PREGNANCY
Looking after yourself
Antenatal care
BIRT H
Planning for the birth
Labour and birth
YOU AND YOUR NEW BABY
Caring for your new baby
Looking after yourself
YOUR GROW ING BABY
Your baby’s development
Health and wellbeing
YOUR TODDLER Bump, You and your child Common challenges Baby & Keeping them healthy and safe Beyond Your journey begins... 1
Contents
Welcome 9 How to use this guide 10 Healthy, happy families 12 Five ways to wellbeing 13
Pregnancy 15 Pregnancy at a glance 16
Looking after yourself 18 Eating well matters to everyone 19 Taking care 26 Active you 28 Your weight in pregnancy 32 Your changing life 33 Dads Information for dads or partners 38 2 3
Preparing for parenthood 40 Birth 73 Smoking in pregnancy 42 Birth at a glance 74 Alcohol in pregnancy 45 Medicine and drugs in pregnancy 46 Planning for the birth 76 Teeth and gums in pregnancy 48 Pain relief in labour 81
Antenatal care 50 Labour and birth 86 Antenatal information and education 51 The start of labour 88 Antenatal care timeline 52 Early labour 90 Tests and checks during pregnancy 54 Coping with labour 91 Vaccinations 55 Checks and monitoring during labour 94 Where to give birth 56 When your baby is nearly ready to be born 95 How will you feed your baby? 58 The birth of your baby 97 Your baby’s movements 60 Being a birth partner 101 Minor problems in pregnancy 62 More serious problems in pregnancy 64 Twins and multiple births 67 Premature birth 68 When pregnancy goes wrong 70 4 5
You and your new baby 103 Your growing baby 149 You and your new baby at a glance 104 Your growing baby at a glance 150
Caring for your new baby 106 Your baby’s development 152 Tests you will be offered for your baby 108 Your baby’s immunisations 154 Feeding during the first six months 110 What you can expect at 1–2 months 156 Things you need to know 124 What you can expect at 3–4 months 157 Car safety 125 What you can expect at 5–6 months 160 Smoke free homes 126 What you can expect at 7–8 months 162 Registering the birth of your baby 128 What you can expect at 9–10 months 164 Babies who need extra care 130 What you can expect at 11–12 months 167 Crying 131
Dads The importance of dads 134 Health and wellbeing 168 Postnatal depression 169 Looking after yourself 136 Giving your baby more than just milk 173 Eating well as a new mum 137 Teething 185 How you may be feeling 140 Safety and your growing baby 187 Getting a good night’s sleep 141 If your baby is ill 190 Relationships 144 Very serious illnesses 192 Sex and contraception 146 6 7
Your toddler 195 Common challenges 222 Your toddler at a glance 196 Temper tantrums 223 When mealtime is a battleground 225 You and your child 198 Toilet training 227 Getting the basics right 199 A good night’s sleep 230 Eating well for toddlers 203 Concerns about sexualized behaviour 232 Childcare 209 Learning to talk 212 Keeping them healthy and safe 234 What you can expect at 12–24 months 216 Daily health care 235 What you can expect at 25–36 months 218 Minor illnesses 238 We are a family 220 More serious illnesses 241 If your child starts choking 242 Specialised health needs 243 Making your home safe 244 Your health service 249
Index 250 8 9
Welcome
This book has been written by parents, health professionals and child psychologists. It is packed with useful information which will support you all the way from the early stages of pregnancy, through to the early days with your baby and into the toddler years. We hope you enjoy this book and that the information it provides will give you confidence and help you to enjoy being a mum or dad. 10 11
The words we use Thanks to How to use this guide Throughout the book, your baby is called ‘she’ • The mums and dads who have shared their in some chapters and ‘he’ in others. This is experiences, ideas and questions and given This book is split into five sections simply because it’s less confusing than using us feedback as we have developed the book ‘he or she’ throughout. • NHS Health Scotland (www.healthscotland. to make it easy to follow and find the com) for their kind permission in the use of Families come in all shapes and sizes, including their content in the production of this book information that you need quickly. single parents and this book is for everyone. • The health and early years’ professionals Feel free to share this book and the information across Wales who have contributed their in it with other people who are important in expertise your baby’s life. This book also avoids assuming • First Steps Nutrition Trust who have that everyone is in a heterosexual relationship supported Public Health Wales with the
and includes information for same sex couples. nutrition information How to use this guide • The New Economics Foundation who Part one: Pregnancy Part three: You and your new baby gathered the evidence and developed the ‘Five Ways to Wellbeing’ concept Find out about your pregnancy, Information about how to look • Tommy’s, a charity which funds research into pregnancy problems and provides information including how to look after after yourself and your baby, Your thoughts and feedback yourself, what to expect from during the first few days and to parents, who have helped us with the antenatal care and how to weeks. We are always looking for ways to make information in the pregnancy section
How to use this guide to use this How prepare for parenthood. this book more interesting and relevant so let us know what you like and what Part four: Your growing baby you want to see more of by emailing: Part two: Birth Information and ideas about [email protected] Find out about giving birth, how caring for your baby up to his you can prepare for the big day first birthday. or by writing to: and what it means to be a birth Dads and partners: partner. Public Health Wales Keep a look out 2 Capital Quarter Dads Part five: Your toddler for this symbol Tyndall Street throughout the book Cardiff Information and tips to help for tips and advice for CF10 4BZ you enjoy the toddler years. you and your important role. 12 13
Healthy, happy families Five ways to wellbeing Parents want their children to be There are five things, that all of us happy and healthy, for you this can do, day to day, to help us feel journey starts now. You can make better. Lots of parents say they like a really big difference to the health these ideas and find them helpful. and happiness of your child by
the way you look after yourselves. waysFive to wellbeing Connect with the people around Keep learning as there’s a lot to Getting things right early on will you, your friends, family, partner and learn when you are pregnant and people at work. Make new friends new parents. Knowing more about help your child to get off to a good with other pregnant mums through what’s going on and what your baby classes or local groups, they will give needs will help you feel more calm start, physically and emotionally. you support when your baby is born. and confident.
Take notice of the changes in your Give your partner a little time Healthy, happy families happy Healthy, body, of the world around you. Enjoy – talk to one another about all the Feeling good: Wellbeing Becoming a new parent is a big change and the little things. changes in your lives and give your We don’t just want to be healthy, we want big changes can be challenging and affect friends and family chance to spoil to enjoy life too and we want the same for how we feel. We need to look after our own Be active, perhaps go for a walk, you and look after you – they’ll our children. Being able to do things that are wellbeing because it will help us to cope better or a swim, or dance to your favourite want to – make the most of it. fun, get on well with family and friends and with the ups and downs of pregnancy and music. Exercising makes you feel cope with the challenges that life throws at being a parent, the day to day things that life good and helps your body cope us are all important. This is what we mean throws at us, or when our lives are difficult. with the changes of pregnancy. by ‘wellbeing’. It is about living in a way that helps us and those around us to feel good Wellbeing doesn’t just happen on its own. and function well. We have to work at it. Think about it as Look out for the symbols something you do, not what you are. throughout this book. 14 15
Pregnancy
Pregnancy is an incredible time of change. Sometimes it is planned, often it’s a surprise. Either way the reality can take some time to get used to. You will have lots of questions and perhaps some worries too. A great team of health professionals are there to support you and are happy to answer any questions you may have – even if you think they might be silly ones!
Your midwife will be your main contact during your pregnancy and for the first few days after birth. 16 17
Pregnancy at a glance Keep yourself active Dads/Partners Staying active will help you to feel Give lots of support to your Looking after yourself is really important. good and get you out and about. partner and get involved. Dads Walking and swimming are great fun. Remember that your wellbeing is Your health and wellbeing now will affect important too. your baby’s growth and development. Be aware of your baby’s movements If you are employed Talk to your ‘bump’ Take pregnancy vitamins This is a good indicator of your baby’s Remember to tell your employer that you are Sing to her. Think about your new baby Take a folic acid supplement and a vitamin wellbeing. Let your midwife know pregnant. You need to do this before you as a little person. Your baby will get to know D supplement or a Healthy Start vitamin if urgently if they slow down or change. are 25 weeks pregnant. the sound of you and your partner’s voice. It you’re eligible for the Healthy Start scheme. will bring you closer together. But avoid supplements containing vitamin A. Think about your baby’s Get to know your midwife growth and wellbeing Your midwife is there to help you. Go to Take time to relax Vaccinations Smoking, drinking alcohol or misusing drugs all your appointments and ask questions. Have fun and de stress. It’s a good Some illnesses such as flu or whooping are not good for your baby. They Contact your midwife at once if things don’t thing to do for yourself and your baby. cough can cause serious problems for can increase your chances of having feel right with you or your baby. you and your baby. Your midwife will problems during the pregnancy. In rare cases talk to you about getting a jab to these things can cause your baby Follow your instincts Eating well protect you and your baby. to die before she is born. Contact your midwife at once if things don’t Eat plenty of good healthy food but feel right with you or your baby. Don’t worry eat for one, not two! Putting on too Go to antenatal classes Relationships that you may be wasting people’s time, you much weight, or trying to lose weight won’t be, even if everything is okay. If you in pregnancy can be harmful. Learn about birth and ways to help you cope Talk with your partner, family or friends and keep calm. Meet other parents there. about your pregnancy and how you are can’t get hold of your midwife, call your They will be going through the feeling. It’s important that dads talk maternity unit or your GP. Don’t drink alcohol or smoke same things as you. about their feelings too. Let others help It’s time to think about cutting out alcohol or you when you feel tired. Talk to your stopping smoking to reduce the risks these midwife if you feel lonely or isolated. activities pose to your baby. 18 19
Looking after yourself Eating well matters to everyone It’s not just you now – you’re growing Everyone wants the best for their a baby. You’ll want to know what you family and eating well is a great should be doing and avoiding to give way to help your children have a your baby the best possible start. fit and healthy future. Having a new
baby is a good time to think about Eating well matters to everyone how everyone in your family eats. In this section we will look at: • Eating well matters to everyone In these pages we cover • Taking care the main topics expectant • Active you Eating well need not be expensive, difficult parents tell us they want • Your weight in pregnancy or dull! Try these tips: Need to brush up on your to know about and provide • Your changing life: • Eat a wide range of different foods cooking skills? lots of links to extra - Emotions • Make meals colourful with lots of different - Work vegetables and fruit Looking after yourself after Looking information if you want Find out about - Relationships • Cook food from basic ingredients where more. If you are worried or • Information for dads or partners you can. It is cheaper, tastier and you will cookery classes want to speak to someone, • Preparing for parenthood know what went into it in your area by asking ask your midwife – she’ll • Smoking in pregnancy • Try and make meals that everyone in the your midwife, local Flying be pleased to help you. • Alcohol in pregnancy family can enjoy Start service, family • Medicines and drugs in pregnancy information service or • Teeth and gums in pregnancy library. There might Tips for healthy eating More recipes and ideas for healthy also be courses at the Further information snacks can be found on the First Steps local college and some See NHS choices: Your pregnancy and baby guide. Or visit www.readysteadybaby.org.uk Nutrition website. Look for schools offer family Or you can call Tommy’s midwives for free expert advice on healthy pregnancies ‘Eating well in pregnancy’. cooking classes. on 0800 0147 800, or visit www.tommys.org, or email [email protected] www.firststepsnutrition.org 20 Eating well during your pregnancy Eating well during your pregnancy 21
Nia (15 weeks pregnant) Becki (8 weeks pregnant) Anna (30 weeks pregnant) Yasmin (20 weeks pregnant)
Nia lives with her partner Dave and works Becki lives with her family and is currently Anna is a busy mum to two other children Yasmin lives with her husband Mahboob and part time at a local department store. studying at the local college. Sophie and Tom. toddler, Fatima age 18 months and works part time in the local building society
For breakfast Nia has a bowl of Becki often feels a bit sick when Anna gets Sophie ready for school whole grain cereal and raisins she wakes in the morning, so has and takes her daily vitamin Yasmin gets up early and with milk, a small glass of a decaffeinated fruit tea and some supplement with a glass of the family have breakfast orange juice and her daily dry toast and a daily vitamin orange juice while they all together, whole wheat cereal vitamin supplement. supplement recommended to sit down to porridge and with milk and fruit and her by her midwife. toast with honey. Yasmin has a cup of fruit tea. Eating well matters to everyone
During the morning at work she has a As she is not going to college Anna takes Sophie to school and She takes Fatima to her mother’s milky decaffeinated until later today, Becki Tom to playgroup where she and when she gets to work has a coffee, two digestive makes herself breakfast of has a milky coffee and snack of fruit and a muffin. biscuits and an apple. a scrambled egg on toast some fruit cake with and a glass of milk and the other parents there. has an apple as a snack. Yasmin has lunch with a work She finishes work at colleague and brings in a 2pm and heads home She and Tom go home and couple of samosas and for lunch, where As food at college is expensive after he has a sleep they salad from home and has she has a has a ham and Becki packs a tuna and have lunch of fish pie a glass of fruit juice. tomato sandwich and a sweetcorn sandwich, some and broccoli, followed banana and yoghurt. cucumber sticks and by yoghurt and fruit.
Eating well matters to everyone well matters Eating a low fat yoghurt. After picking Fatima up at 3pm Yasmin returns home Dave comes home from work She picks Sophie up from school and on and they share a snack of after his shift at 8pm and After lectures she visits the way home they all go to the fruit and some bread sticks. they sit down together to a friend at home and they park and have a snack of plain spaghetti Bolognese and have a toasted teacake rice cakes and grapes that a mixed salad. and a milky coffee. she has brought with her. When Mahboob comes home they eat a lamb and vegetable curry with rice and pear and kiwi chopped In the evening Nia When she gets back she eats supper Anna gives the children their tea but with natural yoghurt. has a milky decaffeinated tea with her family and has a jacket waits to eat with her partner and a piece of malt loaf. potato with chilli and salad. when he is back from work, During the evening she they both have chicken During the watches a film and has stir fry with rice. evening she has a small bowl a bowl of fruit salad. of nuts and a glass of milk. 22 23
Healthy Start Vouchers and food banks You may be entitled to Healthy Start vouchers Lots of fruit and Drinks which contain Women are advised not to which you can use to buy milk and fresh and vegetables for essential caffeine such as drink alcohol at all during frozen vegetables and Healthy Start vitamins. nutrients. Aim for five tea, coffee, cola pregnancy, you may find different types a day. and energy drinks that you go off the idea You can check your eligibility for these should be limited of drinking while you’re vouchers by visiting www.healthystart.nhs.uk in pregnancy. Swap to pregnant anyway, lots of or by speaking to your midwife. Starchy foods such as decaffeinated coffee and tea. women do. bread, potatoes, pasta, rice and breakfast Otherwise have no more than; If you’re struggling to buy food as a result of one mug of filter coffee, or cereals for energy. • financial difficulties you’re facing, please speak Eating well matters to everyone Choose whole grains two mugs of instant coffee, or Foods which might give you food to your midwife about getting vouchers to visit • two cans of energy drink, or where you can. poisoning, like undercooked a food bank. • three mugs of tea. or raw meat, raw or partially • cooked eggs, undercooked ready meals and raw Protein–rich food shellfish (but you can twice every day Snacks and drinks that are high in fat eat cooked shellfish). including meat, and/or sugar and salt have limited poultry, fish, eggs, benefit to you and your baby. Try beans, peas, lentils, swapping them for healthier ones nuts, Quorn and other instead such as fruit, unsalted nuts/ Food which might contain a bacteria meat alternatives to help your seeds, a piece of toast, water or called listeria which might harm your body with growth and repair as well decaffeinated tea or coffee. baby such as unpasteurised milk or as providing other essential nutrients cheese, cheeses such as brie
Eating well matters to everyone well matters Eating such as iron and zinc. and camembert or goats’ cheeses that have a similar Fish is good for you; aim to rind, blue cheeses that Milk and dairy foods like plain eat at least two portions are made with mould yoghurt and cheese are and any pate. good sources of calcium. of fish a week. If you eat Unsweetened calcium fish every day or unusual fortified soya milk can fish check for more also be used instead Foods which are rich in vitamin of cows’ milk. information on NHS A, such as liver products and any choices, or ask supplements containing vitamin your midwife. A (which might be called retinol on the label). 24 25
Useful tips for avoiding food poisoning Vitamins for everyone in pregnancy Your questions: • Always wash fruit and vegetables, including All pregnant women should take a folic acid fruit or salad from pre–packed bags supplement as soon as they think they are I am a vegetarian. Is it okay to avoid • Always wash your hands and any equipment pregnant, or before that if they are planning Can I eat spicy food and curry when I meat during my pregnancy? used, such as knives and cutting boards, a pregnancy. They should also take a vitamin am pregnant? Yes, it is perfectly possible to eat well as a after handling raw meat or fish (to avoid D supplement as soon as they find out they There is no need to avoid spicy food or curry. vegetarian and to get all the nutrients needed salmonella poisoning) are pregnant. Check with your midwife about Lots of people eat mainly spicy food. Some for a healthy pregnancy. You will have a blood • Stor e raw foods separately from cooked which supplements are the best to buy. women may find spicy food is linked to test in pregnancy to see if you need extra iron. foods and don’t let raw foods touch heartburn later in pregnancy. If you do you will be given iron tablets. cooked foods, particularly meat and fish All pregnant women under 18, or are claiming
• Use separate chopping boards for raw benefits, are entitled to free Healthy Start I don’t like milk. Where else can I get Is it alright to carry on eating fast food Eating well matters to everyone food and ready–to–eat food vitamins. Find out more by visiting www. my calcium? like fried chicken when I am pregnant? • If you buy chilled ready meals keep them healthystart.nhs.uk or speaking to your Any foods made from milk contain calcium, Fast food like fried chicken, chips, burgers in the fridge until you are ready to cook midwife. such as yoghurt, fromage frais and cheese. and kebabs are high in fat and salt and them. Then make sure they are cooked If you don’t eat dairy foods then unsweetened should only be eaten occasionally. thoroughly until piping hot inside Taking supplements when you’re pregnant calcium fortified soya milk is a great alternative. • Cook food well when you are pregnant. Avoid any herbal preparations and teas, or A diet that contains a lot of fast food will be Meat must be cooked all the way through non–food substances unless you have checked Is it safe to have probiotic drinks and low in important nutrients, so think about and eggs should have a hard yolk with your midwife they are safe. There are yoghurts when I am pregnant? swapping them for more nutritious foods. • W ash your hands if you blow your nose some old wives tales about things that can be It is fine to drink or eat live probiotic drinks (or help a child blow theirs) or handle pets good in pregnancy or to hurry along the birth, or yoghurts when pregnant, but they do not Do I need chocolate and sweets or sugary before or during food preparation*. but most of them aren’t true and some herbs provide any special benefits for most people. drinks for energy when I am pregnant?
Eating well matters to everyone well matters Eating and other substances might be harmful. No, you don’t need to eat or drink sweet Can I eat shellfish like prawns? things to provide extra energy. Sugary foods As long as shellfish are cooked thoroughly, and drinks are often high in calories and low it is fine to eat them when you are pregnant. in other nutrients. They contain the type of sugars that damage teeth, so limit your Washing your hands when Can I have honey when I am pregnant? intake of these. Be careful! preparing food is one of the Yes, but don’t give honey to babies under Don’t take supplements with best ways to prevent the one year of age. vitamin A in them when you spread of bacteria and keep are pregnant as too much your family safe. vitamin A can harm your baby.
*For more information on hand washing, see page 26 26 27
Avoiding serious infection from animals Sheep, cattle Taking care Zoonoses are infections that pass from animals and goats to humans. They are rare, but some may harm A number of Preventing the spread of bacteria pregnant mums or their unborn baby. diseases that cause abortions and infections during pregnancy is Cats in sheep, cattle Cat litter and cat and goats and can very important for the health of you poo can contain be passed on to and your unborn baby. toxoplasmosis humans. Although the risks of this are low, infection. To to protect yourself: protect yourself: • Do not help deliver lambs, calves or kids • W ear gloves when you garden (even if • Do not milk ewes Preventing the spread of bacteria by washing hands thoroughly you don’t have a cat), in case the soil is • A void contact with aborted or newborn contaminated with cat poo lambs, calves or kids and with the afterbirth, • W ash your hands and gloves thoroughly birthing fluids or contaminated materials, careTaking after gardening or handling soil such as bedding Wet your • A void emptying cat litter trays when you’re • A void handling (including washing) clothing, hands with pregnant – if you can’t get somebody else boots or any materials that may have come water and to do it, wear disposable rubber gloves and into contact with animals that have recently
Taking care apply soap to cover wash your hands thoroughly afterwards given birth. Clothing will be safe to handle your hands surface. • Make sure cat litter is changed every day (the after being washed on a hot cycle litter tray should also be cleaned every day • Make sure your partner or close friends and Rub hands palm to palm Rub left palm over the Rub right palm over the back of the right hand back of the left hand and filled with boiling water for five minutes) family who have attended to any animals • Make sure you wash your hands thoroughly giving birth wear protective clothing and if you come into contact with cat poo have a good wash afterwards
Rinse • Avoid close contact with sick cats hands with • W ash your hands thoroughly after water, dry handling cats Further information thoroughly Please visit: www.gov.uk with a clean towel and use towel to When to get medical advice Rotational rubbing, with turn off Wear gloves when you garden (even Seek medical advice if you have a high Backs of fingers to Rotational rubbing of left clasped fingers of left tap. if you don’t have a cat), in case the opposing palms with thumb clasped in right hand in right palm and temperature, flu-like symptoms or you think you fingers interlocked palm and vice versa vice versa soil is contaminated with cat poo. may have an infection from a farm environment. 28 29
Becoming more active: Activities to avoid Active you • Don’t suddenly take up strenuous exercise • Don’t do sports where you could have a – start gently. Try walking part of the way hard fall, or where you might be thrown The more active you are during to work, or take a stroll with a friend or off balance, or get hit in the stomach your partner in the evening • You may hear advice not to cycle while pregnancy the more easily you will • Swimming is great in pregnancy because the pregnant. This is because your sense of water supports your weight. Lots of pools balance changes, which may make you be able to: avoid putting on too much have aqua natal classes. Your local leisure more likely to fall off. If you are an weight, cope with labour, get back to centre or council swimming pool will give you experienced cyclist, you should be safe details. If you want to join an exercise class, to continue as usual, but if you feel less your normal weight and fitness once let the instructor know you are pregnant. stable then stay off the bike to be on the You could try pregnancy yoga, or low–impact safe side. Cycling on an exercise bike is safe you have had your baby and cope with aerobics which has no high kicks or leaps • Exercising flat on your back after four • Ask your midwife what’s going on locally months may make you dizzy so avoid it
being a busy mum with a baby and for pregnant mums Active you • If you have a disability which makes physical then toddler. activity a challenge talk to your doctor about the types and amounts of physical activity
Active you Active that are right for you. Ask your midwife to refer you to the exercise referral scheme for Staying active Getting moving support from an exercise professional Keep up with your normal daily physical If you haven’t been very physically active now activity for as long as you feel comfortable, is a great time to start. It will be much easier to like walking to work or the shops, playing start now than when you have a baby to care sport, running, dancing, or going to exercise for and you can build activity into your routine. classes. If you have any worries check with A mum’s view: your midwife whether it is safe to continue. Many women find that taking exercise when they are pregnant helps them to adjust to the Listen to your body carefully and don’t push changes that happen to their body and feel “I was very active throughout my pregnancy, up until the yourself. You will need to slow down a bit. well. Making exercise part of your daily routine week before I had Cora I was doing Zumba and swimming. The As a general rule you should be able to hold now will mean you’ll have more energy as a midwives said that because of my fitness the pushing stage a conversation during exercise when you are mum and encourage your children to grow was over very quickly because I had the physical strength pregnant. If you become breathless as you up healthy and active. to do it.” Rachael from Tywyn talk, slow down. 30 31
Keeping your bladder control Belly button test Pelvic floor muscles are important because If your belly button remains relatively still EXERCISE ONE: EXERCISE T WO: they help prevent ‘stress incontinence’, which while performing a pelvic floor exercise, is when you leak a few drops of wee when your technique is correct. you cough, laugh or run. It’s very common to feel you have no control over these muscles Mirror test • Imagine you are trying to • Squeeze and lift as in late in pregnancy and for a couple of days Using a mirror, look at your vagina and stop yourself passing wind. exercise one. – maybe weeks – after the birth. If you do back passage. When you do a correct pelvic these exercises in pregnancy, the muscles floor contraction, there should be a small • At the same time, imagine • Let go straight away. will be stronger and your chances of stress movement of the muscle away from the that you are trying to stop incontinence will be less. mirror. More importantly you should not see the flow of urine. Repeat 10 times. • any bulging towards the mirror as it means It will feel like squeezing Don’t: How to do the exercises you are bearing down. • shut and lifting the back and It is really important to find the correct Tighten your buttocks. front passages. • muscle and the best way to do this is by Vaginal test Active you
doing the following. This one is really important, because it will tell Hold your breath. Start by trying to hold for • you what your muscle is actually doing. Place • three seconds. Rest for five Tighten around the back passage as if to stop your finger or thumb into your vagina, then Squeeze your thighs together. seconds then repeat the •
Active you Active passing wind. Now tighten your muscles as do a pelvic floor muscle contraction. If you are exercise. Don’t stop the flow of wee if stopping a wee. Aim for an upwards and doing this correctly you may feel your finger midstream as an exercise. forwards lift, trying to bring the back passage lift in an upward and forward direction. With Build up to holding for ten This can mean you don’t fully towards the pubic bone. Make sure you fully strong muscles you may also feel your finger • seconds. empty your bladder and increase release the muscles following the lift. This is being drawn inside. If your finger is being the risk of infection. called a pelvic floor contraction. pushed out, it means you are bearing down. Repeat this process up to ten If you feel nothing, don’t worry, you may not times and do five sets per day. It is easy to use the wrong muscles when be using the correct technique or your muscle trying to do a pelvic floor contraction, but may be weak. the following tests will help. Once you feel you are getting the hang of exercise one and are able to hold each squeeze for at If you are having a problem You can do pelvic floor exercises anywhere and no one will least five seconds then you can controlling your bladder notice. You should aim to do them several times a day. have a go at exercise two. tell your midwife, 32 33
Your weight in pregnancy Your changing life Some pregnant mums worry about Becoming pregnant and having a baby their weight. The most important is a huge life changing event which thing is to eat well and be active. can be a bit overwhelming at times. Even if you started your pregnancy heavier than recommended for your You might not have told many people that Pregnancy is an emotional time. It can be quite height, you should not try and lose you are pregnant yet and are still coming to challenging and stressful. It can also feel like terms with the idea yourself, particularly in another pressure on top of everyday things, like Your changing life weight in pregnancy. early pregnancy when you don’t look any money worries, your job, family or relationship different from the outside. problems. If you are struggling, getting help and support early on is really important. How you may be feeling Eat for one and be healthy for two A healthy diet and keeping active will help you: Pregnancy hormones can really affect how Some tips which may help: Sometimes people say you should ‘eat for two’, • Have a more comfortable and enjoyable you are feeling. Sometimes you can feel over • Talk about how you feel with your husband, but this could cause you to gain too much pregnancy the moon, then down in the dumps within a partner, friends or family members, it can
Your weight in pregnancy weight Your weight during pregnancy. In general, women • Reduce the risk of pregnancy complications matter of minutes. That’s normal. It can also help you feel positive and cope with stress only need an extra 200 calories a day in the • Have less weight to lose after you have had be difficult to cope when everyone expects you • Relaxation exercises are one way to manage last 12 weeks of pregnancy. Try to use the extra your baby to feel happy and excited about the new baby. stress, it’s a great idea to learn some now calories wisely, choosing healthy options, such Some women feel anxious about things like the • Keep active. Exercise helps our bodies deal as a small pot of low fat yoghurt and a banana. birth, or whether the baby will be healthy. with stress and improves our mood • Share your worries and concerns with There’s no ‘normal’ way to feel while you’re your midwife or GP. They will provide a pregnant and everyone is different. Your sympathetic ear and can put you in touch Further information midwife will talk to you often about how with local support if you need it If your body mass index (BMI) is high you you are feeling. may need extra care during pregnancy. For more information talk to your midwife Further information or go to www.tommys.org www.stepsforstress.org 34 35
Mental health problems in pregnancy The world of work Your questions: Benefits payments Around 1 in 10 women will have mild to Now you are pregnant you may have questions Working out what money is due to you moderate depression during pregnancy. or worries about your work, like when to tell during and after your pregnancy can be quite Some women may feel down and anxious your employer, when to start maternity leave, I’m pregnant and want to have as complicated. For up–to–date advice, check without becoming depressed. If this happens what benefits and payments you are entitled much time off with my baby as possible with your employer, your trade union or your there are things you can do that will help, to and what rights you have. after she is born. When should I start my local Citizens Advice Bureau. like exercising, using self–help strategies or maternity leave? short–term counselling. When to tell work You cannot start your maternity leave until What you decide to tell your colleagues 11 weeks before the baby is due. You are Further information If you have more severe depression, your and employer and when, will depend on a allowed to work right up to the day the baby About benefits payments: www.adviceguide.org.uk or doctor or midwife should discuss treatment few things, including your relationship with is born and take all your leave after the birth. www.maternityaction.org.uk options with you. Those who have suffered your boss and how you are feeling early in However, you may feel you need to leave work from depression before can be more at risk. pregnancy. It’s a good idea to make sure your a few weeks before the due date. Everyone employer hears the news from you and not feels differently and it is your decision. Relationships Your changing life However you are feeling there’s no need through workplace gossip. Families come in all shapes and sizes. You may to suffer in silence. If you think you may be on your own, with a committed partner, in be depressed, or someone close to you is You may not want to tell anyone until you’re Further information a same sex relationship or with a partner but concerned about you, please don’t be past the first 12 weeks, but you may need to About maternity leave, maternity pay, not quite sure about being together. Whatever your rights at work and paternity leave afraid to mention it to your midwife or GP. let people know sooner. For example, you may your circumstances, you will probably find that go to: www.gov.uk or You are not wasting people’s time or going want to let your boss know if you’re suffering being pregnant changes you, those around you
Your changing life changing Your www.maternityaction.org.uk mad and they will be pleased to help you. bad morning sickness, or if you are particularly and the way you relate to one another. tired or are having other health problems. Your If you already have a mental health problem antenatal rights don’t start until you’ve notified Let those around you know how you are don’t stop taking your medication. Always your employer. They will have to make sure feeling and what you need. They will want talk to your midwife or doctor first. that the kind of work you do and your working to give you extra love and attention. If you conditions will not put your’s and your baby’s feel very lonely and isolated, let someone The ’Five Ways to Wellbeing’ have benefits health at risk. know. Your midwife will be able you put you for everyone, whether your are feeling great, in touch with local sources of support. or finding things tough from time to time.
