Category Archives: Newborn Care And Infant Growth
Infant Vaccinations, Vaccination Schedule And Vaccine Side Effects
Infant Vaccinations offer protection against various infectious diseases. They are typically non-infectious particles of bacterial or viral matter or small amount of toxins produced by them during infections. In some cases, weakened forms of disease-causing organisms, which are rendered incapable of causing the disease, are also used. These materials, when introduced into the body, often by injections, cause the immune system to produce certain substances called antibodies, as a defensive mechanism against those infectious agents. This gives the body immunity against those specific diseases. Hence, immunization is another term used for vaccination.
Small pox has been successfully eradicated from the world by consolidated vaccination programs. Other common childhood infections such as measles, and polio, are also almost completely eliminated in most of the developed countries like the United States. In spite of these positive outcomes, it is essential to continue with the vaccination programs to prevent fresh outbreaks. As long as the infectious diseases remain active in certain undeveloped areas of the world, no one is truly safe, because of international travels which are very common today. The very high risk of the infection rapidly spreading through unimmunized children living in disease-free areas is a threat too big to ignore. Within the developed world too, certain pockets continue to harbor either active infections, or passive carriers, who continue to be reservoirs of the infectious agents. Hence, medical practitioners continue with the vaccination efforts in developed countries too.
None of the vaccines can be considered hundred percent fool-proof, or completely free from vaccine side effects. Occasionally, the vaccines fail to produce sufficient immunity in some children. Some may develop certain adverse reaction to the vaccine. Fever, rashes, and pain at the site of injection are common, and usually resolve within a few days. But rarely, certain dangerous vaccine side effects do occur.
OPV or oral polio vaccine contains a weakened form of the live polio virus and carries a very small risk of causing the polio disease itself, if the virus undergoes a mutation. It is known to happen in about one out of 2.4 million vaccinated children. However insignificant this figure may seem, it has made the doctors in the United States to go for a safer alternative called IPV or injectable polio vaccine, which contains inactivated virus, instead of live ones. Likewise, the DPT vaccine which contained whole-cell pertussis, is being replaced by DTaP vaccine containing acellular pertussis. DTaP is considered safer as it lowers the risk of vaccine side effects. 3 out of every 10,000 children vaccinated with the MMR vaccine against measles, mumps, and rubella, are known to have developed fever induced seizures. However, the media reports implicating MMR vaccine in the recent increase in the incidence of autism has been proven to be wrong. The safety of vaccines is a serious issue and continuous research and innovations are geared towards making them safer and more effective.
People may have genuine concerns and doubts regarding the safety of vaccines. The doctors are required to provide a Vaccine Information Statement with each vaccination to assuage the fears of parents. The benefits the child derives from vaccination against deadly diseases should be weighed against the potential risk of complications. To encourage people to take maximum advantage of the protection offered by the vaccines against dangerous diseases, the federal government has set up a Vaccine Injury Compensation Program. Compensation is guaranteed to anyone permanently affected by negative reactions and vaccine side effects.
Most countries have a definite vaccination schedule, and the medical practitioners of the respective countries try to ensure maximum participation of the general public, to reduce the incidence of infectious diseases. In the United States, the Centers for Disease Control and Prevention recommend a vaccination schedule which is followed by the doctors. According to that schedule, hepatitis B vaccine is administered to the newborns while they are in the hospital itself. The ages for subsequent vaccinations are indicated, but they are more of a guideline, and not an absolute rule. One or two weeks’ difference in the schedule does not affect the effectiveness of the vaccine or the immunity gained by the child. Mild fever due to minor infections, or common cold, need not be a reason to postpone a scheduled vaccination. There are certain vaccines which are given only in select conditions.
When the child is taken to the doctor for a health check-up, a single vaccine or multiple vaccines may be administered. To avoid multiple injections, certain vaccine combinations are available as a single injection too. For example, the DPT vaccine is a combined vaccine which has been available for long, against three diseases, namely, diphtheria, tetanus and pertussis or whooping cough. Now, Haemophilus influenzae type b vaccines are also combined with the DPT to avoid one more injection. Combining these vaccines is not known to affect their efficacy or to cause any safety issues.
