The determination of the safety of a medication can be evaluated by considering the following:

- The age and maturity of the infant. Full term infants are better able to metabolize medications than premature infants

- The weight of the infant.

- The amount and percentage of breastmilk consumed by the infant. An infant taking solid foods with breastfeeding will receive a lower dose of medication.

- The general health of the infant and the general health of the mother.

- The nature of the mother's illness, if present.

- The general information about the drug other literature documenting studies related to the drug and breastfeeding.

- The duration of the drug therapy.

- Is the drug short-acting? A short-acting form of the drug may be a better choice for a breastfeeding mother rather than a longer-acting form that stays in the mother's system for a longer period.

- How is the medication being given?

- Does the drug interfere with lactation?

Over the counter medications are those medications that do not require a prescription to purchase in the US. Medications that require a prescription to purchase in the US may be available in other countries without a prescription. The following guidelines are recommended:

- taking oral medications after breastfeeding rather than before will allow some of the medication to leave the mother's body through her kidneys between nursings.

- in most women without kidney disease, nonsteroidal anti-inflammatory drugs and paracetamol (acetaminophen) are used safely.

- aspirin can cause rashes and even cause bleeding in infants.

- limit the use of antihistamines for long periods of time. These anti-allergy medications can cause crying, sleep problems, fussiness, exsessive sleepiness in babies. Antihistamines have an effect on the amount of milk the body produces and decrease the supply.

- carefully observe the infant for changes or side effects when first taking a medication to watch for side effects. Side effects indicating that the medication is having an affect on the baby is difficulty breathing, rash and other questionable changes that occurred after the medication was started by the mother.

- many times other young children are in the home and keeping these over the counter medications out of their reach is a safe practice.

Other substances or chemicals have been evaluated regarding their safe use during pregnancy. Hair dye or solutions used for a 'permanent' do not pass to breastmilk. No adverse reports of using oral antihastamines and breastfeeding are found. Some of the older antihistamines used by a nursing mother can cause drowsiness in the infant. This may be a concern if the infant misses feedings by sleeping instead of nursing.

According to a study conducted in 2008 by the Pregnancy Risk Assessment Monitoring System (PRAMS) that interviewed women in 26 states in the United States, approximately 13% of women reported smoking during the last 3 months of pregnancy. Of women who smoked during the last 3 months of pregnancy, 52% reported smoking 5 or fewer cigarettes per day, 27% reported smoking 6 to 10 cigarettes per day, and 21% reported smoking 11 or more cigarettes per day.

In the United States, women whose pregnancies were unintended are 30% more likely to smoke during pregnancy than those whose pregnancies were intended.

It is recommended for women planning pregnancy to stop smoking. It is important to examine these effects because smoking before, during and after pregnancy is not an unusual behavior among the general population and can have detrimental health impacts, especially among both mother and child as a result. In 2011, approximately 10% of pregnant women in data collected from 24 states reported smoking during the last three months of their pregnancy.

Confirming the presence of withdrawal in the neonate can be assessed from obtained a detailed medical history from the mother. In some cases neonatal drug withdrawal can be mistaken for central nervous system disorders. Typically the tests that are ordered are CBC, hair analysis, drug screen (of mother and infant), thyroid levels, electrolytes, and blood glucose. Chest x-rays can confirm or infirm the presence of heart defects. The diagnosis for babies with signs of withdrawal may be confirmed with drug tests of the baby's urine or stool. The mother's urine will also be tested.

There are at least two different scoring systems for neonatal withdrawal syndrome. One difficulty with both is that were developed to assess opiate withdrawal. The Finnegan scoring system is more widely used.

The Centers for Disease Control and Prevention (CDC) recommends HIV testing for all pregnant women as a part of routine prenatal care. The test is usually performed in the first trimester of pregnancy with other routine laboratory tests. HIV testing is recommended because HIV-infected women who do not receive testing are more likely to transmit the infection to their children.

