I am a Health Visitor

This episode links really well with our previous episodes about combination feeding and giving top ups (linked in resources section below). In this episode Jen shares all her IBCLC wisdom with us on expressing breastmilk. How much do you know about flanges?! We talk about: - when to express - the emotional and physical load of pumping - how to pump - 'hands on' expressing - does the flange fit - how much milk to expect Resources and Further Reading: Our previous episode on Combination Feeding with Lucy Ruddle (IBCLC and author of 'Mixed Up'): https://soundcloud.com/iamahealthvisitor/combination-feeding-with-lucy-ruddle-ibclc?utm_source=clipboard&utm_medium=text&utm_campaign=social_sharing Our previous episode on Top Ups: https://soundcloud.com/iamahealthvisitor/top-ups-when-what-how-and-how-much-to-give?utm_source=clipboard&utm_medium=text&utm_campaign=social_sharing Breastfeeding twins and triplets charity (Kathryn Stagg IBCLC): https://breastfeedingtwinsandtriplets.co.uk Hand Expressing Video: https://globalhealthmedia.org/videos/how-to-express-breastmilk/ Hands Free Pumping Bra Hack: https://www.youtube.com/watch?v=8stY-2fxt4M Flange Sizing: (see our instagram account 'IamaHV' for a visual) Hands On Expressing: http://www.nancymohrbacher.com/articles/2012/6/27/to-pump-more-milk-use-hands-on-pumping.html Some social media pages to follow and recommend for free resources: Olivia - Hospital Lactation Consultant https://www.instagram.com/olivia_lactation_consultant/?hl=en Stacey Zimmel at Feed Eat Speak: https://www.instagram.com/feedeatspeak/ Kathryn Stagg IBCLC https://www.instagram.com/kathrynstaggibclc/

Jen and Amy delve into the murky world of infant poo in the first six months! What to expect, what is a worry and what isn't. How is poo different between formula and breast or chestfed babies? Or mixed fed babies? What does that green poo mean? What about giving a bit of fruit juice or water for constipation? We answer all your questions and as usual it turns out to be more complicated than we imagined! Thanks to a listener for this request! Do get in touch with any questions, comments or suggestions for future episodes on iamahealthvisitor@gmail.com Thanks for listening! Amy and Jen Resources The baby poo gallery: https://www.facebook.com/babypoogallery/ Philippa Pearson-Glaze IBCLC on green poo: https://breastfeeding.support/why-is-my-babys-poop-green/ Drugs in Breastmilk Advice: https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/ Child Liver Disease on pale stools: https://www.childliverdisease.org/wp-content/uploads/2018/01/Yellow-Alert-Stool-Chart-Bookmark.pdf Frequency of stool slowing - Carol Smythe IBCLC: https://www.carolsmyth.co.uk/breastfeeding-resources/posts/2016/december/should-my-breastfed-baby-poo-every-day-or-is-breast-milk-all-used-up/ First Steps Nutrition: https://www.firststepsnutrition.org Our previous episode on the Aptamil formula changes: https://soundcloud.com/iamahealthvisitor/those-aptamil-formulation-changes GP Infant Feeding Network on constipation: https://gpifn.org.uk/constipation/

Amy and Jen take a dive into a recent research paper suggesting there may be a newly identified biomarker for infants at high risk of SIDS. We look at the recent paper in detail, review the statistics and the methodology and consider what we are able to say and what we are not, as well as possible harms that might come from misinterpretation of the results. We also discuss the article in the context of the current theoretical approaches to SIDS research and general safe sleep advice which importantly still needs to be followed. We love to hear from you. Contact us with suggestions or ideas for future episodes at iamahealthvisitor@gmail.com. Thanks for listening, Amy and Jen References and Resources for further reading: Harrington, Hafid & Waters 2022 - the full text article: https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(22)00222-5/fulltext Media coverage: 1. https://www.biospace.com/article/researchers-answer-how-and-why-infants-die-from-sids/?utm_content=207502735&utm_medium=social&utm_source=facebook&hss_channel=fbp-10530620221 2. https://www.theverge.com/2022/5/13/23071364/sids-research-hype-science-studies for context - there is so much about SIDS deaths we still do not understand: https://www.nejm.org/doi/full/10.1056/NEJMp2119221 Critical analysis of the media hype: https://www.theatlantic.com/health/archive/2022/05/sudden-infant-death-syndrome-cause-study/629886/ Lullaby trust statement about this article: https://www.lullabytrust.org.uk/our-response-to-new-australian-sids-biomarker-study/

