New Born Baby /Infant
New Born Baby/ Infant
(Joy converted into overjoy)
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A child is a father of man "A new born baby is God's way of saying the world must continue, and is the best natural wonder so far- a baby born after conception from a single cell. "Newborn babies are wonderful , and at the same time terrifying for some, when they get unsettled or unwell. Mothers can feel quite overwhelmed by the responsibility of looking after such a tiny, fragile looking bring- and although a baby can be the best thing that ever happened to a couple / family- there may be times when even the most diligent parents may feel exasperated about handling their precious bundle of joy. The baby is wide awake for about 40 minutes after delivery. This is the time to put your arms around the baby and experience you first moments of bonding with his/her; this will probably help to make baby secure all her life. Danger signals in newborn : A newborn who appears sick and stops suckling must be shown immediately to your doctor. Is the baby normal One of the first questions that most parents ask after the birth of the baby is, "Is the baby alright ? Immediately after birth, babies are examined for any abnormalities such as anything that is under developed or sometimes which shouldn't have developed and for any evidence of problems / injuries caused by the actual process of being born (birth trauma). The baby is always given a score for his condition at one minute and five minutes respectively after birth. This is called 'APGAR' score- which is based on his activity, pulse (Heart rate), Grimace, Appearance (Color) and Respiration (Breathing). This is a score which a lot of parents worry about. It is a score intended for the doctors to "attend to " if need be rather then anything else. If there is a concern , a further score is carried out at 10 minutes and that is worth noting, as it will give an indication of any ongoing problem with your baby's development. APGAR scoreIt is calculated right after birth. It is meant to assess the condition of your baby in certain respects at 1 minute and 5 minute after birth. Sixty seconds after the complete birth of an infant, the five objective signs given in are evaluated., and each is given a score of 0, 1,or 2. A total score of ten indicates an infant in the best possible condition. Most normal babies score 7 to 10 points. An infant with a score of 0 to 3 requires immediate attention. Sign 0 Point 1 Point 2 Points Heart Rate Absent Less than 100/ minute More than 100/ minute Respiration Absent Slow, gasping Good or Crying Muscle Tone Limp Some flexion of limbs Active and Flexed Reflexive response to catheter placed in the infant's nose None Minimum grimace Cough, sneeze or cry Color Blue or Pale Body pink, extremities blue Completely pink Clinical Examination Soon after birth, all babies are examined from top to bottom for any abnormalities. A tube is passed through the nose to ensure the passage is fully developed and open, and also from the bottom to ensure the anus is open. On the morning after delivery the baby is given a through clinical examination again. The doctor listen to his heart, looks at the frontenelles (the two holes in baby's skull), and assess the baby's hip to see if they are loose or dislocated.  D.D.H Developmental displasia of hip (D.D.H) is one of the most important aspects in a new born baby- unfortunately many Indian parents are not even aware of this. All babies should be checked for D.D.H). Dislocated hips are probably the most important abnormalities to detect, as early treatment is simple and generally effective. For every baby with a true dislocated hip that is detected and treated (with a splint). Around 20 with 'clicky hips' (which are probably harmless) and have to ask the parents to bring the baby back for repeat examination. This may seem very annoying to parents but hips are so important that, it is better to be safe than sorry. If these hip problems are not detected at birth - then when your son reaches around 30 years of age, they could cause problems with hip pain or may require hip replacement at an early age etc.   Bluish Greenish Mark on Buttocks  These are normal birthmarks called 'Mongolian Spots' that fades in time. Cephalohematoma  If doctors use tools (forceps) during delivery, it can break the blood vessels under the scalp. If the blood builds up under the skin, there may be an increase in bilirubin and increase the risk of jaundice. Cephalohematoma occurs in 1 to 2 percent of all live births Cephalhaematoma :Cephalhaematoma is a localized swelling of the head in a new born baby- which may appear soon after birth or in the first 3-4 days of life. This is due to collection of blood between your baby's skull bones and a tough thin tissue called the periostium, which surrounds the bone (almost like a shrink wrap). Cephalhematoma most commonly occurs over the parietal bone. It can happen during normal deliveries or more commonly following instrumental deliveries like forceps and vacuum. Some times you may see after a caesarean section, as some doctors use a vacuum to get the baby's head out since a baby's head tends to be very slippery. This is a temporary swelling, it usually last for 3-4 weeks and generally disappear with time. If they are huge then they may cause increased chances of higher jaundice or sometimes, rarely, can get calcified, leading to a bump, which becomes less obvious as the baby grows, since 90 % of the head growth happens in the first two years of life. Succedaneum  Succedaneum is a different form of swelling of the head, due to which the head sometimes assumes conical shape. It is due to to fluid collection in between scalp and bone usually seen soon after birth, but more commonly after normal deliveries and disappears within a few days. They are temporary and do not cause any damage to the baby's head or brain and nothing need to be done. Sticky Eyes or Watery Eyes There is a myth that newborn babies should not have tears. But possibly the myth has come into being because generally the tears are generally not seen unless there is an overflow due to increased production during emotional upheavals. When babies get tears , there is another myth to "put breast milk into the eyes." in the erroneous belief that this due to an infection. Indeed teary eyes in babies are due to "blocked tear ducts" which can be treated with a firm massage of the tear ducts ti clear the blockage.,and generally there is no need for eye drops unless there is an infection. associated with it. But many parents give a gentle massage which leads to a blockage of tear glands. lasting longer than it should. . Generally this is very common in the first few weeks to months of life. If it persist beyond one year, most neonatologist, refer them to ophthalmologist whee they perform micro surgery to unblock the tear ducts. Jaundice in Newborn  Physiological Jaundice
