first postnatal visit

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Your postpartum checkup

Your six-week postpartum checkup is a comprehensive visit with your OB or midwife to check on your recovery after childbirth. You'll have a complete examination, including a mental health screening and any tests or immunizations you need. If all is well, you'll get the okay to start exercising and having sex again. This postpartum checkup is a good time to ask for referrals and nail down your plan for birth control. Don't hesitate to call your healthcare provider, though, if you have any concerns or signs of complications before your scheduled visit.

What is the six-week postpartum checkup?

Why is a postpartum checkup so important, what happens at the six-week postpartum checkup, questions to ask your healthcare provider at your six-week postpartum checkup, can i bring my baby with me to my postpartum checkup, concerns that shouldn't wait for the six-week postpartum checkup.

The six-week postpartum checkup is a comprehensive visit with your OB or midwife. The purpose of this appointment is to check on your physical recovery from pregnancy and delivery, see how you're doing emotionally, and address your needs going forward. Many women think of it as the "go-ahead" visit, meaning your practitioner can verify that you're ready for more intense postpartum exercise and having sex again.

This shouldn't be your first postpartum checkup with your provider, though: The American College of Obstetricians and Gynecologists recommends that all women talk to their provider within three weeks after delivery and continue to receive follow-up care as needed, including a comprehensive checkup by 12 weeks postpartum. In many cases, that comprehensive visit happens at six weeks. (Your first contact is generally less comprehensive and may simply be a phone call or a virtual visit.)

Don't feel constrained by appointment dates, though. Sometimes physical or emotional issues come up that need immediate attention, like excessive bleeding , a potential postpartum infection , and any feelings that may lead you to think you might have postpartum depression or another postpartum mood disorder. Never hesitate to call your provider if you have concerns.

When you're busy caring for a newborn – and especially if you're feeling fine – it's easy to think about skipping your postpartum checkup. But this is an important visit. It's an opportunity for your provider to check on you, physically and emotionally. There are potential problems, such as infections and mental health issues, that could be missed without a visit and lead to more serious complications.

Your postpartum checkup is also an opportunity for you to ask questions about your birth experience and recovery, especially if you're recovering from a difficult birth experience . Are you wondering why something went the way it did during labor (why your contractions stopped for a bit or why your doctor used forceps , for example)? Worried about the chances of a repeat ( preterm delivery or cesarean , for example) next time?

You may still be dealing with some pregnancy- or childbirth-related aches and pains, too, and you may have some questions about how your body has changed. You may also have questions about postpartum issues like breastfeeding , birth control, exercise, sex, and going back to work . It helps to jot down the questions you want to ask and any other issues you'd like to discuss ahead of time.

If you've had a miscarriage , stillbirth , or neonatal death (when a baby dies in the first 28 days of life), it's important to see your provider to learn more about why it happened and to determine if you're at risk for it happening again in the future.

Here's what will typically happen at your postpartum checkup:

You'll undergo a physical exam.

During your physical exam, your healthcare provider will:

• Check your weight and blood pressure. They may also take your pulse and listen to your chest.
• Check your abdomen. They'll feel your belly to be sure that there's no tenderness and check your incision if you had a c-section . (Your provider would also have checked your incision a week or two after delivery to make sure it was healing properly.)
• Examine your breasts. They'll be on the lookout for lumps, tenderness, redness, and cracked nipples or abnormal discharge.
• Inspect your external genitalia, including your perineum. If you had an episiotomy , they'll check to see that it's healed.
• Do a speculum exam to look at your vagina and cervix. They'll be checking to see that any bruises, scratches, or tears have healed. And, if you're due for a Pap smear, they'll do that during the speculum exam.
• Do an internal pelvic exam to feel your uterus and check that it has shrunk appropriately, feel your cervix and ovaries to identify any problems, and check your vaginal muscle tone. They may also do a rectal exam.
• Manually check your thyroid (a gland in your neck responsible for hormone production) to make sure it's a normal size.

Your provider will also ask what physical symptoms you're having, such as whether you're still  bleeding  on occasion, having any abdominal discomfort, vaginal or  perineal pain ,  urinary incontinence  or  anal incontinence , or breast pain. If you have a bothersome symptom that your healthcare provider didn't cover, don't be afraid to speak up. They'll also ask if you're breastfeeding and how it's going. If you're having any trouble, they can refer you to a lactation consultant .

Your provider will check on your mental health.

How you're doing emotionally is an important element of your follow-up care. Your provider will want to know how you're adjusting to the demands of motherhood and about any emotional problems you may be having. They'll ask you questions – or have you fill out a questionnaire – to screen for postpartum depression .

Don't be shy. Talk about the baby blues , if you felt them. Especially talk about any lingering sadness or depression you're still feeling. It's important to let your provider know if you're feeling overwhelmed, anxious, or depressed. They can provide medication that's safe to take now, even if you're breastfeeding. They can also refer you to a mental health specialist for ongoing care.

Your provider will order any tests or immunizations you need.

You may need lab tests if your provider is concerned about any conditions you had during pregnancy or delivery that might continue to affect you. If you had  gestational diabetes , you'll need a  glucose tolerance  test. Your OB or midwife will provide you with any necessary follow-up care you need for special health conditions.

They'll also offer any  immunizations  you may need, such as a tetanus, diphtheria, and pertussis booster shot, a flu shot, a COVID-19 shot or booster (the COVID vaccine is safe for pregnant or breastfeeding women), or a  rubella  or  chicken pox vaccine . (If you were not immune to rubella or chicken pox before your pregnancy, you should have been vaccinated before you left the hospital after delivery. If that didn't happen, it's highly recommended that you get vaccinated now.) The chicken pox vaccine requires two doses, so if you got your first dose immediately postpartum, you'll get the second dose now.

Getting vaccinated can help prevent you from getting sick and passing the illness to your baby. In some cases, it can also help you provide your baby with some immunity if you're breastfeeding.

You'll discuss birth control and family planning.

Talk with your provider about if and when you'd like to have more children. Because it's possible to become pregnant at any time postpartum (even if you haven't gotten your first postpartum period yet or you're breastfeeding ), it's important to talk about birth control.

You may need to make changes. For example, if you took the pill before pregnancy and are breastfeeding now, your practitioner will change your prescription to the "minipill" (progesterone only). Or you may decide it's time to try a different method. Talk with your provider about the pros and cons of each method you're considering. If you are planning on getting an IUD or an implant (like Nexplanon), let your OB provider know and they can insert it during this visit.

You'll get the okay to start exercising and having sex. 

If all is well, you'll get the go-ahead for exercise, weightlifting, and sex. Ask your provider if there are any restrictions, because of complications you may have had or chronic conditions you have, for example. If you were active throughout pregnancy and had a vaginal delivery without complications, you've probably been able to do light exercise within days of having your baby, if you felt up to it. But if you had a c-section or weren't exercising all along, then your provider may want you to wait until your six-week postpartum checkup to begin exercising.

Don't worry if you don’t feel up to having sex yet, despite your clearance. Many women have little to no interest in sex for several months after giving birth. Wait until you feel ready.

Finishing up

Your provider will let you know when you should return for routine gynecological care (including any follow-up for your chosen contraceptive method) and give you any necessary referrals. Many women may benefit from physical therapy, such as pelvic floor physical therapy , especially if you had (or have) significant perineal tearing, a forceps delivery, diastasis recti , or urinary incontinence, for example. Talk to your provider to see if you need a referral.