Remember you have to tell See pages 12 and 13 for your employer before your more on wellbeing 25th week of pregnancy. 36 37
Couples Domestic violence Women and men sometimes find their desire Pregnancy is bound to bring Sadly 30% of domestic violence starts in for sex changes during pregnancy and both A midwife’s view: about some quite big changes in pregnancy, or if it is already happening gets may go off it. This is not serious or long–lasting. your relationship, especially if this worse. If this is your experience you are Keep your closeness with lots of warm, physical “Parenting education is your first baby. For some people these probably concerned both for you and your contact that need not lead to sex. If sex played changes happen easily and others find it baby and you are right to be worried. It’s an important role in your lives before, then the classes are great, harder to change. Everybody is different. important that you seek medical attention feelings are very likely to come back in time. they will give you loads of after your partner has hit you. If you are information. The sessions It is quite common for couples to find concerned about violence in your relationship, Being a single parent will add to your knowledge themselves having arguments every now and talk to your midwife. If you’re on your own, the whole business and help you feel confident then during pregnancy, however much they of pregnancy can seem daunting. You may and prepared for what are looking forward to the baby. Some of these Sex during pregnancy feel lonely, especially if it seems as though is ahead. You will cover may be nothing to do with the pregnancy, Sex is normally perfectly safe in pregnancy. everyone else has a husband or partner to but others may be caused by one or other Any sexual activity that doesn’t harm you help them through it. pregnancy, birth and Your changing life partner feeling worried about the future and will not harm your baby. You don’t risk afterwards including how they are going to cope. Perhaps the hurting or affecting your baby. You may be worried about giving birth on feeding your baby and how most important thing to realise is that during your own and how you’ll cope when the to cope with the lack of pregnancy there are understandable reasons Is it ever risky? baby is born and is growing up. You may sleep. It is also a great way for the odd difficulty between you and good Your baby is protected in your womb by the have family or friends nearby and they will of getting to know people, reasons for feeling closer and more loving. bag of fluid which cushions movement. Your probably be happy to help out if you let them Your changing life changing Your baby may feel the movements of vigorous know what you need. That may be anything who live locally and are However, if your relationship is particularly sexual activity, but they won’t do her any harm. from a shoulder to cry on to going along going through the same difficult, or if you are in an abusive relationship, Occasionally, women who have had a number to antenatal classes with you. thing as you. If you are do seek help. of miscarriages may be advised not to have going to be a single mum, sex around the time their period would have You may also want to think about who you’d having twins, in a same sex been due, or even not at all during the first like with you at the birth. It may help to talk relationship or have other three months. There’s no evidence that sex to someone who is in the same situation, individual needs, speak to and miscarriage are linked though and some or who has been through it before. Your Further information your midwife, she may be For sources of confidential support, contact doctors disagree about how to advise couples midwife may be able to put you in touch with www.welshwomensaid.org.uk in this situation. someone locally or a national support group. able to arrange sessions or call the All Wales Domestic Abuse and that address things that Sexual Violence Helpline, on 0808 801 0800 are more relevant to you.” or contact Relate Cymru on 0300 100 1234 Further information Sarah, Abertawe Bro Morgannwg or visit: www.relatecymru.org.uk www.gingerbread.org.uk University Health Board 38 39 Dads
The ‘Five Ways to Wellbeing’ and you Healthy baby, healthy you Information for dads or partners These are simple things you can do to feel It seems obvious that a pregnant mum needs good and better able to cope with the to look after herself to help her baby be As the main supporter for a challenges that life throws at you. You can healthy, but so do dads. Looking after your have a read about them on page 13. Have a health now has lots of benefits: pregnant woman and an expectant think about how many of these are already • If you smoke you will damage your growing part of your life – can you spot an area that baby’s health. Stopping will help your baby parent yourself, your feelings and would be good to make some changes in? and will be supportive to your partner if she is trying to give up too needs can sometimes be overlooked. If you are feeling good and functioning • Eat well and take exercise. Mum is being
well you will be better able to support your encouraged to eat healthily and keep active Information for dads or partners partner and cope better with the challenges and if you join in too it will help her. You will of becoming a parent. both begin life with your new baby feeling Your role is really important. We know that more involved with their children’s day–to– better and more able to cope with the the early involvement of a dad or partner has day lives and emotional needs. Dads who get stresses and strains of being new parents many benefits for children and your support involved during the pregnancy tend to spend See pages 12 and 13 for • Setting good habits now makes it easier will be invaluable to your partner too. more time with their babies after birth. Dads to have a happy and healthy family life as more on wellbeing say that listening to their baby’s heartbeat, your baby grows Your feelings seeing their baby on a scan, or even buying Finding out your partner is pregnant can something little for the baby makes them be an emotional rollercoaster. You are feel more involved. Families that do not live together A dad’s view: probably finding that your partner is very It is not unusual for babies to be born into emotional too – the hormones of pregnancy Supporting your partner families where dad does not live with mum Information for dads or partners dads for Information can make women very tearful and dealing You will want to support your partner, but and baby. If this is how your family is living, “I made a point of going with all this is not easy. Confide in friends knowing how can be difficult, especially if she remember that dads are important wherever to all the appointments. who are already fathers/parents and who is feeling very tired and sick in early pregnancy. they live. You can still be involved. Getting The appointments seem know what you are going through. She may be grumpy and it can be difficult to involved at this early stage, supporting your to be aimed at my wife, know what to do for the best. Knowing more baby’s mum, adopting a healthier lifestyle, but I wanted to be able to The role of fathers has changed over the years. about what’s going on and what to expect can going to appointments and being at the support my wife by knowing Lots of dads are much more involved with the help you feel more confident. You will be very birth mean you will stay more involved as care of their children and studies show that welcome to attend antenatal appointments and your baby grows. Ask your midwife for a what was happening or children really benefit from this. Some men ask questions and lots of areas run sessions to second copy of this book if you are not going to happen.” want to be a different kind of dad from the help you prepare for parenting, or dads groups. living together as a couple. James from Cardiff one their own father was, including being Ask your midwife what’s going on in your area. 40 Dads 41
Ideas to help you bond with your bump What your baby can do Preparing for parenthood • Put on some of your favourite music and Your growing baby can: notice whether she seems more active or • Hear your voice and those around you, taste Your baby’s experiences and what’s whether she goes to sleep (what mum has eaten through the water she • Try playing gentle, soothing music while you is surrounded by) and after 6 months smell around her, both in the womb and are going to sleep. See if she remembers • Sense the rhythms of your daily life it and goes off to sleep after she is born in early life, will lay down her • Babies love nursery rhymes and songs – if Towards the end of your pregnancy your foundations for health and wellbeing. no one is around why not sing a few songs? baby will: • When you feel a kick, put your hand on your • Have her own cycle of rest/activity stomach and say it’s okay I am right here! • Respond to things – may kick in response • Try sitting down and relaxing. Gently rub to loud noise – calm if you chat to her Preparing for parenthood You as parents are your baby’s most Bonding with your bump your bump and ask your baby how she is important influences on her wellbeing and Mums and dads who connect with their • Get your partner to do the same and have Born ready to say hello development. Loving, caring for and taking growing baby will cope better with the sudden a chat with your baby Your baby will be born ready to form a strong notice of your baby as well as good nutrition changes of having a newborn. Connecting • As you go from one activity to another, talk loving bond with you, her parents. If the birth and protection from toxic substances such as with your baby means thinking of her as a to your baby as though she were right there has been straightforward, with not too many tobacco, are essential for your baby’s growth, little person, talking to her, imagining what in front of you. Say what you are doing. drugs, your baby will have a quiet alert period wellbeing and development. All these things she will be like and what life will be like when “Okay, let’s see what we are going to have after birth, you will see her turn her head together have a direct and lasting impact on she arrives. for dinner. Are you hungry?” towards your voice – which is familiar and she your baby’s physical development (particularly will be attracted to your face. From birth your
Preparing for parenthood parenthood for Preparing brain growth) and on her future health, People often talk about bonding – and by this Thinking about what life will be like when baby is learning to feel comfortable, safe and learning and behaviour. they mean the close loving feeling you have for your baby has arrived is helpful. It can be secure in the world. By responding to your your baby – as if it happens when your baby is hard to imagine, especially if it’s your first baby baby’s signals and providing lots of love and There’s lots of information in this book to in your arms – but it can start way before that. and even more so if you don’t have friends or comfort, you help her to form a trusting bond help you, most of what makes a good mum family with babies or young children. with you. It’s trial and error at first – it takes time and dad is simple stuff that you’ll want to do to get to know your baby – trust your instincts – one great thing is that you can start now. and know that just being there is enough.
Mums – share this with your partner – it will help them start thinking about your baby as a little person with needs and feelings now which will make life easier for all of you when she is born. 42 43
Mothers who smoke have an increased If you stop smoking now Smoking in pregnancy risk of miscarriage and stillbirth. Their baby • Your baby will feel better immediately may be born too early and weigh less than • Y ou will be healthier during your Stopping smoking is the best thing normal. A baby with a low birth weight pregnancy and cope better with the birth may pick up infections more easily, can have • Y our baby is less likely to be born too you and your family can do for your difficulty in breathing at birth and can have early and/or be born underweight health problems that last throughout childhood • Y our baby will have a greater chance baby. The earlier in your pregnancy and beyond. Smoking in pregnancy also of growing up healthily increases the risks of sudden infant death • You will reduce the risk of cot death you stop the better, but it is never syndrome (cot death). too late to stop smoking. Second hand smoke (passive smoking) E–cigs Even if you’re not a smoker yourself, breathing
E-cigs are growing in popularity and many in cigarette smoke can still harm you and Smoking in pregnancy people are switching to them as they are your baby. Studies have shown that second Why you should stop believed to be less harmful than smoking hand smoke can also reduce birth weight When you smoke, carbon monoxide and tobacco. At the moment we have no scientific and increase the risk of cot death. You are your baby’s whole over 4000 other harmful chemicals pass research to tell us about the possible effects. world. By looking after through your lungs, into your blood stream We believe they are likely to be less harmful If a family member smokes, then you should yourself; you are also and are then passed on to your baby but we do not know for sure. In pregnancy it talk to them about the effects on you and your looking after your baby. through the placenta. is important to be particularly careful, so we baby. They may not be aware of the impact of recommend stopping smoking altogether. what they’re doing. Encourage them to give Smoking in pregnancy Smoking These chemicals can seriously harm your up, particularly if you share a home. In pregnancy, it’s important not to do some baby, because: things that might have been part of your life • Y our baby gets lower levels of oxygen Further information before. Sometimes it’s hard to make changes, and nutrients and cannot grow as well Call Help Me Quit on 0800 085 2219 but thinking about your new baby is a great as she should or text HMQ to 80818 or visit motivator and there is lots of support out • The nicotine makes your baby’s heart www.helpmequit.wales there so now is a great time to make changes. beat faster which can put a strain on her heart Stopping smoking is one of the
The best way to quit smoking most beneficial steps you as is with free NHS help and a parent can take to improve support. the health of your baby. 44 45
Avoiding second hand smoke Your questions: • Set a date to make your home and car Alcohol in pregnancy smoke free • Discuss your plans to go smoke free Will quitting cause stress to my baby? It is best not to drink alcohol at all with your family and friends and ask Smoking is far more harmful than any stress for their support that might come from quitting. Your stress during pregnancy, as any alcohol • T ell all visitors that your home is smoke can even be reduced when you quit. free and that anyone who smokes will you drink while pregnant will reach have to go outside Why am I fine if my mum smoked? • Set up a smoking area outside – make Smoking will have a different effect on every your baby and may cause harm. it a comfortable space if you can baby. You were fine but your baby may not be. • Keep an umbrella by the back door so Do you want to take that risk?
there are no excuses to not smoke Alcohol in pregnancy outside when it’s raining I didn’t know I was pregnant, is it too Drinking alcohol during pregnancy can affect which we can be sure is completely safe. The • Make sure cigarettes are out of sight. late to stop now? your baby’s growth and development and may official guidance from the UK Chief Medical • Remove ashtrays from the home – put NO. It’s never too late to stop smoking: quitting cause long-term harm. Drinking heavily during Officers, is that if you are pregnant or think you them at the back door or outside for at any stage in your pregnancy is better than pregnancy, can cause your baby to develop could become pregnant, drinking no alcohol when you want a smoke not stopping at all. The sooner you stop the foetal alcohol syndrome (FAS). This is a serious at all is the safest approach to keep the risks to • If you’re going on a longer car journey greater the benefits for you and your baby. condition, in which children have: your baby to a minimum. then plan where and when to stop and get out of the car to take a smoking Is it okay if my partner only smokes in • Restricted growth If you have drunk alcohol during pregnancy, Smoking in pregnancy Smoking break. It will help you feel more positive one room in the house? • Facial abnormalities perhaps before you knew you were pregnant, knowing when the next stop is and NO. Smoke travels even when you can’t see • Learning and behavioural disorders you should avoid further drinking. You should reduce the number of toxins in your car or smell it. Make your home and car smoke be aware that, in most cases, it is unlikely that • Be positive and remind yourself why free. Even better, quit together so that you We know that the risk of harm to your baby your baby has been affected. If you are worried you have made the effort to keep your can support each other. increases the more you drink. The risks of about alcohol use during your pregnancy, do home smoke free drinking small amounts of alcohol are probably talk to your doctor or midwife. Is it true that my baby will be smaller low. There is, however, no level of drinking and it will be easier to give birth? NOT TRUE. Having a smaller baby does not mean an easier birth. In fact if you smoke Further information you have a higher chance of health problems Visit Drink Wise Wales www.drinkwisewales.org.uk for general information, and for support and happening during your labour. guidance contact Dan 24/7 Wales Drug and Alcohol Helpline www.dan247.org.uk Freephone: 0808 808 2234 or text DAN to: 81066 46 47
Drug misuse X–RAYS Medicine and drugs in pregnancy Misuse of drugs is not safe at any time X–rays should be avoided in pregnancy if and especially during pregnancy, this can be possible. Make sure your dentist knows you Any medicine or drug that you take harmful and affect both the baby and mother. are pregnant. If you are addicted to drugs, help is available may affect you or your baby at any to support you to give them up. It is always Herbal and homeopathic remedies best to be honest about all the drugs you have and aromatherapy time during your pregnancy. taken. Midwives and doctors will not judge you Not all ‘natural’ remedies are safe in pregnancy. but will be able to ensure you and your baby This includes herbal or homeopathic remedies get the care you both need. and aromatherapy. Many of these products can be bought over the counter in pharmacies Medicine and drugs in pregnancy Prescribed drugs and or other shopping outlets. Check with a Remember when collecting over–the–counter medicines Further information pharmacist or a registered practitioner. prescriptions or buying Not all drugs or medicines affect you or your Contact the Wales Drug and Alcohol baby but some can, and a number can be Helpline, call 0808 808 2234 medicines over the counter dangerous. You should seek advice from a or text DAN to 81066 or access the Further information you should check with the health professional if you’re taking any sort of DAN24/7 website: www.dan247.org.uk To find a registered practitioner contact pharmacist if it’s okay drug or medication, not just medicines that the Institute for Complementary and Natural to take it when you’re are being prescribed. If you have a condition Medicine: www.icnm.org.uk. Remember to tell the practitioner that you are pregnant. pregnant. Check the label that means you take prescription drugs all the for yourself as well. If you time, for example for epilepsy, talk to your doctor or specialist when you are planning If you decide to use a natural remedy you have any questions ask the to get pregnant, or as soon as possible if the should tell your midwife, doctor or pharmacist Medicine and drugs in pregnancy Medicine and drugs pharmacist, your midwife pregnancy was unplanned. You should not stop which herbal, homeopathic or aromatherapy or your doctor. taking prescribed drugs without advice from remedies you are using. your doctor. Health professionals will not judge you – it’s their job to offer you all the help and support you Remember! A drug includes a medicine you get on prescription, need to make the changes medicines and products you buy over the counter in pharmacies that you decide are right or even supermarkets, herbal remedies and illegal drugs. for you. Teeth and gums in pregnancy 49 Remember! Remember! twice teeth Brush your minutes. two for a day Angela, Aneurin Bevan Health Board Health Bevan Aneurin Angela, A health visitor’s view: A health to make want “All parents child grows their that sure healthy strong up with ache tooth and avoids teeth eat If you decay. and tooth tooth good well and have will be you brushing habits your model for role a good ever haven’t you If children. looking at been very good is now teeth own your after time to start.” a good
between meals Eat well Stop smoking Clean your teeth twice a day V Limit sugary drinks and snacks
• • • • • isit thedentist NHS dental care NHS dental dentist as usual should visit your You Let your dentist know during pregnancy. pregnant. you are free are up and treatments NHS dental check your baby is one and until during pregnancy to have a dental check advisable year old. It’s for a while or seen a dentist up if you haven’t for the important – it’s do not have a dentist and gums and you can health of your teeth if you need it, usually later on have treatment in pregnancy. have a dentist, your Local Health If you don’t information on dentists who provides Board NHS patients. See your Health accepting are or ask your midwife for their website Board contact details. to have healthy want their children All parents can in pregnancy teeth – what you do now, help
t rinse egnancy sickness, important to keep brushing twice a day important to keep brushing twice and, if the symptoms continue, contact your dentist or dental hygienist two minutes using a fluoride toothpaste avoid brushing your teeth immediately avoid brushing your teeth immediately tooth after being sick as this may cause is the wearing away of the which erosion mouth surface of the tooth. Rinsing your fluoride mouthwash with an alcohol–free after being sick can help Brush your teeth twice a day for a full Brush your teeth twice a day for a Spit out excess toothpaste – don’ is If your gums continue to bleed, it If you experience pr
When cleaning your teeth • • • •
48
start, for you and for your baby. baby. your and for you for start, at this now is a good time to make a time to make is a good now this at you might think. If you are not great great not are If you think. might you in pregnancy is more important than than important is more in pregnancy Looking after your teeth and gums and gums teeth your after Looking Teeth and gums in pregnancy pregnancy in gums and Teeth Caring for your teeth and gums Caring for your teeth and gums tender gums that bleed when Swollen, red, a sign of pregnancy you floss or brush are gingivitis. This is a very common complaint The inflammation is caused during pregnancy. your by higher hormone levels which make sensitive to the bacteria in plaque gums more blood supply to your and by the increased gingivitis Pregnancy mouth during pregnancy. is born.should disappear after your baby Teeth and gums in pregnancy in gums and Teeth 50 51
Antenatal care Antenatal information and education Antenatal care means the care you Depending on where you live you receive throughout your pregnancy may have the opportunity to go to and before birth. antenatal classes. Antenatal information and education
What to expect from antenatal care your midwife will start to fill these out. Take Why go to an antenatal class? If these classes are not available in your The aim of antenatal care is to make sure that them with you to all health care appointments They are a good way to meet other people who area, antenatal information and education you and your baby are doing well and to spot and when you go into labour. You might need are about to become parents and many new is available in many other formats. This may any problems before they become serious. them without expecting to, so remember to mums and dads make lifelong friends there. include sessions with your midwife, road take them with you if you’re staying away shows, support groups or DVDs. Most of your care will probably take place from home for any length of time. Antenatal classes aim to prepare you and your at the midwives’ clinic, at your GP’s surgery, partner or birth partner for what is to come. or at home. Some women may be cared for Your midwife will give you the contact They cover all sorts of things that you may Ask your midwife what is Antenatal care Antenatal at hospital with a specialist doctor called an numbers you will need during your pregnancy. have questions about, like: obstetrician who looks after pregnant women. Remember, you can contact the maternity • What to expect in later pregnancy, available in your area. services at any time, day or night, if you have including the early signs of labour Most pregnant women have between seven any concerns. • What to expect during labour and birth and ten antenatal appointments, sometimes and your pain relief options more if they need extra care and support. If The right language for you • Relaxation and breathing techniques to A mum’s view: you are working, you’re entitled to time off Your midwife will ask you if you would like help you cope with labour and birth to attend antenatal appointments. to have your maternity care in Welsh and this • Possible problems during labour and will be provided. If you do not speak Welsh or things like a caesarean section “It was amazing to learn all Your maternity notes English you will be able to use an interpretation • Exercises for before, during and after labour about the different stages Your maternity notes are an important service by phone. If you have a particular • Birth plans of labour itself and how to record of the care you receive throughout language and or communication need, for • Feeding and caring for your baby safely spot postnatal depression your pregnancy and will help midwives and example if you are deaf or hard of hearing • Life as a new parent and how to feed the baby.” doctors keep track of how your pregnancy this will be addressed as part of your care plan. • What a new baby can do Jessica from Swansea is going. At your first antenatal appointment • What a new baby needs 52 53
Dont forget! Antenatal care timeline Take your maternity notes and your copy of Bump, Baby & Beyond to every appointment. It is important that all women and their families understand what Midwife visit happens during their antenatal care. Your midwife will: • Take blood tests to check your iron level and recheck for blood group antibodies. First scan
At this appointment staff will: • Give you your Anti D Antenatal care timeline injection (if you have a • Determine your due date Rhesus negative blood based on the size your baby group you will need is measuring Detailed scan this to protect your next • Take all your blood tests (between 18 – 20 weeks) baby). Midwife visit
WEEK WEEKS 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 BABY +1 +2 +3 +4 +5 +6
Antenatal care timeline care Antenatal IS DUE
Booking appointments Midwife visit Midwife visit Midwife visit Midwife visit Midwife visit (usually between 7 –10 weeks) (first baby only) Your midwife will: (first baby only) Your midwife will: Your midwife will: Your midwife will: • Discuss your blood Your midwife will: • Check your baby’s • Arrange scans and book blood tests tests results with you • Check your blood • Give you your position in tummy • Calculate your BMI pressure and urine blood results to see if baby is breech* • Offer screening tests including Down’s • Measure your tummy and check • Check your blood syndrome, Edwards’ syndrome and Patau’s At every visit your syndrome, scans and blood tests your baby is moving pressure and urine midwife will ask you how well (and on every • Check your blood pressure and urine you are and answer any appointment from • Ask you about your health and explain questions you may have. now on). what to expect from your maternity care *For more information on breech babies, see page 84 54 55
Tests and checks during pregnancy Vaccinations During your pregnancy, you will be The seasonal flu and whooping offered a number of different tests cough vaccines are offered to called ‘screening tests’. all pregnant women.
The screening tests are can also be found at www.antenatalscreening. Flu You can help protect your baby by being • Early pregnancy ultrasound scan wales.nhs.uk/public/antenatal-screening-tests, Flu is a virus that can cause chills, fever, muscle vaccinated against whooping cough, even • HIV however it’s your choice whether you have aches, extreme tiredness and pneumonia. It is if you have been immunised before or have • Hepatitis B them or not. much worse than a bad cold. If you have flu had whooping cough yourself. You can get • Syphilis during the later stages of pregnancy, you could immunised any time between the 16th and • Blood group and antibodies Antenatal Screening Wales have produced a go into premature labour or your baby could 38th week of pregnancy, but the best time is Vaccinations • Sickle cell and thalassaemia film providing more information about the have a low birth weight. Some types of flu have between the 16th and 32nd week. • Down’s syndrome, Edwards’ syndrome Down’s syndrome, Edwards’ syndrome and been linked with stillbirth and there have been and Patau’s syndrome Patau’s syndrome screening test to help support deaths from flu among pregnant women. Rubella (German measles) • Fetal anomaly ultrasound scan your decision about whether or not to have this If you already had two doses of a vaccine test. To watch the film visit Having the flu vaccine could help you avoid containing rubella, e.g. MMR, you will What to do first www.antenatalscreening.wales.nhs.uk/ catching flu and help protect your baby, as be protected against rubella. If you don’t Your midwife will give you all the information public/home. some of the protection passes to the baby. remember receiving two doses please discuss you need about antenatal screening tests, The earlier you are immunised the better, so with your midwife.
Tests and checks during pregnancy during and checks Tests including a series of leaflets on the topic, which Viral Illness during pregnancy whatever stage of pregnancy you are at speak You will be offered jabs to protect you against to your midwife and make an appointment. common, preventable virus infections such as flu during pregnancy. However, you may come Whooping cough Your midwife will give in contact with viral illnesses like chickenpox, Whooping cough is a serious infection in you some leaflets about German measles or parvovirus B19 which young children that can lead to pneumonia Further information these tests and talk to cause a rash. It is important to see your and brain damage. Babies who are too young For more information on vaccinations you about them, but it‘s doctor straight away if you develop a rash, to start their vaccinations are at greatest risk. in pregnancy and how to protect you your choice whether you or someone in the household has a rash due Most babies with whooping cough will need and your baby visit www.nhsdirect. to these virus infections. hospital treatment. wales.nhs.uk/livewell/pregnancy/ have them or not. canIhavevaccinationsinpregnancy/ 56 57
Birth centre or community maternity unit If you have already had a baby Where to give birth In many cases, this unit will be led by midwives by caesarean and it is suitable for women expected to have If you have already had a caesarean section Your midwife will usually ask you a normal pregnancy and birth. It will have links you may be able to have a vaginal birth next with a hospital maternity unit in case you time. Your midwife will talk to you about this. where you want to give birth at the need to be transferred. The benefits of a vaginal birth can be: start of your pregnancy, but you can Midwife–led unit in hospital • Better health for you and your baby change your mind later. It’s important Some hospitals have midwife–led units where • A better chance of successful breastfeeding midwives are responsible for running the unit. • A more positive birth experience your midwife knows what you want. Usually this is for women who are expecting • Shorter stay in hospital a normal birth. For some women another caesarean birth Consultant–led unit in hospital is safer. Your doctor (obstetrician) will discuss Where to give birth Choosing where to give birth At home This will normally be where you give birth if this with you. Your midwife will help you to choose where For some women a home birth is the perfect you or your baby are expected to need care to have your baby, because not all options way to have a baby and it can be a safe option. from a doctor or neonatologist (a doctor who are ideal for everyone. In Wales most women If you are thinking about a home birth it is specialises in caring for newborns). Although have the option of giving birth: important that you discuss your plans with your midwives carry out most of the care in these • At home midwife so she is able to give you up to date units, doctors are available 24 hours a day to Where to give birth Where • In a birth centre or a maternity unit (known information and talk through your options. oversee care where it is necessary. as a midwife led unit) where you will be cared for by midwives rather than doctors • In a larger hospital where doctors may be A mum’s view: A mum’s view: more involved in your labour if there are any problems “It was the happiest time of “I was advised to give birth my life. She was born in the in the consultant–led unit If you are fit and well and have had a Supervisor of midwives pregnancy without any problems, you may lounge of our family home.” due to a heart condition I A supervisor of midwives will listen to any wish to give birth in a midwife–led unit. This is Arwen from Llandrindod Wells have, I was really anxious concerns a woman may have about the care * usually the best way of having a normal birth . about it but the care we she has had from her midwife and make sure that any problems are resolved. If you were given was brilliant.” want to contact a local supervisor *The term ‘normal birth’ is when you push your baby out yourself with the support of a midwife. Sian from Cardiff of midwives, ring 0300 062 8049 58 59
Other benefits Where to get help How will you feed your baby? • Br eastfeeding is free. You don’t have to Even though breastfeeding is the natural way buy formula, bottles, teats or sterilising to feed, to make sure it’s a successful and How you plan to feed your baby is an equipment. enjoyable experience you and your baby will • Br east milk is always available, always at both need to learn how to get it right. There important decision which can have the right temperature and always has the are plenty of people around to help. right ingredients for your baby. This makes lifelong benefits for your own health, it easier to feed your baby at night or on Midwives and health visitors in Wales have all as well as the health of your baby. the go. had extra training to help them support new • Br eastfeeding gives mums a huge sense mothers with advice about breastfeeding. of achievement, seeing your baby grow and develop well, knowing it’s all your In lots of areas there are ‘breastfeeding peer How you will feed your baby? Breast is best The benefits own work! supporters’ – mums who have previously Breast milk is very different to formula milk Your baby will be at less risk of: breastfed their babies and who are keen to because it contains really good things that you • Tummy upsets encourage and support others to breastfeed. simply can’t make in a factory. For example, • Coughs and colds Further information You might meet them at your antenatal class, your milk contains antibodies that help to • Ear and chest infections To view Bump to Breastfeeding film go to: in hospital, or at a local mum and baby group. protect your baby from infection and reduce • Urine infections www.bestbeginnings.org.uk the risk of illness. This protection can last for • Allergies, asthma and eczema There are also breastfeeding counsellors many years and the longer you breastfeed • Childhood diabetes trained by voluntary groups that offer support the greater the health benefits. However, over the phone. breastfeeding for a short time – even a few Breastfed babies also have better mental How will you feed your baby? feed your will you How days or weeks – is better than not at all. development than babies fed on formula milk. A mum’s view: Having been breastfed as a baby protects It is recommended that you breastfeed your children’s health when they grow up, making baby exclusively (this means you give no other them less prone to things like obesity, high “I hadn’t thought about breastfeeding until Further information food or drinks) until your baby is around six blood pressure and heart disease. To get more information and support months old and then continue to breastfeed someone actually pointed to help you with breastfeeding call the as you introduce solids foods for as long as You will be at less risk of: out when I was pregnant National Breastfeeding Helpline you and your baby want, but at least until • Breast cancer just how expensive formula on 0300 100 0212 or NCT Breastfeeding Helpline her first birthday. • Ovarian cancer is. I love that it’s on tap and • Osteoporosis (bone thinning) on 0300 330 0771 or no planning is required!” La Leche League Helpline Louise from Bridgend on 0845 120 2918 Your baby’s movements
61 What if I am unsure about my What if I am unsure movements? baby’s your baby’s whether not sure If you are you should lie reduced, movements are side and focus on yourdown on your left the next two hours. movements for baby’s separate ten or more If you do not feel these two hours, youmovements during should take action (see question below). movements What should I do if my baby’s or changed? reduced are Always contact your midwife/maternity unit a Never go to sleep ignoring straight away. movements. in your baby’s reduction
if away unit straight midwife/maternity your contact Always to go Never or changed! reduced have movements baby’s your movements. baby’s in your a reduction ignoring sleep Your questions: Your movements important? my baby’s Why are you that move will reassure Feeling your baby If you notice your baby is your baby is okay. usual, or if you have noticedmoving less than a change in the pattern may of movements, it You that your baby is unwell. be the first sign midwife or local maternityshould contact your so that they can checkunit straight away your baby. enough? How many movements are specific number of movements is no There be aware which is normal, but you need to pattern of movements. of your baby’s or a change in your baby’s A reduction movements is what is important.
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baby’s swish or roll. Sometimes it can be a bit later if it’s later can be a bit it Sometimes your pregnant for around 18 to 20 weeks. weeks. 18 to 20 around for pregnant Most been have when they moving baby Your Your As your baby develops, the number and type As your baby develops, the number with your of movements you feel will change the afternoon activity pattern. Usually, baby’s busy times for your and evening periods are baby During the day and night, your baby. 20 and 40 has little sleeps that last between longer than 90 minutes. rarely minutes and are these baby will usually not move during Your sleep periods. Your baby’s movements movements baby’s Your Minor problems in pregnancy 63 or anxious when or anxious ** If you are worried, talk to talk worried, are If you midwife. your Anaemia which occurs when Anaemia is a condition blood cells in your not enough red are there shows up in a blood test. The condition body. of illness, not eating the result Anaemia can be sickness, or rich foods, severe enough iron body like when you are extra strain on your given information will be You expecting twins. diet and you may be on changing your and vitamin supplements. iron prescribed Braxton Hicks contractions the muscles of your pregnancy, Throughout releasing your womb ‘practice’ tightening and Mostly you do not feel labour. for ready as the pregnancy this happening. However, muscles goes on, some women can feel the but tightening. It is supposed to be painless, hurt. If the for some women they sometimes call your and regular, painful contractions are not going into midwife to check that you are labour early. or anxious Feeling depressed Some women feel depressed they are pregnant. Talk to your midwife about Talk pregnant. they are feeling. how you are **For more information on depression, see pages 140 and 169 you should telephone * your midwife as soon as possible. Cystitis infection which can cause Cystitis is a urine a burning sensation when you pee and make need to pass urine all the you feel like you symptoms can be felt in time. Some of these be cystitis. so it might not anyway, pregnancy you like this, make sure If you have symptoms and, if you need to, discuss drink lots of water may be given a You them with your midwife. is an infection. if there course of antibiotics veins Varicose legs, swollen veins, in the veins are Varicose cause or in the vaginal opening. They may tights aching and sometimes itching. Support standing for long periods and can help. Avoid with your legs up. Always tell your try to rest or red midwife or GP if you notice any hot, in your legs or vulva. painful areas Swelling of the ankles, fingers, face and hands holds Swelling happens because your body and a certain amount in pregnancy fluid more is normal in later pregnancy. of puffiness cases of swelling can indicate severe More If you get an illness called pre–eclampsia. especially with any of the swelling, severe signs of pre-eclampsia *For more information on pre-eclampsia, see page 65 and your shoulders relaxed avoiding lifting heavy weights W straight Sitting and standing with your back and Bending at the knees when lifting
Constipation in pregnancy Constipation can be a problem in your due to all the changes taking place to tackle diet can be the best way Your body. food, like constipation. Eat plenty of fibre–rich bread. vegetables, fruit, beans and wholegrain getting enough fluids. you are Make sure like swimming or walking, Moderate exercise, can also help you stay regular. Piles or haemorrhoids veins of the back passage, varicose Piles are sometimes very painful or anus. They are and itchy and they can be made worse by midwife or GP can advise constipation. Your you on treatment. • • earing flatorlowheeledshoes • Gentle exercise and taking care while lifting while lifting care and taking Gentle exercise also try: can can help. You
62
Backache further Backache can get worse as you get is This is because there along the pregnancy. extra strain on your joints and hips as you put weight and get closer to the birth. on more Heartburn (indigestion) Heartburn is a burning around sensation common in later It is more the breastbone. fruit pure tea or coffee, Strong pregnancy. it feel juice, spicy and fatty foods can make these foods if they trigger worse. Avoid heartburn and take your time when you eat. ‘Morning’ sickness Morning sickness is one of the most well It can come in pregnancy. known problems down at any time. For most women it settles serious cases need by about 16 weeks. Very eating something Try hospital treatment. up in the morning; getting choose before toast, or a foods e.g. bread, plain starchy smelling food and drinks. strong Avoid cracker. coffee. milk or water instead of tea or Try minor things that can affect you. affect can that things minor During pregnancy there are a few few a are there pregnancy During Minor problems in pregnancy pregnancy in problems Minor Minor problems in pregnancy pregnancy in problems Minor 64 65
Gestational diabetes Pre–eclampsia More serious problems in pregnancy Some women develop temporary diabetes You can only get pre–eclampsia when you during pregnancy, called ‘gestational diabetes’. are pregnant. It affects one in every ten Occasionally, there may be signs It disappears after pregnancy, although some pregnancies. Usually it is mild, but sometimes women do go on to develop diabetes later. it is dangerous for the baby and the mum. This of more serious problems in your Breastfeeding your baby will reduce your risk is called ‘severe pre–eclampsia’ and happens pregnancy and you will need to of this happening. in around one first pregnancy in every 100. seek medical care. If you get gestational diabetes you will be given If you have pre–eclampsia or severe
help and support to eat the right things and pre–eclampsia you may be induced into More serious problems in pregnancy may need to attend a different antenatal clinic labour, even though this may mean your and see a specialist obstetrician. Often you just baby is delivered early. Infections of the womb Vaginal bleeding need to be careful about what you eat, but Bacteria and germs like the ones that cause Seeing blood loss from your vagina is very sometimes insulin injections are needed. Some of the signs and symptoms of a sore throat can sometimes get into a worrying for mums and it can be very serious pre–eclampsia are: pregnant mum’s womb and cause an infection. but it often passes with no harm to you or your Your health care team will keep a close eye on • Rising blood pressure in mid to late It is rare, but it can be very serious so it’s worth baby, especially if there is only a small amount how your baby is growing. Sometimes, if the pregnancy knowing what to look out for: of blood and there is no pain. It is important diabetes is not controlled, your baby can be • Protein in the urine • Headache and feeling generally unwell to get medical advice (by calling your midwife, larger. Your baby will need extra care when she • Severe swelling in the ankles, fingers or face • Sore throat maternity unit, or GP) straight away if you have is born to check her blood sugar levels are okay, • Headaches and/or visual disturbances • Feeling hot and cold any vaginal bleeding during pregnancy. so you will probably be in hospital a little bit • Severe pain just below the ribs • Fast pulse (over 100 beats per minute) longer than normal. Your midwife will talk to • Poor growth of the baby • Fast breathing Abdominal pain you about this.