HIV testing may be offered to pregnant women on an "opt-in" or an "opt-out" basis. In the "opt-in" model, women are counseled on HIV testing and elect to receive the test by signing a consent form. In the "opt-out" model, the HIV test is automatically performed with other routine prenatal tests. If a woman does not want to be tested for HIV, she must specifically refuse the test and sign a form declining testing. The CDC recommends "opt-out" testing for all pregnant women because it improves disease detection and treatment and helps reduce transmission to children.

If a woman chooses to decline testing, she will not receive the test. However, she will continue to receive HIV counseling throughout the pregnancy so that she may be as informed as possible about the disease and its impact. She will be offered HIV testing at all stages of her pregnancy in case she changes her mind.

HIV testing begins with a screening test. The most common screening test is the rapid HIV antibody test which tests for HIV antibodies in blood, urine, or oral fluid. HIV antibodies are only produced if an individual is infected with the disease. Therefore, presence of the antibodies is indicative of an HIV infection. Sometimes, however, a person may be infected with HIV but the body has not produced enough antibodies to be detected by the test. If a woman has risk factors for HIV infection but tests negative on the initial screening test, she should be retested in 3 months to confirm that she does not have HIV. Another screening test that is more specific is the HIV antigen/antibody test. This is a newer blood test that can detect HIV infection quicker than the antibody test because it detects both virus particles and antibodies in the blood.

Any woman who has a positive HIV screening test must receive follow-up testing to confirm the diagnosis. The follow-up test can differentiate HIV-1 from HIV-2 and is a more specific antibody test. It may also detect the virus directly in the bloodstream.

Neonatal withdrawal is prevented by the mother abstaining from substance abuse. In some cases, a prescribed medication may have to be discontinued during the pregnancy to prevent addiction by the baby. Early pre-natal care can identify addictive behaviors in the mother and family system. Referrals to treatment centers is appropriate. Some prescribed medicines should not be stopped without medical supervision, or harm may result. Women can discuss all medicines, and alcohol and tobacco use with their health care provider and get assistance to help stop drug use as soon as possible. Indications that a woman needs help if she is:

- Using drugs non-medically

- Using drugs not prescribed to you

- Using alcohol or tobacco

If she is already pregnant and takes medicines or drugs not prescribed to her, she can talk to a health care provider about the best way to keep to keep the baby safe. Some medicines should not be stopped without medical supervision, or harm may result. Your health care provider will know how best to manage the risks.

In an effort to further refine the United Nations guideline for optimal infant feeding options for HIV-infected mothers, the World Health Organization (WHO) held a three-day convention in Geneva in 2006 to review new evidence that had been established since they last established a guideline in 2000. Participants included UN agencies, representative from nongovernmental organizations, researchers, infant feeding experts, and WHO headquarters departments. The convention concluded with the following recommendations: If replacement feeding is acceptable, feasible, affordable and safe, HIV-infected mothers are recommended to use replacement feeding. Otherwise, exclusive breastfeeding is recommended. At six months, if replacement feeding is still not available, HIV-infected mothers are encouraged to slowly introduce food while continuing breastfeeding. Those with HIV-infected infants are recommended to continue breastfeeding even after 6 months.

According to current recommendations by the WHO, US CDC and U.S. Department of Health and Human Services (DHHS), all individuals with HIV should begin ART. The recommendation is stronger under the following conditions:

- CD4 count below 350 cells/mm

- High viral load (>100,000 copies/ml)

- Progression of HIV to AIDS

- Development of HIV-related infections and illnesses

- Pregnancy

Women are encouraged to begin treatment as soon as they are diagnosed with HIV. If they are diagnosed prior to pregnancy, they should continue with ART during the pregnancy. If the diagnosis of HIV is made during the pregnancy, ART should be initiated immediately.

Measurements of a child’s growth provide the key information for the presence of malnutrition, but weight and height measurements alone can lead to failure to recognize kwashiorkor and an underestimation of the severity of malnutrition in children.

Obstetric ultrasound has become useful in the assessment of the cervix in women at risk for premature delivery. A short cervix preterm is undesirable: A cervical length of less than 25 mm at or before 24 weeks of gestational age is the most common definition of cervical incompetence.