Physiological Jaundice is fairly common, mild and usually harmless. Within the uterus the baby has an abundance of red blood cells. Once the baby is born and breathing, an excessive amount of red blood cells is not needed, so they break down until the level of cells is appropriate for the baby. A by-product of the breakdown of bilirubin, which deposits in the skin and is evident as yellow coloring. It is more common in induced labour, as it causes strong contractions, which can cause just before birth, an abnormally large amount of blood to be shunted to the baby. Extra blood means extra red blood cells, which predisposes the baby to jaundice. Feeding colostrum to the baby helps the baby to pass its first stool, which contains lot of bilirubin, which, if not quickly excreted, can be reabsorbed into the baby's blood stream. This is how colostrum may help prevent physiological jaundice. Hence colostrum should be fed to the baby. The hospital might give a jaundiced baby plenty of water to flush out its system. If this is the case , you should express colostrum or milk after or between feeds with your hands, since the baby whose thirst a slaked with water will reduce sucking. Your expression will stimulate and keep up your milk supply. Physiological jaundice normally appears after 30 hours. Peak level of bilirubin reached on the forth or fifth day and eyes return to the normal color by the seventh day. In physiological jaundice the bilirubin level normally does not exceed 10 mg/ ml. Blood Test On or after the second day of the baby's life , and provided the baby is feeding well, the doctor or nurse will take the blood from the baby for blood group, jaundice level (S.B.R) Serum Bilirubin, Hypothyroidism, and Guthrie test to rule out other conditions like phenylketonuria, G.6.P.D, galactocaemia, along with other metabolic disorders., which can affect the baby in ways, including causing disability and death. Babies with the disorders identified need either simple treatment or a specific diet to remain of normal intelligence. These test also screen the baby for enzymatic or biochemical disorders, which can be picked up in an otherwise physically healthy looking normal baby, to prevent problems before they can manifest and it is a mandatory test in most countries. In India awareness about this is very less. The Guthrie test, also called the PKU test, is a diagnostic tool to test infants for phenylketonuria a few days after birth. To administer the Guthrie test, doctors use Guthrie cards to collect capillary blood from an infant's heel, and the cards are saved for later testing.  Variation in New Born
"If your baby is suckling and is otherwise well, such variations are usually normal." |
Kangaroo Position
The kangaroo position is ideal for the new born. Here, the mother clasps her baby between her breasts, with the baby's face just below the mother's chin. The baby stays quiet, possibly hearing the mother,s heartbeat to which she was accustomed while she was in the womb. If the room temperature is low and the baby is premature, the baby's head may be covered with a cap.It greatly helps to maintains body temperature.
Let the new born have direct skin to skin contact with your body and start breast feeding soon after delivery. Learn the kangaroo position to hold your baby next to your bare chest.
- A crying baby must be picked up for getting body contact or a breastfeed.(other cause of crying may be colic)
Normal Reflexes
While examining your new born baby, the pediatrician will test for certain reflexes like the grasp reflex, the walking and stepping reflex and the Moro reflex. For the grasp reflex the doctor places her finger in the palm of a baby, who is expected to grasp it firmly. To test the walking and stepping reflex, the doctor holds the baby upright so that her feet touch a firm surface. The baby takes a few steps as if she is walking. If the baby's leg comes in contact with the edge of a table, she steps up into the table.
A new born baby see at birth. She can focus at a distance about 15 to 20 cm. Thus she can see her mother's face while breast feeding. She can smell her mother's milk and hear the voice also. She likes body contact, especially with her mother. She is alert for 40-60 minutes after birth. Then she may go to sleep for a few minutes or longer.
Examination of a baby
It is not essential that there be a pediatrician at every delivery. However, most babies should be checked by a pediatrician within 24 hours after delivery. A pediatrician may be called earlier if any problem is expected.
It is normal to worry about your newborn baby. It helps to remember that many things that appear abnormal to you are normal variations in a newborn.
Hearing Test
Ideally all newborn should be screened for possible hearing loss. If that was not undertaken, hearing should be tested at 4, 5, 6, 8, 10, 12, 15 and 18 years of age. Any child whose speech is delayed must undergo a hearing test as soon as possible.
Rooming - In
- Insist on rooming-in of your normal newborn. Baby is kept in mother's room, throughout the hospital stay.
- Contrary to popular belief, the mother who has her baby beside feels less anxious about the baby and sleeps better.
- It helps in proper initiation and maintenance of breastfeeding that provides the baby with all the anti-infective factors and this protects the baby from catching an infection.
- It gives you a chance to respond to your baby right from the beginning. You can feed her or hold her when you want to. It increases your chances of successful breastfeeding.
- There is always a chance of new born catching an infection from an another baby from a nursery. If one baby has acquired an infection, it can pass infection to other babies in nursery.
- In nursery nurse may not always have a time to take each baby to her mother every time she cries, this may interfere with breastfeeding. Babies who do not get adequate amount of antibodies rich colostrum in the first few days are at a great risk of getting infection. Moreover nurse herself may be caring germs that she may pass on to the babies under her care in the nursery. Each time the baby is to be touched, it is essential that the nurse wash their hands properly.
- It is true that mother may have germs that may pass on to her baby. But the point worth noting here is that the mother makes antibodies against such germs in her breast milk, which she than passes to her baby to protect baby against getting infected.
- As far as visitors infecting a baby is concern, breastfeed baby when exposed to visitor have less risk of getting infections, However, to be safe, it is desirable to put a notice outside the room or on the cot, requesting people not to visit the baby, if they have cold or cough or any other illness, and to avoid touching the baby.
- Some new born may normally have swollen breast that subside on their own after a few weeks. Pressing the breast to squeeze milk out of them can be dangerous and should never be done.
- Note that a normal breast fed baby will pass a motion after every feed or in some case even after 5-6 days.
- Do get your baby checked by a pediatrician within a week or two after discharged from the hospital. You can also check with her about the vaccinations that need to be given.
