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. This single change reduced SIDS rates by over 50% when introduced. Once baby rolls independently, repositioning is not necessary.
- Firm, flat, clear surface — firm mattress meeting Australian standards (AS/NZS 8811.1); 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 (Red Nose Australia recommendation)
- Smoke and vape free — before and after birth; even smoking outside significantly increases risk
- Avoid overheating — dress baby in one more layer than an adult would be comfortable in at that temperature; a firm flat surface is safer than soft blankets; 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, even those who plan to cot-sleep exclusively.
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 (lower, but not zero risk): place baby on their back on the maternal side of a firm mattress, not between two adults or between a parent and the wall. Move adult bedding and pillows away. Never place baby face-down on an adult mattress.
Room-sharing without bed-sharing is the evidence-based recommendation — it provides the benefits of proximity without the risks of surface sharing.
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. Expecting infant sleep to mirror adult sleep leads to unnecessary distress and harmful interventions.
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. The circadian system does not mature until around 3–4 months
- Frequent waking to feed is appropriate and necessary for adequate intake and supply establishment
- 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 gut and nervous system maturation, not a sleep problem
- Responsive settling appropriate; sleep training not recommended before 6 months
The "4-month regression" — developmental shift, not a problem
- Around 3–4 months, infant sleep architecture permanently matures toward adult sleep cycles (~45 min cycles, lighter and more fragmented)
- This often causes previously better-sleeping infants to begin waking more — this is normal neurodevelopment, not regression
- 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 (5–6+ hours) 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; many (not all) infants sleep 6–8 hour stretches at night
- Night waking remains common and normal — approximately 25–30% of infants at 9 months still wake regularly
- Separation anxiety peaks around 8–9 months and often disrupts previously improving sleep
- Two daytime naps; transition to one nap often happens closer to 12–18 months
Behavioural sleep interventions have been studied in multiple randomised controlled trials. Consistent findings: when applied from 6 months, both graduated extinction (controlled crying with increasing intervals) and gentler approaches (bedtime fading, parental presence methods) improve infant sleep and reduce parental stress without detectable harm to attachment or emotional development at 12-month follow-up.
- Under 6 months: the evidence base for sleep training is very limited and neurological development at this age does not support it. Responsive settling remains the recommended approach
- From 6 months: multiple approaches have evidence support. None is obligatory — responsive settling and night feeding beyond 6 months are also normal and evidence-consistent choices
- The research context (professional support, individually tailored plans) differs from self-guided approaches; outcomes may differ
- If an approach causes significant distress to you or baby, stop and seek support from your MCH nurse or GP
Weight & growth
Weight loss in the first days reflects normal fluid shifts as the newborn adapts to life outside the womb. Breastfed babies typically lose 6–8% of birth weight by days 2–4, with the nadir around day 3. Formula-fed babies lose slightly less (~5%).
- Normal loss: up to 7% in formula-fed; up to 7–10% in breastfed infants — monitor closely if approaching 10%
- Loss above 10% warrants clinical assessment for feeding adequacy, dehydration, and underlying causes
- Recovery: most infants regain birth weight by 10–14 days; breastfed infants occasionally take up to 3 weeks. Failure to regain by 3 weeks warrants review
- Caesarean-born babies may lose slightly more weight — maternal IV fluids during labour 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 — the older charts were based on formula-fed populations and may incorrectly flag normal breastfed growth as slow. Ask your MCH nurse which chart they are using.
Growth spurts are periods of increased feeding and fussiness associated with accelerated growth. Common around 2–3 weeks, 6 weeks, 3 months, and 6 months. Cluster feeding during spurts drives supply increases and is normal — it does not mean supply is inadequate.
Slow weight gain warrants review when gain is consistently below the lower end of expected range across multiple weigh-ins, or when weight crosses two percentile lines downward. A single weight is rarely meaningful — trends across multiple measurements matter more.
