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The 6-8 week check is important for looking after both you and your baby. However, as you know, COVID-19 has placed a huge challenge on the on the NHS and, if this screening opportunity has been missed due to current circumstance, here is some advice about what you should look out for.

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When should you worry?

Newborn

NEWBORN

Contact your health visitor or GP if your baby is newborn and they…

  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs 
    • Find it difficult to change their position on their own 
    • You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy, or have floppy arms or legs when awake
  • Move their arms and legs in repetitive jerky movements, or writhing movements
  • Don’t have a Grasp Reflex (doesn’t grab your finger or small object when you put it in their hand)
  • Are often startling and you cannot understand why
  • Move one side of their body more than the other, for example:
    • Rarely moves one of their arms compared to the other arm
    • Rarely moves one leg compared to the other leg
    • When your baby startles, one side moves or looks different from the other

6-8 weeks 

6-8 WEEKS

Contact your health visitor or GP if your baby is 6-8 weeks and they…

  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs 
    • Find it difficult to change their position on their own
    • You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy, or have floppy arms or legs when awake
  • Move their arms and legs in repetitive jerky movements, or writhing movements
  • Have not started to bring both their hands to their face, or do not move their arms much
  • Keep their hands fisted, and you find it difficult to open their hands
  • Can’t lift their head when lying on their tummy
  • Move one side of their body more than the other, for example:
    • Mostly moves one arm or mostly brings one hand to their face
    • Rarely kicks or moves one leg compared to the other leg

2-3 months

2-3 MONTHS

Contact your health visitor or GP if your baby is 2-3 months and they…

  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
    • Find it difficult to change their position on their own
    • You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy, or have floppy arms or legs when awake
  • Move their arms and legs in repetitive jerky movements, or writhing movements
  • Have not started to bring both their hands to their face, or do not move their arms much
  • Keep their hands fisted, and you find it difficult to open their hands
  • Can’t lift their head when lying on their tummy
  • Move one side of their body more than the other, for example:
    • Mostly moves one arm or mostly brings one hand to their face
    • Rarely kicks or moves one leg compared to the other leg

3-4 months

3-4 MONTHS

Contact your health visitor or GP if your baby is 3-4 months and they…

  • Have lost skills which they could do before
  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
    • Find it difficult to change their position on their own
    • You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy when awake
  • Prefer to keep their arms by their sides. For example, they do not reach for things, or do not bring their hands together over their face or tummy
  • Move their arms or legs in repetitive, jerky, or strange ways
  • Still need you to support their head, or can’t lift their head when lying on their tummy 
  • Have very tight fists and it’s hard to open their hand
  • Move one side of their body more than the other, for example:
    • Rarely use one of their arms to pick up toys 
    • Rarely kick one leg compared to the other

4-6 months

4-6 MONTHS

Contact your health visitor or GP if your baby is 4-6 months and they…

  • Have lost skills which they could do before
  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
    • Find it difficult to change their position on their own
    • You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy when they are awake
  • Move their arms or legs in repetitive, jerky, or strange ways
  • Move one side of their body more than the other, for example:
    • Rarely use one of their arms to pick up toys 
    • Rarely kick one leg compared to the other
  • Are unable to roll, or can roll in one direction but not the other
  • Find it difficult to reach their arms out. For example, they do not reach for toys
  • Still have their early reflexes, like the startle reflex and grasp reflex
  • Keep their legs flat when lying on their back. For example, they do not bring their feet to their chest
  • Still need you to support their head

