Your baby’s red book or personal child health record (PCHR)
You'll be given a personal child health record (PCHR) for your baby. This usually has a red cover and is sometimes called the red book. Take this book with you every time you visit the baby clinic, health visitor or GP. They will use it to record your baby’s weight, height, vaccinations and other important information such as test results. It’s also helpful to update the developmental milestones section of the book too. You can also add other information if you want, such as any illnesses, medicines or accidents.
Your baby will usually have reviews at the times we talk about on this page. But if you have any concerns at other times, you can contact your health visitor or GP, or go to your local baby clinic. Your baby will be weighed at birth and again during their first week.
Newborn physical examination
Soon after your baby is born, a children’s doctor (paediatrician), midwife or newborn (neonatal) nurse will check your baby is doing well. They will offer a thorough newborn physical examination (also known as ‘the Newborn Check’ or the Newborn and Infant Physical Examination (NIPE)) within 72 hours of your baby being born. They will usually check your baby's eyes, heart, hips and genitalia.They may also check your baby’s reflexes by moving them up and down.
Some parts may be a bit uncomfortable for your baby, but it will not cause them any pain. The aim is to spot any problems early so treatment can be started as soon as possible.
If the health professional carrying out the examination does find a possible problem, they may refer your baby for more tests.
The health professional will check the appearance and movement of your baby's eyes. They are looking for cataracts, which is a clouding of the transparent lens inside the eye. However, this examination won’t be able to tell you how well your baby can see.
Your baby can be referred to the hospital’s ophthalmology (eye) department if they need any more tests.
The health professional will check your baby's heart. They will observe your baby, feel your baby’s pulse and listen to their heart with a stethoscope. Sometimes heart murmurs are picked up in the test. This is when the heartbeat has an extra or unusual sound. These are common in babies and the heart is normal in almost all cases when a murmur is heard. Around 1 in 200 babies has a heart problem that needs treatment.
Your baby will be referred to the hospital’s cardiology (heart) department if they need more tests.
Some newborn babies have hip joints that aren’t formed properly. This is known as developmental dysplasia of the hip or DDH. If this is left untreated, it can cause limp or joint problems. But only about 1 or 2 in 1,000 babies have DDH that needs to be treated. There is more information below about DDH.
Baby boys are checked to make sure their testicles are in the right place. During pregnancy, the testicles form inside the baby's body. They may not drop down into the scrotum until a few months after birth.
In about 1 in 100 baby boys, the testicles only descend partially or not at all. This needs to be treated to prevent possible problems later in life, such as reduced fertility.
Tests and checks for your baby
You'll be offered 2 screening tests for your baby:
- newborn hearing screening test
- blood spot (heel prick) test.
In the early days after the birth, the midwife will also check your baby for signs of jaundice, infection of the umbilical cord or eyes, and thrush in the mouth.
Newborn hearing screening test
The newborn hearing screening test is done soon after your baby is born. It helps identify babies who have permanent hearing loss as early as possible. This means you can get any support and advice straightaway.
If you give birth in hospital, you may be offered the test before you and your baby are discharged. Otherwise, it will usually be done within the first few weeks but can be done up to 3 months of age.
If you aren't offered a hearing screening test, ask your health visitor to help you arrange an appointment.
If the screening test results do not show a clear response from 1 or both of your baby’s ears, your healthcare professional may repeat the test at a later date. Some newborns may ‘fail’ their first hearing tests, even if their hearing is normal. Research has shown that this may be especially true for babies born by c-section.
If the screening test results are still not clear your baby will be given an appointment with a hearing specialist at an audio clinic. Even if this happens, it does not necessarily mean your baby has permanent hearing loss.
The NHS website has more information about the newborn hearing screening test.
Newborn blood spot (heel prick) test
The newborn blood spot test involves taking a small sample of your baby's blood to screen it for 9 rare but serious health conditions, including cystic fibrosis and sickle cell disease. Most babies won’t have any of these conditions, but early screening and treatment can prevent severe disability and even death. This test is not compulsory, but it is recommended because it could be life-saving.
When your baby is 5 to 8 days old, a midwife will collect the blood sample by pricking your baby's heel, which is why it is sometimes called the heel prick test. The midwife will take a few drops of blood onto a blood spot card and send it for testing.
This may be uncomfortable and your baby may cry, but it is very quick. You can help soothe your baby by cuddling and feeding them, and making sure they are warm and comfortable.
You should receive the results by the time your baby is 6 to 8 weeks old. If you haven't received your baby's results, speak to your health visitor or GP. You'll be contacted sooner if your baby’s tests show a positive result for any of the conditions. This doesn't mean they have the condition, but they're more likely to have it. They will be referred to a specialist for more tests.
The NHS website has detailed information about the heel prick test and the possible results.
If your baby was born before 32 weeks they will have an additional test for congenital hypothyroidism at 28 days old or when they are discharged from hospital, whichever is sooner.
The British Thyroid Foundation has more information about congenital hypothyroidism.
Scans for developmental dysplasia of the hip (DDH)
If your health professional thought your baby’s hips felt unstable during their newborn physical examination, your baby will be offered an ultrasound scan of their hip before they are 2 weeks old. This is to check for developmental dysplasia of the hip (DDH), which is where the ball and socket joint of the hip doesn’t form properly.
It's important to remember DDH can’t be prevented and it’s nobody's fault. With early diagnosis and treatment, most babies are able to develop normally and have a full range of movement in their hip.