💧 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. Fewer than 6 wet nappies per day after the first week is a reason to call your midwife, MCH nurse, or GP.
Physiological jaundice affects up to 60% of full-term newborns and 80% of premature infants. It appears after 24 hours of life, peaks around days 3–5, and resolves by 2 weeks in most infants. Adequate feeding accelerates clearance — 8–12 feeds per day is the primary treatment.
Warning signs requiring prompt review:
- Jaundice appearing within the first 24 hours of life — always pathological, always requires immediate assessment
- Jaundice progressing to the legs or soles of feet
- Baby difficult to rouse, arching, or with a high-pitched cry
- Jaundice persisting beyond 2 weeks (3 weeks in breastfed infants)
- Pale/white stools alongside jaundice — may indicate biliary atresia, which requires urgent investigation
UTI is a recognised cause of prolonged or late-onset jaundice — should be considered if jaundice reappears after initially clearing.
Feeding and jaundice: inadequate breastfeeding is a common cause of prolonged or worsening jaundice. If jaundice is causing sleepiness that interferes with feeding, your MCH nurse or GP should assess urgently.
Newborn & infant skin
The vast majority of skin changes in the first months are normal, self-resolving, and require no treatment. What follows are the most common ones parents worry about.
Erythema toxicum neonatorum (ETN): affects 40–70% of term newborns. Blotchy red patches with tiny white or yellow central pustules, appearing from day 2–3. Common on face, trunk, and limbs but never on palms or soles. Not infectious. Resolves spontaneously within 1–2 weeks. No treatment needed; creams worsen it.
Milia: tiny pearly-white bumps, usually on the nose, cheeks, and forehead. Present at birth in up to 50% of newborns. Caused by retained keratin in blocked pores. Resolve spontaneously within weeks. Do not squeeze.
Neonatal acne: small red bumps on the face, beginning around 2–4 weeks, lasting until 4–6 months. Caused by residual maternal hormones. Self-resolving; no treatment needed. Oils and creams worsen it.
Mottling (cutis marmorata): lacy, reddish-blue patterning of the skin when baby is cool. Normal response to temperature change. Disappears with warming. Persistent mottling in a warm, unwell baby warrants review.
Peeling skin: common in the first week, especially in post-dates infants. Normal shedding of the vernix-covered outer layer. Mild baby-safe moisturiser if very dry; no treatment otherwise needed.
Infantile eczema (atopic dermatitis) affects approximately 20–30% of children and typically appears in the first 6 months. Presents as dry, itchy, red, or crusted patches — commonly on the cheeks in young infants, then spreading to elbow and knee creases.
Management: regular, generous moisturising (emollient) 2–3 times daily is the foundation. Use fragrance-free products designed for sensitive infant skin. Avoid soap — use a soap substitute. Topical corticosteroids (steroid creams), when prescribed by a GP, are safe and effective for flares — parental concern about steroid cream is common but largely unfounded at the prescribed strengths and frequencies.
Eczema and food allergy: moderate-to-severe eczema is a significant risk factor for food allergy. Early introduction of allergenic foods (particularly peanut and egg) is recommended — discuss timing with your GP if eczema is significant.
See your GP if: eczema is widespread, not responding to moisturising, infected (yellow crust, weeping, spreading redness), or causing significant distress.
Yellow, greasy, crusty scaling on the scalp — occasionally spreading to eyebrows, face, and behind the ears. Affects up to 70% of infants in the first months. Caused by overactive sebaceous glands, not poor hygiene. Usually resolves without treatment by 6–12 months.
Management if desired: apply a small amount of baby oil or coconut oil to the scalp, leave for 15–20 minutes, then gently brush out the loosened scales before washing. Do not pick or scratch. For persistent or widespread cases, your GP can recommend a mild medicated shampoo or topical treatment.
Caused by prolonged skin contact with urine and faeces, friction, and sometimes secondary candida (thrush) infection. Prevention: frequent nappy changes, thorough drying, and a zinc oxide-based barrier cream with each change.