6-9 months

6-9 MONTHS

Contact your health visitor or GP if your baby is 6-9 months and they…

  • Have lost skills which they could do before
  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
    • Find it difficult to change their position on their own
    • You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy when they are awake
  • Move their arms or legs in repetitive, jerky or strange ways
  • Move one side of their body more than the other, for example:
    • Rarely use one of their arms to pick up toys, or eat and drink
    • Rarely kick one leg compared to the other
  • Can’t sit without support. For example, they lean on their hand, or, when they sit, their back is very curved
  • Still have their early reflexes, like the startle reflex and grasp reflex
  • Keep their legs flat when lying on their back, for example, do not bring their feet to their chest
  • Still need you to support their head
  • Still need you to help turn their head when lying on their back
  • Can’t crawl, or find it hard, for example, drags one of their legs behind them
  • Find it difficult to stand, for example:
    • Can’t stand with support 
    • Doesn’t try to pull themselves up to stand
  • Can’t move a toy from one hand to the other
  • Doesn’t use both hands to hold larger things

9-12 months

9-12 MONTHS

Contact your health visitor or GP if your baby is 9-12 months and they…

  • Have lost skills which they could do before
  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
    • Find it difficult to change their position on their own 
    • You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy when they are awake
  • Move their arms and legs in repetitive, jerky, or strange ways
  • Use one side of their body more than the other, for example:
    • Lean to the side when they sit
    • Use one arm to pull to stand more than the other
    • Rarely use one of their arms to pick up toys, or eat and drink. 
    • Rarely kick one leg compared to the other 
  • Find it difficult to sit, for example:
    • Only sit with support
    • Lean on their hand when sitting
    • When they sit their back is very curved
  • Can’t move a toy from one hand to the other
  • Don’t use both hands to hold larger things
  • Don’t point to objects
  • Can’t crawl, or find it hard, for example, drags one leg behind them
  • Find it difficult to stand, for example:
    • Can’t pull themselves up to stand
    • Find it hard to pull themselves up. For example, they only use their arms and don’t push with their legs
    • Can’t stand with support

2 months

Your Baby By Two Months

Social/Emotional Milestones

  • Calms down when spoken to or picked up
  • Looks at your face
  • Seems happy to see you when you walk up to her
  • Smiles when you talk to or smile at her

Language/Communication Milestones

  • Makes sounds other than crying
  • Reacts to loud sounds

Cognitive Milestones (learning, thinking, problem-solving)

  • Watches you as you move
  • Looks at a toy for several seconds

Movement/Physical Development Milestones

  • Holds head up when on tummy
  • Moves both arms and both legs
  • Opens hands briefly

4 months

Your Baby By Four Months

Social/Emotional Milestones

  • Smiles on his own to get your attention
  • Chuckles (not yet a full laugh) when you try to make him laugh
  • Looks at you, moves, or makes sounds to get or keep your attention

Language/Communication Milestones

  • Makes sounds like “oooo”, “aahh” (cooing)
  • Makes sounds back when you talk to him
  • Turns head towards the sound of your voice

Cognitive Milestones (learning, thinking, problem-solving

  • If hungry, opens mouth when he sees breast or bottle
  • Looks at her hands with interest

Movement/Physical Development Milestones

  • Holds head steady without support when you are holding him
  • Holds a toy when you put it in his hand
  • Uses his arm to swing at toys
  • Brings hands to mouth
  • Pushes up onto elbows/forearms when on tummy

6 months

Your Baby By Six Months

Social/Emotional Milestones

  • Knows familiar people
  • Likes to look at self in a mirror
  • Laughs

Language/Communication Milestones

  • Takes turns making sounds with you
  • Blows “raspberries” (sticks tongue out and blows)
  • Makes squealing noises

Cognitive Milestones (learning, thinking, problem-solving)

  • Puts things in her mouth to explore them
  • Reaches to grab a toy she wants
  • Closes lips to show she doesn’t want more food

Movement/Physical Development Milestones

  • Rolls from tummy to back
  • Pushes up with straight arms when on tummy
  • Leans on hands to support herself when sitting

9 months

Your Baby By Nine Months

Social/Emotional Milestones

  • Is shy, clingy, or fearful around strangers
  • Shows several facial expressions, like happy, sad, angry, and surprised
  • Looks when you call her name
  • Reacts when you leave (looks, reaches for you, or cries)
  • Smiles or laughs when you play peek-a-boo

