Health and Care

 

Treating a high temperature in children

 

 

Fever in children

 

A fever is a temperature of over 37.5°C. Fevers are quite common in young children and are usually mild.

If your child’s face feels hot to the touch and they look red or flushed then they may have a fever. You can check their temperature with a thermometer. Measured under the arm, normal temperature is about 36.4°C (97.4°F). Under the tongue, normal temperature is slightly higher at about 37°C (98.4°F). This may vary a bit.

If you're worried speak to your doctor or take your child straight to the Accident and Emergency (A&E) department of your nearest hospital.

Always contact your doctor if:

• your child has other signs of illness as well as a raised temperature
• your baby’s temperature is 38°C (101°F) or higher (if they’re under three months), or
• your baby’s temperature is 39°C (102°F) or higher (if they’re three to six months)

If the doctor doesn’t find a reason for the temperature they may ask you to collect a urine sample in a sterile container so they can test for infection.

 

How to treat a fever

 

It’s important to keep your child hydrated. Even if your child isn’t thirsty try to get them to drink little and often to keep their fluid levels up. Don’t give them food unless they want it.

Treat discomfort and fever with paracetamol or ibuprofen (always follow the dosage instructions carefully).

The following suggestions may help your child feel more comfortable:

• Give your child plenty of cool clear fluids.
• Undress them to their nappy or vest and pants.
• Cover them with a sheet if necessary.
• Keep the room well aired and at a comfortable temperature (about 18°C (65°F)) by adjusting the heating or opening a window.
• If your child is distressed and uncomfortable, try giving them paracetamol or ibuprofen. You can’t give them both at the same time, but if one doesn’t work you may want to try the other later. Always check the instructions on the bottle or packet to find out the correct dose and frequency for your child’s age.

If you have a thermometer, take your child’s temperature under their armpit. If it’s above 40-41°C (104-105°F), or if your child still feels feverish, contact your doctor.

 

Types of thermometer

 

• Digital thermometers. Digital thermometers are quick to use, accurate and can be used under the armpit (always use the thermometer under the armpit with children under five). Hold your child’s arm against his or her body and leave the thermometer in place for the time stated in the manufacturer’s instructions.
• Ear (or tympanic) thermometers. Ear thermometers are put in the child’s ear. They take the child’s temperature in one second and do not disturb the child, but they're expensive. Ear thermometers may give low readings when not correctly placed in the ear, so read the manufacturer’s instructions carefully and familiarise yourself with how the thermometer works (this applies to all thermometers).
• Strip-type thermometers. Strip-type thermometers, which you hold on your child’s forehead, are not an accurate way of taking their temperature. They show the temperature of the skin, not the body.
• Mercury-in-glass thermometers. Mercury-in-glass thermometers haven’t been used in hospitals for some years and are no longer available to buy. They can break, releasing small shards of glass and highly poisonous mercury. Do not use mercury thermometers. If your child is exposed to mercury, get medical advice immediately.

 

Spotting signs of serious illness

If your baby has a serious illness it’s important to get medical attention as soon as possible.

The following symptoms should always be treated as serious:

• a high-pitched, weak or continuous cry
• a lack of responsiveness, reduction in activity or increased floppiness
• in babies, a bulging fontanelle (the soft spot on a baby's head)
• neck stiffness (in a child)
• not drinking for more than eight hours (taking solid food is not as important)
• a temperature of over 38°C for a baby less than three months old, or over 39°C for a baby aged three to six months old
• a high temperature, but cold feet and hands
• a high temperature coupled with quietness and listlessness
• fits, convulsions or seizures
• turning blue, very pale, mottled or ashen
• difficulty breathing, fast breathing, grunting while breathing, or if your child is working hard to breathe, for example, sucking their stomach in under their ribs
• your baby or child is unusually drowsy, hard to wake up or doesn’t seem to know you
• your child is unable to stay awake even when you wake them
• a spotty, purple-red rash anywhere on the body (this could be a sign of meningitis)
• repeated vomiting or bile-stained (green) vomiting

It can be difficult to know when to call an ambulance or go to the Accident and Emergency (A&E) department, but use the following as a guide.

