Symptom checker
- Not breathing, or breathing very abnormally
- Unresponsive — floppy, cannot be roused at all
- Non-blanching rash — red or purple spots that don't fade when pressed with a glass
- Seizure that does not stop within 5 minutes, or first-ever seizure
- Fever above 38°C in any infant under 3 months — always emergency, always
- Blue lips or extreme breathing difficulty
Breastfeeding
Breastmilk production is strict supply and demand: the more milk removed, the more is produced. In the first days, colostrum (small volume, very high in antibodies and immune factors) transitions to mature milk around days 3–5. Engorgement at this point is normal and temporary.
Signs feeding is going well: 8–12 feeds in 24 hours in the newborn period, adequate wet and dirty nappies (see Growth tab), contentment between most feeds, and normal weight gain. A baby who feeds, settles, and grows is getting enough.
Signs warranting a lactation consultant review: pain throughout feeds (some initial latch discomfort is normal), baby consistently unsatisfied, very frequent feeds under 5 minutes per side consistently, or slow weight gain.
Cluster feeding — very frequent feeding, especially in the evenings or during growth spurts — is not a sign of low supply. It drives supply increases and is normal, expected behaviour.
Blocked duct: a firm, tender lump that doesn't resolve between feeds, usually no fever. Continue feeding, offer the affected breast first, gentle massage toward the nipple during feeds, varied positions, warm compresses before feeds. Usually resolves in 24–48 hours.
Mastitis: blocked duct with systemic symptoms — fever, flu-like aching, redness, warmth in the affected breast. Continue feeding through mastitis — stopping is harmful and worsens the condition. See your GP if fever persists beyond 12–24 hours; most Australian guidelines recommend antibiotics (typically dicloxacillin or cephalexin) if symptoms don't improve rapidly.
Breast abscess: a fluctuant, pus-containing lump — mastitis that has progressed. Requires same-day medical review; may need drainage. Continuing to breastfeed or express is usually still possible and recommended.
It is safe for baby to feed on a breast with mastitis. Milk from an affected breast is not harmful to baby.
Lactose, milk proteins, and total fat are synthesised by the mammary gland — not passed through from food. Eating dairy doesn't send dairy to baby through milk; however, small amounts of intact cow's milk protein can transfer and occasionally cause reactions in sensitive infants.
Fat quality, not quantity: total fat in milk is regulated by the breast. What shifts with maternal diet is fatty acid profile — higher oily fish (DHA, omega-3) intake enriches milk to support brain development.
Vitamin D — the important exception: breastfed infants typically need supplementation because vitamin D transfers poorly to milk regardless of maternal levels. Australian guidelines recommend 400 IU/day of cholecalciferol (vitamin D3) for exclusively breastfed infants. Discuss with your GP or MCH nurse.
Maternal dietary restriction is only warranted when there are clear, consistent signs of cow's milk protein intolerance (CMPI). Blanket elimination of foods is not recommended and can affect maternal nutrition.
CMPI affects around 0.3–0.5% of exclusively breastfed infants (versus 2–7.5% of formula-fed infants). Most reactions are non-IgE mediated — delayed gut symptoms rather than immediate allergic responses. Small amounts of cow's milk proteins transfer into breastmilk and can trigger reactions in sensitive infants.
Signs that increase clinical suspicion:
- Blood or mucus in stool — the most common presenting feature in breastfed infants
- Persistent eczema or skin rashes not explained by other causes
- Excessive, inconsolable crying after most feeds
- Reflux-like symptoms not responding to positioning
- Family history of atopy (asthma, eczema, hay fever, food allergy)
Diagnosis is clinical — a supervised 2–4 week maternal dairy elimination trial followed by deliberate reintroduction. If symptoms resolve with elimination and return with reintroduction, CMPI is the likely diagnosis. During elimination, calcium supplementation (~1,000 mg/day) is recommended. Do not eliminate long-term without GP supervision.
Tongue tie refers to a short or tight lingual frenulum that restricts tongue movement. It is genuinely common (around 4–10% of newborns) and can contribute to breastfeeding difficulties including poor latch and feeding pain.
When it matters: a tongue tie is clinically significant when it is functionally affecting feeding — causing pain, poor latch, or inadequate weight gain. Anatomical presence alone is not an indication for treatment.
