Dr. Rotimi Adesanya (Paediatrician)
This handbook has been developed to help mothers, parents and guardians learn a few things about their babies. These tips give a lot of information on how a baby grows, how to breastfeed, and helpful hints on caring for babies through infancy.
Breast feeding is the normal way to feed babies. Breast milk provides all the nutrition the baby needs. It has hundreds of antibodies, enzymes, and other factors that protect babies from infections and diseases .Breast milk is easy for the baby to digest, it is always at the right temperature, easy to provide, always handy. Breastfeeding is also good for the mothers because it helps them to return more quickly to pre-pregnancy weight, gives stronger bones in later life, helps to bond more closely to the baby and lowers the risk of breast cancer, ovarian cancer and diabetes.
The World Health Organization, and many other National and international organizations Recommend that no other foods besides Breast milk be given to the babies until they are six months old. They also recommend that one continues to breastfeed after starting solid foods at six months.
The Hospital provides lactation service for mothers who register for antenatal care and deliver in the hospital. Lectures and practical guides are given by the lactation experts (Doctors and Nurses)
The soft spots (fontanelles) on top of a baby’s head are there so that the baby’s bones can move a little, so that the baby can more easily fit through the birth passage when he is being born. These spots will usually close over in the baby’s first year or so. Sometimes a fontanelle swells when the baby is crying and goes flat when the crying stops. It can also be sunken if the baby is dehydrated.
Babies do some things automatically without knowing they are doing them. These are called reflexes. For example, if something is put in their mouths they suck on it (sucking reflex), and if something is put in their hands they hold on tight (grasp reflex). If they are startled or upset they fling their arms out and throw their heads back (startle reflex).
Babies are often born with large genitals and Breasts and sometimes ‘milk’ even comes from their breasts. This swelling is due to the mother’s hormones, it is normal (even for boys) and it does not last long. Don’t try to squeeze any milk out of the breasts, as too much pressure can sometimes cause an infection. If the breasts become larger, firm and tender, and your baby seems unwell, there could be an infection, and you would need to take your baby to your doctor.
The baby’s umbilicus (belly button) may take several days to heal fully, and many babies have umbilical hernias. An umbilical hernia is a lump underneath their belly button (umbilicus). It may swell if the baby is crying. This is a small gap in the tummy muscles and will nearly always go away in time. It does not cause health problems.
Cradle cap is a yellowish, patchy, greasy, scaly and crusty skin rash that occurs on the scalp of recently born babies. You can put on olive oil or baby oil to soften the scales and wash the oil off the next day. Gently lift off the softened scales with a soft brush. If some of the scales are sticking to the surface of the scalp, use the oil again the next night. Do not use much pressure to scrape off the scales as this could cause wound on the underlying skin.
Most babies have spots on their faces and often on parts of the body in the first few weeks. They are called milia and can look like acne –red spots with white centers. They are not acne and they do not need any treatment. They seem to be a reaction to the skin being exposed to air rather than to fluid in the womb (uterus) before birth. Sometimes the spots come when the baby gets hot or has been lying on that side: Some may also be reactions of the skin to Baby’s cream, lotions etc
This is a red and painful rash on the diaper area. Rashes can be caused by irritation from dampness of urine or bowel movement on the skin. To Prevent Diaper Rash, Wash your hands before and after changing diapers. Keep the skin dry by changing diapers as soon as they are wet or soiled. Wash the diaper area with warm water and dry well or preferably use a baby wipe. Take the diaper off and expose the area to the air for 10 to15 minutes, three times a day. You can lay your baby on an absorbent towel and play with her during this time: When the diaper area is clean and dry, rub on a thin Layer of zinc-based cream.
