

It's harder for your baby to communicate when exposed to too much noise, too much light, too much cool air, or an uncomfortable lying position. See whether the environment can be calmed down first. In time, you will get to know your baby's individual ways and you may find your baby responding more often and for longer.

Comfort holding

Comfort holding is one of many ways for you and your baby to get to know each other. Your baby may be more comfortable lying in the incubator than being held. In this case, the staff may suggest that you try comfort holding if they think your baby is well enough. Comfort holding is 'still touch'. Cradling your baby with still, resting hands can be more comforting than stroking or massage, which are more stimulating.

Comfort holding can:

soothe your baby during uncomfortable procedures.

settle a restless baby.

help your baby to get back to sleep after feeds and care.

encourage your baby to be quietly awake and responsive.

Comfort holding is a way to experience loving touch when your baby is not ready to be held.

Talk to your baby's nurse about comfort holding. Together you can watch for signs from your baby that will guide you as to when and how to do it.

Be careful to:

Remove watches and jewellery, pull your sleeves up to the elbows, and wash your hands and lower arms. This reduces the risk of infection inside the incubator.

Always make sure that your hands are warm before touching your baby.

If your baby has difficulty keeping warm, make sure there is a layer of fabric (a hat, vest or blanket) between you.

Speak to your baby before touching, so that they are aware of your presence before you start.

Cradle one or both hands around your baby's feet, head or body, and keep them still. Your baby may also like to grasp one of your fingers.

Wait and watch for signs that tell you that your baby is relaxed.

You can continue for as long as you are both comfortable. When you finish comfort holding, move your hands away from your baby very slowly.

Kangaroo Care

Kangaroo Care is skin-to-skin contact when a baby is placed against the parent's chest. Benefits include improvements with lactation and with establishing breastfeeding, and better weight gain for the baby. In the longer term, it helps parents to feel closer to their babies and more confident in caring for them. Kangaroo Care can be used with babies with high medical needs, but this will require careful planning and collaboration with the neonatal staff.

Talk to staff and plan a good time and comfortable place for you to try Kangaroo Care.

While Kangaroo Care is based on direct skin-to-skin contact, removing your baby's clothes is not vital if this is upsetting for him or her. A hat and a blanket for extra warmth might be necessary for very small babies.

Hold your baby chest-to-chest tucked inside your clothes, enclosing him/her to keep his/her temperature stable. Check that the head is well supported and if you can't see your baby easily, try using a hand mirror.

Explore what you both like to enjoy together. Some babies like to have their eyes shielded, others like to be sung to softly or while having a tube feed. Allow time for your baby to settle and get the full benefit.

If you baby is happy, you can cuddle for as long as you are both comfortable. Lie back, relax and enjoy.

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Premature and sick babies undergo many medical procedures that can cause them some discomfort. As your baby's parents, you are the best people to balance this with a positive, reassuring touch.

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Bliss: Looking after your baby on the Neonatal Unit

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Bliss: Looking after your baby on the Neonatal Unit

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Looking after your baby on the neonatal unit | Bliss

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It can be hard to know how to look after your baby in neonatal care. But getting involved can help you and your baby. Find information and support in this section.