Get the best out of your health visitor

What does a health visitor do?

Your health visitor helps you and your partner to learn about being a parent, and supports you to raise a healthy, happy child (NHS 2017a).

Health visitors work closely with midwives, practice nurses, and GPs. Your health visitor is a qualified nurse or midwife who has gone on to do further training (NHS HEE nd, NHS 2017a).

Two weeks after your baby's birth, your midwife will hand over care for you and your baby to your named health visitor. That care will continue until your child is five years old (NHS HEE nd, NHS 2017a).

In your baby's early months and years, your health visitor will advise you about:

• How your baby's developing, both physically and emotionally.
• Helping you get your baby into a bedtime routine and good sleep habits.
• Colic and persistent crying.
• Healthy eating and vitamin supplements for you, your baby and your family.
• Coping with minor illnesses.
• Your baby's immunisations.
• Breastfeeding or formula-feeding your baby, and starting solids.
• Recognising the signs of postnatal depression, and supporting you through it.
• Any concerns you may have about your health or your partner's health.(NHS 2017a)

Your health visitor will give you your baby's personal child health record (PCHR) or red book, either just before or just after the birth (NHS 2017b). In some areas, the hospital where you give birth may supply your baby's red book.

The PCHR is your book which you keep on behalf of your child. Your health visitor will show you how to use it as a record of how your child is growing. In some areas, you can have an online version of your baby's red book. Find out more about the eRedbook.

The red book records your baby's immunisations and information about how much weight he's gaining and how he's growing (NHS 2017b). You can add details yourself about your baby's milestones, any illnesses or accidents he's had, or any medicines he's taken (NHS 2017b).

You may find you take to parenting easily. Outside scheduled visits, you may not need to call on your health visitor for help.

For other parents, the early years, though rewarding and full of love, can also be frustrating and demanding. If you struggle emotionally and financially with parenting, your health visitor is there to guide you.

You may find it hard to get hold of your health visitor at times, due to staff shortages (Merriefield 2017). Some health visitors may have responsibility for between 500 and 1,000 children (Stephenson 2016). If your health visitor is held up because of the number or complexity of her visits, she'll usually call you to let you know she's running late.

You should always get the support you need, though. If you have a concern or a problem, be sure to tell your health visitor. She should make time to help you.

If your health visitor is not available to help you straight away, you can get help from other places. Try contacting your nearest SureStart or children's centre, or your local surgery or clinic. A community nursery nurse or staff nurse may be able to come and see you if your health visitor can't.

When will I first see my health visitor?

Your health visitor will offer to come and see you before your baby is born, at about 28 weeks. She'll discuss how your pregnancy is going, and what support you may need as a new parent (IHV nd).

How often will I see my health visitor once I'm a parent?

Your health visitor will see you for scheduled visits at various stages during your baby's early years. If possible, it's best if you and your partner can be there for each visit. This gives you both a chance to ask for advice and discuss any worries you may have (NHS 2017b).

New birth visit at 10 days to two weeks

Your health visitor will take over from the community midwifery team at this point (NHS 2017b). She'll know how your baby's birth went from the midwives who've been caring for you. The new birth visit will take about 45 minutes to an hour. At this visit your health visitor will:

• Check that your details, which your midwife will have passed on, are correct.
• Chat to you about how the birth of your baby went.
• Check if you have any concerns about your baby's health or behaviour.
• Explain what help and support you can get at your local child health clinic.
• Give you advice about breastfeeding or formula feeding, or both, if you are combination feeding.
• Give advice about sterilising breast pumps, bottles, and bottle-feeding equipment.
• Advise you about safe sleeping and the risk of sudden infant death syndrome (SIDS).
• Explain how to register your baby's birth.
• Explain how to claim child benefit.
• Give tips on keeping your baby safe at home and in the car. This includes guidance if anyone in the family smokes.
• Explain how you can register your baby with your GP.
• Check if you have any concerns about your health or your partner's health. This can be your mental health as well as physical health.
• Explain where to go for your six-week to eight-week postnatal review with your GP.
• Tell you about the immunisations your baby needs. (RCPCH 2017)

Do talk to your health visitor about any worries you have. No question is too silly or too personal, and many other new parents are probably asking the same things.