More serious problems in pregnancy in pregnancy problems serious More • Smelly discharge from your vagina If you have severe pain in your stomach, Let your midwife know straight away if you • Rash you should get medical advice straight away. High blood pressure have headaches and/or visual disturbances, • Vomiting and/or diarrhoea However, a bit of discomfort is normal when If you have high blood pressure during your or severe pain just below the ribs. She will • Tummy and/or leg pains you are pregnant and all sorts of things can pregnancy it can affect your health and your arrange for your blood pressure to be checked. cause it. Early on it could be your womb baby’s health. Your midwife will monitor your If you have two or more of these growing and the support ligaments stretching. blood pressure regularly. Sometimes women signs, especially if they are getting worse Sometimes it is from trapped wind or need blood pressure tablets in pregnancy. If you contact your GP or midwife urgently. constipation. Sometimes it is a sign that you have high blood pressure and other symptoms, are having Braxton Hicks contractions (that’s like protein in your urine, severe swelling, or when your muscles are ‘practicing’ for giving headaches, then you may have pre–eclampsia. birth). If you are worried about discomfort in your stomach area, speak to your midwife. Twins and multiple births 67
edness, heartburn, e your due date ean Further information Further expecting groups, or visit www.tamba.org.uk or groups, Ask your midwife about local support
Have backache, tir Give birth befor Need a caesar nausea, constipation and piles
• • • as joyous Most twin or multiple births are as any other and many of and rewarding perfectly and births are these pregnancies straightforward. than one expecting more Being told you are may find it baby may come as a shock. You with the thought of looking after to cope hard is lots of there However, one baby. than more families. support for twin and multiple birth If you have twins you are more likely to: more If you have twins you are are
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The difference in pregnancy and and in pregnancy The difference birth with twins at If your womb is bigger than expected it could be a sign your stage of pregnancy having twins, triplets or more. that you are during They will also show up on the screen an ultrasound scan. work for can be hard Carrying twins or more especially need lots of rest, You’ll your body. A healthy diet will be later on in pregnancy. important than usual. even more Extra care than one baby expecting more If you are a closer your midwife and doctor will keep They’ll eye on you during your pregnancy. and look carefully watch your blood pressure growing. at how your babies are Twins and multiple births births Twins and multiple The come as can one baby than more of lots there’s But surprise. a big available. and information support are an important an important are * Pelvic girdle pain Pelvic girdle the small joint at the This happens when It can too far. of the pelvis opens up front when walking or even cause a lot of pain or wearing a standing up. Physiotherapy help. support belt can growth Baby’s to have small babies and Small women tend to have bigger babies. taller women tend make allowances for this midwife will Your may your bump. There when she measures size your baby’s be some special cases where But, in general, options for delivery. your affects well for her size, then if your baby is growing has growth this is a good sign. If your baby’s then you’ll slowed down during the pregnancy, the to ensure need to have some extra care baby is still doing well. usual If your baby is moving less than movements baby’s Your way you can keep track of how your baby is way you can keep track of how your worried about your baby’s doing. If you are midwife movements, you should contact your straight away. Follow your instincts right, If you feel that something is not quite Phone your team know. let your healthcare or your GP about general health problems, maternity unit or midwife if you have concerns about your pregnancy. *For more information on your baby’s movements, see page 60
66 Y Y than usual than your vagina your • ismovingless our baby Always call your midwife or call your Always if: unit urgently maternity • from bleeding ou start • You have severe tummy pain pain tummy severe have • You • Feel very poorly
Itching because in pregnancy Mild itching is common to the skin. Later blood supply of the increased the skin of your grows, on, as your bump this may also feel and abdomen is stretched nothing to worry Mild itching is usually itchy. it can itching becomes severe about, but if the condition called obstetric be a sign of a liver symptoms occur after 24 cholestasis. Usually it develops but sometimes weeks of pregnancy the most common symptom. An itch is earlier. but it is often worst The itch can be all over, may be a small on the hands and feet. There risk of complications of pregnancy increased have associated with this condition. If you worried about talk to itching that you are your midwife. More serious problems in pregnancy pregnancy in problems serious More 68 69
Premature birth Your questions:
Some babies are born earlier than Why are some babies born early? Am I in labour? It’s not always known why women go into You may feel your tummy tightening or expected, or they are too sick to labour early. Some possible reasons are: hardening for about 30 seconds several times • Mum has an infection a day from week 28 onwards. These can cope on their own. If this happens • Mum has a condition like pre–eclampsia be easy to mistake for labour, but they are to your baby, you may not be able to • More than one baby. Most twins and probably just Braxton Hicks* contractions. triplets are born before 38 weeks and You will be able to tell the difference because take her home with you straight away. many sooner than this because the uterus Braxton Hicks contractions don’t get longer, starts to contract when it is overstretched stronger or closer together. They tend to be Instead, your baby might need to be • A weakness in the opening to the short and come and go.
womb (cervix) Premature birth looked after in the Neonatal Intensive Time your contractions. This will help you If your labour starts early, your waters may decide if they are the real thing or not. Care Unit (NICU) sometimes called a break or you will start to feel contractions. If you think you might be in labour, call the If you are less than 37 weeks pregnant and Special Care Baby Unit (SCBU). hospital straight away. It may be possible to you’re having more than four contractions
Premature birth birth Premature slow down or even stop your labour. Drugs in an hour, or other signs of preterm labour, that stop you having contractions may give contact your midwife for advice. A midwife’s view: your baby more time in the womb. You may When your baby arrives early also be given treatment to reduce the chances If you go into labour before the 37th week of of your baby having breathing problems after “If your midwife or doctor your pregnancy, this is called ‘preterm labour.’ being born. has told you to expect your baby to be born early then These days, babies born early have a greater it may be possible for you chance of surviving and developing without to visit the neonatal unit any long–term problems. The older your baby and talk to the staff. Ask is and the more she weighs, the less likely she Further information is to have problems. Bliss provides vital support and care to premature and sick babies across the UK. Phone their free your midwife if she can helpline on 0500 618140 or go to their website: www.bliss.org.uk arrange this for you.” They also produce information booklets for parents which are available on neonatal units in Wales. Sarah, Abertawe Bro Morgannwg University Health Board *For more information on Braxton Hicks, see page 63 70 71
How you may be feeling Information for Dads When pregnancy goes wrong Even though miscarriage is common, that Losing a baby at whatever stage of doesn’t make it any less upsetting and you pregnancy is devastating for both Losing a baby, no matter where you may have a real sense of loss and grief. Family parents. As a dad you may not know and friends might try to cheer you up and how best to support your partner and are in your pregnancy, can be a very they mean well, but sometimes it doesn’t cope with your own feelings. It can sometimes help. It can help to talk it over with others seem that all the support is aimed at mum, difficult and upsetting experience. who have been through the same thing. who may need medical care, and that no one Your midwife or GP may be able to put you is interested in how you are feeling. in touch with a local support group, or there are organisations that can give you support, It can be hard to talk to your partner about Miscarriage in early pregnancy What to do information or counselling. how you are coping because you may be When pregnancy goes wrong Most miscarriages happen in the first three If you think you are having a miscarriage worried that you will upset her more. But months of pregnancy and usually nobody you should seek medical help. If you are If you experience a late miscarriage or a it might actually help her to know how you knows why it happens. It is very unlikely that registered with a midwife or local maternity stillbirth you will need care from a midwife feel and perhaps you can support each anything a pregnant woman did or didn’t do unit, contact them if you are having any of to make sure your body is recovering. other. You can get support from the groups will have caused the miscarriage. As many as the symptoms of a miscarriage. mentioned above, or you could ask your one in five pregnancies ends in miscarriage. Stillbirth partner’s midwife or your own GP for details Stillbirth is where a baby dies before or during of support groups in your area. Symptoms of miscarriage Further information labour. It’s a devastating tragedy for families. While some spotting of blood is quite common If you haven’t registered with a midwife While some of the risks that can lead to or local maternity unit yet, contact your GP in early pregnancy, if this happens you should stillbirth are known, the exact causes aren’t When pregnancy goes wrong wrong goes When pregnancy or NHS Direct Wales 0845 46 47 tell your midwife or GP. Heavier bleeding, always clear. A woman who seems to be having sometimes accompanied by cramps that feel a healthy pregnancy can still go on to have like bad period pain, could be the start of a stillbirth. In the event of a stillbirth, your a miscarriage. In either case, you may be Further support midwife and hospital will support you, your referred for a scan to see what’s happening. If you have a miscarriage, ectopic pregnancy partner and family in this very sad time. or molar pregnancy, you can get support and advice from the Miscarriage Association. www.miscarriageassociation.org.uk Further support or call: 01924 200 799 The charity Sands can give you lots of useful information to help and advise you. Visit www.uk-sands.org or call 020 7436 5881 72 73
Birth
As a pregnant mum or dad you might have already learned a lot about birth from reading books, looking on the internet or watching TV. Or you might be trying not to think about it because it makes you feel worried. Getting information and planning ahead can help women feel calmer and more prepared. If you are a dad or birth partner it’s a good idea to find out a bit about what’s going to happen and talk to your partner about what she wants in labour. That way, you will be the best possible help when the big day comes. 74 75
Birth at a glance What happens in labour Second stage of labour and birth? The day your baby is born is one This is when your baby is born. Dads / you’ll never forget. Knowing what Early labour birth partners can be involved by helping you be as comfortable as possible may happen can help mums, dads and This is when you start to feel pain birth partners feel more prepared. (contractions), or your waters may break. Some babies may need to be born with If you are not sure what is happening help. This might be a caesarean birth, or need advice phone your midwife or or help with forceps or a ventouse. maternity hospital. Enjoy a quiet time after the birth. Cuddle your baby, skin-to-skin. This helps you to First stage of labour bond with your baby and helps him to stay Things to think about Things to do warm and feel safe. This is a great time to This is when labour has really got going start breastfeeding too. Who do you want to support you at Pack a bag for the birth and a bag and the hard work starts. the birth? This person will be your for you and your baby afterwards. birth partner. Try to stay relaxed and find a position The third stage Don’t forget: An old nightdress or that is comfortable for you. What will help you relax when you are t–shirt, (something that opens at the front This is when the placenta is delivered. in labour? will make breastfeeding easier later on), Whether you are at hospital or at home, Your midwife can help with this by giving clothes for your baby, your wash bag, make sure you have easy access to your you an injection. Make sure your birth partner knows clothes for you and plenty of sanitary notes and your birth plan. about your birth plan. towels and old or disposable knickers. You may need some stitches if your skin has torn. If you want pain relief what kind is right for you? Try using our tick sheet on page 80 to help you ensure that you remember to pack everything you need. 76 77
Who will be with you at the birth? Making a birth plan Planning for the birth Think about who you would like to be Things to consider for your birth plan are: your birth partner* to give you support and • What are the things that keep you calm Your midwives will do their best to encouragement when you’re in labour. Your and happy? Can you have them around partner, if you have one, may be the obvious you at home during early labour, or bring make sure that the birth of your new choice, but it doesn’t have to be. There is some them with you to the hospital? evidence that having another person with you • Wher e do you think you will feel most baby will be a positive experience. instead of (or as well as) your partner is helpful comfortable during labour and while giving and can shorten your labour. Some women birth? This is where you will be most likely have a close friend or a relative with them. to achieve a complication free birth • What positions do you find most You and your partner or birth partner can Your body, your choices It’s a good idea to discuss your birth plan comfortable?
help things go smoothly by finding out what During your pregnancy, your midwife will ask with your partner and whoever else will be • What kind of pain relief would you like to Planning for the birth to expect and by taking some time to think if you would like to make a birth plan. This with you at the birth. If they know what you use? Which kinds do you want to avoid? about what’s important to you. means that your choices are written down. expect and what your decisions are they’ll be • Ar e you happy for the midwife to give your It’s a good idea because it gives you a chance able to give you better support. baby an injection of vitamin K after birth? How to help your birth stay normal to think about what you’d like and ask • Has your birth partner practiced giving you It’s best for mums to try and have a normal questions before you go into labour. Talk about *The term ‘birth partner’ refers to someone who a back massage or a shoulder rub? You birth and not a caesarean. This is because your plan with your partner or birth partner. you have chosen to give you support during labour. might be glad of it in labour mums recover much more quickly from a • Ar e you happy for the midwife to give you
Planning for the birth the for Planning normal birth and the birth of the next baby If you are not sure what you want: an injection of syntometrine to help bring will be easier if you decide to have another. • Ask your midwife and she will talk you out the placenta after the baby is born? through your options There are some things you can’t control, but • Have a look at the information in this book there are things you can do to increase your • Join a local antenatal class chances of having a normal birth: A midwife’s view: • Stay active during your pregnancy • Keep moving about as long as possible Further information “Remember, it is great to get as much information as possible in labour Visit the NHS choices website: www.nhs.uk to help you feel calm and in control in labour. Whether it • Stay at home during the early part of is watching T V programmes, researching good sites on the labour – you will be calmer and happier Once you have finished your birth plan it will internet or speaking to family and friends, all the preparation be added to your maternity notes and will will be useful to ensure you feel fully involved in all decision guide the midwife caring for you later on. But don’t worry, you can still change your mind. making at this important time.” Sarah, Abertawe Bro Morgannwg University Health Board 78 79
Water birth If your first birth was by caesarean section Syntometrine injection Getting organised: What to pack Labouring in water can help you relax, and If you have previously had a caesarean and you Almost straight after your baby is born you As you get closer to your due date there will mums often say that it helps lessen the pain have no other complications, your midwife will will also deliver your placenta. Because you be lots of things to arrange. It makes sense of contractions. You can spend time in a bath explain how she will support you to have a will be busy saying hello to your baby, it’s to have a bag packed. In fact, you’ll probably either at home or in hospital. If you think vaginal birth. good to think about how you want to deliver want to pack two bags. One with things you you might like to spend a lot of time in water your placenta beforehand. Most women want for the labour and one with everything during labour, a birthing pool will be more Vitamin K and your new baby are happy for their midwife to give them an you’ll need afterwards – including something comfy. Have a chat with your midwife. Some We all need vitamin K to help make our blood injection of syntometrine as the baby is born. for your new baby to wear going home! hospitals have a birthing pool or a large bath clot and when babies are born they have very The syntometrine helps your womb to push they use for labour. You can hire a special little vitamin K. Health experts recommend that out your placenta and means that your Even if you are planning a homebirth, it may pool for use at home or in units where they all new babies receive vitamin K shortly after midwife can help by pulling gently on the cord. be sensible to pack a small bag in case you are not available. they are born to remove the small risk that they Women who have this usually lose less blood. need to transfer to hospital at any time.
will start bleeding. Planning for the birth Sometimes your midwife will recommend There are two methods of giving vitamin K: that you have a syntometrine injection for A mum’s view: by injection, which is done once very soon a medical reason. Use our tick sheet overleaf after birth; or by mouth, which means your to help you pack your bags “I hired a pool to use at baby will need several doses. If it’s given by home. I got into it as soon mouth, it is recommended that all babies get as my midwife arrived and two doses within the first week. For babies Think about what you want
Planning for the birth the for Planning stayed there for 12 hours, who are exclusively breastfed, a third dose and put it in your birth so I got my money’s worth! will be given at one month. plan. That way, there will I cannot describe to you be less to think about on the difference it made, I the big day. still felt the pain of the contraction but I was able to cope with it and get into more comfortable positions. I would not have managed it without the pool!” Sarah from Cowbridge Pain relief in labour
81 Pain relief (without drugs) Pain relief techniques and relaxation Breathing Most antenatal classes teach breathing as a way of coping with the awareness been pain of contractions. If you haven’t to classes, talk to your midwife about techniques for labour – she can breathing quickly show you how to do it. to help you The emphasis is on using breathing which helps you cope with the stay relaxed, take away pain, but it pain. Relaxation doesn’t because becoming stronger it from can prevent shows pain levels. Research tension increases they release relaxed that when women are own pain relievers. endorphins, the body’s
have
drugs
pain–killing
Some women want to avoid to avoid want Some women in labour, because drugs all to some disadvantages or babies. mothers Even if you’re sure you want pain relieving you want pain relieving sure Even if you’re a it’s drugs to help you cope with labour, help there good idea to find out what other usually best it’s is. In the early stage of labour, to try to avoid drugs. Pain relief in labour in labour Pain relief of kind to the thought Give some If you in labour. want you relief pain your to speak questions any have more midwife will and she give you available. what’s about information
Nappies. and sleepsuits. Vests Cotton wool balls. Car seat for going home. Two nightdresses. nightdresses. Two will the front Ones that open at easier. make breastfeeding like leggings Easy to wear day clothes, and loose tops. including Some underwear, large, close–fitting pants to hold maternitybras. pads and nursing may find disposable pants useful You for the first few days. Some towels. Maternity pads or night–time sanitary pads. pads. Breast A box of tissues. Second bag (after the birth) the (after Second bag need: Things you will baby: Things you will need for your
: A mobile phone. A camera. Some drinks and snacks for you and your partner. A thermal pack – the sort you can heat A thermal pack – the sort you can heat for taking with you on in a microwave cold outings. It stays warm for hours and can be wrapped in a towel and to relieve used as a warm compress aches in the back or legs. Some facecloths for cooling your face Some facecloths for cooling your face and skin. Some unscented oil or a light body lotion for massage. Something to slip on your feet, like sandals or slippers. A wash bag with toiletries, including hair bands for long hair. An old nightdress or t–shirt. or t–shirt. An old nightdress at the front Something that opens easier. will make breastfeeding to gown or a big cardigan A dressing in your you are cover you up when nightie or t–shirt. 80
F irst bag (during labour) First bag (during need: Things you will Things you might like Planning for the birth the for Planning 82 83
Birthing pools and lying in water Chemical pain relief (drugs) All opiates can affect a baby’s breathing at Side effects Water is very good at helping you to relax birth. If your baby’s breathing is poor because An epidural does not cause you to be sleepy. and make the contractions seem less painful. Gas and air of the opiates, a drug can be given to your Sometimes your legs might feel numb or heavy Ask if you can have a bath or use a birth pool. ‘Gas’, or ‘gas and air’, is a form of pain relief baby to treat this. which can make it harder to push. This means that is available in hospital and at home births. it can increase the risk of needing help with TENS machine The gas comes with a tube and a mask or If you have had opiates in labour your baby the birth, like a ventouse or forceps delivery*. TENS – short for ‘transcutaneous electrical mouthpiece that you can breathe through when may be sleepier and less interested in feeding It does not increase your risk of a caesarean nerve stimulation’ is a form of pain relief you need it, usually at the start of a contraction. for two or three days afterwards, you will get section. The numbness can last up to a few provided by pads which fix to your back and It can take the ‘edge’ off the peak of the pain. extra help with feeding if you and your baby hours after the delivery. Sometimes an epidural which give a slight electrical charge. It can be The pain relief does not last very long and for it need it. can make your baby a bit sleepy after birth and effective in relieving pain and it is safe for you to work effectively you need to begin breathing make learning to breastfeed more difficult. and your baby. It probably works best in the it at the very start of the contraction so it builds Epidural anaesthesia Occasionally an epidural can give mums a bad
early stages of labour when many mums have up by the time the contraction is strongest. An epidural is when pain–relieving drugs are headache for some days after the birth and reliefPain in labour lower back pain. If you want to try this, ask injected into the space around your spinal mild itching is also possible. your midwife where you can hire or borrow There is no danger of taking too much, but it nerves. The aim of the epidural is to relieve a TENS machine. can make some people feel sick. You can use the pain of labour by reducing the sensation gas with other kinds of pain relief. Babies do in your lower body. You will still be able to A midwife’s view: Complementary therapies not appear to be affected by gas. move around the bed and push when giving Complementary therapies such as homeopathy, birth. An epidural is the most effective form “Pain relief in labour is a hypnosis, acupuncture or acupressure can help Morphine and opiate drugs of pain relief in labour. It is especially useful if
Pain relief in labour Pain relief some mums in labour. You will need to see a Drugs that are related to morphine are often your labour is long or complicated and if your very personal choice, some specialised practitioner if you are interested in used in labour. They are given by injection. baby needs close monitoring. An epidural can women want to feel no these methods. These drugs are not usually used at a homebirth. only be given to you by an anaesthetist, so it pain and for other women is not available at every unit. the benefits of natural Most morphine and opiate drugs take around childbirth are clear. A 15 minutes to work and last for two to four long labour often requires hours. You may feel sleepy and slightly ‘out of it’, so they cannot be used if you are in a effective pain relief, but birthing pool. Some women like this feeling women feel and cope with and it helps them cope. Some don’t and feel the pain of childbirth very out of control. Some women feel sick with differently.” these drugs and an anti–sickness medicine is Sarah, Abertawe Bro Morgannwg usually given at the same time. University Health Board
*For more information on your ventouse or forceps deliveries, see page 98 84 85
Other things that may affect your Pain relief during a caesarean section labour and delivery If you have a caesarean section you will need Your questions: total pain relief. Some women have a general Your baby’s position anaesthetic, which works instantly and means What is a caesarean birth? Why might I need an elective Your baby’s position, or ‘presentation’, refers you are unconscious during the operation. This means your baby is born by an operation. caesarean section? to which part of the baby’s body will be born Most women have an epidural or spinal The obstetrician makes an opening in your • Y ou have a very low–lying placenta first. Although most babies are born head anaesthetic. This completely numbs you from tummy and then your womb to get the – called ‘placenta praevia’ – which first, sometimes they are coming bottom just below the breasts downwards, but allows baby out. blocks your baby’s way out first, which is called ‘breech’ presentation. you to remain fully awake and aware of • For some twins and almost always for everything except the pain. However, you Why is it done? triplets or more How common is breech? may feel some pressure or discomfort. A caesarean section may be planned in • If your baby is in a position which makes By the end of pregnancy only about 3% advance. This is called an ‘elective section’. vaginal birth difficult or impossible
of babies are breech. Babies who are still It takes time to recover from the effects of a Your appointment will probably be in the week • Pr evious surgery on your womb. You reliefPain in labour breech by about 37 weeks of pregnancy general anaesthetic and there are more risks before the date your baby is due so you are less may have had two or more caesarean may not turn around by themselves. to the mum’s health, so epidural or spinal likely to go into labour before the operation. sections before or other rarer operations anaesthesia will usually be given. In some units, Delivering a breech baby doctors administer a combined spinal and Sometimes a decision has to be made to Why might I need an emergency If your baby remains in the breech position epidural which allows a top–up of anaesthetic carry out a caesarean while you are in labour. caesarean section? after 37 weeks you would normally be offered when necessary. This type of anaesthesia takes This is called an ‘emergency caesarean section’, • If you are very poorly, with conditions the chance to have your baby turned around, effect in about 15 minutes. You are more likely although often it isn’t as dramatic or last– like severe pre–eclampsia, kidney disease
Pain relief in labour Pain relief this procedure is called an external cephalic to need a general anaesthetic for an emergency minute as the name suggests. or very high blood pressure and your baby version or ECV. An ECV will be able to turn caesarean section if your baby is in distress needs to be delivered quickly about half of breech babies to being head first. and the doctor has to deliver him as quickly • If your baby is not coping with the stress If your baby remains breech, you will need as possible. You will receive help and support of labour and you are still a long way to discuss whether a vaginal breech birth or to make sure you are able to breastfeed from delivery planned caesarean section is best for you comfortably after a caesarean section. • If your baby is in a position in your womb and your baby. that makes labour difficult 86 87
Labour and birth You have probably heard Your questions: stories about people who Labour has three stages and the have been in labour for Will it hurt? Most women find that contractions get very days and others who length of a normal labour can vary strong as labour gets going and commonly had their babies in describe them as painful. For lots of women enormously for each person. minutes. Most births are the pain they experience when they feel the somewhere in between. urge to push is different, because they have the hard work of pushing to take their mind off it.
First stage Second stage Third stage This is when the neck of the womb, called the cervix, This is after your baby is born. This is when the
This is from when the cervix is open enough to Labour and birth opens. When you go into labour the muscles in your allow your baby to move down into your birth canal afterbirth or placenta is delivered. This is usually womb contract and this gradually pulls the neck of (vagina) and for you to start pushing your baby out much easier than delivering your baby, because the womb (cervix) open. The first stage is usually into the world. Your contractions will change and the placenta is smaller and softer and your midwife the longest and can last anything from one hour to push your baby down the birth canal and you will can give you an injection to help speed this up if 20 hours or sometimes even longer. Early labour is have the urge to push with your tummy muscles. you would like. the very start of this stage when your body is slowly getting ready. Placenta Placenta
Labour and birth Umbilical cord Umbilical cord Umbilical cord
womb womb A mum’s view:
“My midwife was great, she made me feel like Cervix Baby everything was going to Baby be okay and that I was doing well, I feel that she enabled me to have the Vagina Cervix Crowning of birth I wanted.” the head Enfys from Swansea The start of labour 89
early
find
women
Many labour very challenging, home, at are when you even it to take for so prepare on some time. Keep an eye and movements baby’s your your with in touch keep unit midwife or maternity can advise they to ensure labour of when active you started.” to have is likely Morgannwg Bro Sarah, Abertawe Board Health University A midwife’s view: for can last labour “Early try and get so hours, many can. Make if you some rest drinking keep you sure amounts small and eat fancy you of whatever It is important regularly. up. strength your to keep The breaking of the waters of The breaking fluid is a bag of there Inside your womb ‘amniotic sac’. your baby called the around the early signs that you Sometimes one of appears in this in labour is that a hole are escapes. It can happen as sac and the fluid liquid down your legs, but a sudden gush of trickle. Telephone often it will start to more the hospital if your waters your midwife or break don’t Sometimes your waters break. your baby is born. until just before Contractions closer Contractions that gradually come seconds together and last longer than 40 will You sign of labour. sure the only are longer and in feel them getting stronger, pattern. regular of a more False alarms Sometimes women start to have contractions, These can make only for them to fade away. in labour when your body you think you are can be is just having a practice run. This go to confusing and sometimes you may If this hospital only to find everything stops. and happens to you, you may be examined not very far may be disappointed that you are in labour at all. on in your labour or not really if you’d In this situation, you may be asked you to go home. This is sensible, unless prefer feel the hospital. Don’t live a long way from embarrassed. This sort of false alarm happens all the time.
It is a sign that the opening of the womb – It is a sign that the opening of the and stretch called the ‘cervix’ – is beginning to It may for labour. soften a little in preparation It can be actually in labour. not mean you are the start of several days between the show and so. Although or it can be just an hour or labour, have one. a show is common, not all women
88
Call your midwife or maternity unit for advice at any time. any advice at unit for midwife or maternity Call your
The show of the ‘plug’ which seals This is the release women, the opening of your womb. In some as a single the plug comes out of the vagina In others it is a series of blob of pinkish jelly. be reddish smaller pieces and in others it can blood–tinged. and brown Some signs of labour gaps between them shorter. shorter. them between gaps will be longer and stronger and the and the and stronger will be longer Labour can start very quickly, or or very quickly, can start Labour contractions your going labour gets The of labour start your labour. Once in actually are it may take a while to work out if you if you out to work a while take it may it starts without you realising and realising you without it starts it can seem to take ages. Sometimes Sometimes ages. seem to take it can The start of labour of start The 90 91
Early labour Coping with labour The early stages of labour can Provided everything has been be exciting because the day you straightforward during your have longed for has finally arrived. pregnancy, you are likely to cope It can also be boring or frustrating better and have less chance of having because you are waiting for labour a complicated birth if you stay at to get going properly. home in the early stages of labour.
You might not be quite sure when to go into Positions you can try Birthing balls hospital, or you may go to hospital only to find Listen to your body, experiment with different You may find a birthing ball A mum’s view: you are advised to go home for a few more positions and movements and do what’s most comfortable. It is a large inflatable Early labour Early hours. If you are not sure what to do, contact helpful for you. Your midwife will encourage ball which you might have seen at the maternity unit or your community midwife. “I wasn’t sure if I wanted you to find a position that suits you. the gym. It allows you to rotate my partner there when I your pelvis and helps you to In early labour try to relax by: gave birth, but actually sit at a good angle for • Taking deep relaxing breaths it was great, even in the childbirth. Birthing balls • Having a bath or shower are available in most early stages when there Most women cope best • Having your partner give you a gentle birth units and wasn’t much happening. massage with labour if they are delivery suites. • Using an ice pack or hot water bottle We probably talked more free to move around. You on your back if you are uncomfortable than we’ve done in ages. may find that different • Walking around We’ve both been so busy positions work best for • Eating a light, healthy snack and preparing for the baby.” you at different times. drinking plenty of water Sue from Llandrindod 92 93
Kneeling Sitting Breathing When to contact your hospital, birth You can You can sit astride a A very common reaction when experiencing centre, or community midwife rest by chair and lean forward, pain is to tense up and hold your breath, but If it’s your first pregnancy, you may feel leaning rest on a cushion or pillow, this actually makes the pain feel worse. When unsure about when you should go into forward or on a birthing ball or a contraction comes concentrate on keeping hospital or a midwifery unit. The best thing between beanbag. your breathing slow and relaxed and focus on to do is to call your hospital or unit for advice. contractions. breathing out. If your partner understands this For your birth partner and breathes with you during a contraction If your waters have broken, you’ll probably Supported standing Knowing what’s going it can help you remember and create a lovely need a midwife to check you and your baby. Some mums like on will help you to be feeling of closeness between you. This doesn’t If it is your first baby and you are having to stand and a better support. Keep your work for everyone though. Some mums say contractions but your waters have not broken, rock or pace partner company, tell her she’s they can concentrate better on their own. you may be told to wait. You’ll probably be slowly and then doing well, help her stay relaxed and gently told to come in when your contractions are: stop and rock rub her back if it helps. Hold her hand and be As you feel a contraction coming: • Regular Coping with labour when they have there to share the pain, as well as the joy. • Relax. Think especially about your • Strong a contraction, shoulders, your face and your hands. • About five minutes apart For positions for birth, see page 96 if you need Make sure they are relaxed • Last about 45–60 seconds support you • Start to concentrate on your breathing, can lean on keeping it slow and relaxed. Focus on You will probably be told to come in if there a wall or your breathing out are any changes to your baby’s movements. Coping with labour with Coping partner. • As the contraction gets stronger think more carefully about the way you breathe If you are planning a home birth, follow the and try to stay relaxed procedure you have agreed with your midwife. • Sway and rock your pelvis and make any noises you find helpful • Don’ t resist the contraction – it increases A mum’s view: in intensity, reaches its height, then starts to fade “In the early stages I thought my husband Jeff would be • As it goes, blow it away – it’s gone. Don’t forget to phone the invaluable rubbing my back, however, when the time came I That contraction will never appear again hospital or unit before needed the freedom to move around. His verbal reassurance leaving home and remember and constant bringing of drinks and food was enough.” to take your maternity notes. Susie from Swansea 94 95
Checks and monitoring during labour When your baby is nearly ready You and your baby will be checked to be born regularly throughout labour to make For most mums the hardest part sure you’re both doing well. of labour is towards the end of the
first stage, just before the pushing When your baby is nearly ready to be born begins. Your contractions will be How your baby may be monitored Checks on you Listening to your baby’s heart rate will help Your midwife will keep a close eye on you very strong and you will not have your midwife monitor your baby’s health and will examine the neck of your womb and strength during labour and birth. When (your cervix) occasionally to see how the much time in between them to catch everything is going smoothly it is done labour is progressing. This is called a vaginal at regular intervals, but sometimes your examination. The thought of this can be a your breath and relax. This part is midwife will need to keep a constant watch bit scary, because you may never have had on your baby’s heart rate. This is called this done before. Don’t worry, your midwife often called transition. ‘continuous monitoring’. will be very gentle and respectful, and explain everything before she does it. For most mums If you are being continuously monitored it isn’t as bad as they thought and they really Transition: what you can expect For birth partners it does not mean you have to stay lying on appreciate finding out how their labour is Transition affects how you feel emotionally Don’t take her behaviour personally, nothing
Checks and monitoring during labour during and monitoring Checks a bed. A ball, mat, chair or stool may be progressing. as well as physically. You may feel impatient, you do will be right! It’s perfectly normal and is more comfortable. If you have an epidural tired, irritable and even angry and frustrated usually a good sign that the baby is nearly here. for pain relief your baby will need to be with the people looking after you. This is a continuously monitored. perfectly natural reaction and it means that The second stage the birth of your baby is not far off. This is the stage where your baby arrives. • T ry to remember that although it’s hard, It begins when the neck of your womb (your it’s normal and your baby is nearly here cervix) is fully open (to 10 centimetres) and • Make the most of the space that there ends with the birth of your baby. With a first is between contractions and completely baby this stage can last anywhere between relax – ignore everyone else ten minutes and two hours, or sometimes even longer. It’s usually easier and shorter with your second baby. The birth of your baby
97
head
e you want to be when baby’s
really relax in between contractions relax really the baby is born. Do you want to see him being born, or would you rather support the baby later? your partner and greet Keep calm and tell her how well she is doing Keep calm and tell her how well she Help her be as comfortable as possible Don’ Think about wher
For your birth partner can really This stage is very intense and you help your partner if you: • • • • shecan t talktoomuchandmakesure your
is
it
so
first,
as one of the most important moments of your life. of your moments most important one of the as Every birth is unique and special, it may not have been the been the have not is unique and special, it may Every birth it remember will usually you but anticipated have you birth The muscle and skin at the opening to The muscle and skin at the opening and this can your vagina will start to stretch a stinging or burning sensation. At produce not to this stage your midwife may ask you things push, or only give tiny pushes to slow down to give you time to stretch. is taking a occasionally if the stretching Very bornwhile and your baby needs to be quickly, will give the midwife (with your permission) cut. You this bit of skin and muscle a small feel this will have an injection so you do not This cut – and it will all be explained to you. is called an episiotomy. T he birth of your baby of your The birth world the into come Most babies head canal birth the will stretch that born. is very nearly baby when your
little
a
take
can
it
and
All fours allows your pelvis to This position also feel very safe open wide and can supported are and steady as you legs. by all your arms and can sit back on You a your heels and take and a sip of breather water in between contractions. Leaning on the back of the bed on the If you are bed this is a great position, it gives your pelvis to freedom open and you have something to lean on. baby
first
All this pushing can be hard work with with work pushing can be hard All this your doing. you’re what of hang the to get while to your listen midwife will help you Your so your energy your and focus body need her to. if you effective pushes are they will need the to take all strength of your weight and
may find sitting in a your arms, though chair makes this easier. from behind by holding you under behind from 96
Supported standing or squatting Supported standing it allows This position is good for the birth, baby to your pelvis to open wide and your will You be born with the help of gravity. to keep need support for your upper body partner can support you your balance. Your Positions for birth Positions you position for no right or wrong There’s on your back lying to give birth in. However, and makes it more is usually uncomfortable your pelvis, through to push your baby difficult are When women so it is not recommended. what feels best, they hardly encouraged to do If possible, get gravity ever adopt this position. upright and active. to help you and stay When your baby is nearly ready to be born be to ready nearly is baby your When 98 99
If you and your baby need help First moments After a little while, when he is ready, your Dads Sometimes you or your baby will need some Your midwife will have talked to you baby will start to look for your breast. This is You will long to give your partner help during labour. This could be because about what you want to do straight a brilliant way to start breastfeeding, because and new baby a cuddle, put your your baby is getting too stressed, or labour after birth. Most mums like to hold your baby’s instincts to feed are really strong arms round them both. You can have has been hard and long and you have no their baby straight away. How you feel straight now. Your midwife will encourage you to keep skin contact too when your baby has more strength left. after the birth varies with every mum, because your baby in your arms and against your skin had a good hour or two with his mum and it can take a bit of time to take in what has until his first feed has finished. finished the first feed. If you need help before you are in the second happened. ‘pushing’ stage, you will probably have an If you are not planning to breastfeed your unplanned caesarean section. Newborn babies can look funny. Your baby may baby, you should still consider giving him look a little squashed and wrinkly at first and one or two feeds at the start. The very early Once you are in the second stage your doctor possibly blueish on his head, hands and feet. breast milk you produce will protect him A midwife’s view: or midwife may be able to help using forceps against infections. birthThe of your baby or ventouse. Skin–to–skin “All new parents are You will be encouraged to hold your baby Getting to know each other eager to know the weight If you need help with forceps or ventouse straight after he is born, provided you are both Close contact between you and your baby Forceps and ventouse are both instruments doing well. Cuddle him close without anything will help your baby stay warm. He’ll hear of their baby, but allow him that can be attached to your baby’s head so between you, so that his skin touches your your heartbeat as he did in the womb. His to have lots of skin-to-skin that the doctor or midwife can help you as you skin, then you’ll keep him warm and he’ll feel circulation will be better too and he will be first, he will prefer that. He push. Forceps are made of metal and look a bit safe being so close to you. Hold him like this less likely to cry. What’s more, skin–to– can be weighed, dressed
The birth of your baby of your The birth like large spoons for serving salad, a ventouse for a good long while, at least an hour if you skin contact has been shown to help get and passed around for is made of soft plastic and is like a cup that fits feel comfy, it takes a bit of time for all the breastfeeding off to a good start. cuddles later.” on your baby’s head. You will be given a local stress hormones of labour to fade and Sarah, Abertawe Bro Morgannwg anaesthetic – an injection to make the skin and for all the ‘feel good’ hormones Skin–to–skin with mum is best until your University Health Board muscle at the opening to your vagina numb to start flowing. baby has had a good first feed. However, if and your bladder may be emptied by a thin mum is unwell and can’t hold him straight tube inserted into your bladder – called away, the next best thing is for your baby to a catheter and you will probably need a small have skin–to–skin contact with your partner. cut (called an ‘episiotomy’) to allow room for Above all, enjoy these the forceps or ventouse to be inserted. You will Welcome your new baby by talking to him. precious moments. You’re probably be helped to lie down on your back Your voice will be familiar and this will help to meeting your baby! and your legs will be raised. Occasionally your reassure your baby in this strange new world. baby will have a mark (bruising or swelling) from the forceps or ventouse cup on his head, but don’t worry it will soon fade. Being a birth partner
can 101
more
nothing
it felt
I
dad’s view: view: A dad’s of a point to make “I had going was what asking been had things on. Once explained NHS is worth reassured. penny!” every plan a birthing “We had you until obviously but experience it.” for you prepare Cardiff James from Some men feel concerned about being their only supporter and worry about partner’s knowing what to do. What do I need to do? to your partner about her birth plan. Talk will Finding out what she wants and why going on, and help you understand what’s to your may help you explain what she wants midwife if you need to. The hormones and support her. Just be there the same we make when we feel loved are working ones that help keep contractions or tense adrenalin scared well. When we are working is made that can stop contractions and slow the labour. birth partner birth Being a at present now are of dads Lots and children of their birth the child’s their being at most describe most moving of the one as birth life. of their moments If you need stitches after the birth stitches after If you need of your baby and placenta, Soon after the birth doctor will gently inspect the your midwife or If you need for signs of tearing. vaginal area will be done at this point. some stitches they to have your feet held Often you will need can see clearly and you up so the midwife if this is uncomfortable, relief will be given pain usually gas and air. their baby in able to keep Often mums are air and their arms, but if you need gas and your baby can have skin contact get drowsy, for you to with dad. Mostly the time it takes 20 or 30 minutes) have your stitches (around concentrating on passes quickly as you are you how The midwife will tell your new baby. sore are to look after your stitches and if they stitches will you will be given pain killers. The days dissolve soon heal and most stitches these on their own. 100
An ‘actively managed’ third stage An ‘actively managed’ third an injection This is when the midwife gives you This injection, to help you deliver your placenta. born,which is given as the baby is being means pulling the the midwife can help you by gently reduces placenta out. The injection also slightly your baby the small chance of bleeding after if your labour is born. It may be recommended has been long. The placenta is soft and comes out quickly, quickly, The placenta is soft and comes out with a tiny often when you sit or stand up, or notice it much because you’ll won’t push. You The midwife will keep be looking at your baby. you do not lose an eye on you to make sure too much blood at this stage. A natural third stage A natural third or simply baby, your The act of breastfeeding your skin, stimulates the having him against will help you to of a hormone that release It will help your womb deliver your placenta. to fall off to contract and help the placenta get a pain in the wall of your womb. You’ll the your tummy and you’ll feel like pushing placenta out. The third stage The third is when you will stage of labour The third will have a choice You deliver your placenta. midwife helps you with this about how your stage of labour. The birth of your baby your of birth The 102 103
You and your new baby
Find out more about the first few days and weeks with your new baby. These early days are a very special time. Getting to know and enjoy your new baby can be tough too. It’s a big change and you and your partner will be tired. 104 105
You and your new baby at a glance Feeding your baby Getting support Breastmilk will give your baby the best Your midwife will look after you for the Your baby needs lots of attention start in life. It can take a while to become first 10 days after birth. Then the health and cuddles, this helps her to feel confident with breastfeeding, there is visitor will take over your care. lots of help and support so don’t be loved, secure, safe and gives her afraid to ask. Practical things the best emotional start in life. If you are bottle feeding, hold and cuddle You must register your baby’s birth before your baby when you are feeding her and she is 42 days old (6 weeks). keep her face close to yours. This helps to develop the bond between you. Child benefit* is payable from the date your baby is born. If you are bottle feeding, always prepare Your new baby Your new baby’s health bottle feeds exactly as the instructions tell you. Looking after yourself After birth new babies can sometimes look You will be offered various tests to check Remember to take good care of yourself. squashed or even bruised. This is normal your new baby is healthy. You will need Keeping your baby safe The better you feel the more you will be and will disappear after a few days. to give your permission for these. able to take good care of your new baby. Make sure you have the correct car seat for Look back at the ‘Five Ways to Wellbeing’ Your baby is already aware of things going Keep track of your baby’s progress in the your baby’s age and one that is suitable for to help you. on around her. She can see and hear you. red book you will be given. Keep a note your car and learn how to fit it properly. She will enjoy it when you touch her hands of important things such as jabs or illnesses. or feet. Talk to her and stay close to her. Take the book with you when you go to Do not let anyone smoke in your house. see a doctor or health visitor. The safest place for your baby to sleep is See pages 12 and 13 for in a cot by your bed. Put her on her back more on wellbeing to sleep, never on her front or side.