They'll take care of necessary paperwork: If you're on maternity leave , for example, you may have forms for your healthcare provider to fill out, stating that you gave birth. The office team at your provider's office will know what to do to get this taken care of.

If you need a prescription refilled, make sure it's taken care of before you leave. And before you go, look at your notes and make sure that your provider has addressed all of your concerns.

Again, your postpartum visit is a great opportunity to ask your provider about your labor and delivery and your health. Come prepared with a list of questions that have come up in the past six weeks. Jot them down or note them on your smartphone.

Here are some examples:

• Can you check me for diastasis recti?
• Can you provide a referral to a lactation consultant?
• Can you provide a referral for pelvic floor therapy?
• Why were forceps (or a vacuum, or any other procedure) used to delivery my baby? It may have been explained to you at the time, but it's understandable if you don't remember! (Now's the time to get any lingering questions about your labor and delivery answered.)
• Will the fact that I had a preterm birth (or emergency c-section, or any other complication) mean that my next birth will be the same?
• How might the condition I had during pregnancy (gestational diabetes or preeclampsia , for example) affect my health now and in the future?
• What do you suggest for constipation ? (Or headaches, or any other discomfort you're having.)
• What supplements should I be taking now?

Most practitioners will be fine with bringing your infant to your follow-up appointment, but ask ahead of time to make sure.

If possible, consider asking someone to take care of your baby during your visit so you can be totally focused on yourself during your time with your provider. If you want to bring your baby along, have someone come with you to hold your baby and comfort them, if needed, during the visit. But don't neglect this follow up. Taking care of yourself now is just as important as taking care of your newborn.

Some postpartum complications are dangerous and warrant immediate action. Don't wait for your six-week postpartum checkup if you have any concerns about something not being quite right. Call your provider and ask. Also get in touch with your provider right away if you have any of these postpartum warning signs or symptoms:

• Excessive bleeding (blood flow that isn't slowing or that increases after three days, passing large clots, passing bright red blood after three days, or soaking more than one sanitary pad in an hour)
• Abdominal pain or tenderness
• Foul-smelling discharge
• A painful, hard, warm, red area or red streaks on your breast, which are signs of mastitis
• Painful urination or difficulty urinating or feeling of having to urinate often
• Swelling or tenderness in your legs and feet
• Pain, red streaks, or discharge from a tear or incision
• Severe, persistent headaches
• Changes in vision
• Pain in the upper right abdomen or shoulder
• Shortness of breath
• Nausea and vomiting
• Signs of postpartum depression, such as extreme sadness or despair, frequent crying, or extreme anxiety or panic

Call for emergency help if you have excessive bleeding and signs of shock (dizziness, chills , heart palpitations, blurry vision, pale or clammy skin, confusion), or if you ever have thoughts of harming yourself or your baby.

How long does postpartum recovery last?

Diet for healthy post-baby weight loss

How to use a sitz bath for postpartum relief

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BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

ACOG. 2021. Optimizing Postpartum care. ACOG committee opinion. The American College of Obstetricians and Gynecologists. Number 736. https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care Opens a new window [Accessed March 2022]

CDC. 2022. Adult immunization schedule. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html Opens a new window [Accessed March 2022]

March of Dimes. 2018. Your postpartum checkups. https://www.marchofdimes.org/pregnancy/your-postpartum-checkups.aspx Opens a new window [Accessed March 2022]

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Your Postpartum Doctor Appointment

Should You Wait Six Weeks? When to See the Doctor and Why

Verywell / Bailey Mariner

The Postpartum Period

When to see the doctor, why you need to go, what to expect.

• Bring Your Questions

Symptoms to Bring Up

When to call the doctor.

• Skipping It

Your body goes through many changes during pregnancy and childbirth . So, after your baby is born, your body needs time to heal. As you recover, it’s important to make an appointment to see your OB-GYN for postpartum care. Here’s what you need to know about the postpartum visit, including when to see your doctor and what you can expect. 

The time of your life after you have a baby is called the postpartum or postnatal period . It is broken down into three phases.   

• Phase one is the initial recovery during the first six to twelve hours after giving birth.
• The second stage lasts two to six weeks while your body is physically healing, and you are adjusting to life with your newborn.
• The third part is the gradual return of your body to the way it was before your pregnancy. Of course, some things may not entirely go back to the way they were. This time of healing can take up to six months.

Watch Now: The Three Stages of Postpartum Depression

In the past, a postpartum check-up was a one-time visit scheduled between four and six weeks after delivery. However, thoughts on postnatal care have changed in recent years. Health experts now consider postpartum care an ongoing process based on each individual’s needs.

The World Health Organization (WHO) guidelines published in 2013 recommend at least four postnatal interactions after delivery: in the first 24 hours, on the third day, between 7-14 days, and at six weeks.  

In 2018, the American College of Obstetricians and Gynecologists (ACOG) updated its guidelines to reflect an ongoing process.  

After the initial care at birth, the first postpartum contact or visit should be within three weeks. You should stay in contact with your healthcare provider during the first three months, and a complete and thorough postpartum exam should occur no later than twelve weeks.  

After you have a baby, you experience physical and emotional changes .   A visit with your doctor during this time can help prevent complications. If something isn't right, the doctor can catch it and treat it early before it becomes a problem.

This appointment is also time set aside to talk to your doctor about sensitive issues and get answers to questions you may have about bleeding, your sex drive, birth control , the baby blues, postpartum depression , and more.

All pregnant women should receive postpartum care even if the pregnancy ends with a devastating loss . Physical and emotional care and support are even more critical during a very difficult time.

You should see your doctor or talk to your doctor on the phone within three weeks of giving birth. If you have a c-section , complications, or other health issues such as gestational diabetes or high blood pressure , you may see your doctor sooner and keep in touch with the doctor more often as you heal.

At your first contact, you will spend some time talking to your doctor. The doctor may also check your blood pressure or follow up with any other concerns. As your care continues, the health care team can keep in touch with you in a variety of ways. You may go to the office, see a health care provider at home, or talk to the doctor on the phone or by text message.

As postpartum care nears its end, you should have a thorough health and wellness examination before you transition to well-care. Your comprehensive exam can take place as early as four weeks after birth, but no later than 12 weeks, depending on your situation. This visit is a complete check-up of your physical, social, and psychological health.

During this appointment, you will have a full physical exam. The doctor may:

• Check your weight
• Take your blood pressure
• Check your perineum to see how you’re healing
• Check an episiotomy , tear, or c-section wound if you have one
• Check to see if your uterus is shrinking as expected
• Check your breasts and talk about breastfeeding
• Discuss any health issues you have
• Talk to you about the postpartum blues and depression
• Answer questions about your labor and delivery if you have them

You may also have your general gynecological screening if you are due for it. It may include a Pap smear, bloodwork to check for anemia or high blood sugar, and a urine test if you have urinary problems or symptoms of a urinary tract infection.

The doctor will also talk to you about:

• How your body is recovering from childbirth 
• Your emotions and how you feel about motherhood
• Any anxiety or depression that you may be feeling
• Your social support system
• How you are sleeping
• Nutrition and your eating habits 
• How caring for your baby is going
• How bottle-feeding or breastfeeding is going
• If you are considering having more children
• Any concerns about sex
• Birth control
• Managing any health concerns such as high blood pressure, diabetes, or other conditions
• Following up with other health practitioners for any issues you may have
• Continuing to tend to your health through routine care

Bring Your Questions 

You are bound to have questions, especially if you just had your first baby. But, since pregnancy and birth can be very different with each child, experienced moms can have questions, too.