Simple nappy rash: red, slightly raised rash in the nappy area. Treat with a barrier cream at each change and increase nappy-free time if practical. Usually resolves in 3–4 days.
Candida (thrush) nappy rash: suspect if rash is bright red, has satellite spots outside the main rash, has a raised border, or persists beyond 3–4 days of treatment. Requires antifungal cream — see your GP. Oral thrush (white patches in the mouth) often coexists and also needs treatment.
See GP promptly if: rash is blistering, bleeding, or associated with fever. Bacterial skin infections in this area can escalate quickly in young infants.
- Spreading redness, warmth, or swelling anywhere (including navel area in newborns)
- Blisters, pus, or skin that is breaking down
- Non-blanching spots or rash (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, regardless of how well baby appears
- Non-blanching rash — call 000
- Bulging fontanelle combined with fever or extreme lethargy
- Floppy, unresponsive, or impossible to rouse
- Seizures
- Difficulty breathing, ribs visible with each breath, or blue lips
- Jelly-like bloody mucus in stool with episodic screaming — possible intussusception
How to measure accurately: axillary (armpit) thermometers read 0.5–1°C lower than core temperature — appropriate for home use; be consistent. Tympanic (ear) thermometers are reliable from 6 months. Rectal is most accurate but rarely needed outside clinical settings.
Age-based response:
- Under 3 months: any fever above 38°C → go to emergency, no exceptions. Serious bacterial infection can progress rapidly and present without other obvious signs at this age
- 3–6 months: fever above 38.5°C → same-day medical review; after hours, go to ED rather than waiting until morning
- Over 6 months: fever above 39°C with illness → same-day GP review; a well-appearing, playful infant with a low-grade fever differs from a lethargic, pale one
Paracetamol for fever: dose by weight, not age — 15 mg/kg per dose, every 4–6 hours, maximum 4 doses per 24 hours. Ibuprofen is not recommended under 3 months, and is not suitable for dehydrated infants at any age. Do not routinely pre-medicate before vaccines (exception: see MenB guidance in Vaccinations tab).
Teething does not cause fever above 38°C. Multiple high-quality reviews confirm this. Any significant fever should be investigated regardless of teething status.
Infants typically experience 6–10 colds per year — this reflects normal immune development, not poor health. A breastfeeding mother fighting a virus produces secretory IgA antibodies targeted at that pathogen that pass directly into breastmilk. Continue breastfeeding through illness.
Symptoms to watch during a cold:
- Nasal saline drops (isotonic 0.9%) can help clear secretions in young infants who struggle to feed with blocked noses — safe and appropriate
- Feeding difficulties or refusing to feed → see GP
- Fast or laboured breathing, ribs visible with each breath, blue tinge to lips → emergency
- Fever above 38°C in infant under 3 months → emergency
- Symptoms not improving or worsening after 7–10 days
Mucusy stools during a cold: nasal mucus drips to the back of the throat and is swallowed continuously. It passes through the gut and can produce mucusy or loose stools. This is expected, not an additional illness.
Viral gastroenteritis in infants requires close hydration monitoring. The main risk is dehydration.
- Continue breastfeeding — do not stop. Breastmilk provides hydration, immune antibodies, and gut-healing properties
- Oral rehydration solution (ORS) is the clinical first-line treatment when dehydration is a concern — alongside continued breastfeeding. ORS is formulated to replace electrolytes (e.g. Hydralyte, Gastrolyte). Not interchangeable with breastmilk, water, or fruit juice alone
- 6+ wet nappies per day = adequately hydrated; fewer than 4 = concerning; none = go to ED
- Dehydration signs: sunken fontanelle, no tears when crying (after 4–6 weeks), dry mouth, dark or absent urine, increased lethargy
- Bloody diarrhoea with high fever → same-day medical assessment
See GP if symptoms persist beyond 48–72 hours, dehydration signs appear, or infant is under 3 months.