Call an ambulance for your child if they:

• stop breathing
• are struggling for breath (you may notice a sucking in under the ribcage)
• are unconscious or seem unaware of what's going on
• won’t wake up
• have a fit for the first time, even if they seem to recover

Take your child to A&E if they:

• have a fever and are persistently lethargic despite taking paracetamol or ibuprofen
• are having difficulty breathing (breathing fast or panting, or very wheezy)
• have severe abdominal pain
• have a cut that won't stop bleeding or is gaping open
• have a leg or arm injury that means they can’t use the limb
• have swallowed a poison or tablets

Above all, trust your instincts. You know better than anyone what your child is usually like, so you’ll know what’s different or worrying.

Retinoblastoma warning sign: pupil reflects white

Spotting eye cancer (retinoblastoma)

Retinoblastoma is a rare cancer that affects the eyes of children under five years old. It is usually caught and treated early , which is why most children with retinoblastoma are successfully treated.

A sign of retinoblastoma is the pupil of one of your child's eyes looking odd – for example, reflecting white like a cat's eye. This may be noticed in photos in which the pupil of the healthy eye appears red from the flash, or in a dark room, or in a room lit by artificial light. Another symptom can be a squint, when the child's eyes look in different directions.

These signs may be due to something other than retinoblastoma, but you should still get them checked by a doctor immediately.

Spotting a rash

Rashes look different on different people. The colour of spots can vary and may be less easy to see on dark skin. If in doubt, check with your doctor.

Spotting the signs of meningitis

Meningitis is an inflammation of the membranes that surround the brain. It’s a very serious illness, but if it’s diagnosed and treated early, most children make a full recovery.

In recent years there has been a lot of concern about meningitis in children. There are several types of meningitis, and some can be prevented by vaccinations.

Early symptoms of meningitis may be similar to a cold or flu (fever, vomiting, irritability and restlessness). However, children with meningitis can become seriously ill in hours, so make sure you can recognise the signs.

The main symptoms of meningitis are:

• fever (a temperature of 38ºC or more in babies under three months and 39ºC or more in babies between three and six months) vomiting and refusing feeds
• cold hands and feet
• skin that is pale, blotchy or turning blue
• rapid or unusual patterns of breathing
• irritability, especially when picked up (this can be due to limb or muscle pain)
• a high-pitched, moaning cry
• shivering
• red or purple spots that don’t fade under pressure (do the glass test explained below)
• floppiness and listlessness, or stiffness with jerky movements
• children may be drowsy, less responsive, vacant or difficult to wake
• a stiff neck
• a bulging fontanelle (the soft spot on a baby's head)

Not all children will develop all the symptoms listed above. If your child develops some of these symptoms, especially red or purple spots, get medical help urgently.

If you can’t get in touch with your doctor, or you're still worried after you’ve spoken to them, take your child to the Accident and Emergency (A&E) department of your nearest hospital.

The glass test

If your child has red or purple spots press the side of a clear drinking glass firmly against the rash so that you can see whether the spots fade and lose colour under pressure. If they don't change colour, contact your doctor immediately.

This rash can be harder to see on darker skin, so check for spots over your baby’s whole body. They may show up on paler areas such as the palms of the hands, the soles of the feet, the tummy, inside the eyelids and on the roof of the mouth.

Coughs, colds, and ear infections in children

Colds

It’s normal for a child to have eight or more colds a year. This is because there are hundreds of different cold viruses and young children have no immunity to any of them as they've never had them before. Gradually they build up immunity and get fewer colds.

Most colds get better in five to seven days. Here are some suggestions on how to ease the symptoms in your child: 

• Increase the amount of fluid your child normally drinks.
• Saline nose drops can help loosen dried nasal secretions and relieve a stuffy nose. Ask your pharmacist, GP or health visitor about them.
• If your child has a fever, pain or discomfort, paracetamol or ibuprofen can help. There are special products for children. It will state on the packet how much you should give children of different ages.
• Encourage the whole family to wash their hands regularly to stop the cold spreading.
• Nasal decongestants can make stuffiness worse. Never use them for more than two or three days.

Ear infections

Ear infections are common in babies and small children. They often follow a cold and sometimes cause a temperature. A child may pull or rub at an ear, but babies can’t always tell where pain is coming from and may just cry and seem uncomfortable.

If your child has earache but is otherwise well, give them paracetamol or ibuprofen for 12-24 hours. Don’t put any oil, eardrops or cotton buds into your child’s ear unless your GP advises you to do so. Most ear infections are caused by viruses, which can’t be treated with antibiotics. They will just get better by themselves.

After an ear infection your child may have a problem hearing for two to six weeks. If the problem lasts for any longer than this, ask your doctor for advice.