Babies should also have an ultrasound scan of their hip before they're 6 weeks old if:
- there have been childhood hip problems in your family
- your baby was in the breech position (feet or bottom downwards) in the last month of pregnancy
- your baby was born in the breech position.
If you have had twins, triplets or multiple babies and 1 of the babies has any of these risk factors, each baby should have an ultrasound scan of their hips by the time they're 6 weeks old. Even if your baby’s hip stabilises before the scan is due, they should still be checked to make sure.
If your baby is diagnosed with DDH, they are usually treated with a fabric splint called a Pavlik harness. This secures both of your baby's hips in a stable position and allows them to develop normally. Your hospital team will provide instructions on how to look after your baby if they are wearing a harness.
Late-stage signs of DDH
Sometimes hip problems can develop after these checks. Contact your GP as soon as possible if your child has any of the following symptoms:
- restricted movement in 1 leg when you change their nappy
- 1 leg dragging when they crawl
- 1 leg appearing longer than the other
- uneven skin folds in the bum or thighs
- a limp, walking on toes or developing an abnormal ‘waddling’ walk.
The charity Steps offers information and support if your baby has been diagnosed with DDH.
Your baby’s weight
It's normal for babies to lose some weight in the first few days after birth. Putting on weight steadily after this is a sign your baby is healthy and feeding well.
Your baby will be weighed during their first 2 weeks to make sure they're regaining their birthweight. Most babies are at, or above, their birthweight by 2 weeks.
Your midwife or health visitor can help you if your baby loses a large amount of weight or doesn’t regain their birthweight by 2 weeks. They will ask you how feeding is going and look at your baby’s health in general. They may ask to watch you breastfeed, if you’re breastfeeding.
How often should my baby be weighed?
After the first 2 weeks, your baby should be weighed no more than once a month up to 6 months of age. Speak to your health visitor or GP if you have any concerns about your baby’s weight.
Further reviews for your baby in their first 3 months
When your baby is 1 to 2 weeks old
Your health visitor will do a new baby review around 10 to 14 days after the birth. They can talk to you about:
- safe sleeping for your baby
- vaccinations for your baby
- feeding your baby
- adjusting to life as a new parent
- your baby's development.
Your health visitor will see you for more scheduled visits at various stages during your baby's early years. We have more information about how your health visitor can support you.
When your baby is 6 to 8 weeks
Your baby will be invited for a thorough physical examination. This is usually done by a GP.
Your baby's eyes, heart, hips and – for boys – testicles will be checked. They'll also usually have their weight, length and head circumference measured.
A GP or health visitor will also discuss your baby's vaccinations with you. These are offered at 8 weeks, 12 weeks, 16 weeks and 12 months old, and before your child starts school.
They'll also ask you how you've been feeling emotionally and physically since the birth of your baby.
Your baby's first vaccinations
One of the best ways to protect your baby against diseases like measles, rubella, tetanus and meningitis is through vaccination. As well as protecting your own baby, you're also protecting other babies and children by preventing the spread of disease. Vaccinations are free in the UK. You just need to book your appointments with your GP.
Your baby needs their first injections at 8 weeks, then 12 weeks, 16 weeks and 1 year. Your health visitor can talk to you about vaccinations, including what to expect and how you can comfort your baby.
During your baby’s first 3 months, they will need 2 sets of vaccinations:
At 8 weeks old
- 6-in-1 vaccine
- RV (rotavirus) vaccine
- MenB vaccine
At 12 weeks old
- 6-in-1 vaccine – 2nd dose
- PCV (pneumococcal) vaccine
- RV (rotavirus) vaccine – 2nd dose
At 16 weeks old
6-in-1 vaccine – 3rd dose
MenB vaccine – 2nd dose
What to expect after a vaccination
Your baby may be a little upset after a vaccination, but they should feel better after a cuddle or a feed.
Sometimes the area where the needle goes in can be sore and red for 2 to 3 days. This should go away on its own.
Some children may also develop a high temperature. A normal temperature in babies and children is about 36.4C, but this can vary slightly from child to child. A high temperature can be 38C or more.
If your baby has a temperature they might:
- feel hotter than usual when you touch their back or chest
- feel sweaty
- look or feel unwell
You can help ease a high temperature by:
- making sure they're not wearing too many layers of clothes or blankets
- offering them feeds to avoid dehydration
- giving them liquid paracetamol.
It's recommended that you give your baby liquid paracetamol after the MenB vaccine to reduce the risk of a high temperature. This vaccine is given at 8 weeks, 16 weeks and 1 year old.
Make sure you follow the instructions that come with the medicine. If you're unsure, ask a pharmacist for advice. If your baby was premature they may need a dose prescribed for them by the GP.
A high temperature after a vaccination should go away quite quickly by itself.
Always contact a GP or call 111 if:
- your child has other signs of illness, such as a rash, as well as a high temperature
- your baby's temperature is 38C or higher if they're under 3 months old
- your baby's temperature is 39C or higher if they're 3 to 6 months old.
You may find it useful to buy a digital thermometer to check your baby’s temperature accurately. You can buy these at any supermarket or pharmacy.
You can read more about your baby’s vaccination schedule on the NHS Start 4 Life website.
Your emotional health
Watching your newborn have all these tests and check-ups can cause some anxiety. For example, you may worry that the tests will find a problem, or something will happen to the baby or that you will do something wrong. Having anxious thoughts and worries now and again are natural, particularly in the early weeks after having a baby.
Talk to your midwife, health visitor if you have any questions or concerns about your baby’s tests or the results. You can also talk to them about how you’re feeling. If your anxiety is constant and affecting your daily life, you may need some help.