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Baby Checkis your babyreally ill?

The ISBN Number is: 978-0-9559691-0-2

how Baby Check workshow to use Baby CheckBaby Check will help you decide whether yourbaby needs a doctor. Baby Check contains 19simple checks which test for different symptomsor signs of illness. Each check has a score. Gothrough all the checks, then add up the scores.The higher the score the sicker the baby islikely to be.Read the booklet and try the checks when yourbaby is well. You will then find it easier to use ifyou are worried about your baby. If there are anychecks you don’t understand talk to your healthvisitor, midwife or doctor.if your baby:-when you want to checkyour baby:- stops breathing or goes bluehas a fitcannot be wokenis unresponsive and not aware of what isgoing on has glazed eyes and is not focussingon anything has been badly or seriously injured has a rash that does not fade whenpressed with a glassdo not use Baby Check.These conditions require urgent medical help.see page 14 if you think your babyis seriously ill undress your baby in a warm place carefully follow the instructions for each check write down the scores using the foldout scoresheet on page 13 only score if a check is obvious. If in doubt,don’t score after doing all 19 checks, add up the scores page 13 tells you what the total score means

01 unusual cry02 fluids takenYou will know your baby’s usual cries fromhunger or tiredness. An unusual cry could be:weak, high-pitched, moaning or painful.Think about the amount of fluid your babyusually takes in 24 hours (do not includesolids). Then think about the amount of fluidhe or she has actually taken in the last 24hours. If you are breast feeding you will knowfor how long your baby usually feeds, andwhether your baby is sucking normally.Judge how much your baby is taking.If your baby hasan unusual cryscore 2If your baby has taken alittle less fluid than usualscore 3orIf your baby has taken abouthalf as much fluid as usualscore 4orIf your baby has takenvery little fluid2score 9

03 (being sick)04 green vomitMost vomiting is not important. Healthybabies often bring back small amounts of milkafter a feed. This check is about whether yourbaby has started vomiting large amounts afterseveral feeds in a row.Vomit is green when it contains bile. Bile is abright green liquid which comes from belowthe stomach. Green vomit may be a sign ofobstruction in the intestine. It is unlike anyother vomit.If your baby has vomitedat least half the feedafter every one of thelast three feedsIf your baby hashad green vomitvomitingscore 4score 133

05 wet nappies06 blood in a nappyThink about how wet your baby’s nappiesusually are. This will give you an idea of howmuch urine he or she usually passes.You may find small flecks of blood in yourbaby’s dirty nappy. This is usually due to a tinysplit at the opening to the back passage andis not serious.A large amount of obvious blood may beserious. It could be the result of a blockageor damage to the bowel.If your baby has passedless urine than usualscore 3If there has been a largeamount of obvious bloodin your baby’s nappy (notjust a streak on the stool)4score 11

07drowsiness08 floppinessBabies are usually very alert when awakeand respond to what is going on aroundthem. An ill baby may be drowsy at times.This check is not about the time your babyhas been asleep nor whether he or she hasbeen irritable.If your baby has been drowsy and less alertthan usual when awake score as follows:You will know how strong and firm yourbaby usually is.Occasionally drowsyIf your baby seemsmore floppy than usualscore 4score 3orDrowsy most ofthe timescore 55

09watching10 awarenessTalk to your baby. Normally babies look atyou intently. Is he or she watching yourface now?This check may be difficult if your baby iscrying or irritable, but your baby shouldwatch you between cries.Healthy babies are aware and respond towhat is going on around them. Watch yourbaby now. Is he or she responding to what isgoing on?This check may be difficult if your baby isirritable or crying, but he or she should stillbe aware and responsive between cries.If your baby is watchingyou less than usual6score 4If your baby is respondingless than usual to what isgoing on aroundscore 5

11 difficulty breathing inHealthy babies breathe easily and shallowly. If a babyhas breathing difficulty the lower chest and uppertummy will dip in with each breath. This is called“indrawing”. This occurs in well babies when theyhiccough or cry hard.When the baby is quiet, watch the lower chest andupper tummy. The picture shows you where to look.If there is indrawing justvisible with each breathscore 4orIf there is obvious ordeep indrawing witheach breathscore 157

12 looking pale13 wheezingMost babies are naturally pale. What’simportant here is whether most of yourbaby’s body is much paler than usual.Babies often make snuffly or throaty noiseswhen they breathe. Wheezing is different.It makes a whistling noise when a babyis having difficulty breathing out.If your baby’s body ismuch paler than usualscore 3orIf your baby has had anepisode of going verypale at any time duringthe last 24 hours8score 3If your baby is wheezingwhen breathing outscore 3

14 blue nails15 circulationHealthy babies’ fingernails and toenails areusually pink. Compare your baby’s nails to thenatural colour of your own fingernails.This check is about how well the blood isgetting to your baby’s fingers and toes.Gently squeeze his or her big toe to make itwhite. This will not hurt your baby. Then letgo and wait three seconds. Watch howquickly the colour returns.If your baby’s nailsare bluescore 3If your baby’s toe wascompletely white beforethe squezescore 3orIf your baby’s toe colourdoes not return withinthree secondsscore 39