*For more information on child benefit, see page 124 106 107
Your questions: What does my baby need? Caring for your new baby Your baby needs to know you are near, and What can my baby do? she won’t understand that you will be ‘back Becoming confident around your baby Your baby will be able to see from the in a minute’. Reassure her that you are still moment she is born. She will love to near her by: happens slowly over time. Finding out look at your face, which she will be • Being close to her able to see easily when you hold her in your • Talking to her about what to expect can help. arms. She may even hold your gaze for a few • Holding and cuddling her moments, start imitating your expressions within days or weeks. Your baby will feel safe and loved if she doesn’t have to wait too long to be comforted, She can hear and be startled by loud noises. fed or cuddled. She needs to be at the Caring for your new baby How you may feel Bonding with your baby Babies seem to like soft voices best. She will centre of your world. This will increase your New parents react in different ways. Some Bonding is what happens when you get recognise your voice. Speaking to her will help confidence as a parent and will also give her new parents may fall head–over–heels in strong feelings of attachment towards your her to develop a relationship with you, which the best emotional start in life. Babies who love with their baby straight away. Others baby. It is a very individual experience and you is important for her future social skills. have a secure bond with mum and dad usually will take a bit longer. You will probably be shouldn’t worry if it doesn’t happen straight go on to be confident children and will be less excited and exhausted. It may take a while away. Your baby is a completely new little She can grasp. Try touching the palm of likely to have mental health problems later on. to get used to your new baby and to figure person and however cute she is, it takes time her hand, or stroking her feet. Play and out everything she wants and needs. Partners to get to know her. Real bonding develops communicate with her as much as you can. may feel a bit left out at this point, especially and strengthens as you care for her every day. Talk to her, smile at her, laugh with her and Caring for your new baby new your for Caring if they are leaving mum and baby in hospital You’ll find that your feelings deepen over time. watch her reactions. A midwife’s view: to go home. It’s important to involve your partner in supporting you, as well as getting Skin–to–skin contact Your baby will be able to smell. She’ll recognise “When your baby is born, to know the newest member of your family. Touch is incredibly important for babies. That’s the smell of your body and your smell will help why your baby is placed on your tummy as her feel safe. After she is born, hold her to your take time to really get to soon as possible after she is born. This skin– skin and feed her before you have a shower. know them. This time cannot to–skin contact not only helps you and your She’ll be used to a confined space, so she’ll be repeated and rushing into baby to bond, but will comfort her when she love being cuddled close to you. a busy routine, at least for is upset. Remember that she will love to be the first week or so should touched and that it’s a very important part be avoided if possible.” of her emotional growth and development. Sarah, Abertawe Bro Morgannwg University Health Board 108 109
Tests you will be offered for your baby A midwife’s view: In the first days after the birth of “Many new parents can find their baby’s newborn bloodspot your baby, you will be offered various screening test upsetting because your baby usually cries. However, the test usually only takes a minute or two and the tests to make sure that your baby crying usually stops straight afterwards. If you like you can breastfeed during the test which can really help”
is fit and healthy. Tests you be offered will for your baby Sarah, Abertawe Bro Morgannwg University Health Board
The red book Routine examinations Newborn bloodspot screening Shortly after your baby is born you’ll be given You will be offered a physical examination This test can pick up some health problems that Your doctor or midwife a Personal Child Health Record. This is often of your baby after she is born. This may cannot be seen by examining your baby. The will discuss the tests called the ‘red book’ because it usually has be undertaken by the midwife or the doctor. bloodspot test, or ‘heel prick test’, is usually with you beforehand and a red cover. This is called the ‘routine examination of the carried out when your baby is five days old. they will be happy to newborn’ and usually takes place 24 hours after The midwife takes a few small spots of blood answer any questions. The red book will help you keep track of your she is born. from her heel and sends them to a laboratory Although these tests are baby’s health and development, like what tests where tests are done for nine rare but serious recommended, it’s up to she has had and what the results were. This Newborn hearing screening conditions. means that you’ll have a record of her health This is a test to check if your baby has a hearing you whether you decide to which you can show to health professionals loss. It will be done within the first few weeks If your baby is found to have any of the Tests you will be offered for your baby your for will be offered you Tests have them. The results will if you need to. after your baby is born and sometimes even conditions they will receive early specialist be recorded in your baby’s before you leave the maternity unit. care and treatment. You can find out personal record, known When you visit a clinic, your GP or a hospital, more about the tests by visiting www. as the ’red book’. the staff will use the red book to keep a record Hearing is vital for your baby’s development and newbornbloodspotscreening.wales.nhs.uk. of your baby’s health and development. They this screening test means that you can On this site you will find a copy of the will record things like your baby’s weight, what get support and treatment early, if it is needed. Information For Parents Leaflet, which will also vaccinations she has had and other important be given to you as a paper copy by your health information. You will be given a leaflet on newborn midwife, and provides all the information you hearing screening which gives you more detailed need to know about this test. information. 110 111
Top tips for getting off to a good Feeding during the first six months breastfeeding start Tips from the Bridgend • Start off with lots of skin-to-skin contact. breastfeeding group; In the early weeks your baby will Watch for when your baby gives you signs that she wants a feed and take your time. spend most of her waking time The first feed is important, you’ll both gain “Look out for long deep feeding, it’s an important time not confidence if it goes well noisy swallows this shows • Feed her as often as she wants and for as the baby is feeding well.” just so she grows but also so she long as she wants. This will help you make Sarah plenty of milk Feeding • Don’ t give your baby bottles in the first feels safe and trusts that she can “Take it one day and one few days. It might be tempting if you are feed at a time, set short months
tired, but your baby needs to feed from have food whenever she needs it. your breast to get your milk supply going. goals and reward yourself during six Introducing a bottle can also be confusing when you meet them.“
for your baby because she will suck Louise the first Breastfeeding Breastfeeding – getting started differently on a bottle
first the
Your breast milk provides all the goodness Breastfeeding is a completely natural process, • Getting the positioning and attachment “It does take a few weeks and nutrients your baby needs and will give but it is something mums and babies have to right is the key to successful breastfeeding.
your baby the best start in life. Breast milk learn to do together, getting the positioning You may need help to do this, either in for milk supply to properly six during
**
‘come in’ just keep feeding contains your antibodies which will help give and attachment right can take time. hospital or when you get home. Don’t be months your baby immunity against common illnesses afraid to ask for help to your baby’s cue.“ like colds and coughs. Breastfeeding* is good Most mums who have successfully breastfed Laura
Feeding for you too. will tell you that the first few days were tricky, You will soon be able to tell if your baby is but you will be really glad if you keep at it. breastfeeding well. Her mouth will be wide “Please don’t stop breast Learning how to breastfeed can take a Lots of mums say they are sad they gave up open and you will be able to see her feeding feeding – be patient with while, but the benefits will last you and so soon. rhythmically and swallowing. You should be your baby a lifetime. comfortable during the feed. yourself and your baby, it takes about a month for everything to settle but it’s **The term ‘positioning’ refers to how you sit or lie and how you hold your baby and the term ‘attachment’ Further information so worth it and everything On positioning and attachment, ask your refers to how your baby gets her mouth around your nipple and breast. She needs enough breast to get a good is so much better now.” feed and you need to be comfortable. midwife for the ‘Off to the Best Start’ leaflet or visit: www.feedgoodfactor.org.uk Emma *For more information on breastfeeding, see pages 58 and 59 112 113
How to breastfeed Positions Under arm hold Attachment Breastfeeding should not be painful if your This is where you baby is well attached. If feeding is hurting Cross cradle position your baby make sure you ask for help from your This is where your baby under the breast she Hold her close with midwife or health visitor as soon as is held in the opposite will be feeding on her nose opposite possible. The following tips may help you arm to the breast that with her feet and your nipple. & your baby find a good technique: she is feeding from allowing bottom quite • Hold your baby really close to your her more flexibility to move far back. body her head more freely. • Support your baby’s neck, shoulders Wait for her to Feeding and back making sure she can easily open her mouth really wide and tilt her head back Sidelying Cradle hold bring her to the months
• Y our baby’s head & body should be This is where you This is where your baby is breast. facing the same way so she is not can lay down on held in the arm on the during six twisted at all your side whilst your same side as the breast she
• Y our baby’s nose needs to be opposite baby also lays on her is feeding from. Be careful the first your nipple so that she can reach up side in front of you. to make sure her head is She can attach
first the to a big mouthful and attach well free and not squashed in the crook of your arm. of breast and your
Laid back or biological nurturing nipple will end up six in the soft part during
This is where you lay on your back, making at the back of months sure you are comfortable with her mouth. pillows propping you
Feeding up from behind whilst your baby lays on top of you on her Signs of good attachment: stomach. There are lots of • Your baby has a large mouthful of breast and her chin is different positions firmly touching your breast for breastfeeding. Use • Her cheeks are full and rounded when she is sucking whichever position feels Further information • She takes deep sucks and you can hear her swallowing On biological nurturing visit: best for you and your baby. www.biologicalnurturing.com • You feel no pain although sucks may feel strong
114 115
Expressing breastmilk Using your thumb and Your questions: Is your baby: Expressing milk means gently squeezing finger gently squeeze and • Feeding at least 6–8 times in 24 hours milk out of your breast, you can do this by release this area. It should I am struggling to get my baby to in the first few weeks? (Most babies hand or by a pump. not hurt. Squeeze and feed well. Who can help me? feed 10–12 times in 24 hours) release in a steady rhythm There are lots of people who can help • Swallowing while she feeds? You may want to express your milk so that but make sure you don’t you to get breastfeeding going*. • Happy after feeds? your baby can still have your breastmilk when slide your fingers over your • Back up to her birth weight by two someone else is feeding her – because you have skin as this will hurt. How much milk does my baby need? weeks old? gone out for the day or gone back to work. In the early days your baby’s tummy is very • Having six to eight wet nappies a day After a little while drops of small – only about the size of a small egg. (after the first five days)? Feeding Hand expressing milk will appear, if they do Newborn babies need to feed little and often. • Pr oducing dirty nappies at least twice Hand expressing is easy once you have not your fingers are not A breastfed baby will take the amount of milk a day with yellow or mustard coloured months
the knack of it and is the best method of quite in the right place so she needs if given the opportunity to feed poo (after the first five days)?
expressing when your milk is thick and rich move them a bit (further often, but this might be different amounts during six (called colostrum) in the first day or so after back usually) and have on different days or times of day. If you say no to any of these questions talk
birth. It can also be helpful when: another go. You will to your midwife or health visitor or to a the first • Y our breasts feel full and uncomfy but soon find the right How can I tell if my baby is getting breastfeeding counsellor.
first the
your baby is asleep spot for you and enough breastmilk? • You don’t want to buy a breast pump then next time it will Some mums worry that their baby isn’t Can I give my baby too much breastmilk?
be easier and quicker. getting enough milk, but almost every Breastfed babies will take the amount of milk six during
How to express by hand mum can provide enough milk for her baby. they need and will stop feeding when they are months Have a clean, sterilised container ready before If you express before your baby is three or four The secret is to let your baby feed often and full. The milk gets richer in fat towards the end you start. Some mums find that their milk flows days old your milk will be thick and sticky and follow her lead. When she seems to be asking of the feed, which tells your baby she has had
Feeding more easily if they gently massage their breasts you will only see a few drops – later the milk for a feed, feed her even if you think it’s quite enough. You cannot overfeed a breastfed baby and twiddle their nipples before they express. will be thinner and squirt out. soon after the last feed. Think of yourself if you are giving only breastmilk. Do what feels nice and hormones that help – sometimes you go back for a second milk flow will be released. Cup your breast, When the milk flow from helping, or have a little extra snack. Your My baby wants to feed a lot in the work your thumb and forefinger back from this spot slows down move baby is growing fast and needs plenty of evenings and in the night. Is this normal? the base of your nipple about 2cm’s (you your finger like you are milk. Feed her as often as she wants. Yes this is normal. Babies are all different and might feel a different texture here). moving them round the however you choose to feed your baby, you face of a clock so that you will find they have periods when they want to express the milk from all feed more. Many babies feed very often in the parts of your breast. early days and weeks. It is unlikely a baby with a little tummy will be able to go for more than *For more information on helping to breastfeed, see page 59 a few hours without a feed.
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Your questions: Information for partners Bottle feeding The best milk for a bottle fed baby Your support will help your partner Babies who are bottle fed should be held close If you are bottle feeding you should give your Can I feed my baby in public places? and baby get off to a good start with and cuddled just like a breast fed baby would baby formula based on cows’ milk as her Yes. The law says that your baby has the breastfeeding. Breastfeeding can be. This will help you to develop a close bond main milk drink for the first year, unless you right to be fed wherever you are. Some mums be a bit tricky for the first few days with your baby. have been advised to use another sort of milk feel a bit awkward feeding in front of other and they will need you to be encouraging and by a doctor. Look for a milk which is labelled people, but it is very easy to do this without supportive. You can provide practical support Some things are the same for breastfed and ‘suitable from birth’ – sometimes called ‘first drawing too much attention to yourself. Talk so mum can concentrate on feeding the bottle fed babies: stage milks’. You can use this milk all through to your midwife or health visitor if you feel baby, or so that she can rest. Make sure that • Babies need an adult who is paying your baby’s first year. There is no need to worried about this and they will give you attention to them while they are being fed change milk.
mum has plenty to eat and drink and that she Feeding some helpful tips. doesn’t have to worry about keeping the house • Make eye contact with your baby, talk to her tidy or doing the washing. Keep the number and take time to enjoy feeding her You may notice lots of advertising trying months
Can I store breast milk for my partner of visitors limited. Above all, make sure you • Babies should be allowed to decide when to get you to buy other milks, but they are
to give in a bottle if I have to go out? tell her often that she’s doing a brilliant job. and how much milk to drink. Never force not needed. If you are not sure ask your during six You can store breastmilk in the main part your baby to finish her bottle health visitor.
of the fridge for up to five days, in the ice • Only give her breastmilk or formula milk the first compartment of the fridge for up to 2 weeks during the first six months. She doesn’t
first the
or up to 6 months in the freezer. Milk can be need any other food or drinks warmed by standing in a jug of hot water.
six during
Does my baby need a dummy? months Dummies are best avoided in the early days of breastfeeding because babies who have A health visitor’s view:
Feeding a dummy sometimes find it difficult to attach to their mums breast – especially when they “Babies should stay on first are learning how to breastfeed. A dad’s view: stage formula milk until
Whether you are breast they are one year old. Avoid If you use a dummy your baby will be less likely to feed when she needs to, so will “We have saved an or bottle feeding remember changing their milk, as this have less milk and this may in turn affect incredible amount of never to have a hot drink only causes the baby to the amount of milk you make. money. It’s easier whilst feeding a baby as have an upset tummy and because milk is on tap!” it may spill and scald become constipated.” Philip from Bridgend your baby. Angela, Aneurin Bevan Health Board 118 119
How to sterilise feeding equipment Cold water sterilising Steam sterilising (electric or microwave) Sterilising by boiling There are 3 ways to sterilise feeding equipment – you need to do this if you are feeding your baby formula or breastmilk in a bottle until your baby is around one year old.
Before sterilising Wash your hands with soap and water and clean work surfaces. Feeding Clean the feeding bottle and teat or breast months
pump parts in
hot soapy water. • Change the sterilising solution every 24 • Make sure the openings of the bottles, teat • Check that whatever you sterilise this way during six hours or breastpump are face down in the steriliser is safe to boil
• Leave the feeding equipment in the solution • Check how long you can leave any • Boil the feeding equipment in water for the first for at least 30 minutes equipment you do not use straight away at least 10 minutes making sure all items
first the
• Make sure there is no air trapped – the stay under the water solution needs to come into contact with
all parts of the equipment to work properly six during
• Using the floating cover to keep the months equipment under the water
Feeding Rinse all equipment If you are not using the in clean, cold bottles immediately put running water. them together fully with Be careful to ensure the teat and lid in place safety and prevent burns to prevent the inside of and scalds never leave Follow the manufacturer’s Regularly check that teats the sterilised bottle and hot pans and liquids instructions for whichever and bottles are not torn, the inside of the teat from unattended especially if method you are using. cracked or damaged. being contaminated. children are present. Feeding during the first six months 121 WHY IS THIS IMPORTANT? WHY IS THIS IMPORTANT? This is to make sure the amount of water is the amount of This is to make sure or not too strong and that the milk is correct too weak. makes milk powders and different Different amount of scoops. The wrong have different being too strong in the milk powder may result or too weak the teat does not get dirty. This will make sure that the milk is mixed properly. This will make sure the milk is the right This will make sure temperature. you do not give your baby This is to make sure old milk by mistake. MAKING UP A FEED USING FORMULA MILK POWDER FORMULA MILK UP A FEED USING MAKING WHAT SHOULD I DO? WHAT Pour the correct amount of cooled, boiled water amount of Pour the correct the volume of water into bottles. Double–check adding the powder. before for carefully Always check the instructions using. the powder you are Level off with milk powder. Fill the scoop loosely or the back the scoop using the leveller provided, scoop you of a clean, dry knife. Always use the using. get with the powder you are bottle. Add the powder to the water in the the bottle Holding the edge of the teat, put it on ring and cap. the retaining and then secure dissolved. Shake the bottle until the powder is of the bottle Cool the milk by holding the bottom Do not allow the tap under cold running water. water to touch the bottle cap. by shaking a of the milk the temperature Test wrist. It small amount onto the inside of your and feel warm or should be body temperature cool but not hot. away any of the feed that has not Throw been used. WHY IS THIS IMPORTANT? WHY IS THIS IMPORTANT? WHY IS THIS IMPORTANT? WHY IS THIS IMPORTANT? This will stop bacteria growing in the milk and in growing This will stop bacteria make it safer for her. system is not well developed. immune baby’s Your germs on the bottles and teats, Sterilising kills any germs. from the risk of infection reducing too Bottled water is not sterile and may contain much sodium or sulphate. This will help you to be sure that the water you This will help you to be sure This will use to mix the formula is above 70°C. may be kill most of the germs or bacteria that in the milk. This will help prevent the germs in tap water, the germs in tap water, This will help prevent getting on your hands or on work surfaces from into the milk. GENERAL . * MAKING UP POWDERED MILK SAFELY UP POWDERED MAKING MAKING UP A FEED USING FORMULA MILK POWDER MAKING UP A FEED USING FORMULA ers recommend lower temperatures than boiling water, or don’t tell you that water should never be left for longer than 30 tell you that water or don’t than boiling water, lower temperatures ers recommend WHAT SHOULD I DO? WHAT WHAT SHOULD I DO? WHAT 120 Use a kettle to boil at least 1 litre of fresh water of fresh Use a kettle to boil at least 1 litre water that has the cold tap. Do not re–boil from been standing in the kettle. making up your Let the water cool a bit before feed but not for longer than 30 minutes Make up feeds one at a time as your baby needs Make up feeds one it. and store make a batch them. Don’t and equipment to be used. Sterilise all bottles the cold tap to put in your kettle Use water from or for making up a feed. Do not use bottled ready artificially softened water. Clean and disinfect all equipment and work Clean and disinfect all equipment and teat and surfaces, wash your hands and keep bottle cap on the upturned lid of the steriliser. shake using a cold–water steriliser, If you are excess solution and rinse bottles in cooled off the kettle. boiled water from tap water to rinse any of the equipment use Don’t after you have sterilised it.
Some formula manufactur 2005; NHS, 2011. Agency, Food Standards tell you. Source: than what manufacturers rather minutes. Always follow the advice here
*
Feeding during the first six months Feeding during the first six months 123 Is it worth buying ready–to–feed formula? ready–to–feed Is it worth buying out convenient if you are These milks can be can’t you some reason and about, or if for However, up milk safely. heat water or make not usually are very expensive and they are feeds. all your baby’s a good option for to feed infant ready Opened and unused carton should be in the formula that remains the back of the fridge on the top at stored shelf with the cut corner turned down, for no longer than 24 hours. planning to feed your baby formula If you’re birth then you may need to take right from to feed formula in with you to some ready this. hospital. Speak to your midwife about option Is soya–based formula a good allergies in the family? are if there given Soya–based formula should not be unless to babies under six months of age thinking If you are by a doctor. recommended GP about using this formula, talk to your or health visitor. Your questions: Your that is close a formula milk Is there to breastmilk? to make milk that is No. It is impossible like breastmilk. formula help my Will a ‘hungry baby’ baby to sleep better? milk marketed is no evidence that No. There Use any advantage. offer for ‘hungry babies’ the first year if babies first milks throughout breastfed. not being are If a baby is bringing up small amounts a of milk after feeds, do they need special formula? Many babies will bring up small amounts This is of milk after feeds, or if they burp. to your midwife or perfectly normal. Talk worried, but your health visitor if you are need a special milk. doesn’t baby probably Do babies need follow–on formula after six months of age? need follow–on formula. No. Babies don’t buy these milks with Healthy can’t You Start vouchers.
e it in a cool bag e it in a cool bag Remember the safest option safest option the Remember up a feed only is to make needs it. baby when your – and use within four hours – and use within – use within two hours Stor stor Or if you cannot
Warming feeds feeds Warming to use the feed, place ready When you are water to the bottle in a container of warm to warm milk heat it. Never use a microwave could scald as the milk heats unevenly and you mouth. your baby’s of your Always test the feed on the inside it is not too hot before wrist to make sure you feed your baby. • • e inacoolbagwithanicepack up a feed only option is to make The safest needs it. If you do need to when your baby baby needs your feed before make up formula fridge and use it in the back of the it, store within 24 hours. made up feed, cool it for If transporting a of the fridge and then: one hour in the back
ed amount of formula in a ed amount of formula 122 Remember to cool the the to cool Remember giving it to feed before baby your small, clean, dry container small, clean, dry just been boiled with a cap An empty sterilised feeding bottled An empty sterilised A measur of hot water that has A vacuum flask
Make up the fresh feed when your baby Make up the fresh hot when needs it – the water must still be in the you use it otherwise any bacterial formula may not be killed. to be The vacuum flask does not need and sterilised but it should be cleaned only used for your baby. • • • Feeding away from home away from Feeding your baby away from If you need to feed to choice is to use ready home a convenient with an empty sterilised feed infant formula using you are if feeding bottle. However, need: formula you will powdered
Feeding during the first six months 124 125
Things you need to know Car safety Useful advice for all the things All children, including babies, you need to know for your baby’s must sit in a properly fitted child health and wellbeing. seat during every car journey.
You should never sit a baby on your lap or in • Y ou can use infant car seats in the front or Support from healthcare professionals Child benefit your arms on a car journey and you should back seat, but they must be used in the way after the birth This is payable from the date your baby is never put a seatbelt around yourself and a the manufacturer says In the first 10 days after you’ve given birth, born and is paid by Her Majesty’s Revenue baby. Make sure you have the correct car seat • Never put a rearward-facing baby seat in the
you’ll be looked after by a midwife in hospital and Customs (HMRC). Most people with a for your baby and your car. Learn how to front if there is an active passenger airbag Car safety and at home. After this a health visitor will child qualify for child benefit and can receive fit it properly. • Don’ t use a second hand car seat unless be keeping an eye on you and your new it regardless of income. If you or your partner you’re absolutely sure it isn’t damaged. baby instead. You’ll also need to register earn over £50,000 (individually, not joint Rearward-facing seats provide better protection Sometimes you can’t tell if a seat is faulty your baby with a GP. income), some or all of your child benefit for your baby’s head, neck and spine than just by looking will be paid back through tax. forward-facing seats. So, it is best to keep • Some hospitals will let you hire a car seat The role of the health visitor your baby in a rearward-facing seat for as long for a while and some taxis have them too. Things you need to know Things you Health visitors are registered nurses with an Child benefit can be paid directly into your as possible, even up to the age of four. Your If you don’t have your own child seat yet, additional qualification in Public Health Nursing. bank or savings account or through a Post baby will grow quickly, so whichever seat you always ask a taxi firm if they have a suitable Your health visitor will be a great source of Office or national savings account that choose, remember to check that she has not one before booking. Always remember to support and information. S/he will visit you at accepts direct payment. There is a form for exceeded the maximum weight for her seat or wear a seatbelt yourself for protection too home and then invite you and your baby to child benefit in the ‘bounty pack’ handed out that the top of her head is not higher than the • Babies should not sleep in a car seat for long attend a child health clinic. This is your chance by the hospital after your child is born. top of her seat. periods as many seats are not flat, which to ask questions, talk about baby care and can mean babies are slumped over, which have your baby’s health and growth checked. can in some cases affect their breathing. Further information Get the form by phone on 0300 200 3100 Your health visitor will also give you a Further information For further information on safe car seat use, or visit www.hmrc.gov.uk/childbenefit number to call if you ever need any advice For more information on choosing the right please visit www.lullabytrust.org.uk about your baby. car seat for your baby, visit www.childcarseats.org.uk 126 127
Your questions: How can I keep my baby or child Smoke free homes safe from smoke? Why is cigarette smoke so bad? A completely smoke free home and car is Second hand smoke is the smoke Cigarette smoke is a mixture of gases and the only way to make sure that your children particles which contains over 4,000 chemicals. and family are protected. There is no safe level that you breathe in from other Lots of these chemicals are toxic or irritate the of second hand smoke. lungs. Over 50 of these chemicals are known people’s cigarettes. Your new baby to cause cancer. Smoking in a car with the window down, or is powerless to protect herself from near an open door won’t work because the More than 80% of second hand smoke is smoke gets everywhere. Smoking in just one second hand smoke. So don’t ever let invisible, so you can’t see where it goes. The room of the house, waving smoke away, or smoke is impossible to control too. Even if you only smoking inside when it’s raining or cold anyone smoke around your baby. smoke near an open window or door, it can will not protect your loved ones either. stay in the air long after you’ve finished. Smoke free homes There are lots of ways you and your family can benefit from making your home and car smoke Babies and children are more vulnerable free. Keeping cigarette smoke well away from Babies and children tend to breathe more your car and home: Anyone’s health can be quickly and have less–developed airways, • Helps to protect your family from the affected by the effects of lungs and immune systems. Also babies poisons that can damage their health Smoke free homes free Smoke second hand smoke, but can’t complain, or leave the room. • Keeps your home, car and clothes babies and children are smelling fresh Babies and children who are exposed to • Lowers your chance of having a fire in especially at risk. second hand smoke are more at risk of: your home • Cot death • Lowers the cost of insurance • Having damaged lungs • W ill help you to quit smoking if you • Getting illnesses like coughs, colds, haven’t already stopped Further information On the effects of second hand smoke visit bronchitis and pneumonia www.freshstartwales.co.uk • Getting middle ear disease, which can or www.tommysbabybe.org.uk cause deafness If you would like to talk to Further information • Getting asthma, or wheezing someone about quitting, Support is available for free by by calling Help Me Quit on 0800 085 2219 or text contact your midwife, HMQ to 80818 or visit health visitor or GP. www.helpmequit.wales Registering the birth of your baby 129 ental responsibility if a ental responsibility Further information Further Contact Stonewall call 08000 502020 or visit www.stonewallcymru.org.uk parental agreement is made agreement parental responsibility making a parental and parent the birth or jointly registering agreement Applying for par Becoming a civil partner of the other
• • I’m in a same–sex relationship. What are What are same–sex relationship. I’m in a rights?. my partner’s registering in a same–sex relationship, If you’re legal parenthood the birth and assigning complicated. a bit more can sometimes be Civil Partners you civil partners when If you were you will both have conceived your baby responsibility. parental Non-civil partners civil For same-sex partners who aren’t can get parental partners, the second parent by either: responsibility
egister jointly ee declaring that he can be picked up in advance from the can be picked up in advance from Mum will need to sign office. Registrar’s say that a declaration too. The declarations who the father of your you both agree register baby is. This means that mum can without dad needing both of you as parents to be there register The mother can then is the father. be there the birth, without dad needing to with mum. You will both need to go to will both need to with mum. You office the Registrar’s Dad will need to sign the r which Dad will need to sign a declaration, Dad can get a court decr
• • • Your questions: Your do I need to do? I’m married. What you or your partner married, either If you are You’ll baby. the birth of your can register rights the same parental automatically have a copy need to take You’ll and responsibilities. you certificate and the card of your marriage with you. given at the hospital were but I want dad to be on I’m not married, what do I need to do? the register, not married, then mum will take on If you are unless rights and responsibilities all parental register To dad is named on the birth register. for you: options three are dad, there Parental rights and responsibilities Parental you will need to make decisions As parents education and welfare, care, about your child’s the birth together, development. If you register equal parental married, you share or if you are If you and rights under the law. responsibilities or if you are the birth together, do not register these not married, only the mother assumes rights and responsibilities.