Frenotomy (tongue tie division): a simple, low-risk procedure. The evidence for its benefit is moderate — some well-designed trials show improvement in breastfeeding pain and latch; others show mixed results. Current evidence supports frenotomy when there is a functionally significant tongue tie affecting feeding, assessed by a clinician experienced in breastfeeding medicine.
What to do: if you are struggling with feeding pain or latch and tongue tie is suspected, seek assessment from a lactation consultant and your GP or paediatrician before proceeding to division. Lactation support alone resolves difficulties in a significant proportion of cases.
Note: posterior tongue tie is a more controversial diagnosis with less supporting evidence for intervention — be appropriately cautious about private clinics offering rapid or routine division without a feeding assessment.
Formula feeding
Always follow the scoop-to-water ratio exactly as labelled. Adding extra powder causes dangerous sodium imbalance (hypernatraemia). Diluting formula reduces calories and can cause hyponatraemia. Both are medically serious.
- Water temperature: no cooler than 70°C — this temperature is required to kill bacteria including Cronobacter sakazakii. Boil water first, then allow to cool to 70°C (takes approximately 30 minutes after boiling). Do not use water cooled completely.
- Measure water first, then add the levelled scoop of powder
- Prepared formula can be refrigerated for up to 24 hours
- Discard any formula left in the bottle after a feed — do not re-offer
- Do not use a microwave to heat formula — creates hot spots that can burn
Powder formula is not sterile. For infants under 3 months, premature infants, or immunocompromised infants, use water at 70°C as above. WHO and FSANZ both support this recommendation.
Paced bottle feeding mirrors breastfeeding by allowing baby to control flow and intake. It reduces overfeeding, supports satiety cues, and eases the transition between breast and bottle.
- Hold baby semi-upright (45°), not flat
- Offer the teat horizontally — baby should draw it in actively, not have it pushed in
- Pause every 20–30 seconds by tipping the bottle down to reduce flow — this allows baby to signal fullness
- Feed should take approximately 15–20 minutes
- Use a slow-flow teat regardless of age; there is no medical need to "upgrade" teat size
How much formula: approximately 150–200 mL/kg/day in the first months, divided across feeds. Your MCH nurse will guide amounts as baby grows. Responsive feeding — offering when baby signals hunger — is preferable to rigid scheduled amounts.
Starting solids
NHMRC guidelines recommend introducing solids around 6 months, not before 4 months. Age alone is not sufficient — readiness signs must also be present: sitting with minimal support and good head control, loss of the tongue-thrust reflex, and genuine interest in food.
Introduce allergenic foods early. ASCIA guidelines recommend introducing peanut, egg, tree nuts, dairy, fish, wheat, and sesame from around 6 months alongside other first foods. The LEAP trial demonstrated that early regular peanut introduction reduces peanut allergy risk by up to 81% in high-risk infants. Delaying allergens beyond 12 months is associated with increased allergy risk. Do not avoid allergenic foods without a diagnosed allergy.
For high-risk infants (severe eczema or existing egg allergy): discuss allergen introduction timing with your GP or an allergist before starting.
Continue breastfeeding or formula alongside solids through the first year. Solids complement milk — they do not replace it until after 12 months. Cow's milk as a main drink is not recommended until 12 months.
Safe sleep — SUDI & SIDS prevention
These rules are not negotiable — they exist because they save lives
- Always on their back — for every sleep, day and night, until 12 months.
- Firm, flat, clear surface — firm mattress meeting Australian standards; no pillows, doonas, bumpers, soft toys, nests, positioners, or wedges in the cot
- In your room — in their own cot or bassinet, same room as you for at least the first 6–12 months
- Smoke and vape free — before and after birth; even smoking outside significantly increases risk
- Avoid overheating — a wearable sleeping bag rated for the season is recommended
- Breastfeed if possible — independently protective against SUDI/SIDS
Since safe sleep campaigns began in Australia in 1991, SIDS/SUDI rates have fallen by approximately 85%. Red Nose Australia: 1300 998 698
Research shows many parents who intend not to co-sleep do so anyway — particularly during night feeds. Being informed about risk reduction is therefore important for all parents.
