Post provided by Heather Morris Midwife sponsored by Metanium.
With community heathcare access not as freely available to new mums currently, Midwife Heather Morris gives an overview of potential red flag warnings for babies aged 1-12 weeks from a professional’s perspective on behalf of nappy-rash cream, Metanium.
Between 1-12 weeks, babies are likely to develop at very different rates and ‘red flag’ indicators tend to be more relevant after 6 months of age, so the warnings identified should only be used as a guide, and advice should be sought with your health care practitioner on any areas for concern.
And be sure to adjust expectations for premature babies.
Overview of baby’s development at 4 weeks
During the first four weeks of life there is considerable variation between babies in terms of their behaviour and development. Most babies spend long periods of time asleep, with the time they spend awake gradually increasing. Their senses are highly attuned to the caregiver’s face, voice and touch. A baby’s behavioural cues (crying, gazing, imitation) are designed to elicit responsive care and sensory stimulation [Dosman, 2012].
Potential ‘red flag’ warnings at week 4
- Baby doesn’t startle in response to a sudden loud sound
- Baby doesn’t respond to sounds, music, or voices
- Lack of eye contact
- Differences between right and left sides of the body in terms of strength, movement or tone
- Unable to latch on while breast or bottle feeding.
- Loses a lot of milk from the side of their mouth while feeding.
- Baby frequently resists being held and is not calmed by rocking, touching and gentle sounds having been fed and changed.
Overview of baby development at 8 weeks
By about four weeks, a baby is likely to start smiling (although some take longer to do this). Smiling in response to faces and social interaction will start to develop. A baby starts learning how to communicate their needs and will cry when hungry or uncomfortable. There is likely to be a preference for familiar faces and a baby will follow a face with their eyes and maintain eye contact for longer than a newborn. Their pupils will react to light and they will follow a pencil light with their eyes. Facial expressions will become increasingly alert and they will stop whimpering and turn towards the sound of a nearby soothing voice. [Sharma, 2014]
Potential ‘red flag’ warnings at week 8
- Has trouble moving eyes or crosses them most of the time
- Doesn’t respond to loud noises
- Doesn’t notice own hands
- Lack of weight gain
- Does not cry when hungry or uncomfortable
- Unable to settle
- Resists being held
- Does not enjoy different types of movement
- Does not make eye contact
- Fists remain closed most of the time
- Stiff legs with little or no movement
- Difficulty lifting their head
- Problems with feeding and retaining feeds
Overview of a Baby’s development at 12 weeks
Between the age of two to three months, a baby’s movements become smoother, with their arms waved symmetrically and hands held loosely open. They will kick vigorously and need support at their shoulders when being bathed and dressed, but will have head control when supported in a sitting position. At this age, a baby will be able to hold their head erect and steady and show little or no head lag when helped into a sitting position. When lying on their abdomen (supervised tummy time), a baby will lift their head and upper chest, well up to the midline using their forearms for support. [Sharma, 2014; Dosman, 2012]
Visually, a baby will become increasingly alert and show particular interest in nearby faces, moving their head deliberately to gaze attentively around. They will follow movements within their visual field and watch the movements of their own hands with interest. The defensive blink response is clearly shown. When feeding, a baby will fix their eyes unblinkingly on their parent / carer’s face. [Sharma, 2014]. At this stage, a baby will engage caregivers in playful verbal, tactile and motor interactions. [Dosman, 2012].
Potential ‘red flag’ warnings at week 12
- Does not follow moving objects with their eyes
- Does not grasp objects
- Does not smile at people
- Cannot support or lift their head
- They have stiff legs with little movement
- Minimal arm movements
- They keep their fists clenched
- Frequently resist being held
- Does not verbalise particularly when hungry or uncomfortable
- Does not respond to loud sounds
CF Dosman, D Andrews, KJ Goulden. Evidence-based milestone ages as a framework for developmental surveillance. Paediatr Child Health 2012;17(10):561-568.
Ajay Sharma, 2014, Mary Sheridan’s From Birth to Five Years: Children’s Developmental Progress 4th Edition