Further information Further
visit www.gov.uk/register-birth
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Ask your midwife to tell midwife tell to Ask your local your where you is and then registrar them in touch with get to make an appointment. to make
being born. baby within 42 days of your baby baby your of days 42 within baby You must register the birth of your of your birth the register must You Registering the birth of your baby of your birth the Registering Registering the birth of your baby your of birth the Registering 130 131
Babies who need extra care Crying Around one in every nine babies All babies cry. It’s their way of will be admitted to a specialist letting you know that they are not neonatal unit after they are born. comfortable or need something. This is because they arrive earlier Usually it’s obvious what your baby than expected, or are too sick to needs and you can work out that she is hungry, needs a nappy change, care cope on their own. or just wants some company. Crying extra
Having your baby admitted to a Neonatal There will be lots of support available for you
need Unit (NICU) or Special Care Baby Unit (SCBU) if you are in this situation, from the expert
can be a frightening experience. Some families staff in the unit and from others. Ask the When your baby cries a lot who will know beforehand that their baby is likely staff caring for your baby how you can help, Some parents worry Some babies cry a lot more than others, to need special care, but for most families it getting involved with caring for your baby, and it’s not really clear why. Some babies that responding to their is unexpected. even simple things, can really help you feel can be difficult to soothe and seem unhappy Babies closer. Lots of very tiny babies can have baby every time she cries a lot of the time, even if they are healthy and If your baby needs special care, you may find skin-to-skin contact with mum and dad as might not be the right developing normally. Remember you can walking into a unit for the first time confusing long as they are not too poorly. thing to do, but you won’t always get help if you are worried. and frightening. Seeing your baby for the ‘spoil’ your baby by giving first time in a neonatal unit surrounded by her too much attention. How to cope with a crying baby unfamiliar equipment and staff can be a Pick your baby up, talk to her and cuddle Further information Responding to her needs worrying and stressful time. Although your Contact Bliss who are a charity that runs her, offer her another breastfeed. Breastfeeding and listening to her is baby will be receiving the very best care, you a helpline for parents with a baby in the is sometimes just for comfort and that’s okay. may feel helpless and unsure about how to neonatal unit. Visit www.bliss.org.uk, very important and will You can’t over feed a breastfed baby. cope. You may also feel that you have missed or call their family support helpline on help her to feel secure. out on a normal pregnancy and be sad that 0500 618140 (9am to 9pm, Mon to Fri). you can’t go straight home with your baby. Or email them at [email protected] 132 133
Coping with a baby who always seems Parents can get exhausted and upset by a Follow your instincts unhappy is extremely stressful, so try to make baby who never seems to stop crying. If you’re It’s important to trust your instincts. If you A mum’s view: sure there’s plenty of support around. Ask an getting very upset, try putting her down are worried about your baby’s crying, ask your understanding friend to hold her for a while, somewhere safe or ask someone else to hold health visitor to check that she is okay. If there’s or ask your health visitor about local sources her and leave the room. Never, ever shake nothing wrong, you may just have to accept “It took me a while to work of support. your baby, no matter how frustrated you that this is the way your baby is. You’re not out what was wrong when feel. Shaking is very dangerous for your baby, doing anything wrong, it’s not your fault and Tom would cry. Usually he As you and your partner get to know your baby, because her head is big and heavy compared to it happens to lots of people. Over time, she’ll was hungry or just needing you’ll begin to learn what different cries mean. the rest of her body. If her head isn’t supported become more settled. to have his nappy changed. it flops around because her neck muscles aren’t However, sometimes he just If your baby cries, you could try: strong enough. When a baby is shaken her Baby massage needed a cuddle.” • Rocking, patting or gently rubbing her head can be thrown back and forth very quickly Baby massage is becoming popular and most back, tummy or feet with great force. This force can cause tiny areas now offer classes. You will learn how to Katrina from Cardiff • Giving her more frequent feeds blood vessels around your baby’s brain to tear use gentle soothing touch and stroking to calm • Carrying her in a sling. A sling that keeps and bleed and the brain to swell, resulting in your baby. It has benefits for you both. You can
your baby solidly against your body in an bruising and damage to your baby’s brain. start when your baby is about six weeks old. Crying upright position is the safest. Make sure This can be fatal. Don’t do anything your baby doesn’t like and that you check that she has her chin off use natural oils like grapeseed or almond oil. Crying her chest so she can breathe easily If you are getting frustrated by your baby’s ‘Essential oils’ can cause severe irritations or • Giving her a warm bath crying, remember to ‘Step back, Stop and allergic reactions or burns and should always • Having a change of scenery by going Think’ as suggested in the short video be avoided for a baby under three months and for a walk or a drive ‘Shaking your baby is just not the deal’ after that only used with professional advice. Remember: which contains some helpful ideas about Some babies simply cry how to cope in this situation. Skin contact more than others but you Skin–to–skin contact with your baby is good at any age, it’s not just for the first hours after can always speak to your birth. It will help her do well physically and health visitor for local emotionally and it can also help you become sources of support. Remember: more confident as a parent. If you are getting frustrated by a crying Further information To see ‘Shaking your baby is just not the baby, remember to ‘Step deal’ visit: www.youtube.com/user/ back, Stop and Think.’ PublicHealthWales 134 135
Talk to your baby What else can dads, friends and family do? The importance of dads Most brain development occurs between birth As well as needing practical help, new mums and age two, so babies and toddlers need need support, reassurance and someone to Dads are important, whatever shape stimulation as much as they need nourishing listen to them. There’s so much you can do food. The best way to stimulate babies’ brains to help: or size your family. Sometimes, is to connect with them through ‘mutual • Be ready to listen and pass the tissues gaze’ and talk to them from the moment they when mum is emotional especially in the early days after are born. Gaze directly into your baby’s eyes, • Remind her that the baby blues are common birth, some dads feel a bit lost or talk to her and wait for her response. This and will pass stimulation will strengthen the connections • Make sure she isn’t overwhelmed by visitors not sure what to do. Dads sometimes that make learning possible. It will also help her • Help with the baby learn to talk, because it is from listening to your • Of fer to do the cleaning, cooking and feel left out and envious of the baby. voice that she will learn to use language. Good ironing importanceThe of dads speaking and listening skills will help her to • Make sure she gets as much rest as possible become a good reader and writer later on.
Your new baby is the ‘star of the show’, quickly In a few days or weeks, your baby will become Communicating, talking and interacting with followed by mum because she did all the hard more interested in the world around her and your baby will help her to develop social skills A dad’s view: work of giving birth. Mum will be getting lots she’ll need feeding slightly less often. She will and good relationships. It is also a way for you of attention because she needs to recover from want to play with you when she is awake and to show that you love and respect her and the birth. Where does that leave you as a dad? you will learn to comfort and soothe her. help her self–esteem to grow. Spending time “The important thing to The importance of dads of dads The importance talking with her will help the two of you form remember is that it’s not Dad’s role The support and understanding a mum receives a close bond. Communication is the basis of the big things that make Your job for now is to look after mum and from those around her – her partner, parents your relationship with each other. the difference but as many baby together. Keep them safe and support and friends – can make a huge difference at little things as possible. mum by doing all the practical things so she this time. If people around her think about how A cup of tea, a cuddle or can focus on your baby. Do the shopping, she’s feeling, then she is more likely to be able telling great auntie Zelda the cooking and washing. to concentrate on providing the physical and emotional care for your baby. that no, she can’t come and visit. Again. It’s being the arm around the shoulder without being dramatic about it.” Craig from Cardiff 136 137
Looking after yourself Eating well as a new mum Giving birth can be an exhausting It is really important that you eat experience which brings about all well to ensure that you have the sorts of physical and emotional energy and strength to look after changes. The first few days may your new baby. be tough – so don’t be too hard on yourself. Rest and enjoy your baby. Eating well as a new mum The importance of eating well Tips for eating well with a new baby • Eating well is important for you. It will • Make sure you eat and drink regularly help you recover from the birth and give throughout the day. It can be easy to skip The first few days you the energy to care for your new baby meals when you have a new baby to look For the first few days after the birth you • Eating well is important for your family. after, but you need energy and nutrients Even though you might have will probably feel really tired. If you had a As a mum, you will influence your family’s for the demands of parenting and to stay expected to feel great, you caesarean section you will still be recovering diet. If you eat well, it will help encourage well yourself might actually feel a bit from the operation. If you had stitches you everybody else to eat well too • Carry on with the same healthy diet you Looking after yourself yourself after Looking down. It’s important that may be sore and worried about moving around had in pregnancy. There is no need to stop you look after yourself, or going to the toilet. You could have some now that baby has arrived and you will tummy pain as your womb shrinks back to Further information soon have a family to feed so you will take time to recover from For examples of simple, cheap and the birth and get to its normal size and your breasts will be filling want to carry on those good habits with milk. healthy snacks you can make visit: • If you are worried about how much know your baby. www.firststepsnutrition.org weight you gained in pregnancy and how you might get back to a weight you are comfortable with, talk to your midwife or health visitor. They can advise you on where to get support and advice in your area • If you are finding it hard to make meals, then nutritious snacks can be just as good 138 139
Your questions: Breastfeeding mums Alcohol and breastfeeding If you are breastfeeding your baby you It’s probably sensible to drink very little Is there anything I should avoid eating What if my baby shows signs of allergic will need extra energy and extra fluids, while breastfeeding and no more than one and drinking when I am breastfeeding? response to what I eat? here are some examples of healthy snacks: or two units once or twice a week. This is You can eat and drink the same healthy If you are worried that your baby is showing • A glass of milk because alcohol passes through to breastfed food as the rest of the family when you are an allergic response (for example by being • Fruit babies in very small amounts. It’s unlikely that breastfeeding, but there are a few things to very unsettled after feeds, being sick, crying • A bowl of milky porridge with banana having an occasional drink will harm you or watch out for: too much or having a rash), then talk to your and chopped nuts your baby, but it might affect how easily your • Y our baby could become unsettled if you GP or midwife. In rare circumstances babies • A bowl of yoghurt and fruit baby feeds. If you intend to drink more than drink a lot of coffee and tea with caffeine can be allergic to cows’ milk protein and mums • Hot chocolate this on a special occasion, you might want to in them. Try switching to decaffeinated might need to avoid dairy products themselves • Slices of toast with peanut butter think about expressing milk in advance for versions if you think your baby is sensitive when breastfeeding. If so mum may need a
• An egg sandwich and some chilled your babysitter. to caffeine in your breastmilk calcium supplement; your GP can arrange for Eating well as a new mum water or a small glass of pure fruit • Y ou can eat oil–rich fish like salmon, you to see a dietitian. juice unsweetened If you have had a lot to drink and you need to trout, mackerel, herring, kippers, sardines, express your milk because your breasts feel full, whitebait and pilchards, but Will foods like onions, garlic and spicy this milk will contain alcohol and so should be only have these fish twice a week curries upset my baby? Further information thrown away. Once you feel sober again it is Eating ordinary foods will not affect your On eating well for breastfeeding mums visit: okay to feed your baby. However, if you have breastfeeding baby, especially if they are www.firststepsnutrition.org had a lot to drink it is hard to be as aware of foods you have always eaten and ate when your baby’s needs as usual. you were pregnant.
Eating well as a new mum a new well as Eating One unit of alcohol is approximately a single (25ml) measure of spirits, half a pint of beer or half a standard (175ml) glass of wine, although Don’t forget: it depends on the strength of the drink. Keep taking your Healthy Start vitamins from Further information pregnancy, or take a On alcohol and breastfeeding visit: separate vitamin D www.breastfeedingnetwork.org.uk supplement. Talk to your health visitor or midwife about suitable supplements. 140 141
How you may be feeling Getting a good night’s sleep Having a baby is a life changing A full night’s sleep is one of the event, your emotions will probably things that many new parents miss change every five minutes. most after their baby is born.
Feelings of sadness and depression are We don’t exactly know what causes the baby Where your baby should sleep Sharing your bed Getting a good night’s sleep more common after childbirth than many blues, but we do know it’s perfectly normal. Keep your baby close. The safest place for Some parents choose to sleep with their baby people realise. It is perfectly normal to feel a There could be hormonal reasons. The baby your baby to sleep is in a cot by the side of in their bed and some parents fall asleep with bit down after the birth. Around 70% of all blues will go away, but it’s important to get your bed. This means you can hear your baby their baby during the night while feeding and new mums suffer from so–called ‘baby blues’. extra support while it lasts. If these feelings and respond to her needs before she starts comforting whether they intend to or not. don’t pass within a few days, talk to your crying and you can reach her easily without Baby blues describes feelings of mild midwife or health visitor. having to get up. If you decide to share a bed with your baby: depression and tearfulness. It normally kicks • Keep your baby away from the pillows in two to three days after the birth and Postpartum psychosis Listen for these early feeding cues: • Make sure your baby can’t fall out of bed or shouldn’t last very long. But it can happen This is a rare, severe episode of mental illness • Sucking fingers get trapped between the mattress and wall How you may be feeling may you How at any time and may last for only a couple which begins suddenly in the days or weeks • Restlessness • Make sure the bedclothes cannot cover of hours or up to a few days. This is quite after having a baby, most often the first two • Murmuring sounds your baby’s face or head different to post–natal depression. weeks. It affects about one or two in every • Don’ t leave your baby alone in the bed, 1000 mothers. When your baby wakes up, try not to stimulate as even very young babies can wriggle into Baby blues and how it might affect you her too much. As soon as she starts waking, a dangerous position Caring for a new baby can be exhausting. The symptoms vary and can change rapidly. offer her a feed. That way she won’t get too • It is not safe to bed–share in the early Poor sleep and worrying about coping may They can include high mood (mania), upset and it will be easier for her to settle back months if your baby was born very small upset your mood. You may feel really tired depression,* confusion, hallucinations and to sleep. Talk to her in a soft, quiet voice and or preterm or generally not very well. You may cry for delusions. Postpartum psychosis is a psychiatric avoid changing her nappy or clothing unless no particular reason and find it impossible emergency and you should seek help from your she really needs it. to cheer up. Little things that you’d normally GP, health visitor or midwife as soon as possible. take in your stride suddenly seem like huge problems. *For more information on depression see page 169 142 143
When babies don’t settle Bottle feeding WARNING: There may be times when your baby is It is important to be organised to make sure unsettled after feeds. Placing your baby in that bottle–feeding at night doesn’t disturb or Do not put yourself in the position where you could doze off with your baby on a sofa skin–to–skin contact with you and gently upset baby too much. Powdered milk is not or armchair. rocking can provide comfort. Your partner sterile and can cause infections if made up in
can help with this too. If you are breastfeeding advance. Therefore you will need to make up Do not sleep with your baby when you have been drinking any alcohol or taking drugs you can offer your breast again even if your feeds during the night. However, you can make or medicines that may cause drowsiness (legal or illegal). baby has just fed. Babies find the suckling this easier by having bottles and teats ready comforting and there is no risk of overfeeding sterilised, the powder measured out and boiled Do not sleep in bed with your baby if you or your partner are smokers. a breastfed baby. If you have had a particularly water kept in a flask. You may also choose to disturbed night, try to take time out to rest use ready–to–feed milk.
during the day. Visitors can wait – or they ALWAYS REMEMBER: Getting a good night’s sleep can help by taking over chores or looking after other children while you and your Keep the cot beside your bed for at least the first six months. baby catch up on sleep. Your questions: Put your baby down on her back to sleep, never on her front or side. Breastfeeding How much sleep is normal for my baby? Many women choose to feed their baby Some babies sleep more than others. There’s whilst lying in bed. Ask your midwife or no normal amount of sleep. All babies have Position her at the bottom of the cot with her feet at the foot of the cot – not with her health visitor to help you find a safe and days when they want to sleep more and days head at the top. That way, she can’t wriggle down and get caught under her blankets. comfortable position. when they are more wakeful than usual. New babies sleep a lot. This may be as much as 18 Getting a good night’s sleep night’s a good Getting Make sure the cot mattress is firm, flat and well fitted with gaps no larger than two How partners can help hours a day for the first month or so. However, fingers between the sides of the cot and the mattress. Waterbeds, bean bags and Try making sure that mum is they will rarely sleep for more than a few hours sagging mattresses are not suitable for your baby. comfortable. Pass her things, rather at a time. A baby who seems unusually sleepy than her having to reach for them, may be unwell. Trust your instincts and get keep bringing her drinks and snacks medical advice if you are worried. Make sure that your baby is not overdressed or covered with too much bedding. Use and make sure she has a glass of water to no more bedding than you would use yourself and make sure the bedding does not cover her head and remove cot bumpers. hand as breastfeeding can be thirsty work. Parents sometimes think that they are doing something wrong if their baby does not sleep as much as they expect. It can be confusing Make sure the room is not too hot. Around 16–20ºC is ideal. and stressful, but it’s normal for babies to wake during the night to be fed and comforted. The safest place for your baby to sleep is in a cot by the side of your bed. Relationships
145 A dad’s view: A dad’s I can’t and partner “My we are lucky how believe baby. lovely our to have him at we look Every time we feel blessed.” Llanelli Jim from A mum’s view: A mum’s “It’s true, becoming a does change really mum the life. It feels like your the job in most important family Help from world. helped me and friends most the even to enjoy times.” challenging Cardiff from Katrina www.gingerbread.org.uk Further information Further For support for single parents visit: For support for single parents Learning after the baby together to look Mums should is good for a relationship. care. the baby to share encourage partners thing is to keep talking The most important to spend some time alone as Try to each other. a walk for half an hour. just it’s a couple, even if Making friends be a good time to makeHaving a baby can of have groups will areas new friends. Most and good for support that are other parents coffee friendship. Some organisations have baby and toddler or centres, drop–in groups, someoneclubs. If you feel shy you could ask know if they’ll come with you for you already know otherthe first few times until you get to Ask your health visitor for advice people there. and details about local groups. on your own If you’re from to get as much support as possible Try important to make your family and friends. It’s baby. time for yourself, as well as for your help when it all that can groups are There visitor or seems too much. Ask your health who provide like Gingerbread contact groups advice and support to single parents.
happy.
you’re
if
‘Always phone first’ is a good rule. Partners ‘Always phone first’ is a good rule. that can be good gatekeepers by explaining can Grandparents too tired. just you are should help keep people away too, but they when you times are that there remember to see them either. want won’t and your partner You a joyous In theory having a baby should be closer. time which brings you and your partner strain on it can sometimes put a real In reality can both be You even the best relationships. can feel your world has been turned and tired upside down. new arrival. Partners can feel ‘shut out’ by the and that can put sex life may well suffer Your on you both. pressure parent
a
as
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You and your family You help can be welcome and you should of Offers feel you don’t definitely say yes sometimes. But make their have to entertain people. Let them biscuits. If own cup of tea and bring their own be afraid too tiring to see someone, don’t it’s time. to ask them to arrange to come another Making some time for yourself and having Making some time for yourself and often conversation are a normal grown–up to offer important to new mums. If people will offer help, let them. Sometimes people meals, do a bit of shopping to bring around yes! for you or even do the cleaning. Say to help. They will feel good about being able afraid to ask for help if you need it. be Don’t are important, as you’ll feel more more feel you’ll as important, are ‘you’. Your own needs at this time time this needs at own Your ‘you’. confident but you need to feel that you are still still are you to feel that need you but Having a baby is a time of big change, change, a time of big is a baby Having Relationships Relationships 146 147
Taking your time Your questions: Sex and contraception Remember there are other ways of being close that don’t involve penetrative sex and Is breastfeeding a form of contraception? Shortly after giving birth you cuddling is almost always nice. When you This is not a reliable method of contraception do feel the time is right to have sex again, unless you are very strict about keeping to may feel like you’ll never want to don’t be surprised if it feels a bit strange certain rules. If you want to use this method of and different. Your muscles can take several contraception, talk to a GP or family planning have sex again. But at some point months to get back to normal. Doing pelvic nurse first. You can only rely on breastfeeding floor exercises* can help your body to recover. as a contraceptive when you: you probably will, so it’s good to You’ll both probably be a bit nervous too, • Ar e exclusively breastfeeding often, be prepared for how you might be so don’t rush it. including during the night • Have not had a period feeling physically and emotionally Sometimes you can feel too ‘dry’ for sex • Your baby is under six months old Sex
after childbirth and vaginal dryness caused and and think about what form of by low oestrogen levels during breastfeeding When should I start using contraception?
can make sexual intercourse uncomfortable. You should start using your chosen method of contraception contraception you want to use. Lubricant can make vaginal sex more contraception within four weeks of the birth if
contraception comfortable and a water–based lubricant you don’t want to become pregnant again.
such as KY Jelly can help. However, if you and
are using condoms or a diaphragm as Your midwife and health visitor will chat to you It’s okay to wait In reality many couples wait longer than that. contraception, avoid using extra lubricant about contraception now so that you can think Sex Physically there’s no real reason why you You or your partner may be too tired for sex. unless you really need to. Using it when you about it before it becomes more pressing. It can’t have sex as soon as your vaginal You may still feel a bit physically or emotionally don’t need to can increase the chance that may be that the method of contraception you discharge has cleared up (usually after about bruised from the birth and want to wait a the condom might slip off. used before you became pregnant may not be four weeks) and any cut or tear in your while. There’s no right or wrong, it’s up to you the most suitable one now. perineum has healed. Before then sex may when you feel ready. Different people want Don’t use oil–based lubricants such as be uncomfortable and there’s a risk of to resume their sex life at different points. Vaseline or massage oil, as they can damage infection if you haven’t healed up properly. latex condoms or diaphragms. If you’re Keep talking finding that sex actually hurts, talk to your This can be a tough time for relationships. GP as you might have an infection. Try to spend some quality time together Further information without the baby and keep talking to each About contraception, visit the other about how you both feel. Family Planning Association website at www.fpa.org.uk or call 0845 122 8690 *For more information on pelvic floor exercises, see page 30 148 149
Your growing baby
The period from one month to one year will be an amazing time for you and your baby. He will grow from a tiny bundle into a little person. At one year old he will be moving around and may be walking. Even though words will still be few and far between, he will be communicating with you. Your baby’s brain is growing very fast. The experiences he has and the way you respond to him will shape the way his brain and emotional system develop. Find out how to understand your baby’s world and what he needs from you. 150 151
Your growing baby at a glance Illnesses Your baby’s food Mild illnesses such as coughs and colds At around six months your baby may Your baby’s brain is growing very are common. be ready to try some solid food. fast at this time. Give him lots of Contact your GP if you feel something Never add any salt or sugar to your love, smiles, time to play games, talk isn’t right, or doesn’t get better. baby’s bottle or food. and sing together and new things Make sure you know the signs of two Be patient and try to make food very serious illnesses – meningitis and time fun when your baby is trying to learn about the world around him. septicaemia* – get medical help new tastes. immediately for these.
For more information visit Your baby’s teeth www.meningitisnow.org Looking after yourself Your baby’s health Look after your baby’s teeth. Don’t give Safety him sugary and sweet things to eat and If you feel very isolated, low or tearful Breastfeeding will help to keep your baby brush your baby’s teeth as soon as his and it doesn’t get better after a few days, well. He needs only breast or formula milk, Make sure your home is as safe as first tooth appears. talk to your health visitor or GP. You may until six months. possible for your baby. have postnatal depression. It is common and can be treated but do ask for help. Take your baby to be immunised. The Always use a high factor sun cream or first jab is when he is two months old. sun block and stay out of midday sun. Remind yourself of the ‘Five Ways to Wellbeing’ and try do at least one each day. Talk to your health visitor if you have Use a car seat when travelling by car and any concerns. a cycle helmet if you go on a bike ride. Never leave your baby alone around See pages 12 and 13 for water, even for a minute. more on wellbeing
*For more information on meningitis and septicaemia, see page 192 152 153
Your baby’s development Your health visitor will work with you to make sure you have the support you need to help you care for your baby during As your baby develops it is important this important time. that he is immunised and checked regularly to ensure that he is kept safe and well as he develops.
Health review (around 12 – 14 months) Your baby’s development Your health visitor will offer another Health visitor appointment health check, this will be similar to the (around 6 months) check he gets at six to eight weeks and Immunisations This aims to help you keep your baby will help your health visitor make sure he (at 2, 3 and 4 months) safe, now he is moving around. is developing well.
MONT HS 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Your baby’s development baby’s Your
Health review Bookstart Pack Immunisations (6 – 8 weeks) (around 9 months) (12 - 13 months) You will be offered a physical examination of your baby You will be given the when he is six to eight weeks old, This will include a ‘Bookstart Pack’ for babies to physical check, weighing and measuring your baby help you get into the habit of and a postnatal check for mum, including assessment reading to your baby. for postnatal depression. Your GP or health visitor can answer any questions you may have about feeding or caring for your baby and immunisations. 154 155
Your immunisation appointment Your questions: Your baby’s immunisations You will be sent an appointment letter telling you when it’s time to bring your baby What is immunisation? Immunisation is the safest and in for his immunisations. The nurse or GP Immunisation protects us from serious diseases. will explain the process, ask if your baby is Once we have been immunised our bodies are most effective way of protecting well and ask if he is on any medications. better at fighting diseases that we come into The nurse or GP will answer any questions contact with. your baby against some serious you have. diseases. Your baby will be offered Are there any side effects? Some babies are also offered BCG or extra Most babies are fine after their immunisations, his first immunisations when he is Hepatitis B vaccines. Extra doses of Hepatitis B but some have mild side effects like redness
vaccine are given to babies whose mothers are and swelling where they have had the Your baby’s immunisations two months old. Hepatitis B positive. injection, or may seem unsettled. They may also have a fever, particularly after their MenB Immunisation and premature babies immunisations at two and four months. Give BETWEEN Premature babies can be at greater risk of the baby infant paracetamol at the time of DISEASES AND VACCINES 2 MONTHS 3 MONTHS 4 MONTHS 12 AND 13 getting an infection. They should start getting these injections to treat or prevent this. A total MONTHS their immunisations from two months after of three doses should be given with a syringe birth, as advised by a health professional. or 2.5mls spoon at 4 - 6 hourly intervals, please Diphtheria, tetanus, whooping read the instructions on the bottle carefully. cough, polio, haemophilus influenzae type b (Hib) and Hepatitis 4 4 4
Your baby’s immunisations baby’s Your B, known as the DTaP– IPV–Hib-HepB If you have any concerns After the oral rotavirus vaccine, some babies (6–in–1) vaccine. regarding your baby’s can get diarrhoea. In very rare cases the vaccine can cause stomach pain, vomiting, and the 4 4 immunisation speak to Oral rotavirus vaccine baby may pass a red jelly substance, usually your GP or health visitor. Pneumococcal infection 4 4 4 within a week of vaccination. If you are worried – the PCV13 vaccine speak to a health professional.
Meningococcal infection 4 4 4 – the MenB vaccine My baby is ill. Should I still get him Keep up to date immunised? From time to time immunisation Haemophilus influenzae type b and 4 You don’t need to postpone an immunisation meningitis C – the HibMenC vaccine programmes change. For the latest appointment unless your baby has a fever, is information visit: Measles, mumps and rubella – MMR 4 www.wales.nhs.uk/immunisation being sick, or has diarrhoea. Speak to your nurse or health visitor if you aren’t sure. 156 157
What you can expect at 1–2 months What you can expect at 3–4 months Now that your baby is a month old, Your baby will have come a long your life together may have started way in his first three months. Many to settle into some kind of pattern. mums and dads say this is a very It’s still too early to expect to be in enjoyable time for them. You will be a routine, this will start to happen more confident and your baby will What
you months
over the coming weeks and months. be more sociable.
can 1–2
at expect
Even at this early stage, there are many • Smile on purpose, blow bubbles and You will have learned enough about your Around now is a good time to think about things you can do to help him develop. coo when you talk and play together. baby’s personality to understand what he an evening routine. If you follow a similar expect at Talk to your baby and sing to him as much Newborn babies are sensitive to the way wants most of the time. pattern each night, your baby will start to
3–4
can as possible. Read to him, tell him stories you hold, rock and feed them show excitement as he knows what to expect.
and nursery rhymes and describe what you • Mimic your facial expressions. Try sticking Your baby will be able to recognise familiar He will know that after his bath he will get a months you
are doing as you go about your day. Ensure your tongue out or making funny faces faces. He will be able to turn towards your feed and a story before going to bed. Some you have quiet time with your baby and and see if he copies you voice when he hears you and he will be babies even start to sleep through the night What give him time to respond to you. This early • Respond to the sound of your voice excited by familiar sounds. He will be able to at this point, but most don’t! communication is critical to his speech and • Respond to loud noises by blinking, make more sounds and will love to hear his language development and he’ll love hearing startling, frowning, or waking up own voice. He will laugh when he interacts At 3–4 months your baby may be able to: the sound of your voice. • Move his limbs more, or slow down his with people. • Keep his head up almost straight when sucking rhythm when he hears familiar he’s in a sitting position (make sure he’s At 1–2 months your baby may be able to: household noises like footsteps or Your baby will learn to take turns when you supported) and his back is straighter • Reach for you when he needs attention, running bath water play peek–a–boo. Copy his sounds back to than before security or comfort • Begin to face straight ahead while lying him and wait and see what happens. Your • Open his fingers and bring his hands • Str etch and kick more strongly as the on his back and lift his head while lying full attention is the best gift you can offer together weeks go by on his tummy your baby. 158 159
• W ave and kick more forcefully. Make sure Get your baby talking • As your baby gets older, leave books Play ideas there’s nothing dangerous for him to kick You can help your baby learn how to where he can reach them. Don’t worry From about three months, your baby will over, like hot drinks communicate by talking to him and responding if he chews them! be able to hold things. He will soon start to • W riggle. Take care, because there’s a risk to his noises. This will help him develop good • Keep a book handy in your bag when you develop ‘hand–eye coordination’. That means he could wriggle out of your arms, off the relationships, do better at school and be a are out and about. This will keep your baby he will be able to hold something like a rattle bed, or other high places confident, happy child. amused while waiting for appointments, and look at it too. • Start to look towards your voice when you on a journey, or in a queue speak to him. Try having ‘quiet time’ by • Cuddle up with your baby and read Here are some ideas to help you play with putting the TV and radio off. This will help Further information your baby. Remember to turn off the television your baby hear your voice clearly and can www.wordsforlife.org.uk/baby ‘Bookstart’ gives free book packs to every child so your baby can concentrate. help him with talking and language in Wales at nine–months and two–years–old to • Encourage him to play on the floor and What
• ‘Stand’ on your lap with your help and later Get your baby reading inspire a love of reading. Ask your health visitor spend time on his tummy you
months may be starting to take some of his own • It’ s never too early to start. Your baby has or at your local library for more information. • Sing songs and see if he joins in with his
weight with some support been listening to your voice since before he own baby noises can 3–4 • Support his head and chest with his arms was born • Experiment with different noises and see at expect when lying on his stomach • Make it part of your routine. Books, songs Further information which he likes best • Open and shut his hands and start to use and rhymes can easily become part of your www.bookstart.org.uk • Dangle an object in front of his face. From his hands and eyes to coordinate day. Why not share a rhyme with your baby about eight weeks, you should see him expect at • Begin to babble and imitate some sounds during changing or feeding times? follow it with his eyes
3–4
can and enjoy playing with other people • T alk to your baby about the story. Point • Read, sing and tell him stories. Enjoy ‘rhyme
things out and really give him a good chance time’ together, or look for local parent and months you
Playing with your baby at 3–4 months to look at the book. Talk about the pictures baby groups with sing–along sessions This is when parents can really get to know and how the characters are feeling What their baby. The first year is when your baby’s • It’ s fun to make noises to match the pictures. brain develops quickly. It’s very important For example, ‘quack’ when you see a duck Further information to talk, play and to read to him as much as • Point out things that you and your baby For ideas on play activities or things possible. Although he doesn’t understand might have seen. For example, you might you can do in your local area, see what you’re saying, he can hear the patterns want to say, ‘Look, there’s a picture of a dog www.playtalkread.org of your speech and is learning how to – we saw a dog on our walk today’ communicate. It’s important to have • Don’ t worry about sounding silly. Babies love ‘face–to–face’ time with your baby to help to hear different voices and sounds these skills develop. 160 161
At 5–6 months your baby may be able to: Breastfeeding after going back to work What you can expect at 5–6 months • Hold his arms out to be lifted Speak to your employer about your choice to • Roll over from his front to his back and continue breastfeeding. If your childcare is close By the time your baby is five or six sometimes from his back to his front to work you could try arranging your breaks so • Sit up with support in the pram, or on the you can pop out to feed your baby. months old, you will have a good sofa with cushions around him. Don’t leave him alone like this because he could fall You can provide expressed milk for your nursery understanding of his needs. You • Enjoy bouncing in a standing position on or childminder to use. You may need to express your lap milk at work, refrigerate it and then transport will know the signs that he is tired, • Grab small toys and objects that you put it in a sterilised container in a cool bag. Your hungry, or wants attention. You may in front of him employer has a duty to provide a room or space What
• Dr op things and let them fall. If he can’t where you can express milk and a fridge where you
months see things he’s dropped, he’ll forget them you can store it.
be in a routine and be able to tell
quickly. He won’t realise he can look for can 5–6 when he needs feeding, or a sleep. things and find them again If you express milk during the day when you’re at expect • Know that if he shakes a rattle it makes at work, you will still be able to breastfeed in a noise the evening and at weekends when you and • Use his mouth to explore things, or put your baby are at home together. Your body expect at Many babies will be sleeping through the He will be more sociable and will enjoy things in his mouth. Make sure you remove will soon adjust.
5–6
can night by now. Some nights he will still wake watching other children and want to join in. items that could be poisonous or could
up, maybe because he is hungry, has a dirty He will also love your attention and will be cause him to choke From six months, your baby can have expressed months you nappy, or is feeling unwell. When he cries, it learning how to get more of it by waving breast milk from a cup, so there’s no need to will be his way of telling you that something his arms or making a noise. introduce him to a bottle. What is not right. At six months your baby will be ready to Your baby will be smiling and laughing now start having ‘solid’ food, as well as his regular when you play with him. He will show you breast or formula milk. that he is annoyed or angry by squeaking or screaming, rather than by tearful crying. Remember! If you’re entitled to Healthy Start vouchers, you can get Further information free vitamins for your baby. www.maternityaction.org.uk 162 163
At 7–8 months your baby may be able to: What you can expect at 7–8 months • Sit up without help for a few minutes A health visitor’s view: • Move across the floor by sliding, shuffling You and your baby will have got to or rolling “If your baby becomes • Hold and drink from a cup with a spout know each other well by now. He will • Look at where sounds are coming from clingy at this stage, such quite accurately as he gets upset if you leave be a real person who can easily let • React to familiar people around him and the room, or is shy around you know what he likes and dislikes. repeat an act if you praise him strangers don’t worry. It’s • Babble and respond to you with noise
part of normal development, What • Get upset if you take a toy away from him. You will be starting to understand your baby feels safe
He will probably also cry if you leave him and secure with you and you
months for too long
what type of child he will grow into.
• Get ‘clingy’ with you and his regular carers doesn’t know you will come can 7–8 Your baby will behave differently • Roll over back when you leave. He at expect • Move things from one hand to the other will learn this over time. depending on what is going on. • Support his whole weight on his legs when Your baby not liking you he is held upright expect
leaving is a good sign that at • Respond to his own name when you call it
he feels a deep and safe 7–8 can • Explore objects with his hands and mouth
Some babies get quite cranky because they Your baby can get upset if you or your partner • Enjoy playing peek–a–boo connection with you. If you months you
start to realise what they can and can’t do. leaves the room. He doesn’t yet understand that • Be interested in mirrors are planning to go back to Your baby may really want to reach a toy on you’re still in the house, so call out to him to let work this can be a worry, What the other side of the room and get frustrated him know you’re around. will your baby be upset all that he can’t crawl yet. day at nursery? Take your Enjoy spending time with your baby and playing time choosing childcare* At around 7–8 months, some babies start to and singing with him. He may clap his hands get shy with strangers. For some babies this and copy you. that feels right for you and only lasts for a short time, for others it can your family and make sure be longer. you have plenty of getting to know you sessions.” Angela, Aneurin Bevan Health Board
*For more information on childcare, see page 209 164 165
At 9–10 months your baby may be able to: Have fun! What you can expect at 9–10 months • T urn and stretch to grab a toy without Playing with your baby is great fun for him falling over and for you. It’s a useful way to see how he By 10 months most babies are crawling • Use his finger to point at small objects. is developing too. • Babble with recognisable sounds such as or nearly crawling. Some can also ‘mama’ and ‘dada’ and copy noises that Watch how your baby starts games. Your baby you make will enjoy handing things to you and then move around the furniture and pull • Understand some phrases like ‘no’, taking them back. He might start dropping themselves up to a standing position ‘bye–bye’ and ‘dinner’, especially when things on to the floor from his high chair just
they are part of a familiar routine. For so that you will pick them up. He will do it What if furniture is the right height. example, he’ll understand ‘bath time’ again and again! Check that toys and other
when he’s in the bath things you give your baby to play with are safe you months
• Clap and wave and can’t be swallowed or cause him to choke.