As questions come up, write them down so you can bring them to your appointment. If you don't write them down, you may not remember everything you want to ask once you're sitting in the office. And remember, there are no silly questions. You shouldn't feel uncomfortable or embarrassed about asking your doctor anything. That's one of the reasons they're there, and they want to help. Some of the things you may want to ask about are:

• Your delivery
• The healing process
• Preventing problems now and in the future
• Breast issues such as pain or lumps
• Caring for your newborn
• Returning to work

Those pesky pregnancy symptoms may finally be gone, but the postpartum period has its own set of discomforts. Most of the time, postpartum symptoms are common and expected. However, sometimes they can be a sign of a complication. So, you should discuss all your symptoms with your doctor. The doctor can reassure you of what's normal and help you find relief, but also look into any concerning symptoms. You should talk to your doctor about:  

• The amount and color of any bleeding you are experiencing
• Hemorrhoids
• Constipation
• Leaking urine
• How you're feeling
• If you are sad or under a lot of stress

You do not have to wait for your scheduled postpartum appointment to talk to or see the doctor if you have urgent concerns . You should call the doctor or go to the hospital if you have:

• A fever over 100.4 F
• Bleeding that is getting heavier
• Severe pain
• Swelling in your body, especially your hands or face
• Nausea and vomiting
• A headache that is not going away or getting worse
• Foul-smelling vaginal bleeding or discharge
• Difficulty caring for yourself and your baby
• Feelings of depression
• Painful, burning urination or urinary frequency  

Skipping It 

Not all women get postpartum care. Up to 40% of women do not follow up with a doctor after giving birth.   There are many reasons for this, such as:

• Not knowing about it
• Not knowing who to call
• Being too busy
• Having too many other things to do
• Thinking it isn't necessary
• Feeling good
• Not having anyone to watch the baby
• Having been through it before many times
• Concerns about the cost
• The insurance will not cover it  

While there are things that make can make it difficult or inconvenient to get there, you should make every effort to see the doctor. If you have to bring your baby with you, you can. If you’re concerned about the cost or your insurance, talk to the hospital staff or your health care provider for helpful resources.

Skipping out on postpartum care can have some unintended consequences.   

• You may not realize you have an infection or a postpartum complication.
• You may not heal well. 
• You could get pregnant again quickly.
• You could have undiagnosed postpartum depression.

A Word From Verywell

During pregnancy, prenatal visits are plentiful. But, the attention to an expecting mom's health and wellness seems to fade once the baby is born. Care during the postpartum period can be overlooked at a time when many women need it most.  

The body changes so much during pregnancy, birth, and the postpartum period. It is incredible what the body goes through in less than one year. And, it's true that some women feel wonderful after childbirth. But, for others, the physical and emotional challenges of the fourth trimester can be a struggle. 

The continuation of care after pregnancy is so important. Just as you need ongoing care during pregnancy, labor, and delivery, you need it while you're healing in the days, weeks, and months after your baby is born. Postpartum care should be part of your overall pregnancy care. You and doctor should work together to make sure your health is monitored and managed throughout the entire process. So, talk about it with your doctor while you're pregnant, be sure to make your appointments, and don't skip out on them even if you're feeling good. 

Romano M, Cacciatore A, Giordano R, La Rosa B. Postpartum period: three distinct but continuous phases . Journal of prenatal medicine. 2010 Apr;4(2):22.

World Health Organization. WHO recommendations on postnatal care of the mother and newborn. World Health Organization; 2014.

Care OP. ACOG Committee Opinion No. 736 Optimizing Postpartum Care . American College of Obstetricians and Gynecologists. Obstetrics & Gynecology. 2018;131(5):e140-50.

Fahey JO, Shenassa E. Understanding and meeting the needs of women in the postpartum period: the perinatal maternal health promotion model . Journal of midwifery & women's health. 2013 Nov;58(6):613-21. doi:10.1111/jmwh.12139

Al-Safi Z, Imudia AN, Filetti LC, Hobson DT, Bahado-Singh RO, Awonuga AO. Delayed postpartum preeclampsia and eclampsia: demographics, clinical course, and complications . Obstetrics & Gynecology. 2011 Nov 1;118(5):1102-7. doi: 10.1097/AOG.0b013e318231934c

Jordan RG, Farley CL, Grace KT. Prenatal and postnatal care: a woman-centered approach. John Wiley & Sons; 2018 Apr 23.

DiBari JN, Yu SM, Chao SM, Lu MC. Use of postpartum care: predictors and barriers . Journal of pregnancy. 2014;2014. doi:10.1155/2014/530769

Nazik E, Eryilmaz G. The prevention and reduction of postpartum complications: Orem’s Model . Nursing science quarterly. 2013 Oct;26(4):360-4.

Martin A, Horowitz C, Balbierz A, Howell EA. Views of women and clinicians on postpartum preparation and recovery . Maternal and child health journal. 2014 Apr 1;18(3):707-13. doi:10.1007/s10995-013-1297-7

By Donna Murray, RN, BSN Donna Murray, RN, BSN has a Bachelor of Science in Nursing from Rutgers University and is a current member of Sigma Theta Tau, the Honor Society of Nursing.

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Your first postpartum visit: what to expect.

Posted On: June 15, 2023 By CIW

After labor and delivery, it’s common to experience a whirlwind of feelings like excitement, stress, and exhaustion. Although your focus may be on your new family, it’s important to remember that your health and your baby’s health are equally as important. You can expect to check in with your OB/GYN after your delivery to discuss a variety of potential complications, health concerns, and overall progress for both you and your baby. It can be helpful to have an idea of what to expect from this first postpartum visit, so here’s what to know.

When Should I Schedule My Postpartum Visit? 

On average, new mothers return for their postpartum checkup at around six weeks, but it can be scheduled anywhere from three to twelve weeks postpartum depending on your needs. For example, if your pregnancy was high-risk or there were complications during delivery, this may be sooner. The American College of Obstetricians and Gynecologists (ACOG) generally recommends that you see your OB/GYN within three weeks of giving birth, which should include ongoing medical care during the postpartum period as needed, and any necessary appointments before and after.

What Happens During a Postpartum Visit?

Ideally, you may have several postpartum visits, which can serve many important purposes. Your OB/GYN can debrief about your delivery and any concerns you might have. This can be helpful if unexpected things came up like an emergency C-section or last-minute decisions. Your obstetrician can also guide you through the decision-making process and answer any questions about your delivery and your aftercare. Additionally, an important part of your postpartum visit is a “head-to-toe” exam as well as in-depth discussions about some important factors of your health.

A great way to prepare for your postpartum checkup is to bring a list of questions or concerns so that you do not forget anything. In addition to asking questions, your visit may also include the following.

Physical Exam 

Your postpartum visit can be very similar to your yearly gynecological exam, so it might include things like a pelvic exam to check your recovery process, as well as things like a Pap test or breast exam. It may also include taking your regular measurements for blood pressure, weight, and heart rate, for example. Your OB/GYN will spend significant time assessing your pelvic area to make sure your body is returning to its normal state, as well as checking your thyroid to assess your hormone levels. If you’ve been experiencing health complications like incontinence, hemorrhoids, or constipation, your OB/GYN can discuss these, too.