Bacterial meningitis is rare but life-threatening. In young infants, neck stiffness is often absent — a high index of suspicion is required for any unwell-looking febrile infant.
Warning signs:
- Bulging fontanelle — feels tense when baby is calm and upright (crying normally causes transient bulging)
- High-pitched, unusual cry — distinct from normal crying
- Extreme lethargy — floppy, difficult to rouse
- Fever above 38°C in an infant under 3 months
- Non-blanching rash — red or purple spots that don't fade when pressed — call 000 immediately
- Seizures
For any combination of the above in a young infant — go directly to emergency. Do not wait for a GP appointment.
UTIs are among the most common serious bacterial infections in infants under 12 months and often present with no obvious urinary signs. Risk is highest in uncircumcised males under 3 months, premature infants, and those with urinary tract abnormalities. UTI is also a recognised cause of prolonged jaundice.
Presentations suggesting UTI: fever without obvious source, poor feeding, irritability, vomiting, foul-smelling urine. Systemic inflammation from UTI causes gut symptoms — baby may appear to have a gut illness when the source is urinary.
Diagnosis requires a urine sample. Bag specimens are unreliable due to contamination — clean-catch or catheter collection is needed. Do not delay assessment in any febrile infant under 3 months.
✓ Reassuring signs when baby is unwell
Alert and making eye contact · Smiling and responsive · Feeding normally · 6+ wet nappies per day · No fever above 38°C · Gradually improving over days — these together suggest self-limiting illness. Any single red flag overrides this reassurance.
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 — this is entirely normal and not constipation. As long as baby is well and stools are soft when they come, no intervention is needed. Formula-fed infants tend to have more regular, firmer stools.
Black / dark green
Meconium — normal in the first days. Transitions to yellow by days 4–5. Failure to pass meconium within 24–48 hours warrants review.
Mustard yellow, seedy
Classic breastfed stool — loose, grainy, mild smell. Frequency ranges from several per day to once every several days in exclusively breastfed infants past the newborn period — both normal.
Watery or explosive
Very common under 6–8 weeks — often alarmingly runny or forceful. In the absence of blood, weight loss, or fever, this is normal and settles as the gut matures.
Tan/yellow, pastier
Formula-fed stool is typically firmer, darker, and more predictably once or twice daily. Occasional variation is normal.
Green & frothy
Reflects fast gut transit. Occasional episodes without other symptoms rarely need intervention. Persistent frothy green stools with poor weight gain — see GP.
Mucusy streaks
Common during respiratory illness (swallowed nasal secretions). Also seen with mild gut irritation. Persistent mucus without illness — mention to GP.
Blood streaks
Most commonly CMPI, anal fissure, or swallowed maternal blood (from cracked nipples). With an otherwise well infant it's rarely an emergency — but always warrants same-day GP review. Take a nappy photo.
White or pale grey
Absence of bile pigment — can indicate a liver or biliary issue (e.g. biliary atresia). Uncommon but do not wait for a routine appointment.
Red jelly ("currant jelly")
Blood and mucus resembling red jelly combined with episodic screaming — baby cries intensely then suddenly goes quiet and pale, repeating in waves — classic intussusception. Go to ED immediately.
↩️ Reflux, posseting & GORD — what's what
Most infant spitting up is physiological and needs no treatment. It peaks around 4 months and resolves in most infants by 12 months. A happy baby who spits up but gains weight normally does not need investigation or treatment — this is often called the "happy spitter."
When reflux becomes GORD (a medical problem): pain with feeds (arching, crying, feeding refusal), poor weight gain, or respiratory symptoms (chronic cough, recurrent wheeze) alongside spitting up. These warrant GP review. Cot elevation has no evidence of benefit and is not recommended. Most infants improve with positioning (upright during and after feeds) and time.
"Silent reflux" — reflux without visible vomiting — is frequently over-diagnosed. In the absence of the symptoms above, a generally unsettled infant or feeding refusal alone is not sufficient for a GORD diagnosis.