Glue ear

Repeated middle ear infections (otitis media) may lead to glue ear (otitis media with effusion), where sticky fluid builds up and can affect your child’s hearing. This may lead to unclear speech or behavioural problems.

If you smoke, your child is more likely to develop glue ear and will get better more slowly. Your doctor will give you advice on treating glue ear.

Sore throats

Sore throats are often caused by viral illnesses such as colds or flu. Your child’s throat may be dry and sore for a day or two before a cold starts. Paracetamol or ibuprofen can be given to reduce the pain.

Most sore throats clear up on their own after a few days. If your child has a sore throat for more than four days, has a high temperature and is generally unwell, or is unable to swallow fluids or saliva, see your doctor.

Coughs

Children often cough when they have a cold because of mucus trickling down the back of the throat. If your child is feeding, drinking, eating and breathing normally and there’s no wheezing, a cough isn’t usually anything to worry about.

If your child has a bad cough that won’t go away, see your doctor. If your child also has a high temperature and is breathless, they may have a chest infection. If this is caused by bacteria rather than a virus your doctor will prescribe antibiotics to clear up the infection. Antibiotics won’t soothe or stop the cough straight away.

If a cough continues for a long time, especially if it’s worse at night or is brought on by your child running about, it could be a sign of asthma. Some children with asthma also have a wheeze or breathlessness. If your child has any of these symptoms take them to the doctor. If your child seems to be having trouble breathing contact your doctor, even if it’s the middle of the night.

Although it’s upsetting to hear your child cough, coughing helps clear away phlegm from the chest or mucus from the back of the throat. If your child is over the age of one, try a warm drink of lemon and honey.

 

Diarrhoea and vomiting in children

 

Babies

 

Most babies have occasional loose stools (poo). Breastfed babies have looser stools than formula-fed babies. Diarrhoea is when your baby frequently passes unformed watery stools.

Diarrhoea can be caused by an infection and may be accompanied by vomiting. This is called gastroenteritis (a stomach bug). It's usually caused by a virus. Most stomach bugs are more common in formula-fed than breastfed babies.

If your baby comes into contact with other family members or people (for example, at nursery) who have a stomach bug, ask them to wash their hands using liquid soap in warm running water, and drying their hands, frequently. Keep toilets clean and wash towels frequently. With formula-fed babies, make sure that bottles are sterilised extremely carefully.

Diarrhoea and vomiting are more serious in babies than older children because babies can easily lose too much fluid from their bodies and become dehydrated. They may become lethargic or irritable, have a dry mouth, and have loose, pale or mottled skin; their eyes and fontanelle (the soft spot on the top of their head) may become sunken. If they become dehydrated they may not pass much urine. They may lose their appetite and have cold hands and feet. It may be difficult to tell how much urine they're passing when they have diarrhoea.

If your baby becomes dehydrated they will need extra fluids. You can buy oral rehydration fluids from your local pharmacy or chemist, or get a prescription from your GP. Brands include Dioralyte, Electrolade and Rehidrat.

Contact your doctor  urgently for advice if your baby has passed six or more diarrhoeal stools in the past 24 hours, or if your baby has vomited three times or more in the past 24 hours. Get expert advice. If your baby is unwell (is less responsive, feverish or is not passing much urine), or if vomiting has lasted more than a day, get your doctor’s advice straightaway.

General advice:

• Give extra fluids. Give your baby oral rehydration fluids in between feeds or after each watery stool.
• Do not stop giving your baby milk. Give the extra fluid as an addition to milk.
• Make sure everyone in your family washes their hands regularly with soap and warm water to avoid spreading the infection.
• Don't share towels.
• Don't take your baby swimming in a swimming pool for two weeks after the last episode of diarrhoea.

 

Toddlers and older children

 

Some children between the ages of one and five pass frequent, smelly, loose stools that may contain recognisable foods, such as carrots and peas. Usually, these children are otherwise perfectly healthy and are growing normally, but the doctor can’t find any cause. This type of diarrhoea is known as toddler diarrhoea.

Contact your doctor if:

• your child has diarrhoea and is vomiting at the same time
• your child has diarrhoea that's particularly watery, has blood in it or lasts for longer than two or three days
• your child has severe or continuous stomach ache

Otherwise, diarrhoea isn’t usually a cause for concern. Give your child plenty of clear drinks to replace the fluid that’s been lost, but only give them food if they want it.