- Do not clean the tongue or mouth of the baby. Never use ear buds. Never buy surma for the eyes from the market.
- Avoid putting the baby to sleep on the stomach.
- Sun exposure for mother and baby for 10-20 minutes in the morning is strongly recommended.
Breast Crawl
Newborns when placed between the mother's breast soon after birth, have the natural ability to find the mother's breast on their own to take the first breast feed. This is called the 'Breast Crawl.' This helps in successful breastfeeding better bonding between mother and new born and also helps in early expulsion of placenta and reduce risk of bleeding after delivery.
- Soon after birth, when the baby has cried and started breathing well, the baby,s whole body (except the hand) s dried with a cloth.
Medicine Kit For Newborns
- Vitamin D 3 1 ml daily Ultra D 3 400 I U / ml
- Moisturizer Cetaphil (for winters)
- Saline nasal drops
- Nose cleaner
- Ear buds
- Cotton
- Syrup Paracetamol, Crocine
- For Infant colic, gripping pain and flatulence Colicaid, Colimax
- For vomiting Domstal baby
Immunization in Hospital
"0 Dose"
- B.C.G immunization against Tuberculosis.
- Oral Polio vaccine
- Hepatitis B
Why Do Babies Cry
Crying is one of the most difficult subjects to write about. I can only give suggestions and guidelines. As there are no absolute treatments and solutions. I sense that the problem of crying babies is very real in our society, and we can only think that tension and lifestyle are the root causes. Most parents now a days expect babies to behave like adults from the time they are born! Every crying they think has a medical reason, and most of them want a medicine to help a baby to stop crying!
It is said that the babies of working African women and traditional Eskimos rarely cry. These babies seem to have constant contact with their mothers and are probably seldom bored. Also remember that it is the only language they know, so they are trying to tell you some thing , not necessarily every time they cry it is due to hunger!
What can make a baby cry ?
- When the baby is hungry.
- If he is uncomfortable.
- If he is hot or cold.
- If he has colic- but this problem is so exaggerated that most babies are on colic medications now a days before they turn 2 weeks of age!
- When he is bored.
- If he is ill.
Hunger
Babies should be fed on demand, and babies do have hungry days too when they want to feed more often than usual, the mother's should not panic and feel that they are not producing enough milk or that something else is wrong. Quite often they are particularly hungry on the 4th day after birth, and many develop a voracious appetite when they first get home from hospital.
Feed should be unhurried and enjoyable times when mother or father can talk and smile with their little one, rather then making throaty noises. After the feed some cuddling, the baby should be propped up in a chair where he can see his mother until he begins to show signs of wanting to go back to sleep.
Is the Baby Uncomfortable ?
It is rather difficult to generalized whether a baby will cry when his nappy is wet or soiled. Most babies do not seem to care at all but a few may object.
Babies do not have a well developed system for regulating their temperature, and if they are not dressed sensibly they may feel too hot or cold. Mother's often dress their babies too warmly, so consider how many layers of clothing you would feel comfortable in on any particular day and dress your baby accordingly. Many small babies like to feel secure and may benefit from being wrapped in a shawl. As a rule of thumb, babies need an extra layer of clothing than their parents. Remember most parents in India, dress up their babies in the same way in all seasons, hence lot of babies cry due to being too warm in the summer!
Colic
Colic is a name given to a condition which may begin about 2 weeks of age and usually stops by 4 months. The infant screams, draws up legs, and cannot be comforted by anything. It often happens in the early evenings. Colic is caused by spasm of bowels. Babies with colic do seem to have abdominal pain, but we are not better at treating it now then we were 50 years ago.
Breast Enlargement
Some babies get breast enlargement in the first few days of life, this is normal and is due to the hormones transferred from the mothers to the baby, and hence is temporary and nothing should be done. There is an age oil myth that this needs to be squeezed and milk removed from the baby's breasts, as some people believe this is Witch's milk- this is not required., and it also could be expensive since the baby may land up getting a breast abscess which might require medical/surgical treatment.
What Babies Do In A Typical 24 hours Period ?
Massage : Infant massage is a type of complementary and alternative treatment that uses massage therapy for babies. Evidence is insufficient to support its use in either full term or preterm babies to achieve physical growth.
Bath : How often to give your newborn a bath. A bath 2-3 times a week is enough to keep your newborn clean.
Play :Playing with newborns · Play is important for overall newborn development, learning, wellbeing and bonding.
Cry : Babies cry and fuss on average for almost three hours a day. Some cry for a lot longer than this.
Feed : Most newborns eat every 2 to 3 hours, or 8 to 12 times every 24 hours. Babies might only take in half ounce per feeding for the first day or two of life, but after that will usually drink 1 to 2 ounces at each feeding. This amount increases to 2 to 3 ounces by 2 weeks of age.
Sleep :Newborns should get 14–17 hours of sleep over a 24-hour period, says the National Sleep Foundation. Some newborns may sleep up to 18–19 hours a day. Newborns wake every couple of hours to eat.
What to expect in the first few days or weeks ?
Babies generally sleep most of the time, but when they have to communicate something,they generally cry. You can't have a puppy who doesn't bark, likewise you can't expect a baby who doesn't cry. Most new generation parents expect their babies to behave like adults and always smile at them.
Vigorous shaking of the child can be Dangerous
Mention may be made here of the possibility of a rare injury to the brain and eyes following vigorous shaking of the child. This can happen if an angry parent takes recourse to this method to stop a small child crying continuously. Always allow your spouse, family or friends to share the care of a colicky child with you so that you are not stressed too much.