• Copy things you do to make the same thing can 9–10
Your baby may want to stick very close to your Introducing your baby to different foods happen. Show him how to ring a bell and Your baby will love songs and rhymes. Sing expect at
lap. He may still be a bit clingy at this stage if early on can help him to enjoy a variety of he’ll shake it to make the same noise him the rhymes you remember from your he is with new people. Your baby may also be tastes and textures and make him less likely • Understand that things are still there even childhood. Ask your parents, or your brothers
getting more independent and able to make to be a picky eater later on. It might also help if he can’t see them. He will be able to or sisters, what they remember too. at expect
his feelings felt. For example, he may refuse to him to make healthier eating choices. From watch while you hide a toy under a cloth 9–10 cooperate by stiffening his body as you try to now on, your baby will gradually start fitting and find it again by removing the cloth Your health visitor can help you with ideas for can
dress him. He will also begin to use lots more in with your family eating patterns – eating games if you don’t know any. Switch off the months you
gestures, including clapping and waving. breakfast, lunch, tea and maybe a couple of Playing with your baby at 9–10 months television to get rid of background noise when snacks in between. Your baby will be very interested in toys that you’re playing or reading to your child.
What Talk to him about the things you do together. have sound and movement. He will be able to Make your voice tuneful and he will listen. If your baby is eating less than usual, this is use his fingers and hands to open little doors, Give your baby quiet time every day. You will fine as long as he is happy and healthy and or to push things along. Show your baby what Further information notice that he practises with speech sounds continues to grow. It’s normal for your baby’s to do and he will copy you. Try to limit the For ideas on play activities or things when he is on his own. appetite to change from day to day. amount of time he spends in baby bouncers you can do in your local area, see and other types of seats. Where possible, let www.playtalkread.org or him safely play on the floor. www.wordsforlife.org.uk/songs 166 167
Dummies Top Tips: Some parents don’t give their baby a dummy, • Choose your timing. A period of change What you can expect at 11–12 months but if you do make sure you do not let your or stress for you or your baby might not be baby use it for long periods. If your baby is a good time to give up the dummy Think about how far you’ve come as using a dummy after he is one year old it can • Begin by restricting the dummy to certain delay his speech and language development, times and places, like bedtime. This will give parents and how well you’ve done. It cause dental problems and increase his risk your baby time to get used to being without of ear infections. the dummy will not have been easy! • Once your baby is coping for periods of time
Always make sure that your baby’s dummy is without the dummy, set a time and date and What removed before you talk to each other. The then remove the dummy completely
earlier you wean your baby off the dummy, • Make sure you get rid of every dummy so Your baby will have changed a lot in one year. At 11–12 months your baby may be you months
the easier it will be, this is why giving your you are not tempted to give your baby the He will be able to do things he couldn’t do able to:
baby a dummy is not encouraged past the ‘emergency’ dummy before. He will be able to communicate with • Understand simple phrases like ‘do you can 9–10
age of 9 months. • Don’ t turn back! Expect some protests you and move around. He will definitely have want a drink?’ expect at
initially, but stay strong and it will be worth a mind of his own and he’ll be showing signs • Follow simple directions with familiar How to wean your baby off a dummy it in the end of wanting to make his own decisions and he objects, like ‘bring me teddy’
Replace the comfort: Many babies use a won’t always agree with you. • Recognise people he knows at expect
dummy to comfort them, especially when they • Show affection with kisses and cuddles 11–12 are tired, upset or unwell. Replace this need However, in lots of ways your baby will want • Point at objects so that you can say things can
with another comforting object such as a soft to please you and keep you happy. You might like, ‘yes, that’s a cup’ months you
blanket or teddy bear to cuddle. find that your baby will hold his arms out for • Push, throw and knock down everything his jacket or wave ‘goodbye’ if you ask him to in sight and give toys to others
What and he may be able to point to familiar things. • Use gestures like pointing and waving and understand more of what you are saying • Move around. Some children learn to crawl, while others move around on their tummies or their bottoms. Others will roll to wherever If you have any worries they want to go about your baby at this • W alk around, but don’t worry if your baby stage, your health visitor hasn’t done this yet. It happens any time can check your child’s between eight and 20 months health and development. 168 169
Health and wellbeing Postnatal depression Your own health and happiness are Is more common than you might very important. If you are not feeling think. It affects 10 to 20% of new well it is hard to give your baby mums and is common in dads too. everything he needs.
It can happen days, weeks, or even months Feeling lonely
after the birth of your baby. Help is at hand It is common to feel lonely after the birth of Postnatal depression Make sure you are eating a healthy and you are not alone. With the right support your baby, especially if you’ve given up work, balanced diet. Now that your baby is a little and treatment, you will be able to make a or can’t go out shopping or on nights out A mum’s view: bit older, try and find some time to make full recovery. with your friends. If you don’t have a partner some more positive changes to what you or close friends and family around you on a eat if you need to. “It’s easy to forget about Symptoms of postnatal depression regular basis, then it’s especially tough. the things you used to A person with postnatal depression will usually Take your baby out for walks. Talk to him enjoy doing before you had experience a lot of difficult feelings such as: Feeling guilty Health and wellbeing Health about what you see while you are out. He a baby. I found that just loneliness, guilt, worry, getting angry and You might feel that everybody expects you will be taking it all in. frustrated, feeling tearful and crying a lot and to be delighted when your new baby is born, having an hour or two to feeling exhausted. It can affect their appetite, but often this just isn’t the case. If you don’t Now is a great time to make new friends. myself whilst someone sleep patterns, sex drive and concentration. bond with your baby straight away you might There are lots of groups for mums and babies looked after Eva made a For some people, these feelings can be quite feel guilty too. Guilt can sometimes trigger and it’s great to get out and share your huge difference.” mild, but for others they are overwhelming. depression, as well as be a symptom of it. experiences with other mums. Katrina from Cardiff If you have postnatal depression, you may Feeling down Take a bit of time to relax and switch off. feel worried and negative about the future, Sometimes postnatal depression can come Make time for your favourite things, like or overly concerned about your baby’s health. right out of the blue, even if everything listening to some music, reading a magazine, is going well. This can be confusing and going for a swim, or watching an episode See pages 12 and 13 for upsetting. Feeling down for no reason might of your favourite television programme. make you feel anxious and guilty and make more on wellbeing you feel more depressed. 170 171
Postpartum psychosis Talk about it ‘Enjoy Your Baby’ online course Dads Postpartum psychosis is a serious but rare Talk to your midwife, health visitor or GP. They This course, based on cognitive behavioural Dads can get depression after the condition. It usually affects women in the first will have a lot of experience in helping new therapy (CBT) can help you as a new mum or birth of a child too. Between 1 and 4 few days after birth*. parents with postnatal depression. The earlier dad make positive changes in your life and percent of new dads get depression you open up to them, the sooner you will be enjoy being a parent more. It will help you to during the first year. Some new dads Getting help with postnatal depression on the road to recovery. learn how to improve your feelings when you are more at risk of getting depression. Getting help early on is the best thing you are low, worried or hopeless and give you new Being young, unemployed, or not having much can do if you have postnatal depression, so Counselling and psychotherapy skills to help tackle any problems in your life. money when your baby is born increases your if you are feeling bad let somebody know. For most people with postnatal depression risk of depression. The sooner you get help, the sooner you will the best treatment is counselling and support. feel like yourself again. This begins with your health visitor who Further information If mum is depressed this can make dad can listen to you and talk to you about your is available at www.twoinmind.org more stressed, which can increase the risk of registration is required, but it is free.
Not getting the help you need can be harmful, feelings. This may be enough to help you feel dad getting depressed too. Dads might get Postnatal depression because it can affect all your relationships, better. You may decide that you need more depressed for a number of reasons: the new including how you bond with your baby. The in–depth counselling or therapy. If so, that Medical treatment responsibility, the cost of bringing up baby, first step to getting better is to talk about will be arranged for you. Although most mums with postnatal the change in lifestyle, the change in the how you are feeling. depression will not need antidepressants, relationship with their partner, or lack of Self–help you and your GP may decide that this is the sleep and more work to do at home. You are not alone Many parents find that self–help groups are best thing for you. If this is the case, you Some parents with postnatal depression really good. These groups offer support and might be given counselling too. If you are If you are a dad who thinks he might be
Postnatal depression Postnatal try to hide it because they think they should counselling from an experienced counsellor. breastfeeding, your GP will prescribe an depressed, talk to your GP or health visitor. be coping better. They worry about admitting Finding out that you are not alone and antidepressant that will not affect your baby. The sooner you get help the more quickly you that they’re finding it tough. You might also realising that other people know how you are will recover. In lots of areas of Wales there are worry that your baby will be taken away from feeling is often the first step to getting better. Antidepressants may be prescribed for up to dads support groups which may be helpful. you, but that will not happen. There are a Your health visitor will be able to put you in a year. Although this seems like a long time, number of ways in which you will be helped touch with a local group or service it is important that you don’t stop taking them and supported. without talking to your GP, even if you start to feel better. Antidepressants can take two to four weeks before they start to take effect and they need to be taken for up to six months after you’ve started to feel better. This can help to stop your depression from coming back.
*For more information on Postpartum psychosis, see page 140 172 173
Looking after yourself How partners, family or friends can help It is very easy to forget your own needs when If you have family or friends with a new baby, Giving your baby more than just milk you have a new baby. Take up any offers of you can help them avoid or cope with postnatal help from family or friends and try and do depression by doing some of these things: When your baby is around six months some of these things: • Of fer to look after the baby so that parents • Give yourself a treat, or meet up with can have a good rest, ideally in the middle old, he will be ready to have some some friends for coffee of the day • T ry and put your feet up when your baby • Help them around the house by cooking, solid food alongside his breast or is asleep cleaning or doing laundry formula milk. • Get into a night–time routine. Have a • Encourage parents to look after themselves Giving your baby more than just milk bath and a hot drink and read for a while by eating regularly, drinking plenty of water • Do some exercise. Even a short walk and taking a break now and then can make you feel better • T ake the baby out for a walk in the pram Giving your baby solid foods before six months Breast fed babies will always take the amount • Make sure you eat regular nutritious for a couple of hours is not recommended, as his digestive system is they need. Formula fed babies will need about meals rather than quick–fix snacks • Pick up essentials from the supermarket, not fully developed and you will be replacing 400ml a day by the age of around one year • Expr ess your feelings. Talk to someone and make up a sandwich and leave it in milk with less nutritious foods. alongside a good range of healthy foods. you trust, or write it all down the fridge with some other snacks • Be prepared to listen. If you think they may At about six months you can slowly introduce Before six months, if you feel that your baby be depressed, encourage them to seek help other foods, but you should keep giving him is not satisfied with his usual milk feeds, give from their GP, health visitor and midwife breast or formula milk until he is at least one extra breast or formula milk rather than giving
Postnatal depression Postnatal year old. You can continue to breastfeed him solids too early. for as long as you wish. When you first start introducing solid foods alongside milk it is If your baby starts waking up in the night important to know that milk will still be when he used to sleep through, it is not the most important source of nutrition. As necessarily a sign of hunger. Starting solids your baby starts to eat more solids in the early will not help him to sleep longer or second six months, his milk intake will reduce. through the night.
The important thing to remember is that you are not alone with postnatal Further information depression. Help is at hand. On depression visit www.mind.org.uk 174 175
Getting started with solid food Spitting and refusing What to start with Signs to look for that your baby is It is best to start off slowly. Build up gradually When you first introduce solid food to your A baby at six months can start off with food ready to start solid foods include: from one solid feed a day at first, to breakfast, baby it will be a completely new experience. mashed with a fork to a soft consistency, but lunch, tea and snacks by the time your baby is As well as the unexpected taste and texture, with more texture than puréed food. You can • He can sit up well without support and one year old. Some babies will take longer to your baby will have to learn to move the food also give babies finger food they can hold hold his head steady. move over to solids than others. around his mouth and swallow it. Many babies themselves, like soft cooked vegetable sticks. react by spitting their first mouthfuls of food • He can look at food, pick it up and put Find a time that suits you straight back out again! This is normal and Suitable first foods it in his mouth by himself. It’s best not to give your baby solid food you should gently keep trying until baby gets You don’t have to buy any special foods for
straight before a milk feed. You don’t want to the hang of it. You might find that your baby your baby – lots of everyday foods are fine. Giving your baby more than just milk • He can swallow food. Babies who are fill him up because he’ll have less milk that way. refuses food at first. Again, this is fine. Leave not ready will push food back out, so Choose a time when your baby is awake and it for another day and try again. Start off with savoury tastes like: they get more around their face than in alert. The middle of the day may be best. Offer • Cooked and mashed vegetables, like their mouth. food on a plastic spoon and just a little bit at a Your baby’s appetite potato, sweet potato, carrot, broccoli, time to start with. Healthy babies know their own appetite, parsnip or cauliflower and to begin with a couple of teaspoons of • Baby rice mixed with your baby’s usual milk Be safe and comfortable food may be enough. Never force your baby If you believe your baby is At around six months, your baby will be able to eat. Contact your health visitor if you’re Try flavours one at a time to start with. Increase ready for solid foods before to support himself enough to sit in a high chair, worried about your baby’s appetite. the variety of flavours. When your baby has six months talk it through provided he is safely strapped in. Never leave a accepted a range of vegetable tastes, increase with your health visitor. baby alone in a high chair. You should always Solids don’t replace milk. They are given in the range of foods and flavours. Offer baby stay with your baby while he is eating in addition to it in the first year. As your baby mashed egg, beans, fruits, meat, fish, rice, case he chokes*. starts to eat more solids, the amount of milk plain cereals and plain yoghurt.
Giving your baby more than just milk than more baby Giving your he drinks will go down, if you are formula milk Things that you can do to prevent choking are: feeding, to about 400ml a day by the time You can make tasty family meals and use the • Remove any stones or pips from foods and he is a year old. same food for your baby. For example, you avoid tough skins could cook a sweet potato stew (see page • Halve or chop small fruit, like cherry overleaf for recipe). But do not add any sugar tomatoes or grapes or salt to your baby’s food. Salt can damage his • Cut large fruit into slices rather than chunks Further information kidneys and sugar can damage his teeth. If you’re stuck for ideas, talk to your health visitor as they will have access to local resources and recipes. Or visit:www.nhs.uk/start4life *For more information on what to do if your child chokes, see page 242 176 177
From six months old Under one year old Recipes for the whole family SWEET POTATO STEW Your child will be okay to eat: Do not give your child: You can make tasty family meals and use the same food for your baby. For example, you could INGREDIENTS cook a sweet potato stew, but your baby can Yoghurt, cows’ milk in things that Liver pate or honey. have some of the potato on its own mashed. you have cooked such as custard • 11/2 tablespoons vegetable oil or cheese sauce (don’t use • 1 small onion, peeled and diced HOW TO MAKE • 1 red pepper, de–seeded and diced cows’ milk as your baby’s Soft drinks and squashes, • 450g sweet potato, peeled and diced main drink until he is over drinks with added caffeine, one year of age). This recipe makes 4 adult–sized portions. • 75g frozen green beans such as tea and coffee 1. Heat the oil in a large pan and fry the onions or rice milk or rice • 1 large can (400g) chopped tomatoes Giving your baby more than just milk until they start to soften. drinks or alcohol. • 1 large can (400g) red kidney beans, drained Bread, pasta, chapatis, or 2. Add all the other ingredients and bring to and rinsed, (drained weight 240g) any food made from wheat flour. the boil, stirring well. If you are serving • 2 heaped tablespoons (85g) smooth peanut children under 5 with this recipe, you can Salted savoury snacks like butter crisps or whole nuts. add the chilli powder after cooking, after the • 1 teaspoon chilli powder Thoroughly cooked eggs, children’s portions have been put on one side. • 300ml water fish and shellfish. 3. Simmer for about 20 minutes until the • 1 teaspoon freshly chopped herbs such as vegetables are soft. Anything sweetened with artificial coriander or parsley (optional) 4. Sprinkle with the fresh herbs before serving. sweeteners or foods or drinks that Ground nuts and seeds. contain the additives E102, E104, E110, E122, E124, E129 or E211. These additives have been linked to an increase in hyperactive behaviour in some children. Giving your baby more than just milk than more baby Giving your
Any foods, designed for adults, with special ingredients (for example, cholesterol lowering margarines, low–fat or low–sugar products, or fortified products). Or ready meals designed for adults. 25cm 25cm 20cm 13cm
Average portion for: Average portion for: Average portion for: Average portion for: An adult or teenager aged 12–18 years 5–11 year old 1–4 year old 7–12 month old 178 179
Allergies Sometimes parents stop giving their baby Ready–prepared foods Some sample puree foods While variety in your baby’s diet is really some foods because they think their child Baby foods can be expensive to use every important, there is a chance they may be is having a reaction. Always talk things over day, so it is best to make your own. If you do allergic to certain foods. That’s why it’s with your health visitor or GP before making need to use bought foods occasionally, read important to introduce trigger foods one at a any big changes to your baby’s diet. the label to check for added sugars. These time and not before the baby is six months old. sugars may be in the form of concentrated These foods include cows’ milk, eggs, wheat, Specific allergies to peanuts or eggs fruit purée and fruit juice which make food Apple Pear Peaches gluten, nuts and peanuts (serve them ground, If your baby already has a known allergy, like very sweet. Check for starch and water crushed or as a nut butter), seeds, fish and eczema or a food allergy, then they have a content too, because they ‘bulk out’ the
shellfish. higher risk of developing a peanut or egg food but add little in the way of nutrition. Giving your baby more than just milk allergy. If your baby has an allergy, you should Once introduced and if tolerated, keep offering talk to your GP, health visitor, or medical allergy Some babies who have a lot of pre–prepared these foods as part of your baby’s usual diet (to specialist before you give peanuts or foods ‘baby food’ take a while to get used to minimise the risk of allergy). containing peanuts or eggs to your child for the ‘real’ food with its varieties of tastes, Potato Broccoli Peppers first time. Otherwise there is no reason to avoid textures and lumps. Things to look out for: foods containing cooked eggs or nut pastes for • Breathing difficulties babies over six months old. • Runny nose • Stomach upset • Skin reaction: blotchy, raised red rashes, Remember not to give whole Carrot Parsnip Swede • Itchy patches and swelling around peanuts, nuts or seeds to the mouth • Sore, red and itchy eyes children under five years old because of the risk of Giving your baby more than just milk than more baby Giving your choking*.
Egg Baby porridge Baby rice Don’t let your baby suck Further information pureed food directly out of If your child shows any of these symptoms, If you think your is baby is talk to your health visitor or GP for advice suffering a severe allergic a pouch. This can damage or contact NHS Direct at reaction, always call 999 their teeth and doesn’t let www.nhsdirect.wales.nhs.uk your baby see the food or or call NHS direct Wales on 0845 46 47 and ask for a paramedic. practice feeding skills. White fish Salmon Chicken *For more information on what to do if your child chokes, see page 242 180 181
Drinks Vegetarian diets Feeding your growing baby Some sample finger foods The only drinks your baby needs in his first Babies do not need meat or fish to stay After six months you can start introducing From the age of six months: year are breast or formula milk and water. healthy, but you need to make sure he’s getting your baby to foods he can pick up and eat If you are breastfeeding your baby does not enough protein and other nutrients from the by himself. Getting your baby involved in need drinks of water before around six months. rest of his diet. Make sure he gets a good feeding himself can also make weaning variety of foods, including eggs, milk, fruit, easier and more fun. If you are using formula milk, you don’t vegetables, peas, beans and lentils, nut pastes, need to change the formula after six months. Here are a few suggestions for finger foods, soya based foods like tofu, rice, pasta, bread, Banana Cooked carrot Cooked peppers First infant formulas are the best ones to use potatoes and other starchy foods. which your baby can chew, gnaw or suck on:
throughout his first year. From six months • Slices of bread, toast, chapatti or naan Giving your baby more than just milk onwards, you can offer your baby water in • Slices of apple or pear From the age of seven months: a proper cup. It is important that your baby Further information • Sticks of carrot or celery, just cooked a learns to sip and swallow instead of sucking. On eating well for vegetarian infants and little bit to soften them. Tiny sandwiches children visit www.vegsoc.org Give him a little plastic cup without a spout with grated cheese, mashed banana, or or lid. If you want to use a cup with a lid mashed tinned fish make sure you use a ‘free flow’ beaker. Vegan diets • Cooked pasta shapes A lot more care needs to be taken with a vegan • Quarters of hardboiled egg, or strips of Cucumber Peas Strawberries diet, which cuts out animal products like eggs soft meat like chicken and milk, although it is possible for your baby • Cooked vegetables like broccoli florets, to develop healthily on such a diet. Ask your peas, green beans, carrots and halved health visitor or GP to arrange for you to speak cherry tomatoes to a dietitian if you are thinking of weaning your baby on to a vegan diet. Babies between seven and nine months of
Giving your baby more than just milk than more baby Giving your age should have three savoury meals a day Bread squares Pasta shapes Egg with finger foods. Between 10–12 months, Further information you can add a fruit or milk based pudding On eating well for vegan infants and children after the savoury dish. From the age of ten months: visit www.firststepsnutrition.org
See next page for some example menu plans Orange Chicken Cheese 182 183
Sample Menu 1 (7–9 month olds) Sample Menu 2 (7–9 month olds) Sample Menu 1 (10–12 month olds) Sample Menu 2 (10–12 month olds)
Breakfast: Baby rice made Breakfast: Porridge made with Breakfast: Porridge and dried Breakfast: Baby muesli with full–fat milk with a full–fat milk and raisins apricots and a breast feed or with full–fat milk and chopped banana and a and a breast feed or infant infant formula in a cup. full–fat yoghurt and raisins breast feed or formula. and a breast feed or infant infant formula. formula in a cup. Apple slices. Pear slices. Kiwi chunks. Blueberries.
Lunch: Chicken casserole, Giving your baby more than just milk Lunch: Stewed lamb in full–fat yoghurt with Lunch: Butter bean and tomato sauce with baby raspberries and water Lunch: Fish pie, stewed vegetable stew, rice pudding pasta, canned mandarins in in a cup. apple with raisins and with strawberry purée juice and full–fat fromage water in a cup. and a breast feed or frais and a breast feed infant formula. or infant formula. Cooked broccoli. Raw carrot sticks.
Soft–cooked potato. Cooked carrot sticks. Tea: Vegetable couscous and a breast feed or infant Tea: Baked potato with formula in a cup. tomato sauce, canned Tea: Tomato rice with Tea: Scrambled egg with canned mandarin oranges and chicken and a breast chopped tomatoes and a breast a breast feed or infant feed or infant formula. feed or infant Cucumber sticks formula in a cup. formula. and mango slices. Giving your baby more than just milk than more baby Giving your Steamed mange tout. Hard–boiled egg. Cooked greenbeans. Before bed: A breast feed or infant formula. Before bed: A breast feed or infant formula. Before bed: Before bed: A breast feed or infant formula. A breast feed or infant formula.
Remember! Meals need to be mashed or chopped for under ones. Remember! Allow food to cool before serving. 184 185
Stay safe Your questions: • Always wash and dry your hands well Teething before preparing your baby’s food What can my baby eat? • Check that your baby’s hands are clean Some foods are unsuitable for your baby before Teething is when your baby’s first before feeding six months. It is important that you do not • Keep surfaces clean and prevent pets introduce any of these foods before six months. teeth start to come through. Some from coming near food or surfaces where This is because of possible allergic reaction. food is prepared or eaten babies sail through this process • Keep chopping boards thoroughly clean There are also some foods all babies should and are showing off their first teeth • Use separate chopping boards for raw avoid in the first year. The best foods for babies food and ready–to–eat food are simple foods that have not been ‘messed before you know it. For others it can • Keep raw meat and eggs covered and about with’ – like meat, poultry, fish, eggs, away from other foods in the fridge, beans, bread, rice, pasta, yoghurt, fruits be an uncomfortable time, causing including cooked or ready to eat meats. and vegetables. Raw meat should ideally be kept in a sealed distress to both you and your baby. container at the bottom of the fridge so it Does my baby need a vitamin supplement? Teething can’t touch or drip onto other foods It is recommended that all children aged • Cooked food should not be reheated six months to five years are given vitamin more than once supplements containing vitamins A, C and D Some signs that your baby is teething are: Easing teething • Cook all food thoroughly and cool it every day. • Dribbling more than usual Here are some ways you can help to make as quickly as possible to a lukewarm • Flushed cheeks your baby feel better when he is teething: temperature before giving it to your baby Babies that are breastfed should be given • Sore, red gums • Cuddle him. Hugs and cuddles will help • W ash and peel fruit and vegetables, vitamin D drops daily from birth. • Loss of appetite comfort and reassure your baby if he is
Giving your baby more than just milk than more baby Giving your such as apples and carrots • Irritability and disturbed sleep distressed Babies who are having more than 500ml (about • Chewing and biting on everything • Rub his gums. Lightly massaging your a pint) of infant formula a day shouldn’t be baby’s gums with a clean finger will soothe given vitamin supplements because formula If your baby is unwell or has a temperature, him and help to alleviate the pain is fortified with certain nutrients and no other do not put it down to teething. Ask your • T eething rings. Babies like to chew and supplementation is required. doctor or health visitor if your baby is unwell. bite, so teething rings can help. Make sure you watch your baby when he is biting If you are eligible for the Healthy Start Scheme, on the ring. Keep teething rings clean by you can get Healthy Start vitamins free of washing them well in warm soapy water charge. Ask your health visitor how to get these in your area.
*For a list of unsuitable foods for your baby, see page 176 186 187
• Soothe his sore chin. Some babies may Tooth brushing should be introduced as a fun dribble a lot and give themselves a sore part of your baby’s daily routine. You might Safety and your growing baby chin, neck and chest. Try to keep his chin find that playtime or bath time are good times as dry as possible and change any wet to brush teeth. Eventually, you can move to a Make sure that your home is as clothing. A simple barrier cream can help morning and night–time routine. to keep his skin soft and smooth and may safe as possible as your baby gets ease chapped areas Always supervise tooth brushing and never • ‘T eething gels’ should not be used. They do leave a baby or small child alone with either bigger and starts to move around. not work and some brands may be harmful a toothbrush or toothpaste. Here are some things to look out for, • Never rub brandy or any other kind of alcohol on your baby’s gums. You should Sugar is the main cause of tooth decay. Protect
especially when your baby starts Safety and your growing baby never give any type of alcohol to a baby his teeth by choosing foods and drinks without added sugar. Sugary drinks and snacks are to crawl, pull himself around the Looking after your baby’s teeth particularly harmful to teeth when given From the moment his first tooth appears, inbetween meals. The safest drinks for his furniture, or walk. you should brush your baby’s teeth. As more teeth are milk and water. teeth come through, it is important to have a brushing routine. This will help to make You can introduce a beaker or free–flow cup Teething Teething sure that the teeth are brushed properly at six months. Aim to stop using a feeding Around the house each time. Use a toothbrush with a small bottle by his first birthday. There’s a risk that • Cor ds from electrical equipment. Babies • Door slamming on your baby’s fingers; head and soft bristles. Add a very thin layer feeding from a bottle for too long can push can see them as a good thing to grab on Use a door stop or tie a cloth across the of fluoride toothpaste. Fluoride helps to his new teeth out of alignment. There is no to. Unplug them and keep them out of front and back handles, to stop the door strengthen teeth and prevent tooth decay. risk to your baby’s teeth from breastfeeding. reach and switch sockets off when they from shutting completely. Remember to are not in use remove the door stop at night so that you There are various ways to position your • Be carefull of small or sharp objects, like can close the door as part of your night baby when you brush his teeth. You could Further information an older child’s toys, left on the floor time fire prevention routine try sitting him on a changing mat on the www.designedtosmile.co.uk • Hot drinks. Don’t let anyone drink them floor, on your lap, or in a baby chair. while your baby is on their lap or crawling around. Don’t leave hot fluids on low tables where they can be grabbed Did you know that a hot drink • Hanging tablecloths can be easily grabbed can still scald a child 20 by little hands. Remove them or make sure minutes after it was made – there is nothing on the table that could fall keep them out of reach. and hurt your baby 188 189
• Blind cords. These should be kept out of In the sun Water safety Protection against bumps and falls the reach of children. If you can, buy blinds Sun safety is even more important for your Children can drown in even a couple of Never leave your baby or toddler alone on that do not have a cord, especially in your baby than it is for you. Babies under one year inches of water. Never leave your baby alone a raised surface. He may roll off and get hurt. child’s bedroom. If you have these cords, of age should be kept out of direct sunlight in the bath or near water, either inside or Lots of parents can be surprised when their do not place a child’s cot, bed, playpen altogether. Older babies and children should outside the house. Look out for things like baby learns to roll because it can happen or high chair near a window. Tie up the be protected. a garden pond, or even a bucket that has suddenly. cords, or use cleats, cord tidies, clips or collected rain water. Don’t leave the paddling ties. Curtain tie–backs can form a loop The biggest risk to your baby from sunlight pool filled with water overnight. Baby bouncers and car seats should be put on that could injure your child. Remove them is sunburn. This is painful and can cause the floor. Every year many babies are injured until he is much older permanent damage, or even skin cancer. One When you are running a bath for your baby, after falling from a raised surface. • Do not leave your baby alone with a family episode of sunburn will double your baby’s keep an eye on him as he may try to get into pet, even if they are normally friendly. Keep risk of developing skin cancer later in his life. the bath alone. Check the temperature using Babywalkers Safety and your growing baby your pets’ things, like cat litter trays, food your elbow or the inside of your forearm. Your Baby walkers will not help your baby to learn bowls and especially water bowls, away Keep your baby in the shade as much as baby’s skin is thinner than yours and he will to walk. In fact they might slow down his from where your baby can get to them possible and use a sun hat or sun shade on scald more easily. Don’t leave him alone in the progress and can actually cause injury. A baby the pram or pushchair. bath, not even for a second. Not only will he needs to be able to roll, crawl, sit and play on be at risk of drowning, but he may play with the floor to develop properly. Use child sunscreen cream with a high sun the taps and scald himself. Safety and dogs protection factor (at least factor 25). Make As your baby gets older and becomes more Deaths from dog bites are rare. sure he is covered up with at least a T–shirt confident moving around he will be able to Serious injuries from dog bites/ and hat. Some manufacturers now sell bathing move very quickly. You will need to make your strikes are more common, with suits that cover up most of your child’s body. home as safe as possible for him.