Don't give them fruit juice or squash, as these drinks can cause diarrhoea.

Anti-diarrhoeal drugs can be dangerous, so don't give these. Oral rehydration treatment can help.

You can help to prevent any infection spreading by using separate towels for your child and reminding everyone in the family to wash their hands after using the toilet and before eating.

Don't return your child to their school or childcare facility until at least 48 hours after the last episode of diarrhoea or vomiting.

Don't allow children to swim in swimming pools for two weeks after the last episode of diarrhoea

Infectious illnesses in children

Chickenpox

Incubation period: Between 1 and 3 weeks.
Infectious period: The most infectious time is 1-2 days before the rash appears, but it continues to be infectious until all the blisters have crusted over.

Symptoms:

It starts with feeling unwell, a rash and a slight temperature.

Spots develop, which are red and become fluid-filled blisters within a day or two. They eventually dry into scabs, which drop off. The spots appear first on the chest, back, head or neck, then spread. They don’t leave scars unless they're badly infected.

What to do:

You don’t need to go to your doctor or Accident and Emergency (A&E) department unless you’re not sure that it's chickenpox or your child is very unwell or distressed.

• Give your child plenty to drink.
• Use paracetamol or ibuprofen to relieve the fever and discomfort.
• Baths, loose comfortable clothes and calamine lotion can all ease the itchiness.
• Try to stop your child scratching or picking at their spots as this will increase the risk of scarring. It’s hard for children to do this, so give them plenty of praise and encouragement. Distractions, such as TV, are good for taking their mind off the itching. Let the school or nursery know that your child is ill in case other children are at risk.
• Keep your child away from anyone who is pregnant or trying to get pregnant. If your child had contact with a pregnant woman just before they became unwell, let the woman know about the chickenpox (and suggest that she sees her doctor). In women who've never had chickenpox, catching the illness in pregnancy can cause miscarriage or the baby may be born with chickenpox.

Measles

Incubation period: 7-12 days.
Infectious period: from around four days before the rash appears until four days after it's gone.

Symptoms:

• Measles begins like a bad cold and cough with sore, watery eyes.
• Your child will become gradually more unwell, with a temperature.
• A rash appears after the third or fourth day. The spots are red and slightly raised. They may be blotchy, but not itchy. The rash begins behind the ears and spreads to the face and neck, then the rest of the body.
• The illness usually lasts about a week.

Measles is much more serious than chickenpox, German measles or mumps. It's best prevented (by the MMR vaccination). Serious complications include pneumonia and death.

What to do:

• Make sure your child gets plenty of rest and plenty to drink (warm drinks will ease the cough).
• Give them paracetamol or ibuprofen to relieve the discomfort and fever.
• Put Vaseline around their lips to protect their skin.
• If their eyelids are crusty, gently wash them with warm water.
• If your child is having trouble breathing, is coughing a lot or seems drowsy, see your doctor urgently.

Mumps

Incubation period: 14-25 days.
Infectious period: from a few days before starting to feel unwell until the swelling goes down.

Symptoms:

• A general feeling of being unwell.
• A high temperature.
• Pain and swelling on the side of the face in front of the ear and under the chin. Swelling usually begins on one side, followed (though not always) by the other side. 
• Discomfort when chewing.

Your child’s face will be back to normal size in about a week. It’s rare for mumps to affect boys’ testes (balls). This happens more often in adult men with mumps. If you think your child’s testes are swollen or painful, see your doctor.

What to do:

• Give your child paracetamol or ibuprofen to ease pain in the swollen glands. Check the pack for the correct dosage.
• Give your child plenty to drink, but not fruit juices as they make the saliva flow, which can make your child’s pain worse.
• There’s no need to see your doctor unless your child has stomach ache and is being sick, or develops a rash of small purple or red spots or bruises.

Parvovirus B19 (also known as fifth disease or slapped cheek disease)

Incubation period: 1-20 days.
Infectious period: a few days before the rash appears (children are no longer contagious when the rash appears).

Symptoms:

• It begins with a fever and nasal discharge.
• A bright red rash, like the mark left by a slap, appears on the cheeks.
• Over the next two to four days a lacy rash spreads to the trunk and limbs.
• Children with blood disorders such as spherocytosis or sickle cell disease may become more anaemic. They should seek medical care.

