The vast majority of babies are normal at birth and remain so. If you were delivered in hospital, you should take advantage of the opportunity to learn from the maternity staff as much as possible about baby care. The more you handle and look after your own baby while you are in hospital the sooner will you gain confidence in his management and the ability to recognize anything abnormal or unusual.
Crying is part of a normal baby’s natural daily life. It is good exercise and causes no harm. Frequently, however, it may indicate hunger, thirst, temper, cold or heat or that the baby requires attention. Most mothers soon learn to recognize the meaning of these various cries. Sore buttocks. Nappy rash is probably the most common condition affecting healthy babies. A substance called urea, always present in the urine, is turned into ammonia by bacteria that are normally found on babies’ skins and also on wet or soiled napkins. Ammonia is very irritant to the skin causing redness and soreness where it has been in contact with the baby’s skin for any length of time. This can be overcome in four ways, all of which are necessary if treatment is to be successful. Firstly, napkins should be changed frequently and as often as necessary to avoid leaving the baby wet or soiled. Secondly, wash the baby carefully, paying particular attention to the skin folds, rinse away all soap and dry thoroughly. Thirdly, apply a good cream such as zinc and castor oil, petroleum jelly or a reliable proprietary cream. Fourthly, only really clean napkins should be used.
Skin rashes. In the first few months of life a baby sometimes develops a reddish rash on the neck and face. This is due to over-heating, either as a result of too high a room temperature or because the baby is wearing too many warm clothes. Perspiration indicates that clothing is too heavy and too warm. A similar rash caused by excessive dribbling may accompany teething.
Ear infections. An indication of earache is fretfulness and a tendency for the baby to hold and pull his ear. Earache sometimes accompanies teething, but at an earlier age any discharge from the ears is an indication of an infection and your doctor should be consulted.
Vomiting is usually of no significance. All babies vomit a little; this is called positing or regurgitation and happens during or shortly after a feed. A slight adjustment to feeding routine may cure it although some babies continue to vomit regardless. Regurgitation after feeds accompanied by wind is fairly common in normal babies. The appearances of the vomit varies considerably. Fluid returned soon after a breast-feed usually has the appearance of unaltered milk. If there is some delay before vomiting takes place, the vomit contains curdled milk. The presence of mucus suggests irritation of the lining of the stomach. Vomit of any kind has an unpleasant sour but not foul odour. The management of vomiting should be to treat the underlying cause which is usually a simple feeding problem. If the vomiting becomes serious consult your doctor at once.
Constipation. The baby’s motions change their colour and consistency during the first few days of life. They are greenish-black for the first two days and gradually change to a light yellow colour always being soft in consistency. There may be as many as two or three motions in a day although some breast-fed babies may go for two or three days without passing a motion. Provided the baby does not have to strain unnecessarily and the motions are a normal colour, and are soft, then there is no need for concern. Misunderstanding about constipation in infants frequently occurs. If a baby’s stools are infrequent but of normal colour and texture, then the baby is not constipated. If the motions are infrequent and hard then he is constipated. This may be corrected by the addition of a little sugar to feeds.
Sticky eyes are not uncommon and not serious if treated promptly. A sticky eye as an indication of infection is recognized by a yellowish discharge at the inner comer of the eye. The doctor should be informed and further treatment will be prescribed by him if the discharge is heavy and the eyes become red and swollen.
Watering of the eyes is also quite common in infancy and should clear up without treatment between the sixth and eighth months. Colds and snuffles are troublesome but not always serious in young babies. The baby is irritable and his difficulty in breathing caused by a blocked nose interferes with his feeding. Colds in babies should not be neglected and the advice of a doctor should be sought. Colds apart, some babies get snuffles resulting in an increase in the natural secretion of the nose. Nothing need be done unless, as on rare occasions, it interferes with feeding, and the doctor may then prescribe treatment.
Thrush is a common cause of slow feeding. It is a fungus infection recognizable as small white patches on the inside of the cheeks, on the tongue and palate. It may be confused with curds adherent to the mouth immediately after a feed. Gentle swabbing of the mouth will remove any curds but not the white patches caused by thrush. Treatment is simple: the baby’s mouth must be kept very clean and his feeding equipment meticulously sterilized. Nyastin suspension, prescribed by a doctor and given every 4 hours, results in a rapid cure. Fungus infections in a baby’s mouth are nearly always caused because the baby is infected from his mother’s vagina at delivery, so she will also require treatment.
Engorged breasts are fairly common in babies of both sexes during the first few days of life. It is not a serious condition, requires no treatment and disappears within a few days or may rarely continue for a few weeks. The enlargement is due to activity of the glandular part of the baby’s breast immediately after birth, since there are no longer maternal oestrogens in the circulation. In male infants the testicles are also sometimes slightly enlarged.
Menstruation is sometimes seen in a new-born baby girl. It is caused by the sudden stopping, after delivery, of maternal hormones passing to the baby, and is usually noticed on the 3rd or 4th day of life. A small area of the napkin may be stained with bright red blood. No treatment is required since the condition is self curing and is present for only about 48 hours.
Jaundice occurring in the new-born infant about the 3rd day of life is very common and need cause no anxiety. This is called physiological jaundice and is due to the baby’s blood having a high content of red cells which are rapidly broken down after birth. One of the end products of the breaking down of red cells is the yellow pigment called bilirubin which increases in the circulating blood to cause the jaundice. The liver of the baby at birth is unable to excrete the bilirubin sufficiently rapidly to prevent jaundice appearing. The jaundice should fade after the first week.
There are some serious causes of jaundice in the new-born baby such as Rhesus incompatibility. Most of these affect the baby within a few hours of birth so that he is yellow by the end of the first day of his life. If jaundice becomes very severe a condition known as kernicterus may develop in which the baby’s brain cells may be damaged. Because of the recognition by paediatricians of the dangers of severe jaundice, kernicterus is rare today. The bilirubin level in the blood can be partly controlled by drugs and by exposing the baby to a special light. An exchange transfusion will always be used to lower the bilirubin level if the more simple methods fail.
Gastroenteritis is a serious condition in babies and should have immediate medical attention. Gastroenteritis is an infection which is transmitted to the baby via his food usually because his feeding utensils have not been kept hygienically. It cannot be stressed enough that high standards of cleanliness must be observed when dealing with babies.
Acute gastroenteritis can develop from a mild ‘tummy upset’. Vomiting, frequent, loose and watery stools are followed by dehydration. Medical aid must be sought immediately. The baby must be isolated and given adequate fluid either by mouth or intravenously depending on medical instructions. When the infection has been treated, the vomiting and diarrhoea cease and the baby can again start to take fluid by mouth.
Haemorrhagic disease of the new-born baby is rare. When it does occur it starts about the 3rd day of life. The cause is not fully understood. Bleeding comes from the stomach and bowel and also from other organs. It is treated by giving an injection of vitamin K to help blood coagulation which is often deficient in the first few days of life. Most maternity hospitals arrange for all babies to have an injection of vitamin K shortly after birth to safeguard against this disease.