Amy and Jen chat to the inspiring Alison Spiro who has a PhD in anthropology as well as practicing as a health visitor. Listing all her achievements is a podcast summary in itself, but across her career she has worked as a breastfeeding counsellor herself, established an incredibly successful peer support service, taken both a hospital and community trust to BabyFriendly accreditation, worked on the world breastfeeding trends initiative report in 2015, contributes to the APPG on infant feeding on behalf of BestBeginnings, volunteers with the Breastfeeding Alliance, has been the iHV expert advisor on breastfeeding. Most recently, she is the author of 'Breastfeeding for Public Health: A resource for community healthcare professionals'. We discuss with Alison some of the most important issues in breastfeeding support - from culture and anthropology to emotions, wellbeing, mental health and therapeutic communication skills. We talk about the importance of debriefing your own infant feeding experiences and bringing an unbiased listening ear to your interactions with families. Hopefully this will be an interesting and relevant discussion for your health visiting practice. We would love to her your thoughts and comments at iamahealthvisitor@gmail.com Reading & Resources: Alison's new book - 'Breastfeeding for Public Health: A resource for community healthcare professionals': https://www.amazon.co.uk/Breastfeeding-Public-Health-Healthcare-Professionals/dp/0367689561/ref=sr_1_2?crid=3M4VF06U18GP7&keywords=breastfeeding+for+public+health&qid=1652711900&sprefix=breastfeeding+for+p%2Caps%2C71&sr=8-2 World Breastfeeding Trends Report: https://www.worldbreastfeedingtrends.org/resources/publications Becoming Breastfeeding Friendly with Yale University: https://ysph.yale.edu/bfci/ Kathryn Stagg IBCLC: https://kathrynstaggibclc.com Eve Canavan lived experience story: https://www.app-network.org/news-events/news/personal-experiences/story-eves/

This week Jen talks to Maria Renshaw who runs a local sling library in Colchester about her experience of slings and all things baby-wearing from a very practical perspective. She goes through different types of baby wearing from soft wrap slings to buckle carriers with some tips on the differences, fitting, safety tips including the TICKs acronym, common worries about hips and knees, how to find your local services for sharing with parents. Thanks so much Maria for sharing your experience and knowledge with us! As ever we love to hear from you, contact us with your comments or feedback on iamahealthvisitor@gmail.com Amy and Jen References and Resources: Maria's website: https://www.beautiful-bonds.co.uk/meet-the-team The TICKS rules for safe baby wearing: http://babyslingsafety.co.uk Sling Pages (to find a local sling library): http://www.slingpages.co.uk 'Why Babywearing Matters' by Rosie Knowles https://www.amazon.co.uk/Why-Babywearing-Matters-Pinter-Martin/dp/1780665350 Babywearing training and resources: https://www.carryingmatters.co.uk/training/

Amy and Jenny chat to the lovely Alice from the Baby and Infant Sleep Information Source (BASIS) about sleep pods and nests. We cover the evidence base - what can we and can't we say about these products. Are they safe or not? In what circumstances? How do we actually know one way or the other? We talk about what manufacturing standards these products are held to, as well as some of more the hidden risks and implications the use of these items have. We also consider the disproportionate impact on families who live with a low income, who may be tempted to recreate homemade versions and leading to a cluster of co-occurring SIDS risks. Alice tells us about her research from a recent survey with parents about their use of sleep pods and we discuss how to have appropriate conversations with families to help minimise risk while sticking to the evidence base and avoiding scaremongering or judgement. We have quite a few other episodes on sleep now - so do check back through our back catalogue if this is a topic that interests you! Thanks so much for listening everyone - we would love to hear from you with any comments or suggestions to iamahealthvisitor@gmail.com Resources and Further Reading: The BASIS website - check out their resources if you haven't ever used them, they're brilliant: https://www.basisonline.org.uk Professor Helen Ball webinar on "What is Normal Infant Sleep: The View From Anthropology": https://www.youtube.com/watch?v=g5fOogsUpIk Lullaby Trust Resources on Baby Products: https://www.lullabytrust.org.uk/safer-sleep-advice/sleeping-products/ and: https://www.lullabytrust.org.uk/wp-content/uploads/The-Lullaby-Trust-Product-Guide-Web.pdf Specific to sleep positioners: https://www.lullabytrust.org.uk/are-sleep-positioners-safe-for-babies/