What to do:

• Make sure your child rests and drinks plenty of fluids. 
• Give them paracetamol or ibuprofen to relieve the discomfort and fever.
• Pregnant women or women planning to become pregnant should see their doctor as soon as possible if they come into contact with the infection or develop a rash.

German measles (Rubella)

Incubation period: 15-20 days.
Infectious period: from one week before the rash first appears until at least five days after it's gone.

Symptoms:

• It starts like a mild cold.
• A rash appears in a day or two, first on the face, then on the body. The spots are flat (on light skin they're pale pink).
• Glands in the back of the neck may be swollen.
• Your child won’t usually feel unwell.

It can be difficult to diagnose rubella with certainty.

What to do:

• Give your child plenty to drink. Keep them away from anybody who’s in the early stages of pregnancy (up to four months) or trying to get pregnant. If your child has had contact with any pregnant women before you knew about the illness, you must let the women know as they'll need to see their doctor.

Whooping cough

Incubation period: 6-21 days.
Infectious period: from the first signs of the illness until about six weeks after coughing starts. If an antibiotic is given, the infectious period will continue for up to five days after starting treatment. Antibiotics need to be given early in the course of the illness in order to improve symptoms.

Symptoms:

• The symptoms are similar to a cold and cough, with the cough gradually getting worse.
• After about two weeks, coughing bouts start. These are exhausting and make it difficult to breathe.
• Younger children (babies under six months) are much more seriously affected and can have breath-holding or blue attacks, even before they develop a cough.
• Your child may choke and vomit.
• Sometimes, but not always, there will be a whooping noise as the child draws in breath after coughing.
• The coughing fits may continue for several weeks, and can continue for up to three months.

What to do:

• Whooping cough is best prevented through immunisation.
• If your child has a cough that gets worse rather than better and starts to have longer fits of coughing more and more often, see your doctor.
• It’s important for the sake of other children to know whether or not your child has whooping cough. Talk to your doctor about how to look after your child. Avoid contact with babies, who are most at risk from serious complications.

Children's medicines

Medicines aren't always needed for childhood illnesses. Most illnesses get better by themselves and make your child stronger and able to resist similar illnesses in the future.

Paracetamol and ibuprofen are often used to relieve the discomfort caused by a high temperature.

Some children, for example those with asthma, may not be able to take ibuprofen, so check with your doctor.

Both paracetamol and ibuprofen are safe and effective. Always have one or both stored in a safe place at home.

Common painkillers

Don't give aspirin to children under 16 unless it's specifically prescribed by a doctor. It has been linked with a rare but dangerous illness. If you're breastfeeding ask your doctor for advice before taking aspirin.

Paracetamol

Paracetamol can be given to children over two months for pain and fever. Make sure you’ve got the right strength for your child. Overdosing is dangerous. Check with your pharmacist when you buy it, and read the label carefully.

Ibuprofen

Ibuprofen can be given for pain and fever in children of three months and over who weigh more than 5kg (11lbs). Check the correct dose for your child’s age. Avoid ibuprofen if your child has asthma, unless advised by your doctor.

Antibiotics

Children don’t often need antibiotics. Most childhood infections are caused by viruses, and antibiotics only treat illnesses caused by bacteria, not viruses.

If you’re offered a prescription, especially an antibiotic, talk to your doctor about why it’s needed, how it will help and whether there are any alternatives. Ask about any possible side effects (for example, whether it will make your child sleepy or irritable).

If your child is prescribed antibiotics always finish the whole course to make sure all the bacteria are killed off. Your child may seem better after two or three days, but if the course is five days, they must carry on taking the medicine. The illness is more likely to return if you don’t finish all the antibiotics.

Dosages

Make sure you know how much and how often to give a medicine. If in doubt, check with your pharmacist or doctor. Never give the medicine more frequently than recommended by your doctor or pharmacist.

With liquids, always measure out the right dose for your child’s age. The instructions will be on the bottle.

Sometimes, liquid medicine may have to be given using a special spoon or liquid medicine measure. This allows you to give small doses of medicine more accurately.

Never use a teaspoon as they vary in size. Ask your pharmacist or health visitor to explain how a measure should be used. Always read the manufacturer’s instructions supplied with the measure, and always give the exact dose stated on the medicine bottle. If in doubt, ask the pharmacist for help.

