The first month with a newborn is usually spent counting things — breaths, nappies, feeds, the rise and fall of a tiny chest at 2 a.m. Most of what you'll see is normal, and once you know what 'normal' looks like, the watching gets easier. The signals that need attention are clearer than parents tend to assume. For a wider view, see our complete guide to child health.
What the Early Checks Tell You
The first formal assessment happens within minutes of birth: the Apgar score, given at one minute and five minutes. It's a quick five-point check (heart rate, breathing, muscle tone, reflex response, and colour), each scored 0 to 2. A score of 7–10 is reassuring. Lower scores prompt closer monitoring or active intervention, but it isn't a long-term predictor — many babies with low five-minute scores recover quickly and do entirely well.
Within the first 72 hours, your baby gets a full NIPE check (Newborn and Infant Physical Examination) — eyes (red reflex), heart sounds, hips (Ortolani and Barlow tests for developmental dysplasia), genitals (testicular descent in boys), spine, palate, and overall tone. A second NIPE is offered at six to eight weeks. These checks aren't moment-to-moment monitoring — they exist to catch the small list of conditions that genuinely benefit from being caught early, like congenital cataracts and hip dysplasia.
Signs a Newborn Is Doing Well
Feeding and output. A baby who feeds eagerly — breast or bottle — and produces six or more wet nappies a day from day five or six is getting enough. Stools shift from black tarry meconium to greenish transitional stools, then to mustard-yellow seedy breastfed stools or pale tan formula stools by the end of the first week. Frequent small stools in breastfed babies are normal in the early weeks; after about four weeks, established breastfed babies sometimes go several days between stools and that's also normal.
Weight. Up to 7–10% loss in the first three to five days, then climbing. Most babies are back to birth weight by day 10–14, then gaining around 150–200 g a week in the first three months. The trend on the centile chart matters more than any single weighing.
Breathing. Newborn breathing is fast (30–60 breaths a minute) and irregular by adult standards. Periodic breathing — short pauses of up to 10 seconds, then a few quick breaths to catch up — is normal in healthy babies and often more visible during sleep. The signs that aren't normal: a sustained rate over 60 at rest, chest recession (the skin pulling in between or below the ribs with each breath), grunting at the end of each breath, nasal flaring, or any blue tinge to the lips or tongue.
Colour. A pinkish-red baby is the goal in the first days. Mottling (a marbled red-purple pattern) and acrocyanosis (bluish hands and feet) are both common and harmless in the first weeks — the peripheral circulation takes time to settle. Mild physiological jaundice appears from day two or three in roughly 60% of babies and resolves on its own. Significant or rapidly deepening jaundice — and any jaundice in the first 24 hours — needs assessment.
Tone and movement. A healthy newborn isn't floppy. Limbs are typically held in a flexed position — the foetal posture from the womb. They startle to loud noises (the Moro reflex), root toward your finger when you stroke their cheek, suck strongly, and grip your finger reflexively. Asymmetric movement (one arm or leg moving less than the other) is worth flagging.
Alertness. Even in the first week, a healthy baby has quiet-alert windows — eyes open, focused, taking in your face. They may be brief — sometimes only a few minutes — but they're there.
When to Get Help Without Hesitating
Contact your midwife, health visitor, or GP — or NHS 111 out of hours — if your newborn:
- Has a temperature above 38°C or below 36°C (any fever in a baby under three months is a same-day issue)
- Is breathing fast (over 60 a minute at rest) or with visible effort — chest recession, grunting, nasal flaring
- Has a blue tinge to the lips or tongue (not just hands and feet)
- Is unusually limp or hard to wake
- Won't feed for more than six hours, or is increasingly disinterested in feeding
- Looks deeply yellow, especially if it appeared in the first 24 hours or is getting worse after day three
- Has a bulging fontanelle when they're calm and held upright
- Has a cry that sounds high-pitched, weak, or simply not theirs
- Has a non-blanching rash (spots that don't fade when pressed under a clear glass)
The threshold is deliberately low in the first three months. Babies this age can deteriorate quickly, and parents who ring early end up with reassurance more often than not — which is what NHS 111 and your local maternity assessment unit are there for.
The Bloodspot and Hearing Screens
At day five (sometimes day six to eight if logistics intervene), your baby gets the newborn bloodspot screen — a heel-prick test that screens for nine conditions: congenital hypothyroidism, sickle cell disease, cystic fibrosis, phenylketonuria (PKU), and five rare metabolic disorders (MCADD, MSUD, IVA, GA1, HCU). Results take around six weeks; you'll only hear back if there's something to follow up.
The newborn hearing screen is offered before discharge or in the first few weeks at home. It uses an automated otoacoustic emission test — a small probe in the ear, takes a few minutes. A "refer" result on the first attempt does not mean hearing loss; it usually means there's still amniotic fluid in the ear or background noise interfered. A small minority go on to a more detailed assessment.
Both screens are technically optional. Both are worth having, because each catches conditions where early treatment changes long-term outcomes substantially.
A Note on Variation
Healthy babies come in an enormous range of sizes, sleep patterns, and personalities. Some are hungry every two hours; others stretch to four. Some are alert and watchful by week two; others are largely asleep until week six. Some land on the 50th centile; some on the 9th. Centile charts are tracking tools, not pass-fail tests — a baby on the 9th centile who tracks the 9th centile is growing exactly the way that baby is meant to.
The picture that matters is the whole one: feeding, growing, having alert moments, settling for someone, and gradually doing more of all of it as the weeks go by. A baby who is doing those things, and a parent who feels generally able to read them, is almost always a healthy combination.
Key Takeaways
A healthy newborn feeds eagerly, gives you six or more wet nappies a day from day five, and has stretches of quiet alertness between long sleeps. Normal breathing is irregular and quick — 30 to 60 breaths a minute, with pauses of up to ten seconds. Mottled or bluish hands and feet are fine; bluish lips are not. The bloodspot test on day five and the newborn hearing screen are the two early checks that catch the conditions worth catching early. The single most reliable instrument in those first weeks is your own gut feeling — parents notice changes before anyone else does.