Newborn Muslin Diaper changing mat (4)
Nail Cutting Scissors for newborn
Newborn nose cleaner :Aspirator nasal
Baby' laundry Detergent
Sneezing
Contrary to everyone's expectations, babies generally sneeze a lot in the first few weeks of life. Sneezing is normal, it does not indicate 'cold' or 'allergy' and certainly is not due to the AC. We often see the suffering of new mothers as they sweat under woolens and there is no AC because their mothers or mother-in-laws think it is the AC which is making the baby sneeze. No treatment is required for sneezing in babies .
Hiccoughs
Hiccoughs are normal in newborns. It is thought to be due to swallowing air and bloating of the stomach. Giving water, sugar etc will not make any difference. Babies can hiccough up to countless times a day!
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Pain In Abdomen
Heat a water 1 tsp along with asafetida. After cooling, apply the solution around umbilicus of the child
Descent of Testes
In most male babies,the testes are felt in the scrotum at birth. However in some babies they may not have descended. In case one or both testes are not felt in the scrotum your doctor will explain to you about the need.
Care of Newborn at home
Japa Maid
For mother and child care after delivery. Get a help for your first 40 days after delivery. A well trained JAPA Maid to take care of you and your baby 24 x 7, trained in maternity hygiene and newborn care.
She will be a live-in help who will assist the new mother with every aspect of child care including massaging, bathing, changing, comforting and feeding the baby. Additionally she can also massage the mother and provide her whatever child related help she needs.A police verified, 40+ lady who will not be doing other household work like cooking, cleaning but only helping as child support.
Diapers for new born
Pumper's active diapers
About this item
- 5 Star skin protection for new born: best new born tape style diaper for new born baby's delicate skin
- Cotton like softness: made from ultra soft material. For new born babies upto 5 Kgs
- Wetness indicator: turns blue to show when your baby wets his/her diaper
- Up to 12 hours of dryness with pampers magic gel technology. Minimum Age : 1 Month, Maximum Age : 6
Dry feel langot
made of organic cotton for new born
Feeding Pillow
Body Massage
Body massage with oil stimulates the circulation, it provides extra body contact. Himalayan baby massage oil.It improves skin tone, provides essential nourishment. it contains Olive oil and winter cherry(Ashwagandha)
Sesame oil or coconut , ground or mustard oil is adequate.Ideally, the mother should give the massage. Alternatively a trained malishwali can be hired, but she must be closely supervised to ensure that she does not give too vigorous massage. The massage should be done, only after the cord has fallen off. If the mother is massaging the baby, than she should apply some oil, all over the body and gently rub the back, abdomen, legs, arms, neck and face. Gentle stretching of arms and legs should be done. There is no need to go for a almond or olive oil
Bath
Natural Baby Wash : It contains organic Chamomile oil, avocado oil and aloe-vera. It is soap free.
Baby bather for newborn
Bath a newborn with plain Luke - worm water. Soap and oil may be used later.
Sometimes baby may develop skin rash. Daily bath in normal circumstances recommended. In extreme cold weather, daily sponging and bath twice a week should be adequate. The face and diaper area need more frequent cleaning. In the hospital you may be shown how to bath your baby in bath tub and you may follow the same method.
Many Indian women bathe babies without tub. The woman sits comfortably on the floor with her legs stretched out in front of her. The baby is laid on her back or stomach, between woman's bare legs and then massaged or bathed. This is very simple and practical method. Never leave the baby alone in water even for a moments. Negligence can be fatal.
Talcum powder, including special baby powder irritates baby's nostrils and can affect lungs. At times it gets caked in the skin fold. So avoid using all types of powder. If you feel you must use it restrict it to the nappy area. Never buy prickly heat powders, they are often medicated and unsafe for babies. Some children get skin rashes with besan (gram flour) or malai (milk cream) In general their application is not recommended.
Care of the mouth, nails, ears, nose and eyes
Some people clean the mouth and tongue of the baby with a piece of cloth or with glycerin. This is unnecessary and may damage the delicate mucous membrane of the baby's mouth and lead to infection.
Cut your baby's nail while she is sleeping after a bath. Cut a nail straight across with a nail clipper.
Never use ear buds or cotton buds for the baby. After a bath use a corner of the towel to clean the external ear. The wax usually found in the ear canal protects it. Do not try to remove it. Also do not blow into the baby's ear after the bath.
Do not put oil into the ears and nostrils of new born. Oil, if aspirated into the lungs can be harmful. The baby's nose may be sometimes obstructed by thick secretions. These should be moistened with cotton soaked in water and then removed gently with a clean cloth. Do not clean the tongue and mouth of a baby. Avoid pacifiers (dummies) ; besides interfering with proper feeding habits, pacifiers increase the risk of infections (including middle ear infection) and malocclusion of teeth. Never use surma for the baby's eye.Quite a few preparations contains lead, which can be dangerous for the baby.
Genital Area
Do not try to push the fore skin of a male child's penis to separate it from the soft front portion. It is meant to protect the delicate part of the penis.
In a female baby, clean the anal region after the passage of stools, in the backward direction.
Umbilical cord
Generally we put a cord clamp at birth under sterile conditions. By the time babies go home it normally dries off. Dried cord never get infected. It gets infection, only when there is moisture. So soon after bath remove the water using sterile cotton, If that part is kept dry. Apply detol twice a day to the junction of the cord and skin after bath. if the cord is moist even after removing water. Cord stump will fall off in 7-10 days. A smelly cord indicates infection and you must visit your pediatrician immediately.
The umbilical cord starts drying up within the first week and separates towards the end of the first week or in the second week. If you find blood oozing from the cord, report it to the nurse. It should be kept clean and dried properly after the bath. Nothing need to be applied on it. If your doctor gives you spirit to clean the skin around the cord, use it 3-4 times a day.
- Keep the umbilical cord as dry as possible.