16 rash17herniaBabies often have a few spots or small areasof rash. This check is about a rash whichcovers a large part of your baby’s body, orwhich is raw or weeping.A hernia is caused by a small loop of intestinebulging through the muscles in the groin.In boys a hernia shows as an obvious bulge inthe groin or scrotum, as shown by the arrowin the picture. It is very rare for a girl to havea hernia. A hernia gets bigger when the babycries and it may disappear when the baby isquiet or asleep. The shaded groin area on thepicture shows you where to look for a hernia.A hernia can appear on either side of the groin.If your baby has a rashwhich covers a largepart of the bodyscore 4Or if your babyhas a rashwhich is rawor weepingand is biggerthan theshaded areashownscore 410If there is a bulge in thegroin or scrotum whichgets bigger with cryingscore 13

18 temperatureBabies often develop high temperatures when they areunwell. Your baby’s temperature measurement may dependon where you measure it (ear, mouth, armpit) and what typeof thermometer you use. It is important to followaccurately the instructions that come with yourthermometer. For babies below four weeks of age use anelectronic thermometer in the armpit. For babies above fourweeks use an electronic or chemical dot thermometer in thearmpit or an infrared tympanic thermometer in the ear.In a baby below threemonths, if the temperatureis 38.0 oC or morescore 4orIn a baby above threemonths, if the temperatureis 39.0 oC or morescore 411

19crying duringchecksThis check is about how much your babyhas cried during the checks.If your baby has criedduring the checks(more than alittle grizzle)12score 3

Add up your baby’s score hereWhat the totalscore meansNow add up all thescores to get thetotal scorescore0 to 7Your baby is only a littleunwell, and medical attentionshould not be necessary.score8 to 12Your baby is unwell, but isunlikely to be seriously ill.You may want advice fromyour doctor, health visitoror midwife.score13 to 19Your baby is ill. Contact yourdoctor and arrange for yourbaby to be seen.score20 Your baby may be seriouslyill and should be seen by adoctor straight away.DateCheckIf you think your baby is ill watch him or herclosely, if you think he or she is getting worse,do all the checks again.13TimeScoreCheck01 unusual cry11 difficultybreathing in02 fluids taken12 looking pale03 vomiting(being sick)13 wheezing04 green vomit14 blue nails05 wet nappies15 circulationin06 abloodnappy16 rash07drowsiness17 hernia08 floppiness18 temperature09watchingduring19 cryingchecks10 awarenesstotalscoreScore

conditions with a low scorewhich may need medicalattention:What the totalscore meansscore0 to 7Your baby is only a littleunwell, and medical attentionshould not be necessary.score8 to 12Your baby is unwell, but isunlikely to be seriously ill.You may want advice fromyour doctor, health visitoror midwife.score13 to 19Your baby is ill. Contact yourdoctor and arrange for yourbaby to be seen.score20 Your baby may be seriouslyill and should be seen by adoctor straight away.Babies sometimes develop problems such asthrush, sticky eyes, or lumps or swellings.Although rarely serious these conditions maystill need medical attention. You should askyour health centre about them.if you are still worried:Baby Check is not meant to replace your ownjudgement. You know your baby better thananyone. If your baby’s total score is low but youare still worried, ask your health visitor, midwifeor doctor for advice.if you think your babyis getting worse:If you think your baby is ill watch him or herclosely, if you think he or she is getting worse,do all the checks again.lift hereDo the checks again, and if the score is different,follow the advice for the new score.1314if you think your baby isseriously ill:Phone your doctor. If you get an answerphonemessage, call the number given on the messageor call NHS 111. If you can’t make a phone call,take your baby to the Accident and Emergency(Casualty) Department at the nearest hospitalwhich deals with children.if you think your baby’slife is in danger:Telephone 999. Ask for the ambulance serviceand say it is for a baby. You do not need to payfor any 999 calls (so they can be made frommobile phones without any credit).Very, very rarely babies die suddenly with nosigns of illness. Baby Check is not designed topick out such babies. Baby Check is a guide tohelp you decide how well your baby is. Althoughit is accurate most of the time, its advice cannotbe guaranteed. If you are still worried about yourbaby, consult a doctor.

background to baby check:acknowledgements:Baby Check was developed from a 4-year projectwhich analysed the signs and symptoms of illnessin over 1,000 babies under 6 months of age.There were 300 well babies at home and 700babies in hospital with a variety of illnesses. Allthe signs and symptoms were analysed to findthe combination which could be used to assessthe severity of a baby’s illness with the mostaccuracy. The 19 signs and symptoms now usedin Baby Check were found to give the mostaccurate assessment.The parents and babies who assisted with theresearch project and: The Friends of theFoundation for the Study of Infant Deaths;Australian Institute of Health; Ross Trust; FeltonBequests; H & L Hecht Trust; Percy BaxterCharitable Trust; A Williams Private Fund. Theresearch was done in the Dept Paediatrics,University of Cambridge; MRC Dunn NutritionLaboratory, Cambridge; Dept of generalPaediatrics, Royal Children’s Hospital, Melbourne,Australia. The photograph on page 7 wasreproduced with kind permission from Prof Dr BSmalhout’s book, “The Suffocating Child”.The accuracy and acceptability of Baby Checkhas been tested in several field trials.The text about temperature on page 11 has beenchanged from the advice given in the original BabyCheck booklet and now complies withcurrent National Institute for Health and ClinicalExcellence (NICE) guidelines.Baby Check is available to download fromThe Lullaby Trust website www.lullabytrust.org.ukCopyright: The Lullaby Trust(formerly The Foundation for theStudy of Infant Deaths) 200615