Safety and your growing baby growing and your Safety about 100 hospital admissions a year in Wales many of which are Other sensible safety steps include staying very young children and babies. indoors around midday in the summertime Therefore you should never or when you are in a hot country. Make sure leave a baby or young Remember! he gets plenty to drink in the heat. child unsupervised Never leave your baby with a dog, even for a moment, no matter how alone in the bath or near well you know that dog. Keep your baby in the shade water. Not only will he be Further information as much as possible and use at risk of drowning but he Take a look at page 244 Visit www.dogstrust.org.uk a sun hat or sun shade on may play with the taps and for more information on or www.bluecross.org.uk the pram or pushchair. scald himself. making your home safe. 190 191
Seek medical help straight away if your baby: It is also important to think about the other If your baby is ill • Has a fit or convulsion*, this means twitching places in your home where you leave drugs or jerking with unfocused rolling eyes or medicines. For example handbags, drawers Babies who are really ill do not • Has breathing difficulties or carrier bags of shopping left lying on the • Loses consciousness floor. Even everyday medicines which you tend to cry continuously and loudly. • Becomes blue around the lips or face buy over–the–counter, like aspirin, can be • Has signs or symptoms of suspected as dangerous as prescription drugs. A really poorly baby is more likely meningitis or septicaemia** to whimper and moan. • Passes blood or redcurrant jelly–like poo Medicine and your baby • Seems in obvious pain Some over–the–counter medicines are • Has swallowed any poisonous item especially for babies or small children. If in doubt, always ask your pharmacist. Your GP Keep dangerous household products and won’t prescribe medicine for your child if he Serious illnesses • If he seems to have a fever or is medication in a locked kitchen cupboard, doesn’t need it. Make sure you understand If your baby is ill A mild fever can bring on bouts of crying uncomfortably hot high up and out of sight. Just tiny amounts what the correct dose is for your child. and it is usually not too much to worry about. • Has unexplained bruising, or bleeding can be fatal to a young child. Coughs and colds are common too. However, from his ears, mouth, nose or bottom, you should be aware of the more serious and or blood in his poo or pee rarer conditions that your baby can get. If your baby is ill baby If your Telephone or see your GP if your baby: • Seems less bright and alert than usual, or sleeps for an unusually long time • Is having bouts of vomiting for more When in doubt, always A mum’s view: than an hour seek help from your GP • Has diarrhoea which doesn’t clear or health visitor. “Sick children don’t just up in a day need medicine, they need • Has a rash which is not a heat rash reassurance and lots of or the result of clothes rubbing cuddles which is more • Does a poo that is an odd colour or Further information texture for him, or that contains blood Call NHS direct Wales on 0845 46 47 or visit ‘medicine’ in itself” (green poo from time to time is normal) www.nhsdirect.wales.nhs.uk, if you need Carlien from Newport • Has dry nappies and does not seem urgent advice and care during the out–of– hours period when your GP surgery is closed. to be peeing as much as normal *For more information on fits and convulsions, see page 241 **For more information on meningitis or septicaemia, see page 192 192 193
The ‘glass test’ What to do next Very serious illnesses The rash starts as tiny red pinprick–sized Remember that not all babies will develop the spots or marks and later changes to purple signs and symptoms listed on page 192. If they It is important that you understand blotches. These can look like bruises or blood develop some of them, especially the red or and can identify quickly the signs blisters. The rash can be anywhere. purple spots, get medical help urgently. Press a clear drinking glass firmly against the that your baby might be suffering rash so you can see if the rash fades and loses Further information colour under pressure. If it doesn’t change If you can’t get in touch with your GP, from a serious illness and get call NHS direct Wales on 0845 46 47 colour, contact your GP straight away. medical help immediately. The spots and rash are more difficult to see If you are still worried after getting advice, on darker skin, so check paler areas like the trust your instincts and take your baby to Very serious illnesses palms of the hands, soles of the feet and the the emergency department of your nearest Meningitis and septicaemia Signs and symptoms of meningitis or eye area. Any spots or rash may fade at first, hospital. These conditions are dangerous and Meningitis and septicaemia are very serious septicaemia in babies so keep checking to be sure. can develop very quickly. The earlier babies are diseases that can affect anyone very quickly. The early signs and symptoms may be difficult treated, the better their chances of making a They are not common, but it is important to spot as they are similar to flu. Not everyone who gets meningitis full recovery. to know the signs and symptoms and get will have this rash. medical help quickly. They include: • High–pitched, moaning cry Very serious illnesses serious Very What are meningitis and septicaemia? • Irritability when picked up Meningitis means swelling of the linings of • Bulging of the soft spot on his head the brain and spinal cord (meninges) and • Dr owsiness and not responding to you, septicaemia is blood poisoning. These or being difficult to wake conditions can be caused by the same bacteria • Floppy or listless, or stiff with jerky and viruses and can occur separately or movements Symptoms of meningitis together. Viral meningitis is more common • Refusal to feed and vomiting or septicaemia can occur than bacterial, but it is less serious. If treated • A rash or purple bruise like spots that do in any order. Not all babies early enough, most children will survive. not fade under pressure (see the glass test develop all the symptoms. on opposite page) Trust your instincts. If you • Skin, especially on his hands and feet, suspect meningitis get that is pale, blotchy or turning blue medical help urgently! • Fever, with cold hands or feet 194 195
Your toddler
Find out about the big changes that your child will go through as she grows from baby to toddler. It is a time of change for parents too. 196 197
Remember the basics Your toddler at a glance To grow healthy and strong she needs A child Making the effort to understand good healthy food. If you eat well as a Psychotherapist’s view: family she will soon learn to take pleasure the world from your toddler’s point in food and mealtimes. “The toddler years are of view really helps. times of rapid change She also needs lots of activity, get out and and development. Your about together. It’s important for her (and baby is less dependent on you too) that you get involved in lots of fun you and is becoming an Understand what she wants Understand how she learns stuff to do for parents and toddlers locally inquisitive toddler with – find out at your family information service. likes and dislikes of her It helps to remember that your time and Toddlers learn by copying, so show her own. As she learns to walk attention are the most important things love and affection, treat her – and others Brush her teeth in the morning and last and talk, she will both thing at night with toothpaste containing to your child, so if she learns to get lots – with consideration. challenge parents to the fluoride. of it by throwing a tantrum, she’ll continue limits and also make them down that path. Instead, reinforce good Toddlers learn through playing indoors feel proud. All children are behaviour whenever you see it by giving and outside. You are her best playmate, different and will develop her praise and cuddles and kisses. When join in the fun. Look after yourself you praise what she does she’ll respond at their own pace – with parental encouragement by doing it again and again. She will learn to talk by hearing you talking Your own health and happiness are – so try not to compare to her – the more you talk to her and read really important, if you are not okay them with older siblings books together the faster she’ll learn. then your children will feel it. It’s okay She needs to feel safe and secure, and to put yourself first sometimes. or other toddlers. Learning one of the ways you will do this is by to understand things from giving her structure and boundaries – but your child’s point of view she will test them and that’s hard on you. will help.” See pages 12 and 13 for Julie, Aneurin Bevan Health Board more on wellbeing 198 199
You and your child Getting the basics right The ‘toddler years’ will be a time of The time between your toddler’s big changes for you and your child. first and third birthdays can be She will grow from a baby who needs very demanding. Take a practical your constant care and attention approach to the challenges. into a little person who will thrive and develop with your love, patience Getting the basics right Take a positive approach See the world through your toddler’s eyes and affection. • Praise her to encourage her to behave well The world is an exciting place to your toddler, • Respect her, her thoughts, needs and but it can also be confusing. The way she sees wishes. This does not mean giving into her things will depend on her personality as well over everything, but try giving her limited as how far her brain has developed. You can In this section we will look at: choices like what colour top to wear help by making a real effort to see things from • Getting the basics right • T ry and see the world through her eyes. her point of view as she gets used to being
You and your child and your You Try to understand the world • Eating well for toddlers Recognise when she’s feeling unhappy, more independent. from your toddler’s point •e Childcar angry, tired, bored or hungry. These things of view. This will make it • Learning to talk may affect her behaviour Lead the way easier to be patient and • What you can expect at 12-24 months • Be consistent and have basic rules that Children learn by copying so show them help avoid problems. • What you can expect at 25-36 months are right for her age. Make sure that love and affection. Treat them – and others • W e are a family: When mum and dad everyone who cares for her knows what – with consideration. Listen to her views and are not together these rules are respect her feelings. It’s no good telling her that hitting or shouting is not allowed if that’s what you do. 200 201
Lay down some ground rules Reward good behaviour Ignore minor naughtiness Focus on solutions Your toddler will naturally want to please • Praise and attention work far better than Any kind of attention – even a telling off Seeing tantrums, potty training, sleep and you, but she needs to know what you expect criticism or punishment. Show your toddler – can prolong bad habits and behaviour. mealtimes as problems can make them seem of her. Set clear, simple rules that she can you are pleased when she behaves well Don’t overreact. Learn to turn a blind eye if impossible to solve. But by focusing on finding understand and are right for her age. • Let her hear you saying good things about your toddler is just is being silly, not naughty. answers you can feel confident and more in her to other people control. The same goes for your toddler. Help Be consistent • Don’ t use sweet treats to praise good It’s not them, it’s what they do her to put things right if she has behaved badly. Conflict can arise when parents and others behaviour but give her cuddles, kisses Emphasise that it’s your child’s behaviour For instance, say something like, ‘you hit John who care for your child, follow different sets and extra attention you’re unhappy about, not her. For example, and now he’s upset. How can we sort it out?’ of rules. Make sure other carers know what the say, ‘it’s upsetting when you hit your brother,’ rules are. You will confuse your toddler if you Think of their feelings rather than, ‘you are naughty.’ Constant Stay in touch with your feelings allow her to do something one day and then When your toddler misbehaves, it’s often criticism creates bad feeling and it can lead Being a parent can be a tough job and no tell her off for doing the same thing the next. because she is hungry, bored, tired or doesn’t to more difficult behaviour, not less. one gets it right all the time. It helps to say Getting the basics right When you say ‘no’ make sure you mean it. know how to deal with her feelings. There may sorry if you feel you’ve handled something be something in her life upsetting her. You can Avoid harsh punishments badly. It shows you’re human and teaches Show your toddler that you expect help by letting her know that she‘s allowed to Smacking, shouting and swearing is never children how to apologise. If you feel you’re on her to behave well show her emotions and by giving her a name the best way to help your toddler with intense the brink of losing control, take yourself away Although it may not always seem like it, for her feelings so that she can express them. emotions or to encourage her to behave from the situation for a while to calm down. children love to please their parents. If For example say, ‘it looks to me as if you’re well. Toddlers can be easily overwhelmed Above all, count your successes. You’re doing you expect your toddler to behave badly, sad’. Don’t worry if you haven’t identified it and frightened by the strength of their anger, a great job! chances are she will. correctly – she’ll soon put you right if needs be. or that of their parents. They can easily forget Getting the basics right right basics the Getting their loving feelings in the heat of the moment. It’s not your fault! Be realistic Tell her when you’re pleased It is important that your child knows you love All parents sometimes feel as if they have Don’t expect your toddler to know that an Your toddler wants your attention more her, even though you don’t like the way she reached the end of their tether. But what you ornament isn’t a toy to bang on the floor. than anything else. When you praise what is behaving. see as ‘naughtiness’ is part of your toddler’s Put things you don’t want her to touch out she does, she will respond by doing it again urge to explore the world. It is exhausting for of the way. and again. Explain what you mean. Say, you, but they need your love and support as ‘thank you for putting your blocks away’ much as ever. instead of a general ‘that’s a good girl’.
Top tip! Get down to your child’s level and make eye contact when you talk, especially when you have something important to say. 202 203
If you are finding things tricky Remember to look after yourself All parents go through times when they find Your own health and happiness are very Eating well for toddlers being a mum or dad difficult. For some, the important in raising contented and confident toddler phase is particularly tough. If you are children. Put yourself first sometimes. Once your child is over one year finding it difficult, there’s lots of support out there. You might see less of your health visitor What your child needs most of all is you old she will enter a phase of rapid after your baby is one, but she will still be ‘Toddler battles’ are most likely when you feel there to support you. Let her know if you are undervalued, overworked or that life’s getting growth. She will need small, regular finding things hard, or if you need reassurance on top of you. So you have to learn to put or support. She is trained in parenting support yourself first sometimes. healthy meals and snacks to help as well as health issues and will know who you her get all the nutrition she needs. can talk to locally if you need extra help. Feeling good and functioning well Remember the ‘Five Ways to Wellbeing.’ Eating well for toddlers These are really important now. If you look Further information after yourself and keep making time for the A good diet will help your child to grow, Top tips to help toddlers eat well Contact the Family Information Service on ’five ways’ you’ll be in good shape physically learn and have the energy to be active and • Make sure you give your toddler a variety 0300 123 7777 to find services in your area and emotionally even on a difficult day. fight off illnesses and infections. A good diet of foods. Don’t get upset if she doesn’t will also give her a chance to use her hands, eat everything she’s offered. Keep offering When it’s more than just a bad day mouth and senses. foods and you will be amazed what she Talk to your health visitor or doctor if you: suddenly likes • Are finding every day a struggle Spend time talking to her at mealtimes and • Having a few different things on a plate Getting the basics right right basics the Getting • Feel constantly depressed, anxious or help her to be independent and make choices. can encourage her to try new things exhausted even when you’re getting Eating together will also give her a chance to • Food that looks colourful on a plate will enough sleep develop social skills, like sharing, taking turns tempt children. Try different textures as well, • No longer get enjoyment from life, and sitting with others. like raw and cooked vegetables and fruit or if you are feeling suicidal • T oddlers love to mimic adults. Sit with your Top tip! toddler at mealtimes and eat the same food Choose one thing you’d like as she does. Showing how much you enjoy to do for yourself and make it will encourage her to do the same time to do it. It could be a • Never force her to eat and don’t get upset chat with a friend, getting or angry if she refuses food. Appetites, likes and dislikes will vary from day to day. If you stuck into a good book, or See pages 12 and 13 for Remember: Good habits more on wellbeing now will last a lifetime. keep offering a range of foods at mealtimes having a relaxing bath. she will settle into good eating habits 204 205
Top tips for drinks! Drinks and teeth Little and often Snack attack • After your toddler is one year old, drinks Milk will still be an important drink for your Most children need three meals and two Bin the crisps and try some of these snacks: should be given in an open cup, not a toddler in the first four years of life. Children ‘mini–meals’ a day. Toddlers have small bottle. This is so they can learn to swallow should be offered about half a pint (300 mls) tummies, so they need to eat every three Bite–sized chunks of apple and not suck drinks through a teat or nozzle. of milk a day. This could be as a cup of milk hours or so. They are more likely to enjoy or pear or segments of a • The only drinks you need to give your child at one of their snack times and a cup of milk small meals so they aren’t overwhelmed by seedless satsuma. between meals are water or milk. Any other in the evening. the portion sizes. Toddlers don’t need snack drinks can damage teeth, even if they have foods like biscuits, crisps, sweets and ice no sugar in them. Most soft drinks are acidic Which milk to choose cream between meals. These foods will fill Carrot, pepper, cucumber, courgette sticks with hummus and can damage tooth enamel. Children 1–2 years: Whole milk, or them up without providing many nutrients, dip or slices of cherry tomato. • Childr en can have fresh fruit juice diluted unsweetened calcium fortified soya milk if so save them for special occasions. See one part juice to ten parts water, as long as you are avoiding dairy products. examples of snacks you can give your they have it with meals and served in a cup. toddler inbetween meals. Squares of toast, bread rolls, baps Eating well for toddlers • A void artificial sweeteners for children Children 2–4 years: If your child eats well, with butter, spread, or peanut butter or bread sticks, with a under five – things like saccharin and then semi–skimmed milk or calcium fortified tomato dip or soft cheese. aspartame. These are found in almost unsweetened soya milk can be their main milk Further information all squashes and fizzy drinks. drink. If you are worried your child isn’t eating See First Steps Nutrition website for ideas on healthy snacks: • Childr en love water. It quenches their well, you can try giving them whole milk. Mini sandwiches with yeast www.firststepsnutrition.org thirst, which is why they want a drink. extract, tuna, cheese, or Milks to avoid: Children over the age of one mashed banana or even mini pizza triangles. do not need fortified milks, like growing up Never leave a toddler or young child alone Eating well for toddlers toddlers well for Eating milks or toddler milks, unless recommended when eating, as they could choke*. They are by your GP. All young children should avoid still learning how to chew properly, so sit with Low salt oatcakes, rice rice milk, canned milks, flavoured milks, or them. You will be there to help them if they cakes, crackers, crispbreads low fat milks like 1% fat or skimmed milk. get into trouble. or unsalted plain popcorn.
Natural yogurt and fromage frais, with or without a little Breastfeeding will benefit chopped fruit. you and your child for as long as you choose to do English muffins, crumpets, it. Carry on as long as pancakes, potato or cheese you want to! scones *For more information on what to do if your child choke’s, see page 242 206 Portion sizes vary from age to age. Be guided by your toddler’s appetite. 207
Menu 1: Lewis, 18 months Menu 2: Ellie, 26 months Menu 3: Saanvi, 36 months Menu 4: Tom, 12 months
Breakfast: Unsweetened Breakfast: Unsweetened Breakfast: Small glass of Breakfast: Unsweetened orange orange juice, diluted half–and– orange juice, diluted half– unsweetened apple juice, juice, diluted half–and–half half with water. Baked beans and–half with water. Porridge. diluted half–and–half with with water. Scrambled egg and half a toasted muffin. water. Wholegrain cereal and fingers of toast. with milk. A slice of toast Morning snack: Cup of with spread. Morning snack: Cup of water. Bread sticks, cubed Morning snack: Sliced banana milk. Toast fingers and soft cheese, and grapes. and a cup of milk. cheese and a tangerine. Morning snack: Orange segments and mini scotch Lunch: Spaghetti pancakes. Cup of milk. Lunch: Cottage pie with Lunch: Chicken breast and Eating well for toddlers bolognese grated cheese carrots. Melon and grapes mashed potato with peas and broccoli. Tinned rice cut up. Cup of Water. Bananas and custard. pudding with dried apricots. Lunch: Mixed vegetable pilau. Cup of water. Cup of water. Carrot sticks. Cup of water. Afternoon snack: Cup of Afternoon snack: Cup of water. milk. Cucumber sticks Afternoon snack: Cup of milk. Afternoon snack: Sliced apple dipped in with yogurt dip. Toast fingers with peanut Cup of milk. Pineapple in natural yogurt. butter and an apple. juice, with natural yogurt. Tea: Tuna and sweetcorn Eating well for toddlers toddlers well for Eating Tea: Cheese on toast with pasta. Apple cake. Cup of tomatoes. Cup of water. Tea: Scrambled egg Tea: Channa aloo, masoor water. on toast, with chopped dahl and a chapati. tomatoes. Cup of water. Stewed apple with * custard. Cup of water. Before Bed: Cup of milk Before Bed: Cup of milk*
Before Bed: Cup of milk*
*Or a breastfeed 208 209
Your questions: Top Tips! Childcare How much should my toddler eat? The amount your toddler eats will depend Never add salt to foods or It may be hard to leave your on her size and how much she runs about. meals for babies and young Toddlers have growth spurts. These happen children. toddler in someone else’s care. every six months or so during the first few years. Your toddler may want to eat a lot Keep the amount of sugar you If you choose who looks after her during a growth spurt. At other times she use low. Sugar damages teeth carefully, the experience can may have less interest in food and you might and children who are used to worry she is not getting enough. As long lots of sweet things may find benefit both of you. as she is growing well and is healthy, try it hard to enjoy other flavours. not to worry about her changing patterns. Just make sure you offer her healthy foods Don’t serve foods and drinks
regularly and encourage her to take part in designed for adults to young What you need Childcare family meal times. children. Avoid things like Finding childcare can be difficult and stressful adult ready meals, take Young children need as there are so many different types and What about vitamins? away foods, drinks with security and routine, some are very expensive. They range from All children should be given a vitamin A, C caffeine in them, soft drinks, but you don’t have to be childminders, nurseries and nannies, to friends & D supplement between their first and fifth alcohol, foods with artificial the only one who cares and family. Family Information Services are the birthdays. Ask your health visitor, a pharmacist sweeteners and colours in first point of contact for advice and information
Eating well for toddlers toddlers well for Eating for them. You may need or your GP for information about types of on local services for families and carers. them and highly salted foods to go out to work or feel products available. like savoury snacks. that having time apart will help them learn new Further information skills and encourage their Family Information Services are found in local independence. authorities across Wales. Call 0300 123 7777 Remember: Always wash your hands and your toddlers hands before mealtimes and if Top tip! If your toddler is being cared for away from home, let them you are preparing food. take something familiar with them. 210 211
What to look out for Give it time Make sure anyone you leave your child with is When you hand over the care of your toddler To begin with you might find that your toddler responsible, knows where you are, when you’ll A health visitor’s view: to someone else it’s important that emotional cries and clings to you when you leave. She be back and how to contact you. Also, leave as well as physical needs are looked after. You might be angry or annoyed with you when a list of emergency numbers like your GP and “Many mums feel guilty also need to make sure that your carer knows you return and go back to babyish behaviour make sure that the babysitter knows where your views on issues like behaviour, sweets and for a time. This is her way of showing you the first–aid box is and how to leave the house about leaving their baby TV. Before making your choice, take time to how she feels about being separated from safely in case of fire. or toddler in childcare. discuss these areas in detail to avoid clashes you. Be patient and show that you understand It can be a wrench leaving later on. Toddlers get confused if there is a her feelings. Babysitting and the law her but good childcare can very big difference in the way they are looked The laws about who you can leave your child benefit your toddler. She after at home and elsewhere, which is why Babysitting with are not clear. It is your responsibility to will learn to play with other it’s so important to agree some ground rules You and your partner will want to enjoy some make sure your child is safe and well cared for. with your toddler’s carer. There will be minor time alone together, so you may be looking children, make friends, have differences in the way things are done. for a babysitter. In some areas, there are The law doesn’t say at what age a child may a chance to do things that you might not have space babysitting groups where mums get together be left alone, or how old a babysitter should Childcare Safety first and take it in turns to look after each other’s be. If you pay someone to babysit, they should or time for at home. All Between the ages of one and three your children. Again, your health visitor will be able be considered capable of doing so. If they these will help her learn toddler is an active little explorer. A major to tell you what is available locally. are under 16, then you as a parent could be and grow.” Childcare Childcare consideration when choosing a carer or a prosecuted if your child comes to any harm. Angela, Aneurin Bevan Health Board care setting is safety. Registered carers like Spend some time with your new babysitter If your babysitter is 16 or over, a court would childminders and nurseries will be well aware before you go out so that you and your child generally assume that they were capable of of safety issues. But if your child is going to can get to know them. Point out any particular looking after children. If they are babysitting, be cared for by a relative or someone who risks or hazards in your home. Sometimes they have temporary care of your child and a does not have young children of their own, parents ask their teenage children to look after general responsibility to safeguard their health, their home may not be child friendly. You a younger brother or sister. If you’re doing development and welfare. But remember, this will need to work with them to make sure this, make sure they know how to get in touch responsibility only applies if your babysitter is that it is quite safe. with you and are aware of basics such as 16 or over. telephoning emergency services.
Further information For a list of registered childcare providers The type of childcare you choose will depend on your visit The Care Inspectorate website, which circumstances, the amount of money you have available and has a list of registered childcare providers that you can access www.cssiw.org.uk what sort of services there are in your area. 212 213
• Remember to speak slowly and clearly. A Message from Twf Learning to talk Make your voice slightly higher in order Do you want your child to be bilingual from to attract your child’s attention birth? Twf is here to give you advice, support Your toddler has been learning • Have fun singing nursery rhymes and to new parents on how their newborn can songs, especially those with actions like become bilingual from birth. about sounds since before she ‘Pat–a–cake’ or ‘Row, row, row your boat’ • At first your toddler won’t pronounce words Here are a few Twf tips on how to introduce was born. And during her first year properly. Baby talk is okay. They might say Welsh into your home: she has been gaining the skills ‘do’ for ‘dog’ or ‘dat’ for ‘that’. You don’t • If one of you speaks Welsh it’s important need to correct them. They will begin to say for you to speak the language with your she needs to talk, now it all starts things properly in their own good time child all the time • Help them add more words to their • If a grandparent or relative speaks Welsh, to come together. vocabulary with new experiences, like a ask them to speak the language with your
trip on a bus or train, or a visit to a city child all the time, from the very start Learning to talk farm. Talk to them about what they have • Do you intend to go back to work? Why seen and done not choose a nursery or childminder who At around 12 to 18 months your toddler will How you can help • Help other people understand what your speaks Welsh to look after your child? probably be able to say two or three words. • Keep on talking. Your toddler will need to child is saying. If others can’t understand, • Why not attend a ‘Ti a Fi’ (literally means Over the following six months or so she will add hear a word about 500 times before using it help them out so that your child will gain ‘You and Me’) group with your baby to
Learning to talk Learning to talk to these. She will point to objects when asked, • Point out things you see when you’re out confidence in talking play, sing and meet other parents? wave when someone is leaving and say ‘bye– and about (‘there’s a bus’). As she gets older, • If your child uses a dummy, try not to • Read a Welsh or bilingual book together bye’. At this stage words tend to be all–purpose. add more detail (‘there’s a red bus’) allow her to speak while it is in her mouth. • Y ou could watch television together: ‘Cyw’ ‘Cat’ or ‘dog’ may refer to all four–legged • Act it out. Help her to make connections Better to remove it altogether* S4C’s Welsh Service is for young children animals, while ‘mama’ or ‘dada’ can mean between actions and words by talking her • Give your child your full attention. Talk anything from ‘great to see you’ to ‘I’m tired’, through what you are doing. For example, to her face–to–face. This will provide eye ‘I’m hungry’ or ‘give me a cuddle’, depending ‘let’s put your coat on to go out now. First contact with her and allow her to copy you Further information on how it’s said. Simple phrases like ‘want put one arm in the sleeve. Now let’s do the Advice and support on how to introduce Welsh contact Twf on 0845 605 1551 drink’ or ‘all gone’ come out as one word. other arm’ or visit www.twfcymru.com
Soon, she will say her first words, usually between the ages of 9 and 15 months. After that, she will start talking in her own time.
*For more information on limiting the use of a dummy, see page 166 214 215
Around 19 to 24 months How you can help How you can help Ways to help your toddler get the most By 19 months or so, your toddler will usually • T alk about what is happening as you go • Join in her make–believe games. Ask out of watching TV be speaking at least a few words. She may about everyday activities. Like, ‘We’re what she’s doing, where she’s going, • Help her to understand what is on screen. have a working vocabulary of 50 to 70 words putting the toys in the toy box. Pass me where she lives and what she likes to eat Explain anything that could be difficult to and be able to understand as many as 200. the blocks, Gwen, you can help me put • Encourage her to use words to describe understand and ask questions. ‘What do She will be learning words at a rate of 10 or them in the box’ things, such as the ‘red’ ball or the ‘soft’ you think is going to happen next?’, ‘What more a day and be starting to string words • Help her learn the names of her feelings. blanket was your favourite part of the story?’ together such as, ‘carry me’. Like, ‘you’re happy to see Grandad’, • Use every opportunity you can to talk to • Encourage her if she plays games based ‘you’re angry because it’s time to stop her. When looking at a book or TV, on what she has seen. Give her props, By the time she is two, she will usually be playing now’. encourage her to tell you what’s happening like a tea towel for a cloak, or make a able to form sentences of two or three words • Use questions and answers to help her and explain why she thinks things happen cardboard crown and sing simple tunes. Most children will be understand that communication goes • Encourage her to help you and put names • Don’ t have the television on at mealtimes able to follow simple instructions like, ‘take two ways to things. Teach her that different activities and keep it out of the bedroom
your shoes to Daddy’, or ‘where’s your hat?’ • If something happens ask them ‘what?’ have different words. Such as, in cooking • Don’ t use television to reward or punish her Learning to talk or ‘where?’ If you’re looking at a book the words are chop, mix, beat, peel, hot • Don’ t allow the television to be a constant She may be able to identify pictures and together, ask her what is happening in • Enjoy stories, nursery rhymes and songs presence in the corner. Turn it off when point at actions like running, jumping or the pictures together you’re not watching and play instead. Turn crying. She will also begin to talk about it off at least one hour before bedtime what she likes and dislikes. Her favourite Around 25 to 36 months Tune in, turn off
Learning to talk Learning to talk word may be ‘no’. She will still use names Your toddler’s vocabulary will be growing There are some great children’s television If you are worried instead of talking about ‘I’ or ‘me’. For fast now. By about the age of three, she will programmes these days, but don’t let the box Children learn to communicate in their own example, ‘Tami throw ball’ or ‘Daddy get it’. probably have a working vocabulary of around take over. Television can entertain and inspire time. But slow language development can be 300 words and will understand many more. your child – and give parents a bit of a break. a sign of hearing or other difficulties. If you She will be getting the hang of ‘I’, ‘me’, ‘you’ But too much television can lead to weight think there is a problem, talk to your health and plurals like ‘cats’. problems and prevent children giving their full visitor who can refer you to a speech and attention to more important things, like learning language therapist if needed. There is probably By this time most toddlers will be able to put to talk. The best way for your little one to watch nothing to worry about, but the sooner you words together to form simple sentences. Your the box is with you – and in small doses. look into it the better. toddler will probably be able to carry on a conversation and change her tone depending on who she is talking to. She will be able to say her name, age, that she is a girl and name the main body parts. Other people should be able Top tip! Be firm with the amount of screen time your toddler to understand most of what she says. has. Toddlers should have no more than two hours a day. What you can expect at 12-24 months .
s 217 e dressing e dressing en round to en round ound the house by ound the house by etend, but don’t take over etend, but don’t es of herself and her ound you as you do things ound you as you Showing her pictur family and talk to her about them Letting her have other childr sharing. Not expecting her to know about two toys Help by providing it’ Understanding that if she lashes out Show her strong. because her feelings are other ways to get what she wants Letting her help you ar Letting her help you jobs to do but real giving her simple you ar Letting her help when pr Playing games of Letting her be ar example to copy and set her a good she cries when you go away Understanding if her come back. Tell won’t you scared She’s coming back when you’re and undressing her and undressing play or go to their houses, but don’t expect play or go to their houses, but don’t her to play ‘with’ them yet • • • • • • • • • She’s learning more about herself about learning more She’s and other people by; Help her development
eal , as she will want to s learning fast but will om a cup f if she draws on the wall. oundings safe because oundings safe because Giving her lots of healthy finger foods, Giving her lots of healthy finger T her Letting her join in family meals. Give try to Letting her have blocks so she can Letting her drink fr Not telling her of Helping her as she’ Being patient with her know about how things work, so give her things out for herself the chance to figure Making her surr to the shops is a r Realising that going to climb up She may want adventure. steps or on to a wall physical skills – for Helping her develop her get down from example, by helping climbed she’s somewhere can put her arms in the sleeves she doesn’t have a sense of danger yet have a sense she doesn’t so she can feed herself to a piece of paper. no different her it’s To she can draw Show her where build a tower and other toys and objects build a tower and other toys and that allow her to practise her dexterity still want you to play with her and help still want you to play with her and things her to do difficult a spoon to hold, but be patient with her a spoon to hold, but be patient with slow or makes a mess if she’s She’s learning to control her hands learningto control She’s and fingers Help her development by; • • she herso aking timewhenyoudress • • • • • • She’s learning in new ways to move She’s by; Help her development • • •
months
12–24
at
the ages of 12 and 24 months. that it is important to understand However, paces. If you all toddlers develop at different have any concerns or health speak to your GP visitor for further advice, support and guidance. To help to understand your toddlers progress, help to understand your toddlers progress, To as to how see opposite page for a guideline between your toddler should be developing . * expect
can
you
216
Remember: The more active The active Remember: more to starts toddler your important more become the home your it is to ensure them for is a safe place
*For more information on keeping your home safe, see page 244
vital skill for forming relationships. forming skill for vital of other people around her. This around people is a of other understand her emotions and those and those her emotions understand solving problems. She is learning to She is learning problems. solving remembering, imagining and imagining remembering, gets from her senses by thinking, thinking, by her senses from gets to process the information she she information the to process the pace. She will be learning how how will She be learning pace. the space of time. Let your toddler set set toddler your time. Let of space Toddlers learn a lot in a short short in a lot a learn Toddlers What
What you can expect at 12-24 months What you can expect at 25-36 months
219 en at home, etend play is how etend play is how Letting her spend time playing with other Letting her spend time playing with people so she can learn about making friends tantrums Understanding that when she has her feelings may frighten her Letting her play with other childr so she can learn at their house or nursery, taking turns about and sharing more she can Letting her join in family meals so learn to enjoy eating with other people. to tea sometimes, or Invite other children let her go to their house Having fun with her Understanding that pr Understanding that example so she knows Setting her a good how to behave toddler copies things Not worrying if your on makeup if you have you do, like putting if you have a girl or dad shaving a boy, if she copies behaviour Understanding that if you like it will help her more that you don’t off explain why rather than telling her she learns about the world • • • • • • • • • She’s learning even more about herself about herself learning even more She’s and other people by; Help her development
.
. * e out, talk to her about what Remember: The more active your toddler starts to become starts toddler your The active Remember: more the more important it is to ensure your home is a safe place home is a safe place your it is to ensure important more the them for Letting her go up and down steps when Letting her go up and down steps with her Putting on some music and dancing When you’r big and Helping her understand ideas, like toy Getting her a trike or other wheeled Making your home a safe place so she Making your home T Being pr T upstairs Holding her hand when she goes you’re doing so she can learn doing new words you’re wet and dry small, high and low, and climb new skills you are out you are let her join in family games like football let her join in family can explore and practice new things and practice new can explore her to hold on to the banister and remind A hand–me–down one is fine • • • • • *For more information on keeping your home safe, see page 244 She’s learning in lots of to move She’s new ways different by; Help her development • • run,jump aking heroutdoorssoshecan • • and aking herforwalksandswimming forhertokeeprepeating epared •
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Letting her help you lay the table befor Letting her help you lay the table br Letting her pour the milk over her Using jars with safety caps if ther Not making her use her right hand if she Reading to her as much as you can and Reading to her as much as you can paper Giving her blocks to play with and but let Carrying on giving her finger foods, Letting her help you pr cereal shouldn’t in them that she really dangerous touch to use her left prefers letting her turn the pages to her use a spoon and fork if she wants beans, and mix can wash fruit, snap green things too. your meals to draw on She’s learning finer control of her learning control finer She’s hands and fingers Help her development by; • • • • • • • • expect
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218
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Toddlers You development. their will shape What The age at which toddlers learn to do things few things a are worry if there varies, so don’t to pick your child seems to be taking longer to different up. If your toddler seems noticeably think that things aren’t or you other children, for help. quite right, ask your health visitor Important things to remember with your child is important relationship Your way. in helping her to develop in a healthy growth Her physical, mental and emotional and depend on each other. all linked are
What you can expect at 25-36 months 220 221
One on one We are a family It can be very tiring when there’s no one A child else to share parenting. It’s important to Psychotherapist’s view: Families come in all shapes and make time for yourself and get the emotional
support you need, as well as the practical, sizes and it is not family structure financial support you may be eligible for. “It’s hard work being a parent, especially if you that matters the most. Responsible, Smart tips for lone parents are on your own. Try committed and stable parenting by • Don’t be afraid to ask for help if you need it and make some time for • Try to get out of the house regularly yourself during the day, people who care about a child will • Get your child used to being looked after even 30 minutes can make by other people so she doesn’t become too a difference. Meet up with give her the best start in life. dependent on you alone other parents and share We are a family Step–parenting the care and some adult Building a relationship with a child takes time. company. Try and get out If you as parents divorce or separate the change If you are separating If you are a step–parent, look for activities you of the house. A short walk will have an impact on your toddler. But if you Before you part, make plans for sharing can share so you can get to know each other. can provide a breathing handle the break–up sensitively, she will cope. parenting in the future. It is important the space for you and your We are a family We are parent who is leaving has a clear, defined role. If you can’t talk to each other, it’s a good child, as well as reducing idea to get outside help with solving practical stress levels.” Talk to her about the problems. Keep in touch with both sets of Julie, Aneurin Bevan Health Board separation in words she grandparents. Make sure you inform your toddler’s nursery and other groups. will easily understand. She needs to know that Try to keep your toddler’s daily life as familiar both of you still love her and stable as possible. Stick to her routine and will continue to be and have a consistent approach to discipline There are many involved in her life. and treats. Be prepared for her to revert to organisations which can more babyish behaviour for a time. Further information provide support and For support and guidance for changing guidance for changing family circumstances visit: www.gingerbread.org.uk family circumstances. 222 223
Common challenges Temper tantrums Your toddler is developing fast in Try to rise above the tantrums, lots of different ways. So it is no they won’t last forever. Here’s how surprise that at times you can feel to remain calm and cool. overwhelmed and unsure of how to handle some situations. Your toddler If there’s one thing toddlers do well, it’s At this age, she will be learning to do so will need structure and boundaries to throwing a tantrum. The worst time for many things, but she will be frustrated by the tantrums is at around two years old. With things she can’t do yet. She will be grappling Temper tantrums make her feel safe, but she will test firm and fair boundaries the tantrums will with the rules of the world and the fact that usually begin to fade by the time your child some things are not allowed. them and this will be hard on you. is three. By the age of four most toddlers have worked out that there are better ways Because she can’t tell you what she’s feeling to get what they want. she may end up screaming and throwing herself around. Remember she may be scared
Common challenges Common challenges In this section we will look at: A full–on temper tantrum is tough for you by the force of her rage. • Temper tantrums and frightening for your child. The good news Don’t despair. Find • When mealtime is a battleground is that a few simple strategies will prevent or However helpless you may feel, you are the out about the common • Toilet training contain most of your child’s tantrums. one in charge. You need to do everything challenges you’re likely • A good night’s sleep possible to get that message across. That to come across and the • Concerns about sexualized behaviour Why tantrums happen doesn’t mean having a tantrum yourself, steps you can take to It may seem as if your toddler is having a shouting or smacking your child. These are make things a bit easier. tantrum out of spite, to attract attention, signs that you are out of control. What it does or just to annoy you. Tantrums really happen mean is being prepared for tantrums and because she is frustrated by being a toddler. drawing up a tantrum strategy in advance. 224 225
Tantrum control Four questions to ask Try to prevent tantrums by giving praise. If your child is throwing lots of tantrums, it When mealtime is a battleground Your time and attention are the most may help to work out why. This might help important things to your child. If she learns you to spot one happening in the future. Mealtimes are one of the few areas to get your attention by throwing a tantrum, You could ask yourself: she’ll keep doing it. 1. What triggered the tantrum? where your toddler can express 2. What did she do during the tantrum? Reinforce good behaviour whenever you 3. How did you react? her growing independence and have see it by giving her praise and cuddles and 4. What was the end result? kisses. Spotting the early warning signs of control. Mealtimes should be fun, a tantrum is the best way of stopping them Remember so try and avoid fighting when it’s When mealtime is a battleground getting out of control. • Praise her when you see her doing something well time to eat. Try to become aware of tantrum triggers, • Be clear and calm about what you expect like tiredness, hunger, too much heat or • Don’ t be embarrassed, tantrums happen cold. Where possible, try to avoid situations to all parents that you know are likely to start a tantrum, • Stay firm and ignore the behaviour. Don’t Try talking about food, reading about food Be patient like supermarket checkouts and busy argue or reason and playing with new foods. When you give Toddlers tend to be naturally unadventurous. shopping centres. • Make sure your child is safe. a new food to your toddler, she will be more She may need to see a new food five to 15 • Once the tantrum is fading, reassure your willing to try it if she knows what it is. times before she’s willing to eat it. If she says Temper tantrums tantrums Temper Distract your child if you see them gearing child and carry on with what you were no to something new, calmly take it away. up for a tantrum. Sing a funny song, doing before Think small You can try serving it again another time. suggest she helps you to look for a toy, or Toddlers don’t like big portions. Keep servings take her to another room – anything that small so eating doesn’t seem like a big task. Don’t bribe shifts her attention. A mum’s view: Cut finger foods into bite–sized pieces that Don’t bribe, force or reward her for eating. are easy for little hands to pick up. If you promise her a biscuit for eating lunch, Giving her a choice over some aspects of you are teaching her that lunch is a punishment her life can help stop tension building up. “Look around you and Stay calm and the biscuit is a reward. You could allow her to make certain decisions, realise there are 10 other If your toddler turns down food, it is the like what shoes to wear, or whether to toddlers throwing tantrums food they are saying no to, not you. If she brush her teeth before or after her bath. at the same time!!” doesn’t want to eat, take the food away It is normal for small Carlien, mum of Joshua 3 and Luke 1 without a fuss. children not to trust new tastes and textures. 226 227
Let them help Know when to call it a day Get your child to help you with preparing food, If your child stops eating, turns away or gives Toilet training because it will help her to feel part of things. you other signs that they’ve had enough, it’s Even young toddlers can rip up the lettuce for time to stop. Trying to force your toddler to After a couple of years of buying a salad, or wash fruit. Older children can help carry on eating when she has had enough will with mixing, or laying the table. just get everyone cross and could cause her to disposables or washing cloth over–eat or refuse food altogether. Mealtimes Make it special should not usually last longer than 30 minutes. nappies, you probably can’t wait for Children like to be independent and love having small bowls of their own finger foods. your little one to be potty trained. Try strips of cheese, toast fingers, raisins and A health visitor’s view: But don’t be in too much of a hurry. vegetable sticks.
