Intended for healthcare professionals

Practice Practice Pointer

Ask the expert: common problems in new babies in primary care

BMJ 2023; 382 doi: (Published 21 August 2023) Cite this as: BMJ 2023;382:p1489
  1. Ian Wacogne, consultant general paediatrician1,
  2. Kyra Drinnan, GP partner2
  1. 1Birmingham Children’s Hospital, UK
  2. 2Shropshire, UK
  1. Correspondence to: I Wacogne ianwacogne{at}

What you need to know

  • Constipation in newborns can be defined as distress on passage of hard stools ordinarily fewer than three times a week

  • For a baby with jaundice, consider the onset of jaundice, risk factors for developing hyperbilirubinemia, gestation, and whether the baby is feeding well, when deciding whether to refer for onward assessment

  • Refer to secondary care babies who present with noisy breathing associated with poor feeding, respiratory distress, grunting, or those with suspected anatomical abnormality on examination

  • Co-sleeping in bed increases the risk of sudden infant death syndrome, and the risk is higher still on a sofa or chair

BMJ Learning

To obtain accredited continuous professional development points, complete the full BMJ Learning module at The module contains seven additional questions submitted by users of BMJ Learning, related to feeding, reflux, sticky eyes, sepsis, and heart murmurs.

Paediatric consultant Ian Wacogne and GP Kyra Drinnan provide expert answers to GPs’ questions on common problems in new babies in the first month of life presenting to primary care. These include providing advice for babies with constipation, oral thrush, jaundice, noisy breathing, and how to discuss sleep positioning with families.

Test yourself

Susan has had an uncomplicated second pregnancy and delivered a 39 week baby boy at home 18 hours ago. Her previous pregnancy and postnatal period were uneventful. You visit to perform a newborn baby check and notice that the baby is slightly jaundiced. The baby is breastfeeding well and has had a normal wet nappy with meconium.

What should you do?

  • a). Advise the parents to expose the baby to sunlight and ensure he is well hydrated

  • b). Tell the parents to take the baby to the emergency department immediately

  • c). Refer the baby to a paediatrician or neonatologist urgently

  • d). Ask the midwife to do a heel prick to check the serum bilirubin (SBR)

What is the current guidance about screening newborns for jaundice?

As a …

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