🔎 Foremilk & hindmilk — a common misconception
Fat content in breastmilk rises progressively as a feed continues — there are not two distinct "types" stored separately. Occasional green stools alone do not indicate a feeding imbalance requiring intervention.
Development by age
Developmental ranges are wide — the trajectory matters more than hitting exact ages. Use the age slider to navigate.
Tummy time is supervised, awake time spent on the stomach. It is recommended from birth and is critical for building the neck, shoulder, and core strength that underpins all motor milestones.
Why it matters: the back-to-sleep campaign correctly reduced SIDS dramatically, but the trade-off was less time on the stomach. Regular awake tummy time counteracts this and prevents positional plagiocephaly (flat head).
- Newborns: start with short sessions — even 2–3 minutes, several times per day. Chest-to-chest on a parent counts
- By 2 months: aim for at least 20–30 minutes total per day, broken into sessions
- By 4 months: aim for 40–60 minutes total per day if tolerated
- Baby should never be left on their stomach unsupervised and should not sleep on their stomach
- Use a rolled towel under the chest to help if baby strongly resists
Positional plagiocephaly (flat head): mild flattening is very common from back-sleeping and does not cause brain problems. Prevent by alternating the head position at each sleep, maximising tummy time, and carrying baby. If significant or persistent, discuss with your MCH nurse — referral for helmet therapy or physiotherapy is occasionally warranted but is usually not needed if repositioning starts early.
First teeth typically appear between 4 and 12 months, though significant variation is normal. Lower front teeth usually first, followed by upper front teeth. Some infants are barely bothered; others show significant discomfort for several days per tooth.
What teething does cause: drooling (often starts 2–3 months before any teeth), gum discomfort and biting, mild temperature elevation (up to 37.5°C), slightly increased drool-related stools, and irritability for a few days around each tooth.
What teething does NOT cause: fever above 38°C, significant diarrhoea, vomiting, ear infections, or respiratory illness. Multiple studies confirm this. Any significant fever must be investigated regardless of teething.
Safe relief: chilled (not frozen) teething ring, clean finger rubbing the gum firmly, age-appropriate paracetamol if genuinely distressed. Topical anaesthetic gels (containing benzocaine or lidocaine) are not recommended for infants due to the risk of methemoglobinaemia.
Oral care: start brushing as soon as the first tooth appears, twice daily, with a soft infant toothbrush and a smear of low-fluoride toothpaste (500 ppm — sold as "children's" or "infant" toothpaste in Australia). First dental visit by 12 months or within 6 months of first tooth.
Screen time: Australian guidelines (ACECQA, WHO) recommend no screen time for infants under 18–24 months, with the exception of video calling with family. This is not about moral failure — screens displace the face-to-face interaction that drives language and social development. The first two years are a critical period for brain development.
What babies need instead: face-to-face interaction, talking, singing, reading aloud, and floor play. Research consistently shows that "serve and return" interactions — where parent responds to baby's vocalisations and gestures — are the strongest predictors of language and cognitive development.
Sensory play: simple activities — water play, textured objects, rattles, mirrors — provide the sensory input that drives neural connections. Expensive toys are not required; interaction with a responsive caregiver is the most powerful developmental tool available.
Injury & safety
Head bumps are the most common infant injury. The large majority are minor. Key assessment: surface fallen from, what they landed on, and behaviour immediately after and in the following hours.
- Low fall (under 50 cm) onto carpet or soft surface
- Immediate crying — paradoxically reassuring (indicates consciousness)
- Quickly returned to normal behaviour and feeding
- No loss of consciousness, no vomiting, no seizure
- A "goose egg" scalp swelling is alarming but not dangerous in itself
- Fall from change table, bed, or sofa (50–100 cm)
- One episode of vomiting, otherwise settled
- Unusual sleepiness but can be roused normally
- Any fall in an infant under 3 months
- Loss of consciousness — even briefly
- Repeated vomiting (more than once)
- Seizure
- Cannot be roused or unusually difficult to wake
- Fall from over 1 metre or onto hard surface
- Sunken or depressed area on skull after impact (different from a goose egg)
All burns in infants under 12 months require emergency assessment after first aid.