It is important to keep the skin dry. Do not use any binder to cover the cord, also do not allow urine to come in contact with the cord. When the cord falls off, a drop of blood may be noticed around the base. This is normal. If you notice at the base of the cord or redness of the skin around the navel, bring it to the attention of your doctor to rule out infection of the cord. If required the doctor may prescribe medicine.
Urine and Bowel Movements
Stools
Babies pass thick blackish green stools called Meconium during their first day. Frequency of stools may vary from one stool for every feed to another stool once a week, and both are normal, babies who generally pass more stools are less jaundiced. Stools changes at least 5 different colors in the first week.Tell the doctor how many colors you have seen in your baby's stool when you come for the follow up.
Meconium is the first stool that the baby passes. It is dark green and sticky. Most babies pass meconium within 12 hours of birth. The doctor should be informed if the baby doesn't pass meconium within 24 hours. Some babies pass a yellow or grayish -white 'mecinium plug' followed by a typical meconium. It changes to green brown after 2 or 3 days. Gradually over next few days , it changes to greenish yellow and then to the so called normal orange-yellow loose stool of an exclusively breastfed child.
These motions are quite frequent. The newborn baby may pass a motion after each feed or after every hour. At times, the motions are watery, may come out with force and contain mucus. At times, they may also be green. As long as the child is been given only mother's milk and is thriving well, such frequent motions are normal. On the other hand, some babies may pass a motion every 5 to 6 days, but the motion are soft, not hard.This is also normal and there is absolutely no need to give purgative or use a suppository.
Urine
Babies generally pass urine soon after birth.They generally don't pass urine until the 2nd day as they lose weight and even when they pass urine it will be concentrated urine, which looks pinkish in the nappies due to Urate crystals in it. after first five days, they should pass urine at least 4 times a day to indicate adequate hydration and fluid/feed intake.
Most babies would pass urine within 24 hours after birth. Some may do so a little later. But special note is to be taken of babies who have not passed urine within the first 36 hours.Straining or crying a little before passing urine is normal. The stream of urine should be checked. An uninterrupted stream should be brought to the notice of your doctor, who may ask for the urine examination. Similarly, so long as the stools are not hard, straining before passing a motion is also normal.
Rashes in Newborn
Acne Neonatrum
Rashes in Newborns
Wrapping your baby
Keep your baby warm in cold weather. Some babies sleep better if wrapped up, especially during their first month. Some like to have their hands out. Be flexible, go with what your baby seems to like. Gradually the baby should be unwrapped more and more so that she can move her limbs freely. She will start looking her hands later and get to know her body better.
Most baby's tends to sweat profusely on head, but some tends to sweat a lot all over. Some of these babies if wrapped all the times may develop fever due to dehydration. This fever will settle down if your baby is kept cool and is given few sips of boiled and cooled water with cup or a spoon. Never use a bottle for this purpose.
Wrapping the baby is not difficult :
a . Fold the upper corner of the sheet. Put the baby on the sheet.
b . Straighten the baby's right arm gently, wrap the right half of the sheet over the arm of her body.. Take the sheet behind her back and tuck it.
c . Straighten the left arm and wrap the left half of the sheet over the body as before..
d . Lift the lower portion of the sheet upwards over the body , You may secure it with close safety pin or just leave it as it is.
Sleep
To begin with, a newborn baby either feeds or sleeps. She may not be aware of differences between day and night. She may sleep more during the day, and feed often more throughout the night, which can be rather annoying. Fortunately within a couple of weeks, your baby will fall into a routine, that will be convenient to you. Till then doze off while she sleeps during the day. As people at home starts taking more interest in talking to the baby, she may start sleeping less during the day and for longer hours during night.
Put your baby to sleep on her back. Prone sleeping (on the stomach) has been reported to be a risk for sudden infant death syndrome (SIDS). However putting baby to sleep on her side, previously recommended as a safer alternative. also appears to be associated with SIDS, probably because infant placed on their sides tend to roll into their stomachs.
Baby Wet Wipes
Baby wet wipes is the best thing that can be used to clean your little one's bottom after every nappy change. Your little one's skin will feel smooth, soft and moisturized with these wet wipes for baby, as it features Aloe Vera extracts that soothe your baby's skin and protect it
Desitin Tube
Protects against diaper rash. (Zinc Oxide) 136 g.
Using a cradle or a hammock to rock the baby to sleep
Do not let your child dependent on being in a cradle or hammock to sleep; you will find it very difficult to put your baby to sleep, if you happen to go to a new place, where you do not have such facility. However if you baby is already used to it , fold a sari to make a hammock and suspend it securely from both ends of a bed or a table.
Fan or Air-Conditioner
During hot weather, a fan must be used, unless you are lucky to have a room with cross ventilation, which always remain cool. Do not hesitate to switch on an air-conditioner. However, make sure that the baby does not sleep directly under the fan. Keep the windows open when the air-conditioner is not in use. Place a baby little away from the window in order to avoid her being in the draught (a flow of cold air that comes into a room).
Music for the Baby
Ideally you can sing for the baby to lull her to sleep. You can also play recorded music to serve the same purpose. However if you want to listen to music once she asleep, make sure it is soothing music and the volume is not too high.
Carriers for the babies
When you are taking out your baby, use a carrier that straps her to your body. Till you get a carrier, learn how to use a shawl or a thick cloth sheet to serve the same purpose. Many mothers in the hill areas of our country use this simple device with great ease.
"In feeding the baby with glass no fear of aspiration."
Going Out
Traditionally an Indian woman stays at home for 6 weeks after delivery; it takes much time for the woman's anatomy to return to its previous state. For instance as the fetus grows bigger, the uterus goes right up to the top of the pregnant woman's abdomen, this has to come back to its earlier position. The baby sucking at the breast hastens the process of this so called involution of the uterus. The 6 weeks rest also gives mother and the baby time and opportunity to become familiar with each other's mood and to continue the ongoing process of mothering and mother - infant bonding.