Here is the vaccination schedule recommended by the United States Centers for Disease Control and Prevention.
Watch This Video About Vaccination:
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Baby Follow Up Visits (Baby Check Ups)
Visits to the doctor at regular intervals are very important in the first year of life. All infants, even when they do not have any illness, should be checked by the doctor in the first or second week. After the first visit, at least one visit every other month is mandatory till the baby is over 6 months old. After the initial 6 months, the frequency may be reduced to once in 3 months. Vaccination Schedules usually ensure that the baby is taken often enough to the doctor.
At each visit, the weight and length of the baby is measured and recorded. The circumference of the head is also measured. The doctor will ask about the different developmental milestones the baby should have normally reached at different ages. The baby is thoroughly examined to detect any abnormalities in the development as well as for signs of any illness or hereditary condition. The sensory responses are checked out to ensure that the vision and hearing are normal. Pre-mature babies are checked for problems unique to them such as retinopathy of prematurity, which is an eye condition affecting them. Vaccinations are administered according to schedule.
These baby check ups provide an opportunity for the parents to field their queries and clear their doubts regarding the growth and development of the infant. Doctor will advise them on the nutritional requirements and suitable foods for the baby and indicate the ideal time for the next visit. They are usually briefed about the milestones expected in the intervening period too.
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Infant Developmental Milestones
Infant Developmental Milestones:
One Month
- Able to draw the hands towards the baby’s own face and mouth.
- When placed on the stomach, manages to lift the head slightly to make side to side movement s of the head.
- Able to follow with the eyes, moving objects held 6 inches away from the face.
- Startles or cries at loud or sudden noise; often pacified by familiar voices.
- Turns the head in the direction of voices or sounds which are familiar.
- Ability to focus the eyes on a face.
Three Months
- Able to raise the head higher when placed on the stomach, usually between 450 and 900.
- Closing and opening the hands.
- Kicking down with the feet when they are kept touching on any flat surface
- Able to reach out for objects hung above their heads by a swinging motion.
- Able to follow an object in front of the face when it is moved from side to side.
- Shows definite interest in human faces by studying them intently
- Responds to mother’s speech and voice by smiling and showing delight.
- Starting to make certain sounds similar to human speech
Five Months
- Able to hold the head upright and support it very well.
- Able to roll over while lying on the stomach.
- Able to reach out and take hold of objects.
- Able to recognize familiar people from a distance
- Focuses on human speech and actively listens to conversations.
- Frequently smiling in a spontaneous way at people
- Showing delight by squealing
Seven Months
- Able to sit upright without any support
- Able to stand with slight support when the baby is held with its feet resting on a surface
- Able to move things from one hand to the other.
- Searching for toys and other objects dropped from the hand.
- Responding when the baby’s name is called out.
- Definite attempt at speaking with a combination of vowel and consonant sounds.
- Demonstrates excitement and delight on meeting playmates and finding toys by wiggling
- Loves to play peek-a-boo
Nine Months
- Able to crawl on hands and knees
- Crawls towards toys which are not within reach.
- Shows protest when something is taken away from its hands. Objects if toy it taken away
- Able to pull oneself up by holding on to any supporting structure.
- Able to stand for quite some time with support. Loves to walk with support.
- Says a few familiar words like mama, but not exactly meaning the mother.
Twelve Months
- Able to sit up without assistance or support.
- May walk with or without support.
- Sometimes leaves hands from support and balances for a few seconds.
- Calls parents by the names assigned to them, such as ma, pa etc.
- Able to drink liquids from a sipper cup
- Able to clap their hands and wave good-bye at appropriate times.
Adequate nutrition and a safe, protected environment are necessary for the optimal physical growth and development of the infants. Babies develop a special bonding with those who are providing food, consolation and a sense of security to them. They will actively seek their presence and become strongly attached to them.
Babies require affection and support from their parents for their emotional development. They should be provided with a stimulating environment conducive to intellectual development. Human interaction is an important factor in the mental and social development of infants. More than the expensive toys which squeak and light up, it is the smiling face of the mother and father, and their speech and singing, which hold the attention of the baby. Parents should have plenty of physical contact with the baby and spend as much time as possible playing peek- a- boo and such other simple games with it. This will also strongly affect an infant developmental milestones.