Pregnancy is a great way to predict your health later in life. For example, if you had gestational diabetes, your risk for developing diabetes in the future increases, and women with high blood pressure while pregnant may have a greater risk for heart disease. Thankfully, there are many actions that can be taken to reduce these risks when you work with your doctor.

Mental Health Screening 

Postpartum depression is the most common complication after childbirth. Many women experience changes in their mental health with symptoms of depression or anxiety very soon after giving birth. Symptoms of postpartum depression often include feeling sad most of the time, crying a lot, sleeping too much or too little, worrying or feeling anxious, not having an interest in your baby, experiencing constant doubts in your ability to properly care for your baby, pulling away from family and friends and more.

The ACOG recommends screening both before and after labor, so your OB/GYN will ask you some screening questions and discuss any concerns you’ve been having. If you’re experiencing postpartum depression or anxiety or think you may be at risk for it, your OB/GYN can put you on a treatment regimen that works for you as soon as possible.

Breastfeeding, Exercise, Birth Control, and Sexuality 

Your postpartum visit is also a great time to discuss topics regarding breastfeeding, exercise, birth control, and sexual intercourse. Your OB/GYN can make sure you have everything you need to successfully breastfeed, so you’ll likely discuss any concerns you’ve been having or be recommended resources to help. Additionally, your OB/GYN can give you the best idea of when you can return to your exercise regimen based on your recovery process. Women who have had a C-section often have to postpone exercise a bit longer than those who experienced vaginal birth.

Postpartum women have unique needs when it comes to birth control, so your OB/GYN can recommend the right option for you. If you were previously on a specific type of birth control, your OB/GYN can help you get started again or recommend a better option based on your postpartum health and whether you are breastfeeding. Options like IUDs can often be inserted at this time. It’s common for women to experience some sexual complications after giving birth which might include low libido or problems during intercourse so your OB/GYN can help you prepare for what to expect when you’re cleared to return to sexual activity.

This is also a great time to discuss any future pregnancy plans if applicable. A postpartum checkup is a great time for your doctor to get a sense of when you will want to try to get pregnant again. The safest time for most women who wish to conceive again is at least 18 months after the end of their pregnancy.

Schedule an Appointment 

Your first postpartum visit is an important part of your health and wellness after having a baby, ensuring that you receive the support and care you need after delivery. To meet with our award-winning team and learn more about what to expect, we invite you to contact our New York City office by calling or filling out our online form .

Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!

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Perineal health

1.2.15 At each postnatal contact, as part of assessing perineal wound healing, ask the woman if she has any concerns and ask about:

pain not resolving or worsening

increasing need for pain relief

discharge that has a strong or unpleasant smell

wound breakdown.

1.2.16 Advise the woman about the importance of good perineal hygiene, including daily showering of the perineum, frequent changing of sanitary pads, and hand washing before and after doing this.

1.2.17 Consider using a validated pain scale to monitor perineal pain.

1.2.18 If the woman or the healthcare professional has concerns about perineal healing or if the woman asks for reassurance, offer or arrange an examination of the perineum by a midwife or a doctor.

1.2.19 If needed, discuss available pain relief options, taking into account if the woman is breastfeeding.

1.2.20 If the perineal wound breaks down or there are ongoing healing concerns, refer the woman urgently to specialist maternity services (to be seen the same day in the case of a perineal wound breakdown).

1.2.21 Be aware that perineal pain that persists or gets worse within the first few weeks after the birth may be associated with symptoms of depression, long-term perineal pain, problems with daily functioning and psychosexual difficulties.

1.2.22 Be aware of the following risk factors for persistent postnatal perineal pain:

episiotomy, or labial or perineal tear

assisted vaginal birth

wound infection or breakdown

birth experienced as traumatic.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on perineal health .

Full details of the evidence and the committee's discussion are in evidence review J: perineal pain and evidence review H: tools for the clinical review of women .

Assessment and care of the baby

1.3.1 At each postnatal contact, ask parents if they have any concerns about their baby's general wellbeing, feeding or development. Review the history and assess the baby's health, including physical inspection and observation. If there are any concerns, take appropriate further action.

1.3.2 Be aware that if the baby has not passed meconium within 24 hours of birth, this may indicate a serious disorder and requires medical advice.

1.3.3 Carry out a complete examination of the baby within 72 hours of the birth and at 6 to 8 weeks after the birth (see the Public Health England newborn and infant physical examination [NIPE] screening programme ). This should include checking the baby's:

appearance, including colour, breathing, behaviour, activity and posture

head (including fontanelles), face, nose, mouth (including palate), ears, neck and general symmetry of head and facial features

eyes: opacities, red reflex and colour of sclera

neck and clavicles, limbs, hands, feet and digits; assess proportions and symmetry

heart: position, heart rate, rhythm and sounds, murmurs and femoral pulse volume

lungs: respiratory effort, rate and lung sounds

abdomen: assess shape and palpate to identify any organomegaly; check condition of umbilical cord

genitalia and anus: completeness and patency and undescended testes in boys

spine: inspect and palpate bony structures and check integrity of the skin

skin: colour and texture as well as any birthmarks or rashes

central nervous system: tone, behaviour, movements and posture; check newborn reflexes only if concerned

hips: symmetry of the limbs, Barlow and Ortolani's manoeuvres

cry: assess sound.

1.3.4 At 6 to 8 weeks, assess the baby's social smiling and visual fixing and following.

1.3.5 Measure weight and head circumference of babies in the first week and around 8 weeks, and at other times only if there are concerns. Plot the results on the growth chart.

1.3.6 For advice on identifying and managing jaundice, see the NICE guideline on jaundice in newborn babies under 28 days .

1.3.7 If there are concerns about the baby's growth, see the NICE guideline on faltering growth .

1.3.8 Carry out newborn blood spot screening in line with the NHS newborn blood spot screening programme .

1.3.9 Carry out newborn hearing screening in line with the NHS newborn hearing screening programme .

1.3.10 Give parents information about:

how to bathe their baby and care for their skin

care of the umbilical stump

feeding (see recommendations on planning and supporting babies' feeding )

bonding and emotional attachment (see recommendations on promoting emotional attachment )

how to recognise if the baby is unwell, and how to seek help (see recommendations on symptoms and signs of illness in babies )

established guidance on safer sleeping (including recommendations on bed sharing )

maintaining a smoke-free environment for the baby (see also the NICE guideline on tobacco )

vitamin D supplements for babies in line with the NICE guideline on vitamin D supplement use

immunising the baby in line with Public Health England's routine childhood immunisations schedule .

1.3.11 Consider giving parents information about the Baby Check scoring system and how it may help them to decide whether to seek advice from a healthcare professional if they think their baby might be unwell.

1.3.12 Advise parents to seek advice from a healthcare professional if they think their baby is unwell, and to contact emergency services (call 999) if they think their baby is seriously ill.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on assessment and care of the baby .

Full details of the evidence and the committee's discussion are in evidence review F: content of postnatal care contacts and evidence review L2: scoring systems for illness in babies .

Bed sharing

1.3.13 Discuss with parents safer practices for bed sharing, including:

making sure the baby sleeps on a firm, flat mattress, lying face up (rather than face down or on their side)

not sleeping on a sofa or chair with the baby

not having pillows or duvets near the baby

not having other children or pets in the bed when sharing a bed with a baby.

1.3.14 Strongly advise parents not to share a bed with their baby if their baby was low birth weight or if either parent:

has had 2 or more units of alcohol

has taken medicine that causes drowsiness

has used recreational drugs.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on bed sharing .

