Baby Check is a systematic way of grading the severity of illness in infants. We studied its usefulness for assessing 53 infants presenting to a clinic in a West African village. Their ages ranged from 2 weeks to 7 months. The Baby Check scores ranged from 0 to 30. Forty-four infants were considered by the doctors to be well or mildly ill, 41 of these had scores below 9. The three infants with higher scores had symptoms and signs suggesting they were more than mildly ill. Nine infants were considered to be moderately ill. Their scores ranged from 4 to 30. The babies with the low scores had few symptoms and diagnoses suggesting they were only mildly ill. The babies with the highest scores all had diagnoses requiring medical attention. This pilot study of Baby Check in a developing country suggests that its use by health workers could increase the accuracy with which babies are referred for a medical opinion, and be a valuable tool for the identification of such infants in a busy clinic.