Your health visitor will explain how to register with your SureStart centre, which may also be where your nearest child health clinic is.

Once you're registered with your SureStart centre, you'll be able to meet other parents and join in with the activities the centre runs.

Alongside the child health clinics, your SureStart centre may have play and music sessions, and baby massage classes. Your health visitor will also have lots of information about how you can make new friends and access local support.

Before your health visitor leaves, she'll tell you when you'll next see or hear from her or another member of the health visiting team (NHS 2017b).

Check-up at six weeks to eight weeks

Around the same time as you have your postnatal check-up at your GP surgery, your health visitor will offer another home visit. She'll help you with any concerns you may have about your baby's growth, or feeding, for example. She'll also ask about how you're doing, emotionally and physically.

Some new parents feel low as they adjust to the major changes in roles, responsibilities, and identities that having a baby brings to their lives (NHS 2016).

If your health visitor thinks you may be struggling in this way, she may ask you to fill in a questionnaire, or ask you some questions about how you're feeling (NICE 2017). The answers you give your health visitor can help to reveal if you're suffering from postnatal depression.

Postnatal depression can affect not only how you feel in yourself, but can also affect your relationship with your partner and sometimes your baby (NHS 2016).

If your health visitor is concerned that you may be experiencing depression, she'll share the questionnaire results with your GP. Your health visitor may come to your postnatal check with your GP so that you can all work on ways to help you recover.

Your health visitor will advise you to have your baby weighed regularly, probably at your child health clinic:

• once a month between the ages of two weeks and six months
• every two months between the ages of six months and 12 months
• no more than once every three months over the age of one (NHS 2017c, RCPCH 2017)

Developmental check between nine months and one year

Your health visitor will check that your baby's still growing well (RCPCH 2017). She won't just look at your baby's size and weight. She'll also be interested in how your baby communicates and behaves with other people (NHS 2017c).

You can also ask your health visitor if you have concerns about:

• your baby's sight or hearing
• your baby's sleep and routines
• childcare, if you want to go back to work or training
• your own health (NHS 2017c, RCPCH 2017)

Your health visitor may also ask you to fill in another questionnaire about how you're feeling. For some parents, depression can set in months after their baby was born.

Developmental check between two years and two and a half years

Your health visitor may send you an Ages and Stages Questionnaire (ASQ) to fill out before this review. There are two ASQs:

• ASQ-3 asks you about the number of words your child can say or understand, his physical co-ordination and abilities, and how well he interacts with people.
• ASQ-SE explores your child's social and emotional development, such as how he behaves when playing with you or when others are nearby, whether he has long tantrums, and whether he sleeps well and enjoys mealtimes.

Your health visitor will be just as interested in you, and how you're coping now your baby has grown into a toddler.

When should I call my health visitor?

If you have a concern that you feel can't be dealt with at the clinic, or at a scheduled visit, give your health visitor a ring. You can chat through your concerns on the phone or ask for a home visit. Depending on the type of help needed, a community nursery nurse may come to see you instead.

Your health visiting team can deal with almost all concerns you may have about your baby. These may include:

• Your baby's skin, including dry skin, fungal rashes, nappy rash, and cradle cap.
• Feeding problems of any kind, from breastfeeding through to starting solids.
• Your baby's behaviour, from sleep problems through to temper tantrums.
• How your baby is growing, including his sight, hearing, or speech.
• Any concerns about your health, or your partner's physical or emotional health.
• How your baby's umbilical stump is healing.
• If your baby has blocked tear ducts.
• Childcare or nursery choices.
• If your baby has thrush in his mouth.
• Your baby's crying.
• How to stop breastfeeding when you and your baby are ready.
• Potty training.
• Constipation.
• Teething.
• Reflux.
• Colic.

Find out when when you need to call your doctor rather than your health visitor.