If you buy medicines at the pharmacy:

• Always tell the pharmacist how old your child is. Some medicines are for adult use only.
• Always follow the instructions on the label or ask the pharmacist if you’re unsure.
• Ask for sugar-free medicines if they're available.
• Look for the date stamp. Don’t use out-of-date medicines. If you have any out-of-date medicines at home take them back to the pharmacy for safe disposal.

Only give your child medicine given to you by your doctor or usual healthcare professional. Never use medicines prescribed for anyone else.

Keep all medicines out of your child’s reach and out of sight if possible. The kitchen is a good place to keep medicines as it's easy for you to keep an eye on them there. Put them in a place where they won't get warm.

Bad reactions

If you think your child is reacting badly to a medicine, for example with a rash or diarrhoea, stop giving it to them and speak to a health professional.

Looking after a sick child

If your child is ill the most important thing to do is to listen to them. If they say they don’t need to be in bed, they probably don’t. They might feel better on the sofa with a blanket or duvet.

Whether they're in bed or on the sofa the following will help them feel more comfortable. 

• Keep the room airy without being draughty. If the room is too warm they'll probably feel worse.
• Give your child plenty to drink. For the first day or so don’t bother about food unless they want it. After that start trying to tempt them with bits of food and encouraging them to have nutritious drinks like milk.
• Try to give your child time for quiet games, stories, company and comfort.
• Sick children get very tired and need plenty of rest. Encourage your child to doze off when he or she needs to, perhaps with a story read by you or on tape or CD.
• Never fall asleep with a sick baby on the sofa with you, even if you're both exhausted. This increases the chances of cot death.

Looking after a sick child, even for a couple of days, is exhausting. Make things as easy for yourself as you can. Get rest and sleep when you can, and try to get somebody else to take over every now and then to give you a break.

Getting expert help

If you think your child is ill and has signs of serious illness contact your GP or take them straight to the A&E department of your local hospital.

Your doctor and pharmacist can all give you advice on how to treat your child's illness. Your doctor can treat your child and prescribe medicines. 

Serious conditions and special needs in children

Some children are born with or develop medical conditions that are serious, long-term or limit their life expectancy. If this happens to your child, you and your family will need help and support to learn to live with their condition.

Talking to your doctor or specialist can help. Ask them about any concerns you have. Some questions you might like to ask include:

• Is there a name for my child’s problem? If so, what is it?
• Does my child need more tests to get a clear diagnosis?
• Is the condition likely to get better or worse, or will it stay the same?
• Where is the best place to go for medical help?
• Can I get any help or support?
• How can I get in touch with other parents who have children with a similar problem?
• How can I help my child?

You may find it difficult to understand and absorb everything that’s said to you at first. You may also find that not all health professionals communicate well with parents. Ask for the information again if you feel you need to. If you can, get a friend or relative to come with you, or take a pen and paper so that you can make some notes.

Special educational needs

If you’re concerned that your child has special educational needs (that is, you think they might need extra help at school) talk to a health professional who already knows you and your child.

You or any of the professionals involved in caring for your child can ask your doctor to carry out a statutory assessment of your child. This will describe any extra support that your child will need at school.

Getting information, advice and support

Finding out that your child has a disability or illness can be a stressful and upsetting experience. You’ll be trying to cope with your own feelings at the same time as making difficult decisions.

Your doctor or a counsellor can help. So can other parents who have been through similar experiences. Even with help it’ll take time to adjust.

 

Your babies screening programme

 

 Is my baby gaining enough weight?

Over the first few years of their life, your baby will be given a series of tests, assessments and opportunities to see health professionals.

Your baby’s eyesight

Babies are born with the ability to see, although their vision may not be completely focused.

Their eyesight develops gradually over the next few months.

By the time of their first review (at around 14 days), you’ll have noticed whether or not your baby's eyes can follow your face or a colourful object held about 20cm (eight inches) away. If they can't, mention it at the review. At birth, a baby’s eyes may roll away from each other occasionally, which is normal. If your baby squints often or all the time, tell your doctor.

They can refer you to an orthoptist or ophthalmologist who specialises in children’s eyes.

It’s important that any problems with your child’s eyesight are identified as soon as possible as they can affect social and educational development.

Children may not realise that there’s anything wrong with their sight.

Your baby’s hearing

In the first few weeks of your baby's life, they will be given a routine hearing screening test. The test uses the latest technology and can be carried out almost immediately after birth. It is completely safe and comfortable for babies.

After the test, you’ll be given two checklists (Reaction to Sounds and Making Sounds), which list the sounds your baby should respond to and make as they grow.