Jen and Amy go through the world of contraceptive advice. Although not directly our work, it's definitely connected and very relevant to health visitors. Often a bit of a neglected topic, it can be something we feel uncomfortable or poorly prepared to discuss with families. We hope our discussion solves some of those problems as we go through the contraceptive options for families, talk about contraception and lactation and the more emotional side of the conversation about physical intimacy after the birth of a baby. References and further reading: Faculty for Sexual and Reproductive Health Guideline: https://www.fsrh.org/documents/contraception-after-pregnancy-guideline-january-2017/ NHS Contraception Guide: https://www.nhs.uk/conditions/contraception/ Lactation and Breastfeeding: https://www.breastfeedingnetwork.org.uk/contraception/ iCaSH Sexual Health Service & the C-Card Scheme: https://www.icash.nhs.uk/contraception-sexual-health/c-card-scheme Emotional Factors and broader conversation prompts: https://www.nct.org.uk/life-parent/sex-after-baby/sex-after-baby-10-questions-ask-yourself

Jen and Amy gently guide you through the main headlines of the huge, massive, overwhelming and generally awe inspiring 'CHILD Cohort Study' all about the human microbiome. We will discuss how all the things you might expect, and some very unexpected factors, can all impact the infant microbiome and the important long term impacts this can have on that child's health. If you would like to look more into the myriad of research which has been produced from the CHILD dataset, just do a quick google scholar search and you will find heaps to keep you going. For a more curated starting point, check out our further reading down below! We love to hear from you, contact us on iamahealthvisitor@gmail.com Thanks for listening! Further reading: YouTube Summary of the CHILD study: https://youtu.be/eL9dAGiCNLU Study website with the key discoveries highlighted: https://childstudy.ca/portfolio/key-discoveries/

We discuss postnatal anxiety, specifically the measurement of anxiety after birth. In practice we are often using generic anxiety measures which are simply just not appropriate for use in this specific period of a parent's life. Listen in to learn more about the scale, how it can be used and how you might be able to incorporate it in your clinical practice. As ever, we love to hear from you. Get in touch with comments or suggestions at iamahealthvisitor@gmail.com If you would like to use the PSAS in your practice or you would like to be involved with her stakeholder engagement research then Vicky would love to hear from you! Email her at vfallon@liverpool.ac.uk. Resources and Further Reading: Dr Vicky Fallon - other relevant publications mentioned in the episode: 1. A feasibility trial of a single session Acceptance and Commitment Therapy intervention to reduce fear of childbirth in first time mums. https://www.tandfonline.com/doi/full/10.1080/08870446.2021.2024190 2. Challenges and opportunities for child health services in responses to the COVID-19 pandemic https://www.tandfonline.com/doi/full/10.1080/02646838.2021.1890422 THE POSTPARTUM SPECIFIC ANXIETY SCALE - Research Background: Parent Infant Foundation Briefing Paper: https://www.researchgate.net/profile/Sergio-Silverio-2/publication/351736241_The_Postpartum_Specific_Anxiety_Scale_PSAS_Briefing_Paper/links/60a6c586299bf1031fbe1378/The-Postpartum-Specific-Anxiety-Scale-PSAS-Briefing-Paper.pdf Validation study: https://link.springer.com/article/10.1007/s00737-016-0658-9 Short form validation: Creation and validation of the Postpartum Specific Anxiety Scale Research Short-Form (PSAS-RSF) https://pubmed.ncbi.nlm.nih.gov/33900462/ Childbearing specific validation - predicts infant feeding outcomes: https://link.springer.com/article/10.1007/s00737-017-0775-0