Full details of the evidence and the committee's discussion are in evidence review M: benefits and harms of bed sharing and evidence review N: co-sleeping risk factors .

Promoting emotional attachment

1.3.15 Before and after the birth, discuss the importance of bonding and emotional attachment with parents, and the approaches that can help them to bond with their baby.

1.3.16 Encourage parents to value the time they spend with their baby as a way of promoting emotional attachment, including:

face-to-face interaction

skin-to-skin contact

responding appropriately to the baby's cues.

1.3.17 Discuss with parents the potentially challenging aspects of the postnatal period that may affect bonding and emotional attachment, including:

the woman's physical and emotional recovery from birth

experience of a traumatic birth or birth complications

fatigue and sleep deprivation

feeding concerns

demands of parenthood.

1.3.18 Recognise that additional support in bonding and emotional attachment may be needed by some parents who, for example:

have been through the care system

have experienced adverse childhood events

have experienced a traumatic birth

have complex psychosocial needs.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on promoting emotional attachment .

Full details of the evidence and the committee's discussion are in evidence review O: emotional attachment .

1.4.1 Listen carefully to parents' concerns about their baby's health and treat their concerns as an important indicator of possible serious illness in their baby.

1.4.2 Healthcare professionals should consider using the Baby Check scoring system:

to supplement the clinical assessment of babies for possible illness, particularly as part of a remote assessment and

as a communication aid in conversations with parents to help them describe the baby's condition.

1.4.3 Follow the recommendations in the NICE guideline on neonatal infection on:

assessing and managing the risk of early-onset neonatal infection after birth (within 72 hours of the birth)

risk factors for and clinical indicators of possible late-onset neonatal infection (more than 72 hours after the birth).

1.4.4 Be aware that fever may not be present in young babies with a serious infection.

1.4.5 If the baby has a fever, follow the recommendations in the NICE guideline on fever in under 5s .

1.4.6 If there are concerns about the baby's growth, follow the recommendations in the NICE guideline on faltering growth .

1.4.7 Be aware of the possible significance of a change in the baby's behaviour or signs, such as refusing feeds or a change in the level of responsiveness.

1.4.8 Be aware that the presence or absence of individual symptoms or signs may be of limited value in identifying or ruling out serious illness in a young baby.

1.4.9 Recognise the following as 'red flags' for serious illness in young babies:

appearing ill to a healthcare professional

appearing pale, ashen, mottled or blue (cyanosis)

unresponsive or unrousable

having a weak, abnormally high-pitched or continuous cry

abnormal breathing pattern, such as:

grunting respirations

increased respiratory rate (over 60 breaths/minute)

chest indrawing

temperature of 38°C or over or under 36°C

non-blanching rash

bulging fontanelle

neck stiffness

focal neurological signs

diarrhoea associated with dehydration

frequent forceful (projectile) vomiting

bilious vomiting (green or yellow-green vomit). See the following sections in other NICE guidelines for more information:

fever in under 5s: clinical assessment of children with fever

neonatal infection: assessing and managing the risk of early-onset neonatal infection after birth and risk factors for and clinical indicators of possible late-onset neonatal infection

sepsis: identifying people with suspected sepsis

meningitis (bacterial) and meningococcal septicaemia in under 16s: symptoms, signs and initial assessment

gastroesophageal reflux disease (GORD) in children and young people: diagnosing and investigating GORD

diarrhoea and vomiting caused by gastroenteritis in under 5s: assessing dehydration and shock

urinary tract infection in under 16s: diagnosis .

1.4.10 If a baby is thought to be seriously unwell based on a 'red flag' (see recommendation 1.4.9) or on an overall assessment of their condition, arrange an immediate assessment with an appropriate emergency service. If the baby's condition is immediately life-threatening, dial 999.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on symptoms and signs of illness in babies .

Full details of the evidence and the committee's discussion are in evidence review L1: signs and symptoms of serious illness in babies and evidence review L2: scoring systems for illness in babies .

1.5 Planning and supporting babies' feeding

General principles about babies' feeding.

1.5.1 When discussing babies' feeding, follow the recommendations in the section on principles of care , and:

acknowledge the parents' emotional, social, financial and environmental concerns about feeding options

be respectful of parents' choices.

For a short explanation of why the committee made the recommendation and how it might affect practice, see the rationale and impact section on general principles about babies' feeding .

Full details of the evidence and the committee's discussion are in evidence review T: formula feeding information and support .

Giving information about breastfeeding

1.5.2 Before and after the birth, discuss breastfeeding and provide information and breastfeeding support (see the section on supporting women to breastfeed ). Topics to discuss may include (see also recommendation 1.5.12 ):

nutritional benefits for the baby

health benefits for both the baby and the woman

how it can have benefits even if only done for a short time

how it can soothe and comfort the baby.

1.5.3 Give information about how the partner can support the woman to breastfeed, including:

the value of their involvement and support

how they can comfort and bond with the baby.

1.5.4 Inform women that vitamin D supplements are recommended for all breastfeeding women (see the NICE guideline on vitamin D ).

1.5.5 Inform women and their partners that under the Equality Act 2010, women have the right to breastfeed in 'any public space'.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on giving information about breastfeeding .

evidence review P: breastfeeding interventions

evidence review Q: breastfeeding facilitators and barriers

evidence review S: breastfeeding information and support .

Role of the healthcare professional supporting breastfeeding

1.5.6 Healthcare professionals caring for women and babies in the postnatal period should know about:

breast milk production

signs of good attachment at the breast

effective milk transfer

how to encourage and support women with common breastfeeding problems

appropriate resources for safe medicine use and prescribing for breastfeeding women.

1.5.7 Encourage the woman to have early skin-to-skin contact with her baby so that breastfeeding can start when the baby and mother are ready.

1.5.8 Those providing breastfeeding support should:

be respectful of women's personal space, cultural influences, preferences and previous experience of infant feeding

balance the woman's preference for privacy to breastfeed and express milk in hospital with the need to carry out routine observations

obtain consent before offering physical assistance with breastfeeding

recognise the emotional impact of breastfeeding

give women the time, reassurance and encouragement they need to gain confidence in breastfeeding.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on the role of the healthcare professional supporting breastfeeding .

Full details of the evidence and the committee's discussion are in evidence review Q: breastfeeding facilitators and barriers and evidence review S: breastfeeding information and support .

Supporting women to breastfeed

1.5.9 Give breastfeeding care that is tailored to the woman's individual needs and provides:

face-to-face support

written, digital or telephone information to supplement (but not replace) face-to-face support

continuity of carer

information about what to do and who to contact if she needs additional support

information for partners about breastfeeding and how best to support breastfeeding women, taking into account the woman's preferences about the partner's involvement

information about opportunities for peer support.

1.5.10 Make face-to-face breastfeeding support integral to the standard postnatal contacts for women who breastfeed. Continue this until breastfeeding is established and any problems have been addressed.

1.5.11 Be aware that younger women and women from a low income or disadvantaged background may need more support and encouragement to start and continue breastfeeding, and that continuity of carer is particularly important for these women.