- First: cool under running cool (not cold) water for 20 minutes — start immediately
- Remove clothing near the burn if safe; do not pull off stuck clothing
- Do not apply ice, butter, toothpaste, or any cream
- Cover loosely with cling wrap or a clean non-fluffy cloth after cooling
- Then: go to the nearest emergency department
Drowning is a leading cause of death in children under 5 in Australia. Infants can drown in small volumes of water — including buckets, nappy bins, and bathtubs. Infant drowning is typically silent and fast.
- Never leave a baby unattended in the bath — even briefly. Take the baby with you if you need to leave the room
- Empty all containers of water after use
- Pool fencing must meet Australian standards (AS 1926 — 4-sided isolation fencing with self-closing, self-latching gate)
- Supervision at all water settings must be arm's reach — looking at a device or talking to another adult is not adequate supervision
Australian law (Road Rules 2014) requires infants to be restrained in an approved rear-facing car seat from birth until they exceed the seat's weight or height limit (typically reached between 6–24 months). Rear-facing distributes crash forces across the whole body — significantly safer than forward-facing at this age.
- Harness straps should be snug — you should not be able to pinch more than a small amount of slack at the shoulder
- Chest clip (if present) at armpit level
- Keep rear-facing as long as the seat allows — do not rush to forward-face
- Bulky coats impair harness effectiveness — remove thick layers before buckling
- Have the seat professionally installed and checked — many local councils, police stations, and NRMA offices offer this service
For a choking infant (Australian Resuscitation Council guidelines):
- Hold baby face-down along your forearm, supporting the head — head lower than chest
- Give 5 firm back blows between shoulder blades with the heel of your hand
- Turn baby face-up on your forearm, give 5 chest thrusts (2 fingers, centre of chest, lower half)
- Alternate 5 back blows and 5 chest thrusts until object is expelled or baby loses consciousness
- If unconscious: call 000 and begin infant CPR
These steps are a summary only. Completing a certified infant CPR course is strongly recommended for all carers — available through Red Cross Australia, St John Ambulance, and many MCH services.
Bruising in infants who are not yet rolling or crawling is not a normal finding. Mobile infants bruise commonly from bumps and falls; pre-mobile infants rarely do from normal handling.
- Seek same-day medical assessment
- The doctor will assess and may organise blood tests to rule out bleeding disorders
- This is routine infant health safeguarding — not an accusation
Immunisation — Australian NIP schedule
All vaccines on the National Immunisation Program (NIP) are free for eligible children. Vaccines are the most rigorously tested health intervention available — safety monitoring does not stop after registration.
💉 Schedule at a glance — birth to 12 months
| Age | Vaccines |
|---|---|
| Birth | Hepatitis B |
| 2 months | Diphtheria, tetanus, pertussis, hepatitis B, polio, Hib · Pneumococcal (13vPCV) · Rotavirus (oral) · Meningococcal B (Bexsero) — requires prophylactic paracetamol |
| 4 months | Diphtheria, tetanus, pertussis, hepatitis B, polio, Hib · Pneumococcal (13vPCV) · Rotavirus (oral, 2nd dose) · Meningococcal B — requires prophylactic paracetamol |
| 6 months | Diphtheria, tetanus, pertussis, hepatitis B, polio, Hib · Pneumococcal (13vPCV) |
| 12 months | Meningococcal ACWY · Pneumococcal (4th dose) · MMR (measles, mumps, rubella) · Chickenpox (varicella) |
Always verify the current NIP schedule at immunise.health.gov.au — this reflects the schedule from early 2026.