Amy and Jen discuss a government guidance document published in the past year which reviews the Hepatitis B selective immunisation pathway for pregnant people and newborns. We look at this guidance from the perspective of health visitors in practice - what do you need to know? What should be happening, what actually IS happening and what do you need to do when this crops up on your caseload? As ever we love to hear from you with any comments or thoughts by email on iamahealthvisitor@gmail.com. Resources and Further Reading: I am a HV episode on the Hexavalent vaccine: https://soundcloud.com/iamahealthvisitor/changes-to-the-immunisation-schedule-august-2017-episode-2 Guidance Document - Hepatitis B antenatal screening and selective neonatal immunisation pathway. https://www.gov.uk/government/publications/hepatitis-b-antenatal-screening-and-selective-neonatal-immunisation-pathway

Extra bonus episode! In this special extra episode, Jen and Amy talk to the lovely Kitty Lamb of the CPHVA Education Development Trust Macqueen Bursary team. Kitty walks us through the types of projects the Macqueen bursary funds and how to apply. Hopefully it will give you lots of ideas for your own career development projects. Good luck and get applying! The deadline is the 29th January 2022. To reach Jen and Amy, you can email the podcast at iamahealthvisitor@gmail.com Resources: Download the Macqueen form and guidance document from here: https://cphvaeddevtrust.wordpress.com Macqueen bursary social media: Twitter: https://twitter.com/cphvaeddevtrust Facebook: https://www.facebook.com/cphvaeddevtrust/

Happy new year everyone! For our first podcast of 2022 we are lucky to be joined by Hannah Poulton, who is an experienced physiotherapist with a specialism in women's health, scar therapy and c-section recovery. We talk all things pelvic floor! We learned heaps from this episode and could have talked all day, so hopefully this episode will really help you add to your clinical knowledge in this important area. As ever, we love to hear from you with any comments in relation to this episode or any other. Get in touch with us by email at iamahealthvisitor@gmail.com References and further reading: Follow Hannah on social media at HLP Therapy: https://www.instagram.com/hlptherapy/ Hannah's YouTube page: https://www.youtube.com/channel/UCWv85jKP4N2WZSfWxTdreIw Physiotherapy centre Liverpool: https://thephysiotherapycentre.com https://www.instagram.com/thephysiotherapycentre/?hl=en https://www.facebook.com/PHYSIOTHERAPYCENTRE1/

Merry Christmas! Get your IamaHV Bingo card at the ready (downloadable from our twitter and instagram feeds @IamaHV), mince pies and cup of tea lined up and get ready to laugh. A lot. Have your tissues at the ready for the last section, which got unexpectedly emotional! Thank-you everyone for all your amazing funny stories. You are all hilarious! Thank-you to our volunteer voices who have recorded the specially selected few. Thank-you to every single one of you who is continuing to just. keep. going. through everything and still managing to have a smile on your face from time to time. You are awesome. Merry Christmas with so much love, Jen and Amy x iamahealthvisitor@gmail.com

Amy and Jen talk about something we see and manage all the time, but as we always find there is more to it than meets the eye! We discuss definitions and different forms of jaundice in terms of the underlying mechanism, red flags and risk factors, assessment including how to spot jaundice in darker skin tones (and some promising new tech to help with this!), how to judge severity and what your management plan should be. We also talk a lot about feeding issues - as is to be expected with this topic. The episode would pair really well with our top-ups episode where Jen puts her IBCLC hat on to give us loads of detail on how to supplement a baby who is struggling to transfer enough milk at the breast, if you wanted to check that one out too the link is in the resources section below. We also discuss some International differences with the management and response to jaundice and wonder whether there are lessons we can learn from other places in the world. We always love to hear from you - please do get in touch with any comments or suggestions by email iamahealthvisitor@gmail.com. You can also send us your funny anecdotes for our Christmas episode to this address too! **References and Further Reading: ** Our Top-Ups Podcast Episode: https://soundcloud.com/iamahealthvisitor/top-ups-when-what-how-and-how-much-to-give?si=d2195fa54aa04d19aec62fdcb4e5d179 Pilot study of a smartphone app for jaundice recognition in babies with darker skin tones: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216970 NICE Clinical Knowledge Summary for Jaundice: https://cks.nice.org.uk/topics/jaundice-in-the-newborn/ Massage for neonatal jaundice - an RCT: https://europepmc.org/article/med/33116094 Systematic Review of Massage for neonatal jaundice: https://www.sciencedirect.com/science/article/abs/pii/S1355184119301255 ABM Jaundice Protocol: https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/22-jaundice-protocol-english.pdf NHS Direct page: https://www.nhs.uk/conditions/jaundice-newborn/