Fetal fibronectin (fFN) has become an important biomarker—the presence of this glycoprotein in the cervical or vaginal secretions indicates that the border between the chorion and deciduas has been disrupted. A positive test indicates an increased risk of preterm birth, and a negative test has a high predictive value. It has been shown that only 1% of women in questionable cases of preterm labor delivered within the next week when the test was negative.

Access to available resources for the prevention of MTCT of HIV varies across different cultural regions. “MTCT of HIV has been virtually eliminated in well-resourced settings such as the United States and Europe”. Available medical and therapeutic resources in developed countries can include drugs for HIV-positive mothers during pregnancy and labour, cesarean delivery to reduce the infant's exposure to infection; and modifications in infant feeding practices. In third world settings, medical resources and technology can be very hard to find and can serve as a financial burden to HIV-positive mothers. HIV-infected mothers refer to counselors for expert knowledge and recommendations on infant feeding and health. Treatment amenities in resource-constrained settings are also available to HIV-positive mothers in the form of antiretroviral therapy (ART) which is one resource that has contributed to the elimination of MTCT of HIV in first world countries. In order to have access to resources, HIV-positive mothers must be able maintain follow up appointments regularly, however, this is problematic in resource-limited settings due to weak infrastructure in health care systems in countries such as India, Tanzania and Nigeria. This can also serve as a dilemma for HIV-positive mothers because although limited resources are available to them, financial constraint can prevent women from accessing available treatments. This can influence HIV-positive mother's decision to rely solely on breastfeeding as a primary feeding option due to financial instability.

Anthropological research demonstrates that in contexts where breastfeeding is essential to infant survival, such as in resource poor settings, PMTCT infant feeding guidelines challenge notions of motherhood and women's decision making power over infant care, and colour HIV positive mothers' infant feeding experiences. In eastern Africa, infant mortality is high and breastfeeding is vital for infant survival. Here, motherhood is defined as the responsibility for ensuring the child's proper growth and health. Breastfeeding is also seen as a cultural practice that helps create a social bond between mother and child. However, there is a disjuncture between PMTCT policy's infant feeding guideline and what is considered to be good mothering behaviour. The PMTCT policy promotes replacement feeding because it is believed to prevent the risk of transmission of HIV. However, adhering to such guidelines are difficult for mothers in resource-limited settings who believe that not breastfeeding one's child would be harmful to their health and survival, as well as threaten the “development of close bodily and emotional bonds between mother and child”. As such, not breastfeeding, for HIV-positive women, is perceived as failing to be a good mother. Thus, PMTCT programs impact HIV-positive women's agency and decision-making in infant care, as well as challenge their cultural conceptions of good motherhood.

Growth stunting is identified by comparing measurements of children's heights to the World Health Organization 2006 growth reference population: children who fall below the fifth percentile of the reference population in height for age are defined as stunted, regardless of the reason. The lower than fifth percentile corresponds to less than two standard deviations of the WHO Child Growth Standards median.

As an indicator of nutritional status, comparisons of children's measurements with growth reference curves may be used differently for populations of children than for individual children. The fact that an individual child falls below the fifth percentile for height for age on a growth reference curve may reflect normal variation in growth within a population: the individual child may be short simply because both parents carried genes for shortness and not because of inadequate nutrition. However, if substantially more than 5% of an identified child population have height for age that is less than the fifth percentile on the reference curve, then the population is said to have a higher-than-expected prevalence of stunting, and malnutrition is generally the first cause considered.

Neonatal sepsis of the newborn is an infection that has spread through the entire body. The inflammatory response to this systematic infection can be as serious as the infection itself. In infants that weigh under 1500 g, sepsis is the most common cause of death. Three to four percent of infants per 1000 births contract sepsis. The mortality rate from sepsis is near 25%. Infected sepsis in an infant can be identified by culturing the blood and spinal fluid and if suspected, intravenous antibiotics are usually started. Lumbar puncture is controversial because in some cases it has found not to be necessary while concurrently, without it estimates of missing up to one third of infants with meningitis is predicted.