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Infant Development: Social Development In Infants
Just as the physical development of infants varies greatly, the intellectual and social development in infants also may exhibit marked individual differences. Some babies may develop at a faster rate, reaching the developmental milestones such as sitting up, and walking, much ahead of their counterparts. A certain amount of hereditary influence in the rate of development has been observed in families, where babies attain the developmental milestones such as talking, either earlier, or later. Environmental factors also greatly influence the developmental rate. Lack of stimulation may result in slower development, while adequate mental and physical stimulation can speed it up.
Congenital abnormalities like deafness or blindness can negatively affect the social and intellectual development of babies as the sensory inputs through the auditory or visual channel are completely absent. Development is usually a continuous process, but occasional breaks and setbacks may occur. Serious or prolonged illnesses or trauma may temporarily retard certain functions like speech development in some infants.
For infants, the main mode of communication is crying. They cry when they feel hungry, wet, cold or uncomfortable in any way. Any physical or mental distress is expressed by crying. It is normal for 4 to 6 week old infants to cry for about three hours on most days. The frequency and duration of the crying may reduce as the baby grows older. Another reason could be that the parents learn to understand other possible cues which may indicate the needs of the baby and meet them even before they demand them by crying. Whatever the reason, by the time the baby is 3 months old, the crying would have normally reduced to just an hour per day unless the baby is ill.
To pacify a crying baby, parents may offer food and it often works. They should never try to force-feed a crying baby, though. If the infant is crying because of hunger, it will readily accept the feed offered. If it shows disinclination towards food, other possible causes of distress should be investigated. The diaper should be checked for wetness. The baby’s bottom should be examined for signs of diaper rash too. A change of position or environment may help relieve distress. Carrying the baby around or taking it out in a baby carrier or pram may help. There are occasions when nothing seems to work. Parents should be alert to signs of illness which may be causing additional distress to the baby.
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Infant Development: Physical Development Of Infants
The physical development of infants is dependent on hereditary traits, environmental factors and nutritional inputs. The abnormalities present in a baby at birth can also have an effect on the growth and development. Adequate nutrition, as well as good physical and mental health, is essential for the optimum growth of the infant.
In the initial days after birth some weight loss is observed in the newborns. In the first week, they may lose between 5% and 7% of their original weight at birth. The weight loss is more apparent in breastfeeding babies. The lost weight is typically regained within the next one or two weeks as the quantity of feeds increase. Babies gain weight rapidly after this, acquiring on the average, one ounce of weight everyday in the first two months of life. After this period, they gain about one pound every month. At five months, most babies would have doubled their birth weight, and tripling it, as they complete their first year of life, is considered a marker of optimum physical development. The length of the baby also increases correspondingly, with a 30% increase at five months, and over 50%, by the end of the first year.
The rate of growth of different organ systems may vary at different ages. After an initial spurt of growth soon after birth, the reproductive system of the child lies dormant till the pre-pubertal growth spurt. On the other hand, the brain develops rapidly in the first year, reaching three fourths of its final adult size by the end of it. The kidneys are too mature during the first year and reach the adult functioning level as the baby completes its first year of life.
The teething starts around the middle of the first year, with more often the lower incisors or front teeth making their appearance between the 5th and 9th months. The incisors on the upper jaw soon follow, and by the end of the first year, most babies have around 2- 4 teeth. It is quite normal for some babies to cut their upper incisors before the lower ones appear.
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Baby Sleeping Patterns And How To Avoid SIDS
Baby sleeping patterns vary from one month to the other. Newborns spend large amounts of time in sleep due to the immature condition of their nervous system. They fall asleep frequently, but each episode of sleep is rather short; it is never more than 2 hours at a stretch. The sleep-wake pattern of the newborn is not dependent on day and night cycle. When the baby is around one month to one and a half month old, some pattern may evolve. Some babies may have a sleep-wake cycle of four hours each. After a 4 hour period of sleep, the baby may remain awake for the next 4 hours. After 2 to 3 months, babies may sleep longer at night, but they still wake up for 2- 3 feedings during the night. They may need a diaper change during the night too. Babies eventually sleep through the night, for up to nine hours at a stretch, in the second year of life.