Ahead of road safety week, Amy and Jen talk to two experts in car seat safety to get the key messages for you to pass onto parents. I know I often talk with parents at the antenatal contact about what kit they have bought for baby, often they are keen to share with me their ideas or thoughts and often quite receptive to suggestions regarding safety. When it comes to car seats, I am often out of my depth and struggle with what to tell them! There's huge variety in safety and mistakes with fitting to the car and fitting the child in the seat are common. We are sure you will learn heaps from this discussion, just as we did. Thankyou to Margaret and Ron for all your time and passion - it really came across so strongly. For more information see the resources on Margaret's website and Facebook page, listed below. If you would like to contribute to our conversation or for thoughts or feedback please do contact us on iamahealthvisitor@gmail.com **Resources and Further Reading: ** Margaret's Website: www.rearfacingtoddlers.com YouTube Channel: www.youtube.com/rearfacingtoddlers Facebook Page (Car Seat Advice UK): https://www.facebook.com/groups/CSAUK Check It Fits Ireland service (where Ron is based): https://www.rsa.ie/road-safety/road-users/passengers/children/check-it-fits

Have you ever considered a career in academia? Or perhaps a blended career with a mixture of clinical and research across your week? If so then listen in as Amy chats about the process of finding and applying for a PhD. You might be more well qualified than you realise! Health visitors make excellent candidates because of our passion for evidence based healthcare and our ability to read and think critically about the literature; applying it to real life. For comments, suggestions or questions get in touch at iamahealthvisitor@gmail.com Further reading and Resources: National Institute of Healthcare Research Fellowship Programmes: https://www.nihr.ac.uk/explore-nihr/academy-programmes/fellowship-programme.htm Find a PhD: https://www.findaphd.com

Jen is leading the way this week sharing her IBCLC knowledge with us on the topic of mastitis. We discuss a new school of thought on the treatment of blocked ducts as inflammation - moving away from vigorous massage and towards cold compresses and Ibuprofen. What's the deal with cabbage leaves - an old wives tale or does it work? What about antibiotics? How might disposable nappies be helpful here? All these questions and more. As ever, there is more to know than we realised! As ever we welcome your thoughts and contact about all our episodes, email us at iamahealthvisitor@gmail.com Resources and Further Reading: Nancy Morbacher's Website: http://www.nancymohrbacher.com NHS Choices: https://www.nhs.uk/conditions/mastitis/ La Leche League: https://www.laleche.org.uk/mastitis/ KellyMom (American IBCLC run evidence based page): https://kellymom.com/bf/concerns/mother/mastitis/ Breastfeeding Network: https://www.breastfeedingnetwork.org.uk/wp-content/dibm/BFN%20Mastitis%20feb%2016.pdf The Flipple Technique for a deep latch: https://www.llli.org/breastfeeding-info/positioning/ https://www.lactationmotivation.com/post/using-the-flipple-technique Positioning including Laid Back/Biological Nurturing Breastfeeding Positions: https://www.llli.org/breastfeeding-info/positioning/ The TABBY Tool for Tongue Tie assessment: https://pubmed.ncbi.nlm.nih.gov/31346346/ NICE clinical knowledge summary on Mastitis: https://pubmed.ncbi.nlm.nih.gov/31346346/ Bergmann, H; Rodriguez, J.M; Salminen, S; et al (2014) Probiotics in human milk and probiotic supplementation in infant nutrition: A workshop report. British Journal of Nutrition 112(7) 547-549 cited in Mohrbacher, N (2021) Breastfeeding Answers (2nd Edition). Available from: https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/probiotics-in-human-milk-and-probiotic-supplementation-in-infant-nutrition-a-workshop-report/EBA29A2197CEBDFB90950B2628552309#