Three main things are needed to reduce stunting:

- a kind of environment where political commitment can thrive (also called an "enabling environment")

- applying several nutritional modifications or changes in a population on a large scale which have a high benefit and a low cost

- a strong foundation that can drive change (food security, empowerment of women and a supportive health environment through increasing access to safe water and sanitation).

To prevent stunting, it is not just a matter of providing better nutrition but also access to clean water, improved sanitation (hygienic toilets) and hand washing at critical times (summarised as "WASH"). Without provision of toilets, prevention of tropical intestinal diseases, which may affect almost all children in the developing world and lead to stunting will not be possible.

Studies have looked at ranking the underlying determinants in terms of their potency in reducing child stunting and found in the order of potency:

- percent of dietary energy from non-staples (greatest impact)

- access to sanitation and women's education

- access to safe water

- women's empowerment as measured by the female-to-male life expectancy ratio

- per capita dietary energy supply

Three of these determinants should receive attention in particular: access to sanitation, diversity of calorie sources from food supplies, and women's empowerment. A study by the Institute of Development Studies has stressed that: "The first two should be prioritized because they have strong impacts yet are farthest below their desired levels".

The goal of UN agencies, governments and NGO is now to optimise nutrition during the first 1000 days of a child's life, from pregnancy to the child's second birthday, in order to reduce the prevalence of stunting. The first 1000 days in a child's life are a crucial "window of opportunity" because the brain develops rapidly, laying the foundation for future cognitive and social ability. Furthermore, it is also the time when young children are the most at risk of infections that lead to diarrhoea. It is the time when they stop breast feeding (weaning process), begin to crawl, put things in their mouths and become exposed to faecal matter from open defecation and environmental enteropathies.

Measures have been taken to reduce child malnutrition. Studies for the World Bank found that, from 1970 to 2000, the number of malnourished children decreased by 20 percent in developing countries. Iodine supplement trials in pregnant women have been shown to reduce offspring deaths during infancy and early childhood by 29 percent. However, universal salt iodization has largely replaced this intervention.

The Progresa program in Mexico combined conditional cash transfers with nutritional education and micronutrient-fortified food supplements; this resulted in a 10 percent reduction the prevalence of stunting in children 12–36 months old. Milk fortified with zinc and iron reduced the incidence of diarrhea by 18 percent in a study in India.

Physicians, Nurse Practitioners, Physician Assistants, Nurses and Midwives will typically ask for the need of relief. Women in labor have many pain relief options that work well and pose small risks when given by a trained and experienced clinician. Clinicians also can use different methods for pain relief at different stages of labor. Still, not all options are available at every hospital and birthing center. Depending on the health history of the mother, the presence of allergies or other concerns, some choices will work better than others.

There are many methods of relieving pain used for labor. Rare and unpredictable, serious complications sometimes occur. Also, most medicines used to manage pain during labor pass freely into the placenta to the baby. Asking questions about the procedures and medications might affect the baby are valid questions.

Families who are impacted by SIDS should be offered emotional support and grief counseling. The experience and manifestation of grief at the loss of an infant are impacted by cultural and individual differences.

Opinions differ about optimal screening and diagnostic measures, in part due to differences in population risks, cost-effectiveness considerations, and lack of an evidence base to support large national screening programs. The most elaborate regimen entails a random blood glucose test during a booking visit, a screening glucose challenge test around 24–28 weeks' gestation, followed by an OGTT if the tests are outside normal limits. If there is a high suspicion, a woman may be tested earlier.

In the United States, most obstetricians prefer universal screening with a screening glucose challenge test. In the United Kingdom, obstetric units often rely on risk factors and a random blood glucose test. The American Diabetes Association and the Society of Obstetricians and Gynaecologists of Canada recommend routine screening unless the woman is low risk (this means the woman must be younger than 25 years and have a body mass index less than 27, with no personal, ethnic or family risk factors) The Canadian Diabetes Association and the American College of Obstetricians and Gynecologists recommend universal screening. The U.S. Preventive Services Task Force found there is insufficient evidence to recommend for or against routine screening.