Oral Thrush (Candidiasis)
Thrush is a common infection in infants. Thrush appears as a whitish Gray coating on the tongue and on the inside of the cheeks and gums. This coating is not easily wiped off. Babies may also develop thrush on their skin. Most babies do not have any pain or complications with thrush
Lots of babies have hiccups after feeds. This is normal. Some babies spill some milk after feeds. If they are growing well and happy this is nothing to worry about. If the baby is bringing up milk in big spurts much of the time and not putting on weight or is miserable a lot of the time, you need to see the doctor.
Many babies cry for up to three hours, or sometimes more, a day in the early weeks. Most babies like being held and comforted. Some babies still cry when they are being held. Remember that every baby is different. While babies usually follow similar patterns with their development, your baby might do things faster or slower or differently from other babies and this is usually fine. If the baby is doing things much more slowly or not doing some things at all, it is a good idea to check with your doctor to make sure that all is going well.
Some babies have little white lumps like tiny pearls in their mouth, especially on the gums . These is normal and go away when the baby grows.
Most babies get their first tooth between 6-9 months. Once teething starts, it continues almost uninterrupted for about two years. Some babies have no difficulty with teething while others may become fussy and uncomfortable. Some things you can do to relieve sore or tender gums: Give the baby a clean teething ring (Teether). Clean and massage the gums regularly to ease discomfort.
Very young breastfed babies usually do several ‘poos’a day. Even if your baby seems to be pushing hard, the “poo” is usually very soft. After a few weeks some breastfed babies only have a “poo” every few days and it will still be soft. All this is normal. Bottle fed babies might have firmer “poos”. If the “poos” seem very hard, water may be given to the baby to help the poos are soft again. Some may also have constipation for days, they may need to be assisted with the bowel movement.
A little light pink or orange stain from urine on the nappy is common and is nothing to worry about. It is caused by a reaction between chemicals in the baby’s urine (urates) and chemicals in the fibres of the nappy. It is more likely in boys because their stream of wee (urine) is more likely to be all in the same place on the diaper. If it is red or leaves a brown stain, that is, if it looks at all like blood or your baby seems unwell and is not feeding normally you need to have it checked by a doctor. Sometimes there can be small ‘crystals’ on the inner surface of a disposable nappy. These come from the inside of the nappy not from the baby.
Vaginal blood loss
Some female babies have a small vaginal blood loss a few days after birth. This loss is due to the change in hormone levels after birth causing a brief menstrual period. This bleeding stops after a day or two. There will not be any more vaginal blood loss until the girl reaches puberty and starts to have periods.
The child developmental milestones are briefly analyzed below:
Six week: he can smile at you when you smile at him.
Two month : Neck Control i.e he can hold up his head when you are holding him upright and lift his head up if he is lying on his tummy.
Three month: he will enjoy hitting toys that make a noise and he can hold a rattle for a short time.
Four month: he may be able to roll from his front to his back, but it may be another couple of months, or more, before he can roll from his back to his front.
Six month: he may be able to sit without support
Seven month: she will be sitting up and might be starting to crawl.
Nine month: many babies can pull themselves up to stand. Some babies take longer. It takes another two or three months or so before he can stand without holding onto something and then a few more weeks before he can actually walk.
Twelve month: babies will talk to you in their own language, and expect you to
understand. They may say one or two clear words – Hello, No etc. They can understand some words. The baby will be able to hold something with his thumb and forefinger and play little games like wave goodbye.
Jaundice appears in about half of full term babies and about three most of preterm babies. Babies has extra red blood cells. As the blood cells breakdown, A yellow Colored substance called bilirubin is released. The yellow coloured substance in the baby’s blood causes the skin and the whites of the eyes to take on a yellowish tinge called jaundice. In most infants, Jaundice is mild. It comes on during the first three to five days and lasts only a few days. The only treatment needed initially is lots of breastfeeding and later phototherapy. Do not give water by bottle as bilirubin is better eliminated through stools than urine. Untreated severe jaundice can lead to brain damage and deafness.