The room in which the baby sleeps at night should be kept dark. It helps the baby develop a sense of day and night, and a proper pattern of sleeping. Besides, it is found to be essential for the normal development of vision. Instead of the parents making the baby sleep in their arms, it is a good practice to let the baby fall asleep on its own at night. That will enable the baby to go back to sleep on its own, whenever it wakes up at night.
Babies are prone to sudden infant death syndrome, known as SIDS for short, while they are asleep. To reduce the risk of SIDS, babies should be placed on their back while sleeping, instead of on their tummies. Infant mortality due to SIDS has reduced significantly since the awareness has grown. Objects which may suffocate a baby, such as heavy or thick blankets, pillows, cushions, and stuffed toys, should be kept away from the baby cot. Giving a pacifier to the baby at bedtime has played a role in preventing SIDS. However, for breast-fed babies, pacifier should not be given before they are one month old and have become used to breast feeding.
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Baby Urine, Baby Stool and Baby Diaper
Infants urinate very frequently, often more than fifteen times a day. The color of the baby urine may vary, it may be dark or light yellow, or even clear. The bowel movements are also frequent; sometimes babies may have 6 to 8 motions a day but they may have it less frequently too. Some may have a movement only on alternate days. Baby stool in the early days of life is often yellow and runny, especially in breast-fed babies. It may become firmer with more food intake. The color may vary from mustard yellow to darker shades of brown in babies taking formula milk. The consistency also may be firmer. The frequency as well as the nature and color of the stool may depend on the diet and may vary between infants.
It is very important to keep the skin dry to protect it from rashes. Frequent diaper changes may be necessary to prevent diaper rash. Cloth diapers should be changed as soon as they become wet or soiled. Most of the latest disposable baby diapers have a gel which absorbs the urine and locks it away, keeping the baby dry through one or two urinations. However, it is not advisable to keep the same diaper on for longer periods.
It is absolutely essential to change the baby diaper as soon as it gets soiled with stool. The urea present in the baby’s urine is broken down by certain bacteria in the stool, creating an alkaline environment which may irritate the baby’s tender skin. The diapers, especially the disposable ones, should be checked very frequently. The advantages of using disposable diapers are many, but among the disadvantages, the environment hazard it causes deserve special mention. They accumulate in landfills and take a long time to disintegrate. Using reusable cloth diapers also have environmental repercussions due to the water and detergent use necessary for their upkeep. Besides, they are not as hygienic as disposable diapers and do a poorer job of keeping the baby dry.
Baby powders may be used to keep the baby’s body dry from sweat but they have no real use against urine. They are better avoided from the diaper area, especially talcum powders which can cause certain lung problems if the baby inhales it. Cornstarch-based baby powders are safer for use.
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Newborn Feeding: Bottle Feeding and Baby Formula
If bottle feeding is opted for, the first feed is usually given within four hours of birth. Subsequent feedings are offered as and when the baby demands it. In the first week, each feed may be one or two ounces only, but in the next week it may gradually increase to 6 to 8 feeds of three to four ounces each. The baby should be allowed to decide how much feed it should have at a time; parents are not to insist that the baby finishes the bottle every time. As the baby grows, the quantity of each feed may increase up to 8 ounces, while the frequency slightly decreases.
Babies should be held in a semi-reclining or upright position during bottle feeding. They should not be lying flat while feeding from the bottle as there is a high risk of the milk entering into the nose. It may flow into the eustachian tube and lead to ear infections too. Babies may eventually learn to hold the bottle and feed themselves, but it is not safe to leave them unattended while feeding. Allowing the babies to drink themselves to sleep is a bad practice which can lead to dental decay due to prolonged contact with milk or fruit juices.
The baby formulas available commercially contain all the different nutrients necessary for the healthy growth and development of the baby. They are available in different forms such as powders, concentrated liquids which can be diluted with water, and as ready-mixed servings in feeding bottles. Though formulas containing additional iron are recommended by many doctors, some are available without the addition of iron too. Whichever formula is being used, it is essential to follow the exact directions for mixing and usage as printed on the container. Even though cow’s milk in the plain form is not recommended for babies under one year of age, most formulas are manufactured from cow’s milk. But for babies who have low tolerance to cow’s milk, there are many options. A pediatrician can prescribe a hydrolyzed formula or a special amino acid formula suitable to the baby. Using a specially made baby formula, instead of the standard formula, does not adversely affect the growth and development of the baby in any way.