Our 'bread and butter' (no pun intended!) but as with everything our perspective and advice changes over time so time for an update! What are the current important messages we should be conveying to parents as they begin to introduce solids to their babies. Why should we not be calling it 'weaning' and what about giving milk alongside solids? What signs of readiness should we look for? What is responsive feeding in terms of solid foods and what key messages about this should we be passing on to parents? What is the current guidance on introducing allergens, including where there is a known allergy in the family? We put the emphasis on discussing the important messages about food - feeding responsively to the child's cues, building healthy habits for life, satiety and hunger signals, the social aspects of a mealtime and enjoyment of food; rather than on arbitrary rules or lists of requirements. We would love to hear from you with any thoughts or suggestions, email us at iamahealthvisitor@gmail.com **Resources and Further Reading: ** Our previous podcast - Does early weaning REALLY make babies sleep better?: https://soundcloud.com/iamahealthvisitor/does-early-weaning-really-help-babies-sleep-better Dewey 2001 - Nutrition, growth, and complementary feeding of the breastfed infant: https://pubmed.ncbi.nlm.nih.gov/11236735/ First Steps Nutrition 'Eating well recipe book Simple, cost-effective ideas for the whole family': https://www.firststepsnutrition.org/eating-well-infants-new-mums Introducing allergens to baby - Allergy UK: https://www.allergyuk.org/assets/000/002/342/Weaning_–_Introducing_your_baby_to_solids_original.pdf?1547805087 St John's Ambulance: https://www.youtube.com/watch?v=oswDpwzbAV8 Introducing solids to the breastfed baby: https://kellymom.com/nutrition/starting-solids/solids-how/ Rewards and Punishments for food - Why not?: https://www.health.qld.gov.au/news-events/news/ask-an-expert-reward-punish-children-with-food HENRY - Health Exercise and Nutrition for the Really Young: https://www.henry.org.uk NHS Choices info on food storage and preparation: https://www.nhs.uk/start4life/weaning/safe-weaning/preparing-food-safely/#anchor-tabs Feed Eat Speak: https://www.feedeatspeak.co.uk

Amy and Jen discuss the importance of using the right language and being kind and respectful when working with parents. We go through the use of pronouns, preferred names and discuss LGBTQIA+ communities and how they relate to our role. We go back to basics with definitions for those people who don't yet understand the difference between sex and gender, what to do if you make mistakes and how to get it right; as well as talking briefly about the potential complexities of lactation and birth for transgender parents. You might think of these issues as niche but it they truly aren't - this is an issue for every single health professional. If you think it doesn't apply in your area, or you have not come across it yet, even more reason for you to listen to this and gain more knowledge and understanding. As a society we are on a journey to become kinder, more inclusive, more compassionate and more empathetic to other human beings. This is all part of that journey. We won't get it right every time - but we urgently need to start trying. We would love to hear your thoughts. If you feel we have missed something or you would like to contribute to this conversation please do drop us an email at iamahealthvisitor@gmail.com Resources and Reading: Mentioned in the podcast - The queer birth club - https://queerbirthclub.co.uk 'Animal: The Autobiography of a Female Body' by Sara Pascoe Academy of Breastfeeding Medicine Clinical Protocol: https://abm.memberclicks.net/assets/33%20Lactation%20Care%20for%20LGBTQ%20Plus%20Patients.pdf Brighton Midwives Gender Inclusion: https://www.bsuh.nhs.uk/maternity/our-services/specialist-support/gender-inclusion/ Statistics on Outcomes for Transgender People: https://www.stonewall.org.uk/sites/default/files/trans_stats.pdf Additional Resources: If you are looking to understand more about gender issues there are some excellent resources to help you learn. Gender Spectrum - a range of excellent summary articles covering the essentials: https://www.genderspectrum.org/articles/understanding-gender An Ally's Guide to Terminology: https://www.glaad.org/sites/default/files/allys-guide-to-terminology_1.pdf Birth for Every Body: Group of midwives aiming to make birth feel safe and inclusive for everyone: http://www.birthforeverybody.org

In the last of our summer #Replay series, we look back at a simple intervention health visitors can recommend in practice to resolve a common clinical issue. Health Visitors are well placed to identify these granulomas and advice parents on how to treat these, preventing unnecessary and potentially harmful treatment with silver nitrate. Jenny and Amy discuss what Health Visitors need to know to advise parents confidently on this, including the practicalities of how to apply the salt and common parent concerns with this. We would love to hear your thoughts or suggestions for future episodes. Email us at iamahealthvisitor@gmail.com Thanks for listening! iHV Top Tips for Parents: ihv.org.uk/wp-content/uploads/…a_26_9_2017_b-1.pdf iHV Good Practice Points: file:///Users/richard/Downloads/iHV_GPP_Treatment_of_Umbilical-Granuloma_19_9_2017_b-1.pdf