"Giving babies a voice" can improve early identification and support
Study recommends innovative observational health visiting tool should be rolled out across the UK
Jane Barlow
An evaluation conducted by Professor Jane Barlow at the Department of Social Policy and Intervention (DSPI) in partnership with the Institute of Health Visiting (iHV) has found that an innovative observational tool can help heath visitors identify babies experiencing early psychological distress, discuss issues with parents and improve access to timely support.
The research recommends that the Alarm Distress Baby Scale (ADBB) should be rolled out across the UK, with ADBB training given to all health visitors and specialist training for practitioners working in Specialist Perinatal and Infant Mental Health services.
Professor Jane Barlow, Chair in Evidence-Based Intervention and Policy Evaluation (EBSIPE), commented: 'Babies communicate their emotional wellbeing long before they can use words yet these "signals" can be overlooked during routine assessments. Our evaluation shows that ADBB gives practitioners the skills to recognise babies' social cues, helping to "give babies a voice" and enhance conversations between health visitors and the babies’ families. By identifying issues earlier, health visitors can help provide timely support and potentially reduced the need for specialist help.'
The Alarm Distress Baby Scale (ADBB) is an internationally recognised observational tool used during routine health visiting checks. Rather than relying solely on parental reporting, it focusses on a baby’s social behaviours, such as eye contact, facial expression, vocalisation, and activity levels, to help practitioners and families understand the baby’s emotional wellbeing. By ‘giving babies a voice’, it can be used to recognise early signs of psychological distress, enabling specialist support to be accessed quickly.
Professor Barlow'By identifying issues earlier, health visitors can help provide timely support and potentially reduced the need for specialist help.'
Evaluating ADBB in UK health visiting
The evaluation was conducted in two phases.
The first phase, which ran from May 2023 to February 2024 across two NHS Trusts, explored whether a modified version of the tool (m-ADBB) could be incorporated into health visitors’ routine 6-8-week checks. The findings demonstrated that the approach was feasible and effective.
The second phase, conducted between October 2024 and March 2026 across eight locations in the UK, examined the impact of training health visitors in the use of ADBB and m‑ADBB. Researchers assessed how training influenced practitioners’ knowledge, confidence and practice, examined changes in identification, referrals and support at the 6–8-week postnatal review, and explored parents’ experiences of the approach.
Earlier identification and greater confidence
The evaluation found the ADBB model was effective by:
- Filling the gap: ADBB training addressed an important gap in health visiting practice by improving practitioners’ understanding of infant social withdrawal and increasing their confidence in observing and interpreting babies’ behaviour.
- "Giving the baby a voice": health visitors reported feeling better equipped to articulate the baby’s perspective, an area they felt received less emphasis in other training which often focuses more on parental behaviours. As a result, conversations with parents were richer and more balanced.
- Helping practitioners to recognise concerns: using ADBB, the proportion of babies identified with concerns increased from 7% to 12% during the routine 6-8 week review. Importantly, referrals to specialist services reduced, suggesting that ADBB helps health visitors to identify emerging needs earlier and provide general support.
- Building parents’ confidence: parents described the 6–8‑week review as reassuring, supportive and confidence‑building, highlighting the non‑judgemental communication with clear explanations of their baby’s behaviour and cues.
Supporting policy and practice
The evaluation provides evidence that ADBB is effective in the UK context and recommends that ADBB training should be made available to all UK health visitors. Based on this, the Royal Foundation Centre for Early Childhood is funding the iHV to produce an implementation guide for local authorities considering using the ADBB model. The funding will also enable the development of new UK-specific training resources.
The study was funded by The Royal Foundation.