Common reactions (1–2 days after vaccination) — expected and not concerning:
- Redness, swelling, or a firm lump at the injection site (may persist for weeks — this is normal)
- Low-grade fever, unsettledness, and increased sleepiness
- Decreased appetite temporarily
Paracetamol: routine use is not recommended for all vaccines. Give paracetamol if baby has a fever above 38.5°C or is clearly uncomfortable. Exception — MenB (Bexsero): give 3 doses prophylactically: Dose 1 at time of vaccination (or immediately after); Dose 2 six hours later; Dose 3 six hours after that — regardless of whether baby has a fever. Do not pre-medicate before other vaccines routinely.
Seek assessment if: fever above 38.5°C persisting beyond 48 hours, redness at injection site is spreading significantly, baby is very difficult to rouse, or you are worried about any reaction.
Anaphylaxis is an extremely rare vaccine reaction — this is why you wait 15 minutes at the clinic after vaccination. It can be quickly treated if it occurs.
Vaccines are the most extensively safety-monitored medical intervention in existence. Monitoring continues after registration through SAEFVIC (Surveillance of Adverse Events Following Vaccination in the Community) and the TGA's database.
The MMR-autism claim: the 1998 paper suggesting a link between MMR and autism was retracted in full, its lead author lost his medical licence for ethical violations, and its data were found to be falsified. Since then, population studies involving tens of millions of children have found no link between any vaccine and autism. The scientific and regulatory consensus is unambiguous.
What vaccines prevent: measles, whooping cough, and meningococcal B carry significant rates of hospitalisation and death in young infants. The risks of these diseases are substantially higher than the risks of the vaccines. Herd immunity from vaccination also protects infants too young to be fully vaccinated.
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. The first year is genuinely hard. Struggling does not mean you are failing.
Postnatal depression and anxiety affect approximately 1 in 7 mothers and 1 in 10 fathers or non-birthing partners in the first year. Anxiety is at least as common as depression — often more so. Both are common, both are treatable, and both affect parenting and child development if untreated.
Common signs: persistent sadness or flatness lasting more than 2 weeks · frequent or excessive anxiety about the baby's health · feeling disconnected from or unable to bond with the baby · not feeling like yourself · inability to sleep even when the baby sleeps · intrusive or frightening thoughts.
The baby blues — tearfulness, mood swings, and emotional sensitivity in the first 1–2 weeks after birth — are normal hormonal responses affecting up to 80% of new mothers. Baby blues persisting beyond 2 weeks, or that are severe, warrant assessment.
For fathers and partners: paternal postnatal depression is underdiagnosed because it often presents differently — irritability, withdrawal, increased risk-taking, or overwork rather than classic sadness. A partner's mental illness is a significant risk factor for paternal depression. It is appropriate and important to seek support.
The Edinburgh Postnatal Depression Scale (EPDS) is a validated 10-question screening tool used by maternal child health nurses and GPs. It covers mood, anxiety, and coping — not just depression. It has been validated for use with fathers and non-birthing partners.
Scoring above the threshold does not mean you have a diagnosis — it means further assessment is warranted. A positive screen opens a conversation and a pathway to support, not a judgment.
You do not need to wait to be screened. If you are concerned about your mental health between MCH visits, contact PANDA on 1300 726 306, or speak with your GP who can perform a formal assessment and discuss treatment options.
Parental sleep deprivation in the first year is documented to impair cognitive function, emotional regulation, and decision-making at levels equivalent to mild intoxication. It contributes significantly to postnatal depression and anxiety, and to relationship stress.
- Driving on less than 5 hours of sleep carries a crash risk comparable to legal blood alcohol limits — take this seriously
- If you are at the point of feeling like you might lose control, put baby safely in the cot and step away for 5 minutes
- Asking for and accepting help is not weakness — it is protective for both you and your baby
- Sleep deprivation that is significantly affecting your functioning or safety is worth raising with your GP
📞 Australian perinatal mental health contacts