If it is urgent you can go earlier. Whenever possible take your baby with you. Do not worry that she is not yet immunized. Avoid taking her to crowded places as far as possible. If you are going to a party and you have a maid, take her with you. Let the baby with her in the adjoining room.
"Expose the baby to the morning sunlight for 10 minutes to avoid Rickets or Vitamin D deficiency."
Assessment by the pediatrician at 9 months
Baby's name.........Baby's age.....
Weight
Eyes : Eye movement
Squint test
Vision behavior
Indian Joint Family System
A caring joint family offers you the ready made support of people who are usually knowledgeable about and sensitive to the need of new mother and baby, and who will support you through the post - partam depression. If any accept, their help and advice; it works for your benefit to consider all solutions to any problem that arises.
Remember that the child's grandparents too want the best for their new grandchild. It is observed that , the presence of grand mothers in the home was seen to be helpful in preventing unnecessary accidents and emergency visit to the hospital. Listen to the suggestions, but do not follow their advise blindly, especially if it contradicts new knowledge about child care. Most important is do not allow tension to arise in the family. If you believe that your mother in laws belief clash radically with yours, decide in advance to spend first couple of weeks after delivery at your parent's house.
If you are truly confused about what to do in a certain situation, consult your pediatrician. For instance, if elders insist that you give water to your baby, let the doctor convince them that an
exclusively breastfed baby does not need water in the first 6 months of life, even on a very hot day.
Finally, of course it is for you to decide whether you want to spend the time after delivery at your mother's place or with your in laws or with just your husband. But before you decide, do keep in mind the fact that there are several benefits in living in a joint family. So do not take a hurried decision to stay alone if adjustment is possible.
Resuming relationship
Avoid relationship in the first 6 weeks after delivery. Do discuss family planning with your doctor. If you do not believe in modern family planning methods, make sure that you exclusively breastfeed your child for 6 months and after that, add other foods gradually, while breast feed is continued and bottle feeding is avoided.
Frequency of Check-Ups
After seeing the baby at birth by a doctor, it is advisable to visit about one week after discharge from the hospital. At around 10 days the baby is suppose to regain her birth weight. Doctor also like to know, how breast feeding is going on. The condition of umbilical cord is seen by the doctor.
Followed by visit at the 6,10 and 14th week for immunization. Again the status of breastfeeding is checked. The milestones of development that the child has achieved and record her height, weight and head circumference.
Then the child could be checked-up at about 6 months, 9 months, 15 months and 2 years.
At 6 months, addition of complementary food will be discussed. At 9 months, measles vaccine will be advised. Child is observed for vitamin, calcium and iron supplement. At 15 months, M.M.R vaccine will be advised. Through these visits, the growth and development of the child is observed. A booster of D.P.T and O.P.V at 2 years. At this age we may also get a rough idea of about the height that a child will achieve later in life. Then once a year visit to guide the parents for healthy and happy childhood and adolescence. If you would like your pediatrician to see your child every month for the first year or two of her life , discuss it with her and arrange for check-up accordingly.
Physiological Jaundice
Physiological Jaundice is fairly common, mild and usually harmless. Within the uterus the baby has an abundance of red blood cells. Once the baby is born and breathing, an excessive amount of red blood cells is not needed, so they break down until the level of cells is appropriate for the baby. A by-product of the breakdown of bilirubin, which deposits in the skin and is evident as yellow coloring.
It is more common in induced labour, as it causes strong contractions, which can cause just before birth, an abnormally large amount of blood to be shunted to the baby. Extra blood means extra red blood cells, which predisposes the baby to jaundice.
Feeding colostrum to the baby helps the baby to pass its first stool, which contains lot of bilirubin, which, if not quickly excreted, can be reabsorbed into the baby's blood stream. This is how colostrum may help prevent physiological jaundice. Hence colostrum should be fed to the baby. The hospital might give a jaundiced baby plenty of water to flush out its system. If this is the case , you should express colostrum or milk after or between feeds with your hands, since the baby whose thirst a slaked with water will reduce sucking. Your expression will stimulate and keep up your milk supply.
Physiological jaundice normally appears after 30 hours. Peak level of bilirubin reached on the forth or fifth day and eyes return to the normal color by the seventh day. In physiological jaundice the bilirubin level normally does not exceed 10 mg/ ml.
Breast Milk Jaundice
This is rare kind of jaundice that develops about one week after birth and could continue for two months. Although jaundice can become as deep as 20 mg bilirubin / 100 ml of serum. It does bot harm the baby's brain, but it occurs after the first week of life, when the blood brain barrier is reasonably well developed. You can continue breast feeding.
However if your baby's bilirubin rises too high, your pediatrician may request you to interrupt breastfeeding for a while, say six to twelve hours. If at the end of this time the bilirubin level has fallen for more than say 2 mg per 100 ml of serum, breast feeding can be resumed.. Usually the bilirubin level rises slightly before falling slowly and steadily. If the level rises during the break or breaks, the jaundice is not being caused by the breast milk, and other causes need to be investigated. Generally jaundice is no cause to stop breastfeeding. Some people wrongly believe that breast milk jaundice means that breast feeding should be completely stop. This is not so. The condition resolves spontaneously in time, with no ill effects on the baby from breast milk.
Abnormal Jaundice
That is jaundice that occurs in the first 24 hours. It is more severe and serious and is called haemolytic jaundice. It may be the result of blood group incompatibility between the mother and the baby and needs urgent treatment to prevent brain damage in the child. The baby needs to be treated in the hospital. It may require complete exchange transfusion of blood, after which breastfeeding can continue normally.