Highest-risk situations — never co-sleep if:
- Either parent has consumed alcohol, cannabis, or sedating medication
- Either parent smokes, even if not in the bedroom
- Baby is premature or low birth weight
- On a sofa, armchair, or water bed — significantly more dangerous than a bed
If bed-sharing occurs: place baby on their back on the maternal side of a firm mattress, not between two adults. Move adult bedding and pillows away. Never place baby face-down on an adult mattress.
Normal infant sleep
🌙 What normal sleep actually looks like — by age
Infant sleep is biologically different from adult sleep. Total sleep needs and patterns shift substantially across the first year.
Newborn sleep — no day/night distinction yet
- Total sleep: 14–18 hours per day, in 2–4 hour stretches
- No consolidated night sleep — normal and expected
- Frequent waking to feed is appropriate and necessary
- Newborns cannot be "spoiled" by responsive settling
Some patterns emerge, but still highly variable
- Total sleep: 13–16 hours; some infants begin slightly longer stretches at night
- Evening unsettledness peaks around 6 weeks — normal
- Responsive settling appropriate; sleep training not recommended before 6 months
The "4-month regression" — developmental shift, not a problem
- Around 3–4 months, sleep architecture permanently matures — more fragmented. This is normal neurodevelopment
- Total sleep: 12–15 hours; 3–4 daytime naps remain important
Sleep begins to consolidate
- Total sleep: 12–15 hours; most infants capable of a longer stretch at night, though many still wake
- Daytime naps consolidate to 3, then 2 per day
Longer nights, 2 naps, waking remains common
- Total sleep: 12–14 hours; approximately 25–30% of infants at 9 months still wake regularly
- Separation anxiety peaks around 8–9 months and often disrupts sleep
Behavioural sleep interventions have been studied in multiple randomised controlled trials. Consistent findings: when applied from 6 months, both graduated extinction and gentler approaches improve infant sleep without detectable harm to attachment at 12-month follow-up.
- Under 6 months: evidence base is very limited. Responsive settling remains the recommended approach
- From 6 months: multiple approaches have evidence support. None is obligatory — responsive settling and night feeding are also normal, evidence-consistent choices
Weight & growth
Weight loss in the first days reflects normal fluid shifts. Breastfed babies typically lose 6–8% by days 2–4. Formula-fed babies lose slightly less (~5%).
- Loss above 10% warrants clinical assessment
- Recovery: most infants regain birth weight by 10–14 days; breastfed infants occasionally to 3 weeks. Failure to regain by 3 weeks warrants review
- Caesarean-born babies may lose slightly more — maternal IV fluids can inflate birth weight
Expected weight gain once feeding is established:
- 0–3 months: approximately 150–200 g per week
- 3–6 months: approximately 100–150 g per week
- 6–12 months: approximately 70–90 g per week
Use WHO growth charts for breastfed infants — older charts were based on formula-fed populations. Trends across multiple measurements matter more than any single weight.
💧 Wet nappy guide — hydration at a glance
Wet nappies are the most reliable home indicator of adequate intake:
Urine should be pale yellow. Dark, orange-tinged, or absent urine warrants prompt assessment.
Physiological jaundice affects up to 60% of full-term newborns. Appears after 24 hours, peaks days 3–5, resolves by 2 weeks. Adequate feeding accelerates clearance.
Warning signs requiring prompt review:
- Jaundice within the first 24 hours — always pathological, always requires immediate assessment
- Jaundice progressing to the legs or soles of feet
- Baby difficult to rouse, arching, or high-pitched cry
- Persisting beyond 2 weeks (3 weeks in breastfed infants)
- Pale/white stools alongside jaundice — may indicate biliary atresia, urgent
Newborn & infant skin
The vast majority of skin changes in the first months are normal, self-resolving, and require no treatment.
Erythema toxicum neonatorum: blotchy red patches with tiny white/yellow pustules from day 2–3. Never on palms or soles. Self-resolving 1–2 weeks. Creams worsen it.
Milia: tiny pearly-white bumps on nose and cheeks. Resolve within weeks. Do not squeeze.
Neonatal acne: red bumps on face 2–4 weeks to 4–6 months. Maternal hormones. Self-resolving. Oils and creams worsen it.
Mottling: lacy reddish-blue patterning when cool. Normal. Disappears with warming.
Peeling skin: common in the first week. Normal.
Infantile eczema affects approximately 20–30% of children, typically in the first 6 months. Management: generous fragrance-free emollient 2–3 times daily; soap substitute; topical corticosteroids when prescribed are safe and effective.