1.5.12 Provide information, advice and reassurance about breastfeeding, so women (and their partners ) know what to expect, and when and how to seek help. Topics to discuss include:

how milk is produced, how much is produced in the early stages, and the supply-and-demand nature of breastfeeding

responsive breastfeeding

how often babies typically need to feed and for how long, taking into account individual variation

feeding positions and how to help the baby attach to the breast

signs of effective feeding so the woman knows her baby is getting enough milk (it is not possible to overfeed a breastfed baby; see also recommendation 1.5.14 )

expressing breast milk (by hand or with a breast pump) as part of breastfeeding and how it can be useful; safe storage and preparation of expressed breast milk; and the dangers of 'prop' feeding

normal breast changes during pregnancy and after the birth

pain when breastfeeding and when to seek help

breastfeeding complications (for example, mastitis or breast abscess) and when to seek help

strategies to manage fatigue when breastfeeding

supplementary feeding with formula milk that is sometimes, but not commonly, clinically indicated (also see the NICE guideline on faltering growth )

how breastfeeding can affect the woman's body image and identity

that the information given may change as the baby grows

the possibility of relactation after a gap in breastfeeding

safe medicine use when breastfeeding.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on supporting women to breastfeed .

Assessing breastfeeding

1.5.13 A practitioner with skills and competencies in breastfeeding support should assess breastfeeding to identify and address any concerns.

1.5.14 As part of the breastfeeding assessment:

any concerns the parents have about their baby's feeding

how often and how long the feeds are

rhythmic sucking and audible swallowing

if the baby is content after the feed

if the baby is waking up for feeds

the baby's weight gain or weight loss

the number of wet and dirty nappies

the condition of the woman's breasts and nipples

observe a feed within the first 24 hours after the birth, and at least 1 other feed within the first week.

1.5.15 If there are ongoing concerns, consider:

observing additional feeds

other actions, such as:

adjusting positioning and attachment to the breast

giving expressed milk

referring to additional support such as a lactation consultation or peer support

assessing for tongue‑tie.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on assessing breastfeeding .

Full details of the evidence and the committee's discussion are in evidence review R: tools for predicting breastfeeding difficulties .

Formula feeding

1.5.16 Before and after the birth, discuss formula feeding with parents who are considering or who need to formula feed, taking into account that babies may be partially formula fed alongside breastfeeding or expressed breast milk.

1.5.17 Information about formula feeding should include:

the differences between breast milk and formula milk

that first infant formula is the only formula milk that babies need in the first year of life, unless there are specific medical needs

how to sterilise feeding equipment and prepare formula feeds safely, including a practical demonstration if needed

for women who are trying to establish breastfeeding and considering supplementing with formula feeding, the possible effects on breastfeeding success, and how to maintain adequate milk supply while supplementing.

1.5.18 For parents who formula feed:

have a one-to-one discussion about safe formula feeding

provide face-to-face support

provide written, digital or telephone information to supplement (but not replace) face-to-face support.

1.5.19 Face-to-face formula feeding support should include:

advice about responsive bottle feeding and help to recognise feeding cues

offering to observe a feed

positions for holding a baby for bottle feeding and the dangers of 'prop' feeding

advice about how to pace bottle feeding and how to recognise signs that a baby has had enough milk (because it is possible to overfeed a formula-fed baby), and advice about ways other than feeding that can comfort and soothe the baby

how to bond with the baby when bottle feeding, through skin-to-skin contact, eye contact and the potential benefit of minimising the number of people regularly feeding the baby.

1.5.20 For parents who are thinking about supplementing breastfeeding with formula or changing from breastfeeding to formula feeding, support them to make an informed decision.

For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on formula feeding .

Lactation suppression

1.5.21 Discuss lactation suppression with women if breastfeeding is not started or is stopped, breastfeeding is contraindicated for the baby or the woman, or in the event of the death of a baby. Follow the recommendations in the section on principles of care . Topics to discuss include:

how the body produces milk, what happens when milk production stops, and how long it takes for milk production to stop

self-help advice, such as:

avoiding stimulating the breast

wearing a supportive bra

using ice packs

over-the-counter pain relief

sparingly expressing milk to ease engorgement

when to seek help

medicines that can be prescribed to suppress lactation

the advantages and disadvantages of the different methods of lactation suppression

the possibility of becoming a breast milk donor (also see the section on screening and selecting donors in the NICE guideline on donor milk banks ).

For a short explanation of why the committee made the recommendation and how it might affect practice, see the rationale and impact section on lactation suppression .

Full details of the evidence and the committee's discussion are in evidence review K: information for lactation suppression .

This section defines terms that have been used in a particular way for this guideline.

Bonding and emotional attachment

Bonding is the positive emotional and psychological connection that the parent develops with the baby.

Emotional attachment refers to the relationship between the baby and parent, driven by innate behaviour and which ensures the baby's proximity to the parent and safety. Its development is a complex and dynamic process dependent on sensitive and emotionally attuned parent interactions supporting healthy infant psychological and social development and a secure attachment. Babies form attachments with a variety of caregivers but the first, and usually most significant of these, will be with the mother and/or father.

Continuity of carer

Better Births , a report by the National Maternity Review, defines continuity of carer as consistency in the midwifery team (between 4 and 8 individuals) that provides care for the woman and her baby throughout pregnancy, labour and the postnatal period. A named midwife coordinates the care and takes responsibility for ensuring the needs of the woman and her baby are met throughout the antenatal, intrapartum and postnatal periods.

For the purpose of this guideline, the definition of continuity of carer in the Better Births report has been adapted to include not just the midwifery team but any healthcare team involved in the care of the woman and her baby, including the health visitor team. It emphasises the importance of effective information transfer between the individuals within the team. Having continuity of carer means that a trusting relationship can be developed between the woman and the healthcare professional(s) who cares for her. For more information, see the NHS Implementing Better Births: continuity of carer .

Effective feed

In general, effective feeding includes the baby showing readiness to feed, rhythmic sucking, calmness during the feed and satisfactory weight gain. For a first feed at the breast or with a bottle, effective feeding is shown by the baby latching to the breast or drawing the teat into mouth when offered and showing some rhythmic sucking.

First infant formula

First infant formula or 'first milk' is the type of formula milk that is suitable for a baby from birth to 12 months.

Low birth weight

A birth weight of less than 2,500 grams regardless of gestational age.

Nominal group technique

This is a structured method that uses the opinions of individuals within a group to reach a consensus. It involves anonymous voting with an opportunity to provide comments. Options with low agreement are eliminated and options with high agreement are retained. Using the comments that individuals provide, options with medium agreement are revised and then considered in a second round. For more information, see supplement 1 on methods .

Parental responsibility

See the government definition of parental responsibility .

Parents are those with the main responsibility for the care of a baby. This will often be the mother and the father, but many other family arrangements exist, including single parents.

Partner refers to the woman's chosen supporter. This could be the baby's father, the woman's partner, a family member or friend, or anyone who the woman feels supported by or wishes to involve.

Prop feeding

When a baby's feeding bottle is propped against a pillow or other support, rather than the baby and the bottle being held when feeding.

Responsive feeding

Responsive feeding means feeding in response to the baby's cues. It recognises that feeds are not just for nutrition, but also for love, comfort and reassurance between the baby and mother (or parent in case of bottle feeding). Responsive breastfeeding also involves a mother responding to her own desire to feed for her comfort or convenience. Responsive bottle feeding involves holding the baby close, pacing the feeds and avoiding forcing the baby to finish the feed by recognising signs that the baby has had enough milk, and to reduce the risk of overfeeding. For more information, see the UNICEF Baby Friendly Initiative (BFI) information sheet on responsive feeding .