It is quite safe to feed your baby even if your blood group is rhesus-negative. and your baby is rhesus-positive. Rhesus antibodies are present in breast milk if they are present in the mother's blood, but they get inactivated by digestion in the baby's gut; therefore you can safely feed the baby. It is also quite safe to breast feed after having an injection of Anti D Immunoglobulin.
Other causes
Other causes for prolonged jaundice could be infection, metabolic condition such as low blood sugar or even administration of drugs to the mother in pregnancy. While your baby is off breast milk, keep your milk supply by going by expression or pumping more frequently than your baby would have fed, and discard your milk until your milk can again be fed.
Treatment
Babies with moderately raised bilirubin are often treated by being placed uncovered in a cot sixteen inches beneath a day light fluorescent tube with their eyes covered. This is called photo therapy. There is no harm if you take baby from under the light every two hours to feed, and may be more often if he/she demands it. Remove the eye cover when you feed
If your baby is otherwise well your pediatrician will agree to your taking the baby home and giving it exposure to sunlight. You can place the baby naked next to the window but make sure he /she does not get too hot or too cold. You can blind fold the baby if the sunlight is too strong, so that it does not affect baby's eyesight. You may have to take your baby back to hospital for blood test.
Healthy food Habits
- Mother's milk is the ideal milk for the baby. Colostrum, the first milk is vital for the baby. So start breast feeding soon after the baby is born
- From 6 months on wards, meshed fruits and home made soft food like 'khichdi' and porridge should be added to the breast feed. Never use a mixer. Avoid ready made cereals available the market.
- A one year old requires half the amount of food that an adult consumes. Vary the flavors and taste by adding different Indian spices.Fruits, vegetables and sprouts are a must in their diet.
- Children need ghee, oil, butter as well spices in their food, but in moderation.
- Children should sit up and eat. They should be encouraged to eat on their own.You may help in between but do not force or take over.
- Children should not be sent to school on an empty stomach.
- Parents must set the right example of healthy food habits. Washing hands before and after meals must be made an conscious lifelong habit.
- A balanced vegetarian diet can meet all the requirements of toddlers as well as adolescents. For non-vegetarians, fish is a healthier choice as compared to other flesh foods.
- After 9 months of age, check with the doctor, if the child needs any extra vitamins, calcium or iron. If the adolescent have unhealthy eating habits, they may need these supplements.
- Make healthy eating choices. For instant energy, give them a banana instead of a glucose drink. Other nutritious snacks/fruits should be offered frequently between main meal.
Where To Get Help ?
Following people are there to help you look after your baby.
- Your own parents, relatives & friends- who have had children of their own , and who visited daily after your baby,s birth, can prove to be an invaluable support to you, with some reservations.
- Your Obstetrician and Neonatologist will provide information and help on child care at home and at the clinic.
- Family doctor could be consulted if you think your baby is ill. Some doctors can advise over the telephone.
Family Medical History
Hearing issue Mother Father Brother Sister
Vision issue Mother Father Brother Sister
Asthma Mother Father Brother Sister
Allergies Mother Father Brother Sister
Other issues Mother Father Brother Sister
Health issues in other near relatives ?
Newborn Hearing Screening Test by A.A.B.R Method
An infant's hearing is screened by measuring the automated auditory brainstem response (AABR). The AABR method produces a simple pass or fail result without requiring interpretation, and the test can be conducted in the presence of background noise.
Newborn hearing test Date Pass Refer Test
R R
L L
Newborn discharge examination
Subject Appropriate Comments
Head & Fontanels
Eyes
Ears
Mouth & Palate
Cardiovascular
Femoral pulse R/L
Respiratory
Abdomen &Umbilicus
Anus
Genitalia
Musculo -skeletal
Hips (tests of entry & exit R/L)
Skin
Reflexes
Others
Examiner........... Designation.......
Signature........... Date.......
Information for Parents
Maintain a Record Book of child
This is an important book to use and keep. so that you can keep a record of your child's health. Take this book with you every time you visit your doctor. Keep it in a place where you can find it quickly if you need it.
The first thing you will need to do is write your child's name on the cover.
Questions for Parents
It helps to think about your child,s progress. You should circle your answers to these questions before meeting with the pediatrician.
When is child Sick ?
If your child does not seems quite 'right' to you, he may be unwell. A number of clues can help to identify if your child is unwell and may need to see a doctor. You child may :
- Be fretful and listless.
- Cry readily and cannot be comforted easily.
- Not smile or play as usual
- Be abnormally quiet and inactive.Have breathing that sounds different.
- Not want to eat.
- Be irritable when disturbed
- Feel hot to touch.
- look tired and flushed.
- Feel cold and look pale.
- Have persistent vomiting or repeated diarrhea.
- Has less than four wet nappies in 24 hours.
If your child has a fits or convulsions, vomit green fluid or has a persistent high fever, see any doctor immediately.
Babies who look and behave as usual are unlikely to be very ill.
Meeting With You Neonatologist
(Pediatrician sub-specialized in babies)
At different stages of your child's growth and development, you will need to make appointments to meet your pediatrician. These meetings are important as they can track the health and development of your child and can also help to identify any potential problems.
All babies develop at different rates, since you know your baby so well you are often the first person to sense or have a feeling that there is something not quite right. if you have any concern about your child's health, development of behavior, contact your pediatrician.
It is important for you and your child to be seen by the pediatrician at the following ages :
- Birth -10 days
- 6-8 weeks
- 10-12 weeks
- 3-4 months
- 8-9 months
- 12-15 months
- 18 months
- 24 months
In the first 10 days of life, your baby will undergo many changes- rashes appear, weight loss occur and jaundice appears- jaundice reaches the maximum on the 5th and 6th day- the combination of weight loss and jaundice may some babies lethargic. If any of these were to be noted- you need to see the pediatrician immediately and not weight till 10 days.