Keep it simple “Lots of toddlers are fussy Toilet training Don’t waste time and energy creating eaters, as they are eating complicated meals. Fresh food that tastes food they have never seen Getting started and looks good is best. before and some days Once she has got a rough idea of what it’s Don’t be worried if other they are hungrier than all about, get a potty or toddler toilet seat Set a good example children learn to use the and step and let her get used to it. At first, others. Toddlers also have Children learn by watching you. If you are a potty earlier than yours. she’ll probably use it as a toy. You can a small attention span fussy eater, your child may become one too. Many children start at encourage her to find out what it’s really for Eating together at a table will help your child and are easily distracted. by playing at putting a doll or a teddy on it. around the age of two, but to learn. It’s important that you eat Children this age love to copy you, so let her When mealtime is a battleground When mealtime every child is different. together as a family, as come with you when you go to the toilet. Talk Stay calm and don’t rush Don’t expect manners little eyes are watching about what you’re doing in simple terms and Don’t expect toddlers to have good table her into it. perhaps let her use the flush if she’s not scared and will copy everything manners. It’s natural for a young child to want by the noise. Avoid words like ‘dirty’ that may to squash their food and explore it with their you do and the faces you cause her to feel unclean. Be patient and try fingers. Playing is part of understanding. Put make when eating food. Also not to expect too much, too soon. You may a bib on her, protect the floor with a plastic remember their tummy is find your toddler masters her bladder before tablecloth and don’t worry about the mess. the same size as their fist, her bowels, or the other way around. It will She’ll get tidier as she gets older. so it doesn’t take a lot of all work out with time. food to fill it up.” Angela, Aneurin Bevan Health Board 228 229
Three clues that your child is ready for Potty training without the tears Don’t hang about Let her set the pace potty training: Don’t ignore it when she says she needs to If you know when she is likely to want the 1. She tells you she wants to do a wee or Time it right go. To begin with, when she needs to go, potty, encourage her to sit down on it. Make a poo. At first, this may be after rather Pick a period when you have plenty of time. she will need to go straight away. As she sure she feels it is her choice. She will like to than before the event! But at least she’s If she is about to start nursery, or you have gets older she will be able to wait longer. feel that she’s in control. becoming aware of her bowel and a holiday planned, it’s best to leave it until bladder movements things are less hectic. Be consistent once The summer months can be an easier time Be prepared for accidents 2. There are longer spells between wet you’ve started. Don’t change backwards and to try potty training, as your little one can run It is normal for toddlers to do a poo or nappies. She has a wet or dirty nappy forwards from nappies to pants or knickers around without a nappy. Bath time is another wee before they can get to the potty during after a meal or drink and can then be during one day. good time to introduce the pot. Make a note potty training. When these accidents happen, dry for a good few hours of your child’s pattern of bowel movements change her clothes straight away and calmly 3. She shows that she’s aware of bodily Be prepared so you can pick the best times of day to try it. encourage her to have a go on the potty or functions. She imitates you going to the If you live in a house, keep a potty upstairs toilet next time. toilet or shows some other sign that she is and another one downstairs. Be sure to have Get the clothes right Toilet training aware of what’s going on inside her body a potty with you when you’re out and about. You don’t want to spend ages changing your Encourage them with praise It’s a good idea to keep one in the car too and toddler’s clothes. Make sure what they’re If she uses the potty give her praise, but don’t to take a set of spare clothes out with you. wearing is easy to remove. make a big deal of it. For example, don’t reward her with food or toys. Ignore the odd lapse and never tell her off for not using the
Toilet training training Toilet potty or for having an accident.
A health visitor’s view: A child Top tip! Psychotherapist’s view: Make sure everyone who “Toilet training is a subject everyone has an opinion on. Your cares for your child child should be ready to potty train at around two years of “Be prepared for backward knows that they are potty age. Watch for your child showing signs that they recognise steps, usually at times training. Tell them the the need to go. Plan when you are going to start and remain of change.” words you and your child consistent. Starting and stopping only causes confusion Julie, Aneurin Bevan Health Board use for the toilet. for your child.” Angela, Aneurin Bevan Health Board 230 231
Things that may help your child sleep Your questions: A good night’s sleep • Keep it down: Try to keep things calm and quiet during the hour or so before Is it okay to let my toddler cry for a few The world is a new and exciting bedtime. This will help your toddler get in minutes if she wakes at night? the mood to rest. Switch off the television It’s difficult to decide just how long to leave a place for your toddler, so sleep at least an hour before her bedtime crying toddler at night, because it is distressing • Curb your enthusiasm: Avoid rough and to both of you to allow her to cry for too long. can seem like a boring interruption. tumble games, scary stories, television However, don’t jump out of bed at the first programmes and electronic games cry. She will often soothe herself and return to • Gently does it: Warn her when it is sleep. If she doesn’t, some gentle reassurance nearly bedtime so that it doesn’t come can be what’s needed to settle her. At this age, your child will also realise that Routine matters as a surprise she is separate from mum and dad and she The single most important thing you can do • Beds are for sleeping: Never confuse the When is it time for a nap? A good night’s sleep may be frightened of being left alone for good. to ensure that your toddler gets a good night’s issue of sleeping by sending your little Typically, a one–year–old needs about an hour sleep is to set up a simple bedtime routine. It’s one to her cot or bed as a punishment in the morning and an hour in the afternoon. On top of this, it is becoming clear to her that up to you to develop your own system, but it • Get in the groove: Stick to a regular A two–year–old usually needs an hour in playing up at bedtime is a great way to wind could go like this. bedtime. Children sleep best if they go the afternoon, but by the age of three most up the grown–ups. But don’t despair, peaceful to bed and get up at around the same toddlers are okay with a short nap in the nights are just a few simple steps away. Talk to her about how she is going to get ready time every day afternoon or none at all. for bed now. Play a quiet game and talk about • Start helpful routines: Don’t let her
A good night’s sleep night’s A good what you did today and any plans you have for become reliant on drinks (unless you are Between 15 and 18 months your child may A health visitor’s view: tomorrow. continuing to breastfeed), or television reach a stage where one nap doesn’t seem • Hold your nerve: Changes in routine – enough, but two is too much. The same may
Give her a warm bath, put the lights on low, as a result of teething, illness, the arrival happen around the age of three. “Sleep is all about routine keep distractions to a minimum and clean her of a new baby, Christmas or a holiday – and calming down before teeth. Put pyjamas on her in her bedroom. can disrupt sleep patterns. Be prepared If she falls asleep in the pushchair don’t disturb bedtime. Try and stick to Finish with a story – nothing too exciting – or for this and try not to get into bad habits. her. It sometimes helps during these transition a regular bed time. Don’t a gentle song or rhyme. Kiss and cuddle her If you behave consistently, they’ll soon periods to make bedtime a bit earlier. Even if give them too much fluid and say ‘goodnight’ or ‘I love you’, then leave go back to their usual routine your toddler doesn’t sleep during the day, some before bedtime or they will the room with confidence and without fuss. • W arning signs: If your child seems grumpy ‘quiet time’ after lunch should help to relax and during the day she is probably over–tired. revive her. wake up frequently to use Try putting her to bed a bit earlier the toilet.” Angela, Aneurin Bevan Health Board 232 233
Concerns about sexualized behaviour GREEN AMBER RED Many toddlers show an interest in Holding or playing with Pulling other Persistently touching holding or playing with their genitals, own genitals. children’s pants down the genitals of other or skirts up/trousers children. or games that may seem a bit sexual down against their will. Attempting to touch or like mummies and daddies or doctors curiosity about other Persistent attempts Concerns children’s genitals. Talking about sex to touch the genitals and nurses. Parents have told us that using adult slang. of adults.
Attempting to touch
they are not sure what is normal and behaviour about or curiosity about Simulation of sexual when they should worry. breasts, bottoms or activity in play.
genitals of adults. sexualized sexualized
Look at the chart opposite to see: Games e.g. mummies and daddies, doctors • Things your toddler may do which are part about
and nurses. behaviour A health visitor’s view: of normal development – these are labelled green “Do talk to your health • Things that a toddler may do which might visitor if you have any cause a worry and that you need to keep Concerns worries about these issues, an eye on and have a chat to your health she will be able to give you visitor or GP about – these are labelled amber support and information • Things that are a definite cause for concern and where you need to get help – these and help you if you need Further information are labelled red • Talk to your health visitor or GP to take action.” • Call the NSPCC Helpline on 0800 800 5000 or visit www.nspcc.org.uk Angela, Aneurin Bevan Health Board • Call the Child Exploitation and Online Protection Centre (CEOP) on 0870 000 3344 or visit www.ceop.police.uk • Call Stop it Now! on 0808 1000 900 or visit www.stopitnow.org.uk • Call Parents Protect! on 0808 1000 900 or visit www.parentsprotect.co.uk 234 235
Keeping them healthy and safe Daily health care All children will get ill from time Making basic health care a part to time and most will have the of your daily routine at an early occasional accident. Find out here age will instil good habits for your how you can help to keep your child toddler, which they will continue safe and healthy. Remember good to follow as they get older. habits that you instil now will last Daily health care her a lifetime. Teeth • Brush your child’s teeth in the morning • Sugar is the main cause of tooth decay. and last thing at night with fluoride Don’t give her sugary snacks, especially toothpaste. For children under two years between meals. The safest drinks for In this section we will look at: use a thin layer of toothpaste and for older children’s teeth are milk and water • Daily health care children used a pea–size amount • Both you and your child should visit the As your toddler grows and • Minor illnesses • Encourage your child to spit, but not rinse dentist regularly. The dental team can develops and becomes more • More serious illnesses after brushing. Leaving toothpaste on the give more information about looking
Keeping them healthy and safe healthy them Keeping independent, caring for her • If your child starts choking teeth gives it time to work after her teeth will become different from • Specialised health needs caring for her when she • Making your home safe was an baby. • Y our health service: What to expect and who can help All NHS dental treatment is free in Wales for children Further information up to and including 17 Designed to Smile is an NHS Dental years. Contact your local Health Improvement Programme funded Health Board to find NHS by Welsh Government helping children to have healthier teeth. dentists in your area. www.designedtosmile.co.uk 236 237
Ears Feet Skin Lungs • The ears are self–cleaning. Never poke a • Let your toddler go around barefoot • W ipe your child’s face and hands gently • Make sure nobody smokes around cotton bud into them indoors – but make sure your floor is clean before and after eating. Be careful of your child. Do not smoke in your car. • A child tugging or holding their ears can and safe. This will encourage her feet to her delicate skin. Don’t use baby wipes Second hand smoke* can damage your be a sign of ear infection develop properly all the time child’s health. Children are more • Contact your doctor if your child is grouchy, • For outdoors, give her comfortable, • Keep her nails short vulnerable because their bodies are in pain, or has a discharge from her ear lightweight shoes with flexible, non–skid • Give your child a bath every few days, or young and still developing soles daily if she likes it. For some families it is • Ensur e she gets plenty of fresh air Eyes • Have her feet measured every six–to–eight part of the bedtime routine. Dry her well • Check with your doctor or health visitor • A void risk of irritation by never smoking weeks, because she’s growing rapidly at and apply body moisturiser if needed. Never if she develops wheezing, coughing around your child this time leave your child alone in the bath, even if (especially at night), shortness of breath, • Consult your health visitor or doctor if • Always make sure that her socks fit. Tight she is with another child. She may turn on or complains of pain or tightness in the your toddler seems to have problems socks can damage her feet too the hot tap and be scalded and children chest. These are all symptoms of asthma
with her sight. Watch out for squinting • Keep an eye on her toenails and always cut can drown in seconds Daily health care or crossed–eyes, closing or covering one them straight across the top • In summer use a sunscreen with a sun eye, rubbing her eyes a lot, or a family • If something is wrong with your child’s feet protection factor of at least 15 on her skin history of sight problems or they’re walking oddly, talk to your health and dress her in light, loose clothes and visitor or GP ensure she wears a hat Hair • Always put on more sunscreen after she • Keep her hair clean and brushed or combed Urinary/genital area has been in water Daily health care care health Daily • Make hair washing a game. Prevent tears • Keep your child’s genital area clean and at bath time by using a shampoo shield, use a barrier cream to prevent nappy rash or flannel if needed A health visitor’s view: • W atch out for head lice (‘nits’). You may see • If a rash develops, let her go around them on her hair close to the scalp. Your with her nappy off. Ask your health visitor pharmacist or health visitor can tell you for advice “Bath time isn’t just about cleanliness it can be fun and a about the best products to get rid of them • W atch out for threadworms. They look like great time for learning about water too. If you have some • Regular combing with a ‘bone comb’ little white threads in your child’s poo. Your simple toys in the bath such as a little plastic tea pot and cup, (a fine–tooth comb) at least twice a week pharmacist or health visitor will be able to or an old yoghurt pot and a jug you can play with your toddler will help to prevent hair lice becoming a suggest treatments and she will learn pouring, about full and empty and overfilling, serious problem • Seek medical advice from your health visitor all without a mess for you to clear up.” • Shampoos and sprays that claim to prevent or GP if your child is often constipated, has head lice do not work loose poo, or blood in their poo Angela, Aneurin Bevan Health Board
*For more information on second hand smoke, see page 126 238 239
If your toddler has a temperature Caring for an ill child Minor illnesses • Encourage her to rest and drink plenty Children are usually tired and grouchy when of fluids they are ill, so be patient. She may want Toddlers tend to get more minor • She doesn’t have to stay in bed unless to sleep more, so let her stay in bed if she she wants to. It’s okay for her to be with asks. She’ll probably want you around, so be illnesses like coughs and colds than you as long as she can rest prepared to spend time reading and watching • A void exciting games and toys. Do quiet television together. Breastfed children may older children because their immune things with her until she feels better wish to breastfeed more often at this time. systems are still developing. The • Keep the room cool – open a window if it’s hot Keep things familiar and low–key – now is occasional bout of illness is to be • Dr ess her in just a nappy, or pants if not the time to wean her off a dummy or she’s toilet trained change routines. expected and can help them to build • If she’s staying in bed, take the duvet or
blanket off if she starts sweating If she’s hungry, give her something light to Minor illnesses up immunity. • Give sugar–free paracetamol syrup or eat and give her plenty to drink. Drinking is ibuprofen for children. Always stick to more important than eating when she is ill. the dose that’s recommended. Don’t leave it in her bedroom Once she’s feeling better, she can go outside Easy ways to stay well • Remember , never give aspirin or adult’s if the weather is fine – but keep her indoors
Minor illnesses Too many illnesses can • Keep floors clean and egularlyr change medication to a child under 16 or if it is cold, damp or foggy. and wash bedding, clothes, towels and soft ibuprofen to a child who has asthma wear your child down. toys. Watch for any build–up of moulds or Healthy nutritious food, dust mites that can trigger allergies such regular activity, fresh air as asthma. and a few simple hygiene • Keep kitchen surfaces clean and don’t let pets A health visitor’s view: measures can help to go near family food. Use separate chopping boards for raw food and ready–to–eat food. keep them healthy and “When your toddler is ill it is hard work for you. When she is • Keep your home tidy to help avoid injuries will help prevent many • Make sure your toddler washes her hands better and you get the chance take a bit of time for yourself to common illnesses. after going to the toilet. Do the same yourself recharge your batteries. Have an early night, treat yourself to and also after changing their nappy or a soak in the bath, go for a walk with a friend. Something that blowing your nose and before meals will help you feel better and help you get your energy back.” • Make sure your child gets all their Angela, Aneurin Bevan Health Board immunisations and has check–ups 240 241
Your questions: More serious illnesses How do I know if my child is sick? Always call the doctor or NHS Direct Wales You’re the best judge of whether your out of hours if your child: Don’t hesitate to see the GP if your toddler is unwell. If you think she’s ill, even • Cries constantly and can’t be comforted if you can’t quite put your finger on what’s • Seems drowsy and floppy and won’t child has any of the symptoms wrong, speak to your GP or health visitor. wake up • Has a fever that lasts for more than described below. A classic sign of illness is a fever. Your child three days may have one if she’s flushed or feels hot and • Is not getting better after an operation sweaty, or if her temperature is over 38°C or or course of treatment for an illness 100.4°F. You can use a strip–type thermometer • Has been vomiting for more than Fits and fevers Here’s what to do: or a digital, non–breakable one to measure 24 hours A sharp increase in temperature can cause • Put her into the recovery position More serious illnesses her temperature. You can also get a rough • Has a headache or stiff neck a child to have a fit – or a ‘febrile convulsion’. (pictured below), lying on her side idea by feeling her forehead. • Seems to be dehydrated, for example If this happens, your child will go stiff, lose has strong concentrated wee or has consciousness, throw her head back and her Other clues that your child is ill include a not had a wee for several hours limbs will jerk. She will go pale and may foam runny nose, coughs and sneezes, a rash, at the mouth. The attack will end after a few sleeping more, lack of appetite, increased minutes and she will return to normal colour
Minor illnesses whining, clinginess and listlessness. If your and becomes conscious, or falls into a deep toddler’s temperature doesn’t stop her from Further information sleep. These fits are scary to watch but playing and eating normally, there may not If you need urgent advice and care when usually harmless. be anything to get too worried about. your GP surgery is closed you can also • Loosen her clothing and don’t try to call NHS Direct Wales on 0845 46 47 or Teething does not give children a fever. If Always seek medical help hold her down information on childhood illnesses is also you are concerned, no matter what their available at www.nhsdirect.wales.nhs.uk • After the first convulsion • Don’ t put anything into her mouth and temperature, call your health visitor or GP. • If there’s no improvement after a convulsion remove anything she might swallow • If a convulsion lasts longer than five minutes • In case of breathing difficulties Meningitis and septicaemia • If another one starts soon after the first Meningitis and septicaemia* are very serious Top tip! diseases that can affect anyone very quickly. You’re the person most familiar with your toddler’s health, They are not common, but it is important so follow your instincts if you think there’s something wrong to know the signs and symptoms and get that should be looked at by the doctor. medical help quickly. *For more information on meningitis and septicaemia, see page 192 242 243
If your child starts choking Specialised health needs Remember you should always stay In cases of chronic illness, with your child while they are eating disability or developmental, in case they choke. behavioural or emotional difficulties, there are services to support you and your child. Specialised health needs IF YOUR CHILD STARTS CHOKING
Doctors, occupational therapists, speech quite quickly, but the time it then takes to and language therapists, physiotherapists, access the specialised services your child If your child does choke and eye and hearing specialists, dietitians, needs may vary considerably. cannot breath properly, follow psychologists and nurses are there and ready these instructions: to help. They can also put you in touch with Seven important questions you should ask families in similar circumstances to you. if your child has a specialised health need: 1. Shout for help 1. What is the name of my child’s condition? Tapping into the system 2. How can it be treated or managed? If your child starts choking child starts If your 2. Pick up your child and support Your toddler may have been identified as 3. What extra support will my child need, their chest and their chin in needing specialised care at birth, or at an and who will provide this? one hand early–years check. But it may be you who 4. How long will I have to wait to get the notices something is not quite right. Your services my child needs? 3. Give 5 sharp blows between first port of call should be your health visitor 5. Wher e can I get more information about the shoulder blades with the or GP. Be persistent until your concerns are my child’s problem? heel of the other hand to help properly addressed. Your GP or health visitor 6. Ar e there any support groups or charities dislodge the object. Further information may refer you to a hospital specialist, or to a that can help my child, me, or my other Learn how to deal with choking by visiting child development centre, where you’ll be able children? If your baby is still experiencing www.redcrossfirstaidtraining.co.uk to see a community paediatrician and a team 7. Could you put me in touch with any other difficulty breathing, you should Or ask your health visitors about local of other experts. Your child should be assessed parents of children with the same problem? call 999 immediately. first aid courses. 244 245
Preventing falls from a height Windows: Fitting a window restrictor is Making your home safe There are many causes of falls from a height, the safest way to avoid a fall from an upstairs but the most common are shown below: window. If possible, fit one that opens without Toddlers can move very quickly, a key as these are safest. If you have one with Stairs: For toddlers under 24 months old, a key, make sure the key is kept on a hook and you may feel you can’t turn screw mount a safety gate at the top and next to the window, but high up and out of the bottom of the stairs. Adults should always sight of children. Always put the key back in your back on them for a second. keep it closed and should not step over it as the same place, you’ll need to know where it Our guide to safety around the children learn by copying your behaviour. is in an emergency.
home can help you think ahead If your toddler is over 24 months old, she will Removing toys, games and teddies from the be able to climb over the gate, so the safest window sill will make them less attractive to and avoid any nasty injuries. thing to do is to remove it. This may feel toddlers, also keep cots, beds and toy boxes Making your home safe uncomfortable, but if you teach her to climb away from the window. up and down the stairs slowly and with the handrail, then it is likely to be safer than Children will still have bumps, bruises and leaving the gate up. A consultant little trips and this is fine. We should focus on A child safety expert’s Paediatrician’s view: preventing the type of injuries that can lead If you have a young child in your house, view: to serious injuries. then leave the safety gate up, but teach your toddler not to climb over it and to ask an adult “Toddlers view the world as Making your home safe your Making “We shouldn’t wrap children For toddlers, these serious injuries are most to open it if she wants to go through it. an adventure playground, up in cotton wool. They likely to be caused by: so we usually need to be do need to learn about • Falls from a height High chairs: Every year, many children are two steps ahead of them! risk and to be given the • Scalds injured after falling out of their high chair. They depend on us to learn • Burns Use a securely fitted four or five point harness opportunity to explore about danger, but also need • House fires every time and don’t leave your toddler alone and develop.” • Drowning in it. Many high chairs only have a lap strap and the freedom to explore Karen, Children in Wales • Poisoning this is not enough to prevent falls, so you may and learn some lessons • Blind cords have to buy a harness. themselves. Over–cautious parents lead to under– confident children.” Aideen, Aneurin Bevan Health Board 246 247
Preventing scalds Preventing house fires Preventing poisoning Preventing blind cord injuries The biggest causes of scalds in toddlers are hot Having a working smoke detector, a safe night Toddlers explore everything without Toddlers love to look through windows, drinks and bath water, but prevention is simple. time routine and a well practiced fire escape understanding the dangers. Their taste buds climb onto window sills and play in blinds plan can all help to reduce the risk of a fire. are still developing. Because of this, things like and curtains. Unfortunately blind cords have Hot drinks: A hot drink can still scald a child cleaning products may not taste nasty to them. been the cause of fatal and serious injuries 20 minutes after it has been made. You may Check your home for any poisonous items that in children. feel this is too cold for you to drink, but a Further information might be lying around. You’ll be amazed at child’s skin is thinner and it could still be You can book a free home fire safety check what there is. There might be tablets and Preventing blind cord injuries: dangerous to them. with the Fire and Rescue Service by phoning bleach in the bathroom, cleaning products • Look around your home, have you got any 0800 169 1234 and liquitabs under the sink, perfumes and cords that form a loop. These might be Never hold your toddler when drinking a hot medication in the bedroom, nicotine products blind cords, roman blinds, venetian blinds drink. It’s not worth the risk, so just wait until Preventing drowning and liquid air fresheners in the lounge. or curtain tie backs you have put your baby down. Keep hot drinks Children can drown in as little as 3cm of water. • Wher e possible, use a cleat hook. This is, Making your home safe pushed towards the back of a high surface so Check your home and your garden to see Poisoning prevention: a hook with two ends that you can wrap the that your toddler can’t reach them. where your risks are. • Check every room for poisonous items cord around to keep it out of the way. Place • Lock them away, up high and out of sight it as high as possible Baths: Most bath scald injuries happen when Preventing drowning at home: • Swap your kitchen cupboards around. For • Consider other options than a blind in your children are unsupervised. They happen when • Check outside for buckets and toys that example, put your tins under the sink and child’s bedroom running a bath and if an adult leaves during have collected rain water the cleaning products in a high cupboard • If buying a blind, choose a blind with no the bath. Never leave a running bath or the • If you have a pond, think about how you • Put all poisonous items in a high kitchen cords or loops children unattended. Always check the water can make it safer. Can you fill it in, fence it cupboard and use a cupboard restrictor. • Take tie–backs off curtains Making your home safe your Making with your elbow, it should be tepid and not off or put a grid over the pond? Doing this means that you are more likely • Move beds and other furniture away from hot as a child has thinner skin. • Does your neighbour have a pond? If so, to prevent your toddler being poisoned the windows where you have blinds could your toddler get access to it through • Remember that handbags often contain Preventing burns the fence or the hedge? medicines. Hang your bag up and ask Burns are usually caused by contact with a hot, • Always stay with your toddler when they visitors to do the same dry area. This includes oven doors, radiators, are in the bath. If the phone rings, either fires and heated hair appliances such as hair leave it or take her with you straighteners. Supervise children around these • Dr owning can happen in seconds. It is and wherever possible, keep them out of reach usually a quiet accident and you won’t of children. Use a fireguard that is securely always hear it happening. Don’t assume fixed to the wall. that you will hear splashing or coughing 248 249
Kitchen Out and about Make sure your kitchen is a safe place and Always make sure your child is: Your health service the things your child does in there are safe • In an appropriate car safety seat for her age. Always keep an eye on children • Safely strapped into a five–point harness Your health visitor is still at the in the kitchen at all times. in their pushchair • Kept hold of at all times. A harness or end of a phone, even when your Fit short power leads on kettles and other wrist strap can be helpful but remember appliances and push them well back out of that pulling too hard could hurt your child child gets older. reach. Use the back hobs on your cooker and • Reminded often about road safety and The best time to call your health visitor is first learning or behaviour, you should contact your turn pan handles away from the edge. Don’t the dangers of traffic thing in the morning, or towards the end of health visitor to discuss whether your child put chairs near the cooker, as she can climb the day. They will usually have an answering needs any additional help or assessment. up. If you have to leave the room, remove Children will always have injuries, this does machine, so leave a message if they are not in. pans from the heat. not mean that you are a ‘bad’ parent. Toddlers Immunisations Your health service are susceptible to injuries at home because Make the most of your GP Further routine immunisations are due at Put away plastic bags, including nappy sacks. of how they explore, develop and learn. As Your GP is there to help you if your child is 12 to 13 months and the flu vaccine is offered Babies can suffocate on nappy sacks, always a parent, you can use the tips above to help ill or if she has a chronic condition like eczema to all children from the age of two years each keep them out of reach. prevent the more serious and common injuries, or asthma. Don’t forget to take your child’s red year in autumn. but also learn from any injuries that do happen book if you have one. You won’t always come Never leave the front door open. Your and make changes if necessary. away with a prescription. Many illnesses get At three years and four months your child toddler can be through it and out on to the better on their own. will need a second dose of MMR (measles, road in an instant. Things to think about for the future: mumps, rubella). This is to boost protection Making your home safe your Making • Where did it happen? Think about the Checks you will be offered before your child goes to school. Measles still room. Could you move things around, Your child will be offered a programme of causes outbreaks in schools in Wales. They also add something or take something away health checks at different stages, combined get a booster against whooping cough which • When did it happen? What time of day was with support and advice during her early commonly affects children. it? Was there lots of chaos around or too years. These are listed in your ‘red book’ much time on her own? which helps you keep an important record Remember, it’s important to catch up on • How did it happen? Were rules broken, of your child’s development. missed immunisations. If your child has was it a normal everyday activity? missed an immunisation and is older than the • Why did it happen? These health checks are intended to support recommended age, talk to your health visitor, you as a parent in helping your child develop. practice nurse or GP. Answering these question will help you to As her parent, you will be aware of your understand why it happened and also how child’s strengths and needs. If you are worried Further information to stop it happening again. about any aspect of your child’s progress, www.wales.nhs.uk/immunisation such as speech, hearing, walking, coordination, 250 251
A C F M Abdominal pain 64 Caesarean section 57, 78, 84 Flu 55 Medicine 46, 191 Alcohol 45 Caffeine 22, 139, 176 Forceps delivery 98 Meningitis 192, 241 Alcohol and breastfeeding 138 Car safety 125 Formula milk 58, 117 Mental health 34 Anaemia 63 Child benefit 124 Midwife-led unit 57 Antenatal care 50 Childcare 209 G Miscarriage 70 Antenatal classes 51 Choking 242 Gas and air 82 Morning sickness 62 Community maternity unit 57 Gestational diabetes 65 Morphine and opiate drugs 82 B Complementary therapies 82 Baby blues 140 Constipation 62 H N Baby massage 133 Consultant–led unit 57 Hand washing 26 Newborn blood spot test 109 Baby’s movements 60 Contraception 146 Healthy eating 19, 137, 203 Newborn hearing screening 109 Backache 62 Crying 131 Heartburn 62 Benefits payments 35 Cystitis 63 Herbal and homeopathic remedies O Birth centre 57 and aromatherapy 47 Over-the-counter medicines 46 Index Birthing pool 82 D High blood pressure 65
Index Birth partner 101 Dads 17, 38, 40, 71, 99, 101 Home birth 56 P Birth plan 76 116, 134, 142, 144,171 Hormones 33 Pain relief (drugs) 82 Bonding with your baby 106 Dental care 48 Pain relief (without drugs) 81 Bottle feeding 117, 122, 142 Depression 140, 169 I Pelvic floor exercises 30 Braxton Hicks 63 Domestic violence 36 Immunisations 152, 154, 249 Pelvic girdle pain 66 Breastfeeding 58, 110, 138, 142 Drinks 180 Infections 27, 54, 64 Physical activity 28 Expressing breastmilk 114 Drug misuse 47 Itching 66 Piles or haemorrhoids 62 How to breastfeed 112 Postnatal depression 169 Positioning and attachment 113 E L Postpartum psychosis 140, 170 Breathing and relaxation techniques 81 Eating well 19, 137, 203 Labour and birth 86 Pre-eclampsia 65 Breech 84 E-cigs 43 Coping with labour 91 Premature birth 68 Epidural anaesthesia 83 Early labour 90 Prescribed drugs 46 Exercise 28 Signs of labour 88 Expressing breastmilk 114 252
R T Registering the birth 128 Talking 158, 212 Teething 185 S Temper tantrums 223 Safety 187, 244 TENS machine 82 Babywalkers 189 Toilet training 227 Dogs 188 Twins 67 In the sun 188 Kitchen 248 U Out and about 248 Ultrasound scan 52, 54 Preventing blind cord injuries 247 Preventing bumps and falls 189, 245 V Preventing burns 246 Vaccinations 55 Preventing drowning 246 Vaginal bleeding 64 Preventing house fires 246 Varicose veins 63 Preventing poisoning 247 Vegetarianism 180
Index Preventing scalds 246 Ventouse delivery 98 Water safety 189 Vitamin K 78 Screening tests 54 Vitamins (supplements) 23, 24, 184, 208 Septicaemia 192, 241 Sex 146 W Sex during pregnancy 36 Water birth 78 Sexualized behaviour in toddlers 232 Weight 32 Single parent 37, 145 Whooping cough 55 Skin-to-skin contact 98, 106 Work 34 Sleeping 141, 230 Smoking 42 X Second hand smoke 43, 44, 126 X-RAYS 47 Smoke free homes 126 Solid food 174 Sterilising feeding equipment 118 Syntometrine injection 79 Publication details Title: Bump, Baby & Beyond Publisher: Public Health Wales NHS Trust Date: April 2014 ISBN: 978–0–9572759–7–3 Your journey continues... For further information please contact: [email protected] © 2014 Public Health Wales NHS Trust Material contained in this document may be reproduced without prior permission provided it is done so accurately and is not used in a misleading context. Acknowledgement to Public Health Wales NHS Trust to be stated.
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