Immunizations help to protect children from many diseases. Other words for immunizations are inoculations, vaccinations, boosters, and shots. Immunizations help the baby’s immune system make substances called antibodies that fight diseases. The baby then develops protection against these diseases. Some vaccines are only given once or twice, and some need to be given over a period of time in a series of properly spaced immunizations. By immunizing your baby, you give him the best possible protection against many serious diseases. Always take your child’s record with you when he gets his immunizations. Keep it with other important papers, because your child will need his immunization record when he is older. Sometimes immunizations may cause minor side effects, but these are temporary. These side effects might be soreness or swelling where the needle went into the arm or leg, or a slight fever. These do not usually last long. Serious side effects from immunizations are very rare.
Vitamin K Injection
All newborns should have an injection of Vitamin K within 6 hours after birth.This injection helps prevent haemorrhagic disease of the newborn. Haemorrhagic disease of the newborn is a bleeding problem that occurs during the first few days of life.
Pediatrians recommends that all newborns receive treatment to prevent an infection of gonorrhoea or chlamydia. These infections can get into the baby’s eyes during birth. Today, an eye ointment is usually used to treat a baby’s eyes if the discharge is copious. If not treated, these infections are severe and can cause blindness.
Middle ear infections is called Otitis Media. Children can also get infections in the ear canal (called Otitis Externa).It causes pain, fever and distress to children and is one of the reasons why they may wake at night. Ear infections can also affect children’s hearing.
Fever is usually caused by an infection. The source of the infection can be bacteria or a virus. Fever is the normal process of fighting an infection. Babies less than six months old should be taken to their health care provider if they have a fever. Let the baby breastfeed more, or offer more to drink, take off extra clothes that the baby is wearing. Give medicine to help bring down the fever and make him more comfortable. Give your baby a tepid sponging or lukewarm bath. Not every sick baby will have a fever, especially if they are less than 1 month old. Some signs of a sick baby may be poor feeding, excessive crying or being irritable.
Your baby’s body temperature changes throughout the day. It is lowest in the early morning and highest in the early evening. Normal temperature taken under the armpit is 36.5°C to 37.4°C (97.7°F to 99.3°F).Put the tip of the thermometer in the centre of the armpit. Tuck the arm snugly against the body, then comfort and distract your baby. After about 1 minute the thermometer will beep if it is digital. Mothers are advised to get their own digital thermometer for home use.
Paracetamol or Ibuprofen
Paracetamol (which in some countries is called acetaminophen/tyelenol ) has been safely used for many years to help with mild to moderate pain and fever for babies, young children and older children. But if too much paracetamol is given to a child, especially a sick child, for too long, it can harm the child. Ibuprofen is a newer drug than paracetamol, but it has also been used for fever and mild to moderate pain in children and adults for some years. It is not suitable for children under six months of age. If the fever persist for 1-2 days,it is advisable the child is seen by the doctor.
Circumcision, where allowed and legal, is the removal of the flap of skin which naturally covers the tip of the penis.
Circumcision can be painful for the child, both at the time of the operation and even some days after. Male Circumcision reduces risks of urinary tract infection in infancy and reduces the risk of HIV/AIDS later in life and also balanitis that occur in some uncircumcised individuals. The babies are placed on paracetamol after the procedure.
Female circumcision is harmful and is not or be allowed to be done due to the various complications that the surgery exposes the female child to. When she becomes adult, female circumcision is harmful to good enjoyable sex life and a danger to child birth of the circumcised woman
Preterm babies “or preemies” are those who are born before 37 weeks gestation. Preemies may have immature organ systems. Generally, the younger the baby’s age at birth, the more health problems she may have. Preterm baby may need to be separated from the mother at birth if special care is required. When the preterm baby is well enough, she may be encouraged to have skin-to-skin contact with the mother. This is called Kangaroo Care. The baby is unwrapped and placed on the chest where he can hear the heart beat, feel the breathing, and breastfeed. The babies may have problems with feeding. They may be fed via special tubes or pump to give breast milk for feeding.
Remember – Never shake a baby or throw a baby up! It can lead to seizure, brain damage and death.