Any child who is unwell or not feeding well should be taken to the pediatrician immediately. There may be times when you would like to talk to the doctor; this can be done by making appointment.
Appointments are for regular check ups, but when your baby is sick, please don't call for an appointment, just go to the pediatrician.. As pediatrician should be always available 24 by 7 and 365 days a year.
Medical Check Up By Pediatrician At 6-8 Week
5
Baby's name...... Baby's age.....
Type of Feeding- Breast / E.BM / Bottle.....
Growth parameters : Weight.....kg Length .... cm Head circumference...cm
Medical Assessment Appointment
General Skin rash, Jaundice, Muscle Tone, Posture
Head Anterior Fontanelle , Head Shape
Eyes Lens clear- red reflex,eyes fixate, and follow briefly, Presence of constant strabismus
Ears R/L Pinna and central patency,startles to loud sounds,responsive, stills to listen
Mouth Palate suck
Cardiovascular R/L Cardiac murmurs, Cyanosis, Femoral pulse.
Respiratory Breath Sounds, Stridors
Abdomen Hernia, Umbilicus
Genitalia R/L Urethal meatus, penis, anus
Musculo Skeletal R/L Hips :Barlow / Ortolani signs, Hands, feet
C.N.S Muscle tone, limbs in flexion, Symmetrical limb movements, motor excitability
Health education Reinforce immunization, discuss family planning,parenting issues
6-8 Weeks
Is anyone in my family a smoker?
Does my baby watch my fave and make an eye contact with me?
Does my baby turn towards the light from the windows?
Does my baby smile back at me?
Does my baby prefers to turn head on one side more than the other?
Why does my baby regurgitate?
1 . Physical length of the Esophagus.
The very short food pipe between the mouth and the stomach of the infant.
2 . Small stomach size infant.
Babies have very small stomachs and with rapid feeding or high volume feeding, the small stomach capacity rapidly fills.This especially in association with loweresophageal sphincter relaxation,contribute to regurgitation.
3 . Peristaltic dysfunction
Normally, more than than 90% of re fluxed volume can be cleared from the esophagus by one or two normal peristaltic waves.Motor abnormalities associated with immaturity may result in failed peristaltic contractions, thereby permitting regurgitation.
4 . Lower esophageal sphincter immaturity
Resulting either as hypotonia (insufficient muscle tone) or under developed control mechanisms (nervous system development) which allows transient relaxation. This permits easy flow of stomach contents back to the food pipe into the mouth (gastro - esophageal reflex) where it dribbles effortlessly out of the mouth, the typical symptom known as "regurgitation".
As the infant grows and body functions mature, most of thses factors no longer contribute towards gastro -esophageal re flux and regurgitation, and the incidence of regurgitation decreases in an age-related manner.
3-4 Months Old Baby
Does my baby watch my move all round the room?
Does my baby follow a small object up and down, side to side with his eyes?
Had my baby had a severe eye infection or eye injury ?
Is my baby trying to bring his hands together?
Does my baby try to reach out and touch me?
Red reflex test : The red reflex test uses transmission of light from an ophthalmoscope through all the normally transparent parts of a subject's eye, including the tear film, cornea, aqueous humor, crystalline lens, and vitreous humor.The red reflex test is used to screen for abnormalities of the back of the eye (posterior segment) and opacities in the visual axis, such as a cataract or corneal opacity. ... To be considered normal, the red reflex of the 2 eyes should be symmetrical
Safety and Discipline
- Around 9 months your baby will be naturally curious and will be moving quickly. When you see your child approaching a bad situation , remove him from the situation and say "No" firmly. He may not yet be able to develop mentally mind his parents and may repeat the act. This is only disobedience, just natural curiosity and exploration. Do not punish your child, rather encourage his independence and exploration by providing a safe home.
- No matter how safe is your house is, children at this age need constant watching unless they are in a playpen or a crib.
- They are prone to falling injuries. Use gates at stairs. Remove all sharp edged objects like glass tables and breakable objects from the ground.
- Be sure crib mattresses are as low as possible, if the crib railing comes to child's chest level, there are chances of your baby falling from it.
- Do not use tablecloths, or children may grab these to pull themselves up, in turn risking falling of heavy or hot objects placed on them.
- Put medicines and poisonous items like detergents, toilet cleaners, etc. in high or locked up places.
- Keep sharp objects like knives, scissors and other hazardous objects like coins, beards,pins etc. in a secure place.
- Cover all electrical outlets and do not leave mobile chargers, etc hanging from them.
- Turn the handles of pots and skillets away from stove's edge. Keep the gas cylinder switched off when not in use.
- Never leave your child alone in the bathtub, pool or bucket of water.
Illness or Injuries
Record your child's illnesses or injuries including infectious diseases , significant illnesses, , surgeries, serious allergies or other serious health problems.
Danger signals in newborn
- Yellow or green vomit
- Convulsions
- Excessive crying
- Listlessness
- Breathlessness
- Very hot or very cold skin
Safety Tips for Toys
- Walkers : Avoid them, as they are associated with high chances of head injuries.
- Choking Hazard : Do not buy small toys, or toys with detachable parts less than a one rupee coin for children less than 3 years. Never give young children small balls, balloons- as baby might swallow them or choke on them while playing with them.
- Magnetic toys : Keep magnetic toys with powerful magnets away from children below 6 years.
- Toxic Chemicals : Avoid toys made of P.V.C plastic and lead painted wooden toys. When buying a wooden specially ask if the paint on it has lead in it.
- Noise : Children's ear are sensitive. If toy makes sounds loud for your ear then it is probably too loud for your child.
- Strangulation Hazard : Strings, plastic bags and ropes can get entangled around your child's neck.
Prepare Baskets for newborn service
1 .
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