Good hygiene practices should be followed while preparing and feeding formula milk to the baby to avoid possible infections. Sterile containers and bottles should be used to mix the formula and to feed the baby. Boiling for at least 5 minutes in plain water can sterilize the feeding bottles and nipples. Plastic liners for the bottles can be used to eliminate the need of sterilizing the bottles. These disposable liners and single-use nipples are very convenient when travelling.
The formula should be just as warm as the body temperature. Before starting bottle feeding, the temperature of the bottle should be checked by putting a few drops of the milk on the inner part of the wrist. Hot milk can cause serious burns in an infant. Refrigerated or ready-mixed bottles of formula should be warmed by placing it in a tub of hot water. The bottle should be shaken to distribute the heat evenly, and the wrist test should be performed before feeding the baby. Microwaving is not recommended for heating up formula milk as they heat the liquid quickly and unevenly, without heating the bottle, increasing the chance of causing accidental burns. The hole in the nipple determines the rate of flow of milk. The flow can be tested by holding the bottle upside down. The liquid should be dripping slowly. The nipple opening can be wider in the case of older babies who can drink faster.
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Newborn Feeding: Breastfeeding Basics And Breastfeeding Tips
Newborns usually display strong reflexes for rooting and suckling, right after birth, showing their readiness for feeding. If the mother is breastfeeding, the baby is put to breast as early as possible, even within the first half hour after birth. If the baby is to be fed with formula milk, the first newborn feeding is usually given within the first four hours of life.
Mother’s milk is the ideal diet for the baby, and for the first six months, doctors usually advice feeding the baby exclusively on breast milk. However, there are situations in which breastfeeding is not recommended. Certain disease conditions in the mother as well as certain drugs taken by her may make breastfeeding risky. Babies can be brought up well on formula milk too.
While feeding on milk, babies tend to swallow some air too. Since they cannot bring up the air on their own, they should be helped to burp after every feed. Holding the baby in an upright position by supporting it on the parent’s chest and shoulder, and gently patting them on the back, usually helps in bringing up the gas in audible burps. Babies may bring up some milk along with the burps, but it is quite normal.
Breastfeeding Basics
Breast milk contains all the nourishment a baby needs for its growth and development in the first few months of life. The nutrients in the breast milk are easily digested and readily absorbed by the babies. It also contains antibodies produced in the mother’s body as well as white blood cells which would fight infections they may be exposed to. It has a protective effect against diarrhea of bacterial origin, as it promotes the growth of beneficial bacteria in the baby’s intestines. Consequently, breastfed babies have fewer infections, especially those related to the digestive system, when compared to their bottle-fed counterparts. They are also found to be less prone to allergies and auto immune problems such as Crohn’s disease, celiac sprue, as well as diabetes.
The advantages of breastfeeding include the benefits to the mother too. Faster recovery after delivery is a beneficial side effect of the hormone oxytocin produced when the baby suckles. This hormone triggers the contraction of the uterus, helping it to return to its pre-pregnancy size faster. Also, the mother and the baby develop a close bond through the process of breastfeeding.
There are certain long-term benefits too. The risk of developing breast and ovarian cancers is reduced in women who have breastfed their babies at least for the initial six months. Osteoporosis and obesity are also found to be less common in them. Currently, six out of every ten mothers in the United States choose to breast feed their babies. With the awareness of the benefits of breastfeeding spreading, more people are opting for this natural method of feeding the babies. Colostrum is a yellowish secretion produced in the breasts before the production of milk starts. This fluid is very rich in antibodies and proteins. Babies are greatly benefitted from colostrum as the mother’s antibodies contained in it protect them from many infections. Mothers who may have to return to work soon after delivery can breastfeed during the time they are at home. Breast-milk expressed and kept in sterile bottles in the refrigerator, can be fed to the baby when the mother is not at home. After about 2 months, vitamin D drops are given daily to breastfed babies to avoid deficiency diseases.