Your baby after the birth

Having skin-to-skin contact with your baby straight after the birth can help keep her or him warm and can help with getting breastfeeding started.

First feed, weight gain and nappies

Some babies feed immediately after birth and others take a little longer.

The midwives will help you whether you choose to:

• feed with formula
• combine breast and bottle feeds

It's normal for babies to lose some weight in the first few days after birth. Putting on weight steadily after this is a sign your baby is healthy and feeding well.

Read more about your baby's weight , and your baby's nappies, including healthy poo .

Tests and checks for your baby

A children's doctor (paediatrician), midwife or newborn (neonatal) nurse will check your baby is well and will offer him or her a newborn physical examination within 72 hours of birth.

In the early days, the midwife will check your baby for signs of:

• infection of the umbilical cord or eyes
• thrush in the mouth

On day 5 to 8 after the birth, you'll be offered the blood spot (heel prick) test for your baby.

Before you baby is 5 weeks old you should be offered a newborn hearing screening test .

If your baby is in special care , these tests may be done there. If your baby is at home, the tests may be done at your home by the community midwife team.

Learn how to tell when a baby is seriously ill .

Safe sleeping for your baby

Make sure you know how to put your baby to sleep safely to reduce the risk of sudden infant death syndrome (SIDS) .

2 weeks and beyond

You don't need to bathe your baby every day. You may prefer to wash their face, neck, hands and bottom carefully instead.

Most babies will regain their birthweight in the first 2 weeks. Around this time their care will move from a midwife to a health visitor.

The health visitor will check your baby's growth and development at regular appointments and record this in your baby's personal child health record (PCHR) , also known as their "red book".

You after the birth

The maternity staff caring for you will check you're recovering well after the birth.

They will take your temperature, pulse and blood pressure.

They'll also feel your tummy (abdomen) to make sure your womb is shrinking back to its normal size.

Some women feel tummy pain when their womb shrinks, especially when they're breastfeeding. This is normal.

Seeing a midwife or health visitor

Midwives will agree a plan with you for visits at home or at a children's centre until your baby is around 10 days old. This is to check that you and your baby are well and support you in these first few days.

Bleeding after the birth (postnatal bleeding)

You'll have bleeding (lochia) from your vagina for a few weeks after you give birth.

The bleeding usually stops by the time your baby is 12 weeks old.

Non-urgent advice: Speak to your GP, midwife or health visitor if you've got postnatal bleeding and any of these:

• a high temperature over 38C
• the bleeding smells unusual for you
• tummy pain that gets worse
• the bleeding gets heavier or doesn't get any less
• lumps (clots) in the blood
• pain between the vagina and anus (perineum) that gets worse

It could be a sign of infection.

Make sure you know the signs of a serious heavy bleed after giving birth (postpartum haemorrhage, or PPH). This is rare and needs emergency care.

Immediate action required: Call 999 if you've got postnatal bleeding and:

• the bleeding suddenly gets heavier
• you feel faint, dizzy or have a pounding heart

This could mean you're having a very heavy bleed (postpartum haemorrhage) and need emergency treatment.

Read more about your body after the birth , including when you might need urgent medical attention.

Feeding your baby

When you're breastfeeding in the early days , breastfeed your baby as often as they want. This may be every 2 hours.

Let your baby decide when they've had enough (this is called baby-led feeding).

You can express your breast milk if you're having problems with breastfeeding . Problems can include breast engorgement or mastitis .

Get breastfeeding and bottle feeding advice .

Your baby's crying

Crying is your baby's way of telling you they need comfort and care. It can be hard to know what they need, especially in the early days.

There are ways you can soothe your crying baby .

How you feel

Find out how to cope if you feel stressed after having a baby . There are support services for new parents that may help.

You may feel a bit down, tearful or anxious in the first week after giving birth. This is normal.

If these feelings start later or last for more than 2 weeks after giving birth, it could be a sign of postnatal depression .

Postnatal depression and anxiety are common, and there is treatment. Speak to your midwife, GP or health visitor as soon as possible if you think you might be depressed or anxious.

Sex and contraception

You can have sex as soon as you feel ready after having a baby.

There are no rules about when to have sex after giving birth. Every woman's physical and emotional changes are different.

You can get pregnant from 3 weeks (21 days) after giving birth. This can happen before you have a period, even if you're breastfeeding.

You need to start using contraception from 21 days after the birth every time you have sex if you don't want to get pregnant again.

Talk to your doctor, midwife or contraception (family planning) nurse about contraception after having a baby . They can arrange contraception before you have sex for the first time.

Being active may feel like a challenge when you're tired, but gentle exercise after childbirth can help your body recover and may help you feel more energetic.

You should also do pelvic floor exercises to strengthen the muscles around your bladder, vagina and anus.

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DHDD Newsletter – May 2024

A Note from the DHDD Director

Dear DHDD Partners,

As our division prepares to implement our FY2024–FY2028 strategic plan, we are guided by a shared vision, which is for people with disabilities and developmental concerns to achieve their optimal health and well-being. Although disabilities and developmental concerns are common, this population often faces unique challenges in attaining their optimal health, which is made clear from the disparities we see in the data. To achieve our vision we need to focus on populations rather than focusing solely on the individual. Policy, systems, and environmental or PSE changes focus on root causes and seek to create sustainable change by taking a population or systems-wide approach. PSE factors include physical and social contexts which can help make health improvements practical and available to people with disabilities and developmental concerns.

Dr. Karyl Rattay, DHDD director

We have embedded PSE approaches throughout our strategic plan to strengthen our collective impact. Our strategies include enhancing the understanding of PSE factors on health and well-being while increasing capacity to implement PSE activities. In addition, DHDD promotes the adoption of PSE interventions that help achieve equitable outcomes for people with disabilities and developmental concerns.

To achieve these strategies, DHDD leads public health efforts through data and evidence-based decision making. As one example, this recent publication  describes potential risk factors for attention-deficit/hyperactivity disorder (ADHD) as well as PSE changes that may modify these risks to improve the health and well-being of people with ADHD. The findings highlight the importance of data to drive innovative solutions that improve outcomes.

As we continue our collaborations, PSE approaches will help us create sustainable, lasting change with and for the populations we serve. Together, we can identify, promote, and support impactful interventions that help every person achieve their optimal health and well-being.

With gratitude, Karyl

Karyl Rattay, MD, MS, FAAP DHDD Director

In the Spotlight

Adhd prevalence among u.s. children and adolescents in 2022: diagnosis, severity, co-occurring disorders, and treatment.

A new study from CDC shows that ADHD diagnosis in children aged 3-17 years is the highest it’s ever been, and the gap between ADHD diagnosis and treatment is wide—nearly 2 million kids are not receiving the treatment that could help them. Many children with ADHD also have other co-occurring conditions or concerns, such as behavioral conduct problems, anxiety, and learning disabilities. New data collected in 2022 from the National Survey on Children’s Health show that the estimated number of U.S. children aged 3-17 years with diagnosed ADHD increased from 2016 to 2022 by 1 million, and nearly 78% of children with ADHD have at least one other co-occurring condition such as a behavior or conduct problem (44.1%) or anxiety (39.1%). For more information on the latest ADHD data, please visit: Data and Statistics on ADHD | Attention-Deficit / Hyperactivity Disorder (ADHD) | CDC

CDC Offers Provider Trainings and Resources on ADHD and Other Co-Occurring Conditions

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Many children with ADHD have other co-occurring conditions, such as behavior or conduct problems, learning disorders, Tourette syndrome (TS) , anxiety and depression. Many other disorders or conditions can have symptoms that look like those of ADHD. In fact, the American Academy of Pediatrics (AAP) recommends  that every child diagnosed with ADHD be screened for other conditions as well.