Eczema and food allergy: moderate-to-severe eczema is a significant risk factor — early allergen introduction is recommended. See GP if widespread, infected, or not responding to moisturising.
Yellow, greasy, crusty scaling on the scalp. Not poor hygiene. Usually resolves by 6–12 months. Apply baby oil, leave 15–20 minutes, gently brush before washing. Do not pick.
Prevention: frequent changes, barrier cream. Simple rash resolves in 3–4 days with zinc oxide cream and nappy-free time.
Candida rash: bright red with satellite spots, raised border, or persistent beyond 3–4 days — needs antifungal cream, see GP.
- Spreading redness, warmth, or swelling anywhere
- Blisters, pus, or skin that is breaking down
- Non-blanching spots — press a glass, if it doesn't fade, call 000
- Any skin change combined with fever, lethargy, or poor feeding
Illness & infections
- Fever above 38°C in any infant under 3 months — always an emergency
- Non-blanching rash — call 000
- Bulging fontanelle combined with fever or extreme lethargy
- Floppy, unresponsive, or impossible to rouse
- Seizures
- Difficulty breathing, ribs visible, or blue lips
- Jelly-like bloody mucus with episodic screaming — possible intussusception
Age-based response:
- Under 3 months: any fever above 38°C → go to emergency, no exceptions
- 3–6 months: fever above 38.5°C → same-day medical review
- Over 6 months: fever above 39°C with illness → same-day GP review
Paracetamol: dose by weight — 15 mg/kg per dose, every 4–6 hours, max 4 doses per 24 hours. Ibuprofen not recommended under 3 months.
Teething does not cause fever above 38°C. Any significant fever must be investigated.
Infants typically experience 6–10 colds per year — normal immune development. Continue breastfeeding through illness.
- Nasal saline drops (0.9%) can help clear secretions in young infants
- Fast or laboured breathing, ribs visible, blue lips → emergency
- Fever above 38°C under 3 months → emergency
- Symptoms not improving after 7–10 days → see GP
Mucusy stools during a cold are from swallowed nasal secretions — expected and benign.
- Continue breastfeeding — do not stop
- ORS (Hydralyte/Gastrolyte) if dehydration is a concern
- 6+ wet nappies = hydrated · fewer than 4 = concerning · none = go to ED
- Dehydration signs: sunken fontanelle, no tears, dry mouth, dark urine, increased lethargy
See GP if: under 3 months · symptoms beyond 48–72 hours · dehydration signs · bloody diarrhoea with fever.
- Bulging fontanelle — feels tense when baby is calm and upright
- High-pitched, unusual cry
- Extreme lethargy — floppy, difficult to rouse
- Fever above 38°C under 3 months
- Non-blanching rash — call 000 immediately
- Seizures
Any combination of above in a young infant — go directly to emergency.
✓ Reassuring signs when baby is unwell
Alert and making eye contact · Smiling and responsive · Feeding normally · 6+ wet nappies · No fever above 38°C · Gradually improving — these together suggest self-limiting illness. Any single red flag overrides this.
Nappy reference guide
Breastfed infant stool is highly variable. Most of what alarms new parents is completely normal.
After around 6 weeks, breastfed infants can go from several dirty nappies per day to once every several days or even less — entirely normal. As long as baby is well and stools are soft, no intervention is needed.
Black / dark green
Meconium — normal in the first days. Transitions to yellow by days 4–5.
Mustard yellow, seedy
Classic breastfed stool — loose, grainy. Frequency from several per day to once every several days past 6 weeks — both normal.
Watery or explosive
Very common under 6–8 weeks. In the absence of blood, weight loss, or fever, normal.
Tan/yellow, pastier
Formula-fed stool is typically firmer and more predictable.
Green & frothy
Fast gut transit. Occasional episodes rarely need intervention.
Mucusy streaks
Common during colds. Persistent without illness — mention to GP.
Blood streaks
Always warrants same-day GP review. Take a nappy photo.
White or pale grey
Possible liver or biliary issue. Do not wait for a routine appointment.
Red jelly ("currant jelly")
With episodic screaming — classic intussusception. Go to ED immediately.
↩️ Reflux, posseting & GORD
Most infant spitting up is physiological and needs no treatment. A happy baby who spits up but gains weight normally does not need investigation.