Breastfeeding Tips: Correct posture during breastfeeding is important. Mother should be relaxed physically, and mentally, while breastfeeding. Breastfeeding can be done in a comfortable sitting position or when lying down. The mother should hold the baby facing towards her and support the baby’s head in a slightly raised position with one arm. With the other hand, she should hold her breast between her fingers. When the nipple touches the cheek or the lips, the baby will open the mouth and turn towards the breast. The mother should take care to introduce not only the nipple, but the whole of the areola as well, into the open mouth. Baby draws out the milk with a milking motion with its palate and tongue. If the areola is not positioned correctly into the mouth, it may cause soreness of nipple which is very painful and difficult to treat. Even when the baby has fallen asleep at the breast, the mother should not try to pull out the nipple from the baby’s mouth as strong suction force may result in bruises. A finger should be introduced into the mouth to break the suction and then the chin should be gently lowered to open the mouth and release the breast.
When the baby is placed at the breast, very little milk comes out initially. A few minutes of suckling produces a powerful let-down reflex indicated by a sudden rush of copious amounts of milk. For successful breastfeeding, the baby should feed long enough to take advantage of this reflex. The more milk the baby feeds, the more quantity is produced. In the beginning, babies should be made to suck from both the breasts to stimulate milk production. If the baby falls asleep while drinking from the first breast, the next time, it should be fed at the other one. It may take 3 to 4 days for proper milk production to take place in a first-time mother. From the second time onwards, milk production may start earlier. Irrespective of the amount of milk produced, the baby should be allowed to suckle very frequently to stimulate milk production.
One of the most important breastfeeding basics is to avoid a feeding routine in the initial weeks. Whenever the baby demands a feed, it should be fed. There should not be any restriction on the duration of each feed too. Usually babies fall asleep when they are full. In the first few weeks, babies feed every 2 to 3 hours, even during the night.
After the baby is discharged from the hospital, the parents should take it to the doctor within the first week itself, to assess if the growth rate is satisfactory. The first visit is of great importance, especially to a first-time mother, as the doctor will weigh the baby and determine if the breast feeding is proper and sufficient. The doubts of the new mother will be answered by the doctor. Unlike in bottle feeding, the quantity of breast milk consumed by the baby cannot be measured by the mother or the doctor. When sufficient quantity of milk is not produced by the mother, the baby may remain hungry and may need very frequent feedings. The weight gain also may be unsatisfactory. Doctors depend on these parameters to decide whether breast feeding is adequate or supplemental formula feeds are necessary.
Weaning: It is the process of gradually decreasing the frequency and duration of breastfeeding as the baby starts on other forms of feeding. Ideally, the baby should be fed exclusively on breast milk in the first six months, and then for the next six months, a combination of breast milk and solid food should be given. Beyond the first year of life, breastfeeding may not have any significant nutritional benefits, but the mother can continue with it as long as both the mother and the baby want. When the mother decides to wean the baby, a gradual transition is better than abrupt stopping of breastfeeding. A few feedings during the day can be replaced by expressed breast milk or formula milk in bottles, for babies younger than six months.
For those who are six months or older, the replacement can be either formula milk or fruit juice. In the meantime, solid food can replace mealtime feedings. Infants who are sitting up already can be weaned to a sipper cup instead of bottle. Acquiring the ability to drink from a cup is considered a milestone in the developmental journey of an infant. By the age of ten months, most babies acquire sufficient capacity to take all liquid feedings from a cup rather than a bottle. Unless actively weaned, most babies may continue with one or two breast feedings a day, especially at bedtime or during the night till they are one and a half to two years. It is very important to ensure that the nutritional requirement of babies are met by solid foods, and the feedings from the cup, by the time they are one year old, whether they are completely weaned or not.
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Baby First Week: What Should You expect ?
The baby first week is the most exciting and sometimes difficult time for the whole family. The parents get to be with their baby immediately after birth, if the mother and the baby are doing well. The new parents can hold and cuddle the baby, and the early interaction is said to help them bond with the newborn. If the mother intends to breastfeed the baby, she is encouraged to initiate the feeding as early as possible, even within the first 30 minutes after birth. Early feeding is beneficial to both the mother and the baby, as suckling releases a hormone called oxytocin which helps uterine contractions resulting in faster healing. It also stimulates milk production.