CDC works with partners to better understand ADHD, TS, and other conditions to improve early identification of these conditions in childhood and to help improve the quality of life for those affected and their families.

Additional information and free provider trainings on ADHD and other co-occurring conditions:

• Not Just ADHD? Helping Children with Multiple Concerns | CDC : Learn more ways to help children who have ADHD and other co-occurring conditions

Free Provider Trainings:

• Identifying and Managing ADHD with Co-occurring Conditions – American Academy of Pediatric (AAP)’s live PediaLink Training, scheduled for June 11, 2024 . Register today
• Identifying and Caring for Children and Adolescents with ADHD – Register here for AAP’s enduring training, available online through 2026
• Pocket MD Podcasts – Free continuing education training on ADHD in children and adults from the National Resource Center on ADHD (NRC), a program of CHADD – Children and Adults with Attention-Deficit/Hyperactivity Disorder

More Information on ADHD:

• Data and Statistics About ADHD | CDC – The latest ADHD data from CDC
• ADHD Information and Resources for States – States can play an important role in treatment for children with ADHD. They can monitor how health resources are utilized, implement ADHD treatment policies, and shape access to behavioral health services
• Other Concerns and Conditions of Tourette Syndrome | CDC : ADHD is a common co-occurring condition among children with Tourette syndrome (TS)
• Free Materials About Tourette Syndrome – More information on TS from CDC and its partners
• ADHD Across the Lifetime: A Toolkit for Partner Organizations | CDC – Join CDC in raising awareness about ADHD across the lifetime. Use your voice and platforms to raise awareness, encourage inclusion, and help connect people with ADHD and their families to support services and one another

Related Resources:

• Expanding the Behavioral Health Workforce | ChangeLab Solutions : Resources to support children with ADHD, TS, and co-occurring mental health conditions
• “Meeting the Challenge: Evidence-Based Policies to Support Children’s Mental Health & Well-Being” – A webinar series developed by ChangeLab Solutions with support from CDC
• Evidence-Based Policies to Support Children’s Mental Health & Well-Being | ChangeLab Solutions
• Workforce & Health Care Policies to Support Children’s Mental Health | ChangeLab Solutions

Tools and Resources

Dhdd releases partner toolkit for national speech-language-hearing month.

DHDD recognizes National Speech-Language-Hearing Month with the release of a new partner toolkit designed to help you raise awareness about the importance of timely hearing screening, diagnosis, and intervention on a child’s development of communication, language and social skills. The toolkit features promotional ideas, key messages, links to educational materials, and social media content in English and Spanish. To access the toolkit and social media graphics, visit the Early Hearing Detection and Intervention website .

Publications

Policy, systems, and environmental opportunities for public health impact.

A policy, systems, and environment (PSE) change approach focuses on changing the laws and policies, organizational rules, infrastructure, and physical and social contexts within which individuals live to support healthy behaviors. These PSE approaches can support impactful interventions for people with disabilities and developmental concerns, including attention-deficit/hyperactivity disorder (ADHD). A CDC commentary provides an overview of factors that may be associated with ADHD, as well as the public health concerns and opportunities moving forward. Examples of PSE opportunities include integrated perinatal support, child health promotion, family support, and responsiveness toward community level chemical exposures. Find out more about how CDC is using PSE strategies to help reduce risks, target prevention efforts, and improve the long-term health and wellbeing of children and adults with ADHD .

The commentary provides an overview of the following previously published metanalyses of factors potentially associated with ADHD:

• Chemical Exposures
• Childhood Physical Health: Modifiable Factors
• Prenatal, Birth, and Postnatal Factors
• Parenting and Family Environment
• Exposure to Parental Substance Use
• Parental Depression, Antidepressant Usage, Antisocial Personality Disorder, and Stress and Anxiety

New CDC Website Live!

We are thrilled to announce the new CDC.gov  is now live! The new site is a direct result of our agency-wide effort to modernize and transform digital communications at CDC. As you browse the website, you will notice:

• A fresh, new look and feel with better readability.
• Page summaries to help you better understand what information is on each page.
• Streamlined information and easier access to content.
• New navigation and an improved user experience.
• Tailored content for public health professionals, healthcare providers, and the general public.

Find DHDD’s new disability and child development content:

• Attention-Deficit/Hyperactivity Disorder
• Autism Spectrum Disorder
• Child Development
• Cerebral Palsy
• Fragile X syndrome
• Hearing Loss in Children
• Tourette syndrome

Cross-cutting content that may be of interest:

• Early Care and Education Portal
• Parent Information
• Right to Know: Breast Cancer Screening Campaign

The new CDC.gov will continue to prioritize remaining pages related to disability and child development, including translated content, for updates over the coming months.

Accessing older content

Because we have cleaned up our site, some previous CDC.gov content is not available on the new site. However, we have provided two options to find older content:

• Snapshot2024.cdc.gov allows you to see CDC.gov exactly as it was before launch. This will be available until November 29, 2024.
• Archive.cdc.gov is where CDC will host archival versions of key content previously available on CDC.gov. You can use the search bar to find earlier versions of past content to view, print, or save. This will be available indefinitely.

Syndication

Syndicated pages will continue to work using the new CDC.gov, but content may have changed. We encourage you to review any syndicated pages to ensure the content you are syndicating from the updated page still meets your content needs.

Changes to URLs

The new CDC.gov includes link changes that will automatically direct users from the old URLs to the new corresponding webpage. If you are linking to CDC.gov pages and need help updating your links, email us at [email protected] .

We are excited to share the new CDC.gov with you and hope you find it enriching to your work! If you have questions about the new CDC.gov, email us at [email protected] .

CDC Releases Guidance to Prevent the Spread of Infections in Schools

CDC has released evidence-based guidance  for preventing the spread of infections in K-12 schools. The guidance can help schools take everyday actions to prevent and control the spread of common childhood illnesses, such as flu and strep throat. Strategies include teaching proper hand washing; improving ventilation in schools; cleaning, sanitizing, and disinfecting when appropriate; and promoting vaccinations for students and staff.

The guidance also includes actions to take when children or staff become ill, such as staying home when sick and using personal protective equipment when caring for sick children.

Key resources:

• Guidance for Preventing the Spread of Infections in K-12 Schools
• Science Brief: Prevention and Control of Respiratory and Gastrointestinal Infections in Kindergarten through Grade 12 (K-12) Schools

Partner News and Announcements

National physical fitness and sports month: partner promotion toolkit.

The HHS Office of Disease Prevention and Health Promotion and the President’s Council on Sports, Fitness & Nutrition has developed a partner toolkit to help you spread the word about National Physical Fitness and Sports Month. This resource focuses on how physical activity and sports can positively impact mental health. The toolkit includes Move Your Way® campaign resources, including key messages, social media, and promotional graphics. The Move Your Way® campaign helps promote the second edition of the Physical Activity Guidelines for Americans , which includes the benefits of physical activity for people with disabilities.

Please feel free to share this communication broadly within your networks. If you are not currently a subscriber, click the button below to subscribe.

DHDD’S mission is to lead inclusive programs to optimize the health and development of children and adults with, or at risk for, disabilities.

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