When reflux becomes GORD: pain with feeds, poor weight gain, or respiratory symptoms. These warrant GP review. Cot elevation has no evidence of benefit.
Development by age
Developmental ranges are wide — the trajectory matters more than hitting exact ages.
Tummy time is supervised, awake time on the stomach — recommended from birth. Aim for 20–30 minutes total per day by 2 months, 40–60 minutes by 4 months.
Positional plagiocephaly: mild flattening is very common. Prevent by alternating head position at each sleep and maximising tummy time.
First teeth typically 4–12 months. Teething causes: drooling, gum discomfort, mild temperature up to 37.5°C.
Does NOT cause: fever above 38°C, significant diarrhoea, vomiting, or ear infections.
Safe relief: chilled teether, firm gum rub, paracetamol if distressed. No topical anaesthetic gels.
Oral care: start brushing with first tooth, twice daily, smear of low-fluoride toothpaste (500 ppm). First dental visit by 12 months.
Injury & safety
- Low fall, immediate crying, quickly returned to normal
- No loss of consciousness, no vomiting, no seizure
- Fall from change table or bed (50–100 cm)
- One vomit, otherwise settled
- Any fall in infant under 3 months
- Loss of consciousness, repeated vomiting, seizure
- Fall over 1 metre or onto hard surface
- Cool under running water for 20 minutes immediately
- Do not apply ice, butter, or any cream
- Then go to the nearest emergency department
- Never leave a baby unattended in the bath — even briefly
- Pool fencing must meet AS 1926 — 4-sided isolation fencing
- Supervision must be arm's reach at all water settings
- 5 back blows (face-down, head lower than chest)
- 5 chest thrusts (2 fingers, centre of chest)
- Alternate until expelled or baby loses consciousness
- If unconscious: call 000 and begin infant CPR
Complete a certified infant CPR course — Red Cross, St John Ambulance, or MCH services.
Immunisation — Australian NIP schedule
💉 Schedule at a glance — birth to 12 months
| Age | Vaccines |
|---|---|
| Birth | Hepatitis B |
| 2 months | DTaP-HBV-IPV-Hib · PCV13 · Rotavirus (oral) · MenB — give prophylactic paracetamol |
| 4 months | DTaP-HBV-IPV-Hib · PCV13 · Rotavirus · MenB — give prophylactic paracetamol |
| 6 months | DTaP-HBV-IPV-Hib · PCV13 |
| 12 months | MenACWY · PCV13 · MMR · Varicella |
Always verify at immunise.health.gov.au — this reflects the schedule from early 2026.
Common reactions: redness/swelling at site (may persist weeks — normal), low-grade fever, unsettledness.
MenB paracetamol: give 3 prophylactic doses — at time of vaccination, 6 hours later, and 6 hours after that — regardless of fever. Do not routinely pre-medicate before other vaccines.
Seek assessment if: fever above 38.5°C persisting beyond 48 hours, spreading redness, or very difficult to rouse.
The MMR-autism claim was retracted, its author lost his medical licence, and data were found to be falsified. Population studies of tens of millions of children have found no link between any vaccine and autism. The scientific consensus is unambiguous.
Your wellbeing matters too
Parental mental health directly affects infant outcomes. Taking care of yourself is not separate from caring for your baby — it is part of it. Struggling does not mean you are failing.
Affects approximately 1 in 7 mothers and 1 in 10 fathers in the first year. Both are common, treatable, and affect parenting if untreated.
Signs: persistent sadness beyond 2 weeks · excessive anxiety about baby · feeling disconnected · inability to sleep even when baby sleeps · intrusive thoughts.
Baby blues (first 1–2 weeks) are normal. If persisting beyond 2 weeks or severe, warrants assessment.
Paternal PND often presents as irritability, withdrawal, or overwork rather than sadness.
- Driving under 5 hours sleep = crash risk comparable to legal blood alcohol limits
- If you feel like you might lose control — put baby safely in the cot and step away for 5 minutes
- Asking for help is not weakness — it is protective for you and your baby
📞 Australian perinatal mental health contacts
Ask the guide
Ask anything about your baby's health, feeding, sleep, development, or what you're seeing. This assistant is grounded in the evidence throughout this guide.
Not a substitute for medical advice. For urgent concerns call 000 or go to ED.