Language/Communication Milestones

  • Makes a lot of different sounds like “mamamama” and “bababababa”
  • Lifts arms up to be picked up

Cognitive Milestones (learning, thinking, problem-solving)

  • Looks for objects when dropped out of sight (like his spoon or toy)
  • Bangs two things together

Movement/Physical Development Milestones

  • Gets to a sitting position by herself
  • Moves things from one hand to her other hand
  • Uses fingers to “rake” food towards himself
  • Sits without support

1 year

Your Baby By One Year

Social/Emotional Milestones

  • Plays games with you, like pat-a-cake

Language/Communication Milestones

  • Waves “bye-bye”
  • Calls a parent “mama” or “dada” or another special name
  • Understands “no” (pauses briefly or stops when you say it)

Cognitive Milestones (learning, thinking, problem-solving)

  • Puts something in a container, like a block in a cup
  • Looks for things he sees you hide, like a toy under a blanket

Movement/Physical Development Milestones

  • Pulls up to stand
  • Walks, holding on to furniture
  • Drinks from a cup without a lid, as you hold it
  • Picks things up between thumb and pointer finger, like small bits of food
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Green
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Advice and Guidance

Your Baby

Your baby should have had a full physical examination soon after birth. This will have picked up many, but not all, of the problems which we look for during the 6-week postnatal check.

If your baby does not have a 6-8 week check, you should ask yourself the following questions. If the answer to any is “yes”, you should contact your health visitor or GP.

Eyes
  • Do you think your baby can’t ever fully open both eyes?
  • Do you think your baby doesn’t make good eye contact and hold his/her gaze at you?
  • Do you think that your baby doesn’t follow your face if you move your head from side to side when standing near him/her (less than 1 metre)?
  • Do you think that your baby’s eyes shake/flicker/ wobble?
  • Do you think there is something unusual about, or in, your baby’s eyes, for example, the dark central area (pupil) looks cloudy or the eyeball is an unusual shape or size?
  • If the whites of your baby’s eyes are yellow, contact your health visitor or GP.
Hips
  • When you change your baby’s nappy, do you find that one leg cannot be moved out sideways as far as the other?
  • Does one leg seem to be longer than the other?
  • Do you have any other concerns about your baby’s hips?
Heart

If the answer to either of these is 'yes' you should speak to someone the same day:

  • Does your baby seem breathless or sweaty, at any time, especially when feeding?
  • Does your baby have blue, pale, blotchy, or ashen (grey) skin at any time?

Remember: if the answer to any of these questions is 'yes', you should contact your health visitor or GP.

You

During the 6 week postnatal check:

  • You'll be asked how you're feeling as part of a general discussion about your mental health and wellbeing.
  • You'll be asked if you still have any vaginal discharge and whether you have had a period since the birth.
  • Your blood pressure will be checked if you had problems during pregnancy or immediately after the birth.
  • You may be offered an examination to see if your stitches have healed if you had an episiotomy or caesarean section.
  • If you were due for a cervical screening test while pregnant, this should be rescheduled for 12 weeks after the birth.
  • You'll be asked about contraception.
  • If you're overweight or obese, with a BMI of 30 or more, you may be weighed. Your doctor should give you weight loss advice and guidance on healthy eating and physical activity.

If this screening opportunity has been missed due to current circumstance, it’s really important to contact your health visitor or GP if:

  • you're feeling sad or anxious – looking after a baby can sometimes feel overwhelming. Do not feel you have to struggle alone or put on a brave face. It's not a sign that you're a bad mother. You need to get help, as you may have postnatal depression. Your doctor or health visitor can provide help and support.
  • you're having trouble holding in your pee or wind, or you're soiling yourself with poo
  • having sex is painful
  • you're not sure if you have had 2 doses of the MMR vaccination – if you have not had these, your practice nurse will offer them with a gap of at least 1 month between doses. You should avoid becoming pregnant for 1 month after having the MMR vaccination.

Further information regarding the 6-week postnatal review can be found on the NHS website.

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