Some pregnant women and careproviders choose to forgo routine screening due to the absence of risk factors, however this is not advised due to the large proportion of women who develop gestational diabetes despite having no risk factors present and the dangers to the mother and baby if gestational diabetes remains untreated.

Symptoms and the isolation of the virus pathogen the upper respiratory tract is diagnostic. Virus identification is specific immunologic methods and PCR. The presence of the virus can be rapidly confirmed by the detection of the virus antigen. The methods and materials used for identifying the RSV virus has a specificity and sensitivity approaching 85% to 95%. Not all studies confirm this sensitivity. Antigen detection has comparatively lower sensitivity rates that approach 65% to 75%.

Infants who are colicky do just as well as their non colicky peers with respect to temperament at one year of age.

A large investigation into diphtheria-tetanus-pertussis vaccination and potential SIDS association by Berlin School of Public Health, Charité – Universitätsmedizin Berlin concluded: "Increased DTP immunisation coverage is associated with decreased SIDS mortality. Current recommendations on timely DTP immunisation should be emphasised to prevent not only specific infectious diseases but also potentially SIDS."

Many other studies have also reached conclusions that vaccinations reduce the risk of SIDS. Studies generally show that SIDS risk is approximately halved by vaccinations.

Colic is diagnosed after other potential causes of crying are excluded. This can typically be done via a history and physical exam, and in most cases tests such as X-rays or blood tests are not needed. Babies who cry may simply be hungry, uncomfortable, or ill. Less than 10% of babies who would meet the definition of colic based on the amount they cry have an identifiable underlying disease.

Cause for concern include: an elevated temperature, a history of breathing problems or a child who is not appropriately gaining weight.

"Red flag" indicating that further investigations may be needed include:

- Vomiting (vomit that is green or yellow, bloody or occurring more than 5/day)

- Change in stool (constipation or diarrhea, especially with blood or mucous)

- Abnormal temperature (a rectal temperature less than or over

- Irritability (crying all day with few calm periods in between)

- Lethargy (excess sleepiness, lack of smiles or interested gaze, weak sucking lasting over 6 hours)

- Poor weight gain (gaining less than 15 grams a day)

Problems to consider when the above are present include:

- Infections (e.g. ear infection, urine infection, meningitis, appendicitis)

- Intestinal pain (e.g. food allergy, acid reflux, constipation, intestinal blockage)

- Trouble breathing (e.g. from a cold, excessive dust, congenital nasal blockage, oversized tongue)

- Increased brain pressure (e.g., hematoma, hydrocephalus)

- Skin pain (e.g. a loose diaper pin, irritated rash, a hair wrapped around a toe)

- Mouth pain (e.g. yeast infection)

- Kidney pain (e.g. blockage of the urinary system)

- Eye pain (e.g. scratched cornea, glaucoma)

- Overdose (e.g. excessive Vitamin D, excessive sodium)

- Others (e.g. migraine headache, heart failure, hyperthyroidism)

Persistently fussy babies with poor weight gain, vomiting more than 5 times a day, or other significant feeding problems should be evaluated for other illnesses (e.g. urinary infection, intestinal obstruction, acid reflux).

Medical organizations strongly discourage drinking alcohol during pregnancy. Alcohol passes easily from the mother's bloodstream through the placenta and into the bloodstream of the fetus, which interferes with brain and organ development. Alcohol can affect the fetus at any stage during pregnancy, but the level of risk depends on the amount and frequency of alcohol consumed. Regular heavy drinking and binge drinking (four or more drinks on any one occasion) pose the greatest risk for harm, but lesser amounts can cause problems as well. There is no known safe amount or safe time to drink during pregnancy.

Prenatal alcohol exposure can lead to fetal alcohol spectrum disorders (FASDs). The most severe form of FASD is fetal alcohol syndrome (FAS). Problems associated with FASD include facial anomalies, low birth weight, stunted growth, small head size, delayed or uncoordinated motor skills, hearing or vision problems, learning disabilities, behavior problems, and inappropriate social skills compared to same-age peers. Those affected are more likely to have trouble in school, legal problems, participate in high-risk behaviors, and develop substance use disorders themselves.