The Alarm Distress Baby Scale (ADBB)

Contact our Health Visitors service if you need support.

Babies communicate long before they can speak. Their facial expressions, movements, sounds and behaviour can all give clues about how they are feeling.

Health visitors are in a unique position to notice those early signs and support parents to understand and respond to their baby’s emotional needs. Tools such as the Alarm Distress Baby Scale can help identify when a baby may be showing signs of distress, so families can be offered additional support as early as possible.

This story looks at how our health visiting teams are using the tool alongside their existing skills to better understand infant wellbeing, strengthen early relationships and support healthy emotional development from the very start.

The Alarm Distress Baby Scale

The Alarm Distress Baby Scale (ADBB) is a tool that can be used by health visitors during routine checks to support infant wellbeing. It looks at a baby’s social behaviours, including eye contact, facial expression, vocalisation and activity levels, helping practitioners and families better understand how babies communicate how they are feeling.

It can also help identify early signs of psychological distress, so that additional support can be offered as soon as possible.

A key part of this is emotional attunement, noticing, understanding and responding sensitively to a baby or young child’s emotional state. When parents, carers and professionals recognise a baby’s cues and respond appropriately, it can help children develop a strong sense of security and trust.

Our health visiting teams across Hull and the East Riding work with families to strengthen these early relationships and help parents understand how everyday interactions can support a baby’s social and emotional development.

Karen Hardy, Specialist Health Visitor, said:

“Babies begin communicating from birth through facial expressions, body movements, sounds and behaviour. Attunement is about noticing those signals and responding with warmth, sensitivity and understanding.

“These everyday interactions help babies feel secure and support the development of healthy relationships, emotional regulation and resilience. Attunement is built through thousands of small moments — a smile returned, a cry comforted, a shared moment during feeding or play.

“These experiences help shape a baby’s developing brain and emotional wellbeing. We want families to know that being present, responsive and connected in everyday interactions can make a real difference.”

The difference it’s making

Humber has played a part in a wider national programme exploring how the Alarm Distress Baby Scale can support infant wellbeing and help identify families who may benefit from additional support at an earlier stage.

Her Royal Highness The Princess of Wales first saw the ADBB tool in use when she met health visitors in Denmark in February 2022. Since then, The Royal Foundation Centre for Early Childhood has worked with the Institute of Health Visiting to explore how the approach could benefit families across England, Wales, Scotland and Northern Ireland.

Humber was one of eight UK sites involved in the second phase of the Royal Foundation-backed study, building on earlier work to test how ADBB could be used as part of routine health visiting practice.

The approach is designed to complement the skills health visitors already use, giving them an additional way to observe a baby’s social behaviour, talk with parents about emotional wellbeing and identify when a family may need extra support.

Early findings have shown that the tool can be used within routine checks with minimal additional time, while helping health visitors have more focused conversations with families about bonding, responsiveness and infant emotional development.

One Health Visitor said:

“Once the ADBB training was completed, the tool was easily embedded into my practice alongside the skills I already use. It has helped with the early identification of families who may need additional support.

“Taking part in the research has also been really valuable. It has helped me see how changes in practice can make a difference and has sparked a real interest in this area of my work.”

The work is helping build a stronger understanding of infant emotional wellbeing and how recognising signs of distress early can support babies, parents and families from the very beginning.

Tips and advice

Simple Ways to Build Connection

Small, everyday interactions can make a big difference to a baby’s emotional development.

Try to notice your baby’s cues, including their facial expressions, movements and sounds. These can help you understand when they want to interact, when something is bothering them or when they need a break.

Responding to a smile, copying a sound or following your baby’s lead during play can help them feel noticed and understood. Everyday routines such as feeding, changing and bathing are also valuable opportunities for eye contact, talking, reassurance and connection.

Your own wellbeing matters too. Looking after yourself can make it easier to respond calmly and consistently to your baby, helping them feel safe and supported as they learn to understand and manage their own emotions.

How to get support

To learn more about what support is available for local families, Health Visitors provide advice through scheduled appointments at baby’s key milestones and offer drop in sessions or telephone support where needed.

Hull:
Call: 01482 259600
Email: hnf-tr.isphnspoc@nhs.net

East Riding:
Call: 01482 689689
Email: hull.cypcommunityservices@nhs.net

Find out more

Learn more about ADBB

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