If the first few hours could not be spent with the baby due to some reason, the bonding can happen later also, when the parents are taught how to take care of the baby. The parents familiarize themselves with the different aspects of looking after the baby, such as changing the diapers, bathing, dressing up and feeding the baby, during the hospital stay of one or two days after the delivery. They also learn to understand the baby’s needs from its sounds and cues. For a normal delivery, the hospital stay does not usually extend beyond one or two days in the United States, though it may be longer in some other countries.
Bringing the baby home entails a lot of preparation. All the members of the household and their schedules have to adjust to the natural schedule of the new member. Tremendous lifestyle changes are necessary, if it is the first baby in the household. If older children are there, they should be well prepared and sensitized to the new arrival. Jealousy may be an issue, but giving them extra attention and involving them in the care of the newborn usually help. Special attention should be given to household pets also. Sometimes, it may be necessary to keep them away from the newborn during the initial period.
Umbilical Cord: A day after the birth, the plastic clip used for clamping the umbilical cord should be removed. Special care is taken to keep the stump clean as well as dry till it falls off. It usually falls off during the baby first week. If any discharge or swelling is noticed, the doctor should be informed as soon as possible, as it could be due to an infection which should be treated promptly.
Circumcision: There may be different reasons for circumcision. If the parents opt for circumcision either due to religious traditions or out of personal choice, the minor surgical procedure may be done before the baby is discharged from the hospital. The usual medical reason for conducting circumcision is urinary obstruction due to a tight foreskin. The lower rates of urinary tract infections, sexually transmitted diseases, and cancer of the penis, observed in circumcised males, are often cited as the benefits of circumcision. However, these are not sufficient medical grounds for circumcision, as the same benefits can be obtained by good hygiene practices. Complications such as infections or bleeding may occur in up to 2% of cases, but they are usually minor. Major complications like scarring or serious infections are rare, but not unheard of. The tip of the penis getting amputated accidentally is also a rare possibility. About 2% of babies who are not circumcised at birth may require the procedure later on.
There are a few situations which preclude circumcision in the early days after birth. If the baby has not passed urine or if any abnormality with the penis is detected, circumcision is postponed. If the penis has any structural abnormality requiring plastic surgery, the foreskin can be used for the purpose. If the mother had been on anticoagulant drugs or aspirin during pregnancy, the effect of those drugs may cause excessive bleeding in the newborn. In such cases, circumcision is postponed till the effect wears off.
Skin: A skin rash may appear during the baby first week. It is usually found in places such as the back, arms, and legs, where the clothing rubs the body, but the face is rarely affected. No treatment is necessary as it usually disappears on its own. The rash is likely to become worse with the use of soaps, powders or lotions. When the weather is hot, dressing up the baby in plastic pants to prevent leakage also aggravates the rash. At the skin creases in the ankles and wrists, dryness as well as peeling of skin is normal.
Jaundice may appear after a day in babies who are born quite normal. The skin develops a yellow tinge due to the immature liver’s inability to process all the waste produced by the body. It is normal, and usually resolves without treatment as the liver function improves. If jaundice develops earlier, it is a cause of concern as it may be a sign of some serious disorder. The blood level of the bile pigment bilirubin is tested, and if it is found to be high, the baby is given phototherapy treatment. The baby is kept under special fluorescent lights called bilirubin lamps, with the whole body (without clothes) exposed to the light. The baby may have to remain in the hospital for one or two days more, for the treatment.
Urine and Bowel Movements: When the newborn urinates for the first time, the urine is very concentrated, containing urates. The diaper may look pink due to these chemicals. If the baby does not pass urine within 24 hours after birth, the reason is investigated. Usually baby boys are delayed in their first urination.
Newborns normally pass a substance called meconium in their first bowel movement. It is a greenish black substance, sticky like tar. It is essential that meconium is passed within a day after birth. If it is not passed, it is investigated immediately as a congenital defect, such as an intestinal block, could be the reason for the delay.