If test results show that there could be a problem with your child’s hearing, you’ll be invited to a follow-up assessment. Sometimes, a cold or other infection can temporarily affect hearing.

You can also ask for another appointment if the results show that there’s no problem but you’re still concerned about your child’s hearing. If your child doesn’t seem to hear properly at the second appointment or you’re still worried, ask for a referral to a specialist paediatrician.

If your child's hearing problems are relatively minor, they may simply need some extra support to learn to talk. If the problems are more serious, they may need to learn other ways of communicating. The earlier that hearing problems are discovered, the greater the chance that something can be done.

Your baby’s weight and height

Steady weight gain is a sign that feeding is going well and your baby is healthy. In the early days after birth, it's normal for a baby to lose some weight. Your baby will be weighed to make sure that they regain their birth weight.

Four out of five healthy babies are at or above their birth weight by 14 days. If your baby loses a large amount of weight, your health visitor will talk to you about how feeding is going, and they'll look at your baby’s health in general. After this, your baby will only be weighed during routine reviews unless there’s cause for concern. Your doctor may ask you to bring your baby more often if they think they need more regular monitoring.

Generally, you don’t need to weigh your baby too often: no more than once a month up to six months of age, once every two months from six to 12 months of age, and once every three months over the age of one.

A baby’s length is measured by trained staff using appropriate equipment. By age two, your child’s height can be measured when they're standing up.

Understanding your child’s chart

Your child’s growth will be recorded on a centile chart. This allows you to see how their height and weight compare to other children of the same age. Boys and girls have different charts because boys are on average heavier and taller and their growth pattern is slightly different. 

Centile lines

The curves on the chart, or centile lines, show the range of weights and heights (or lengths) of most children. If your child’s height is on the 25th centile, for example, this means that if you lined up 100 children of the same age in order from the shortest to the tallest, your child would be number 25 and 75 children would be taller.

It is normal for a child’s weight or height to be anywhere within the centile lines on the chart.

The centile lines show roughly the pattern of growth expected in weight and length, but these don't usually follow one centile line exactly. Weight usually stays within one centile space (the space between two centile lines).

All babies are different, and your baby’s growth chart won’t look exactly the same as another baby’s (even their brother's or sister's).

Weight

Usually, weight gain is quickest in the first six to nine months. It gradually slows down as children move into the toddler years.

If your baby is ill, weight gain may slow down for a while. Toddlers may lose weight when they're ill. When they recover, their weight will usually return to normal within two to three weeks. If your baby drops two or more centile spaces from their normal position, ask your health visitor to check them and measure their length.

Height

You child’s height after the age of two can give some indication of how tall they will be when they grow up. Use the adult height predictor on the height page of your red book. It’s normal for your child to be on different centiles for weight and height/length, but the two are usually similar.

If there’s a big difference or if your health visitor is concerned about your child’s weight, they will calculate their Body Mass Index (BMI) centile. This will show if your child is overweight or underweight. If this is the case, talk to your health visitor about your child’s diet and physical activity levels. They can help you plan any changes needed.

Your baby's screening timeline

One day to one month: newborn hearing
This is a test to check whether your baby’s hearing is normal. It can be done before you go home from hospital.

One to three days: newborn physical examination
This includes screening of your baby’s heart, hips and eyes (and testes in boys), plus a general physical examination.  It doesn’t have to be done before you leave hospital.

Five to eight days: newborn bloodspot
This is a heel-prick blood test for phenylketonuria, congenital hypothyroidism, cystic fibrosis and sickle cell disorders. In some areas, the test also includes MCADD, a metabolic disorder.

Six to eight weeks: physical examination
This involves screening of your baby’s heart, hips and eyes (and testes in boys). Your baby will be weighed and given a general physical examination. You’ll be asked whether your baby is being breastfed or bottle fed.

Eight weeks onwards: vaccinations
Vaccinations are routinely offered at 8, 12 and 16 weeks; 12 and 13 months, and three years and four months. 

Six to eight months: hearing assessment
An infant distraction test is offered if your baby didn’t have the newborn hearing test.

Between 8 and 36 months: general reviews
You may be offered a general review of your child’s wellbeing between 8 and 12 months, and again at around two to two-and-a-half years.

Between four and five years: school entry screening
This includes vision screening, a height and weight check and a hearing test. Your child may also be given a general health review.