CARE OF THE NEWBORN (commonly misunderstood observations)

Breast feeding

Breast feeding is the most important aspect of new born care which should be started within ½ hour of birth in case of normal delivery and within 2-4 hours of Caesarean section delivery. Baby should be fed every 2–3 hours on an average but in effect it is variable and babies are known to feed in a phasic manner with phases of frequent feeding (feeding every 30-40 min) and prolonged sleep (upto 5 or 6 hours). By the end of the first week the mother and the baby get use to the demands of each other. This pattern is normal and not a cause for concern.

Baby should be exclusively breast fed till 6 months of age. Exclusive means no water, gripe water, Janam Ghutti, honey…etc.

Sleep and awake cycle

This is going to be the most important part of adjustment for the mother and the baby. When the baby is in utero, he/ she sleeps during the day time due the rocking movements felt by mother’s activity and is awake at night when the movements cease. This pattern takes time to adjust after the baby is born. Within 10–15 days, the baby becomes used to the mother pattern of sleeping. When the baby is awake in the night he / she will demand more feeds which is the normal.

Stool

Baby’s first stool is usually past within first 24 hours (if delayed consult pediatrician). The color changes from black- green (Stage 1 -meconium)

Fig 1. Stool in first 2-3 days

Figure 2: Stool between day 4 to 5

Figure 3: Stools between day 7-10 in breast fed babies- loose watery and upto 15/20 times

in the first 2-3 days to green-yellow (stage 2) by 4-5 days and yellow watery with granular matter (stage 3) by 7-10 days. The usual stool frequency is 2-5 in the first few days and subsequently depends on whether the baby is breast fed or top fed.

An exclusively top fed baby passes 1-2 stools/day to once in 3-4 days. In exclusively breast fed babies stool frequently progressively increases so that the baby passes upto 15/20 loose watery stools by 7-10 days of life. This then settles to about 1-2 to 6-8 stools per day by one month of age. To clean the babies always use soft clean cotton cloth to minimize the chances of diaper rash.

In case of babies on mixed feeding either type or variable stools may be seen

Urine

Baby’s first urine is past within first 6-8 hours but can be delayed upto 48 hours. The frequency can range from a minimum of 6 times per day, upto 15 times per day. If frequency is less than 6 times per day it could indicate inadequate intake-contact your pediatrician

Diaper / Nappy

Avoid plastic nappy or diapers in the first month of life to prevent harm to the baby’s sensitive skin. This is advised as the stools at this stage are unpredictable and sometimes baby may lie soiled in the stool.

Clothes

The baby should be made to wear loose and soft cotton clothes. Even during the winter months the baby should be made to wear cotton inner wear under the woolen clothes. From the months of August –March baby should be made to wear socks, mittens and cap.

Temperature

Maintaining the right temperature for the baby is an essential part of new born care. The ideal temperature should be between 24-30° C. It can be checked by frequently touching the baby’s hands feet and tummy. If any of them feels hotter or colder than the other, the environmental temperature or clothing should be adjusted.

Cord care

The umbilical cord usually falls of by the end of 10 days. The umbilicus however is still slightly protuberant but progressively invaginates with age. The normal shape can develop over 2-4 months.

To keep the area clean, always keep it dry and clean once a day with betadine / spirit. If there is any redness or discharge consult your pediatrician.

Bathing

Baby should be given sponge bath till the cord has fallen off. After that baby can be given a water bath daily after checking the water’s temperature with your hand. Any soap or shampoo can be used. Remember to dry the baby quickly specially the head and cord area. Avoid any powder, perfumes & moisturizer.

Massage

Baby can be given a massage after initiation of bathing. Coconut or olive oil can be used. It should be done preferably by the mother or any close relative. Avoid professional masseurs. The technique should be comfortable for the baby. During the massage move your hands along the long and horizontal axis of the limbs and trunk. Ensure that you move the limbs in their entire range of comfortable motion

Jaundice

Normally observed phenomenon

a) Milia – small white dots mostly on the face and neck due to blockage of the sebaceous glands.

b) Erythema toxicum– small red dot like rashes over the skin which disappear by the end of 1 week.

c) Mongolian spots– small to large blue–black areas of skin discoloration, mostly over back and buttocks, which are harmless.

d) Breast engorgement – may occur on the second or third day due to effect of maternal hormones . This regresses spontaneously by it self.

e) Vaginal discharge / bleeding – May occur on the fourth or fifth day in some female babies due to effect of maternal hormones this is not a cause for concern.

Jaundice or yellowish discoloration of skin occurs in 60–70% of the babies. It is best judged by observing the baby under sunlight. Pediatricians will usually be able to roughly visually estimate if blood levels and/or treatment is required. Early onset of jaundice, jaundice in low birth weight babies or jaundice beyond a certain cutoff (deep yellow ness is seen) may be harmful. However usual or normal jaundice starts decreasing by the end of 1 week but can take a month or more to disappear. Sunlight helps in prevention of jaundice, production of vitamin–D and in establishing the day and night cycle of the infant and to ensure this keep the baby in a room well lit with natural light.