Should I phone the doctor?
Most babies get sick in those very early months. Fortunately, it’s seldom serious, but sometimes you do need to call your paediatrician, writes Shanda Luyt
UNDERSTANDABLY YOU’RE WORRIED when something isn’t quite right with your brand-new baby – he is, after all, the most valuable gift you’ll ever receive, and you don’t want to take any chances. But, you don’t want to run to the doctor with every little thing. How do you know when the symptoms are serious enough that a doctor needs to take a look?
THE SOFT SPOTS
Babies are born with soft spots (fontanelles) on their head where there’s no bone. The front one on top of the head is relatively large and disappears by 15 to 18 months, and the smaller triangular one at the back is usually gone by four to six months. The absence of bone might make you anxious, but there’s a strong membrane protecting the brain. Sometimes you’ll see the fontanelle beating – that’s normal. Your baby’s fontanelle will usually feel slightly sunken. If your baby cries or lies down it could bulge slightly, but it will recede if he stops crying and sits up.
WHAT YOU CAN DO
Watch the fontanelle for premature closing, and also keep an eye if it’s unusually sunken or swollen.
GO TO THE DOCTOR WHEN
❯ The fontanelle closes up much too early or does not close up at all.
❯ The fontanelle is very deeply sunken, especially if your baby has diarrhoea or is vomiting – it’s a sign of dehydration.
❯ The fontanelle remains bulging. It could point to pressure on the skull.
THE CORD
Most newborns have a slight yellow discharge on the belly button before the umbilical cord falls off after seven to 10 days. There’s usually also a little bleeding when it falls off, or afterwards. You’ll usually spot it during a nappy change, and it can last a week.
WHAT YOU CAN DO
Researchers have found it’s not really necessary to clean your little one’s umbilical cord with alcohol, but it won’t do any harm – it might just take longer before falling off.
❯ Don’t tug on the cord or fiddle with it. ❯ Fold the nappy over, so it doesn’t rub up against the cord and stays free from urine in order to avoid infection.
GO TO THE DOCTOR WHEN
❯ The cord is actively bleeding (if blood appears again immediately after you’ve wiped it off), even after you’ve been applying pressure with gauze wipes for about 15 minutes.
❯ There’s any sign of infection, for example if the skin around the cord is red and swollen, the yellow discharge smells foul, or your baby is running a fever.
JAUNDICE
If your little one’s skin and eyes look yellow, he probably has jaundice. The yellow appearance is caused by high levels of bilirubin (bile pigment) in the blood, because newborn livers often have not effectively removed it. Jaundice can sometimes make Baby drowsy and not nurse well. In most babies, it’s harmless and disappears after two weeks without treatment, but it’s important that the jaundice be monitored. If more serious jaundice is left untreated, high levels of bilirubin can lead to serious complications, such
as brain damage.
With serious jaundice, your doctor will test the bilirubin level. In hospital, your baby will be placed under blue lights to help break down the bilirubin. You can rent the lights to use them at home.
WHAT YOU CAN DO
❯ Always inform your doctor or clinic sister when your baby starts looking yellow.
❯ Nurse your baby as often as possible (preferably breastfeed every two hours) – regular feeds lead to regular stools, which helps with the removal of the bilirubin.
❯ Put your baby in mild sunlight often – it helps break down the bilirubin.
GO TO THE DOCTOR WHEN
❯ Your baby is very yellow, especially if the soles of his feet are yellow.
❯ The jaundice becomes worse following your discharge from hospital, it’s been persisting for longer than two weeks or baby develops other symptoms. ❯ Baby is running a fever, is listless, has dark urine and doesn’t want to nurse.
COUGHS AND SNEEZES
When your little one sneezes, it doesn’t mean he’s got a cold. Because small babies breathe through the nose, and their nasal passages are quite narrow, even a little bit of phlegm can block their nose. Sneezing helps to clear the nose. A cough could sometimes be cause for concern, because babies seldom do so.
WHAT YOU CAN DO
❯ Unblock his nose with saline drops.
GO TO THE DOCTOR WHEN
❯ The sneeze or cough occurs alongside other symptoms such as fever, listlessness or a tight chest.
❯ He has a barking cough and battles to breathe.
WEIGHT LOSS
Baby’s health is always measured in terms of how much weight he gains. But all babies lose weight in the first three days after birth before they start gaining it back again. Most babies lose three to 10 percent of their birth weight, and only regain it after two to three weeks. Your baby will also not gain weight exactly according to his growth-chart percentile. More important than the amount is that he is actually gaining weight. Some babies are just bigger than others!
WHAT YOU CAN DO
❯ During the first months, weigh your baby at the clinic every week to monitor his weight.
❯ Check that he has at least six to eight dirty nappies per day, his urine is light yellow, and his overall condition is good. ❯ Make sure he latches correctly when he nurses. Don’t rush out to get formula – rather go to a lactation consultant for help and support.
GO TO THE DOCTOR WHEN
❯ You’re worried about your baby’s weight gain.
VOMITING
It’s normal for your baby to spit up a little milk after a feed, because the sphincter between the tummy and the oesophagus doesn’t work as it should yet. If your baby is really vomiting, it will happen a while after the feed, and it will smell foul. If your baby often brings up large volumes of milk after a feed, this needs to be checked out further. Reasons for vomiting could include lactose intolerance, reflux, urinary tract infection or a viral infection (especially when he also has diarrhoea). If your little one often projectile vomits – where the milk is propelled out forcefully – after a feed, discuss this with your doctor, because it can affect his feeding and weight. Projectile vomiting can point to pyloric stenosis (narrowing of the lower part of the tummy that connects to the small intestine), a potentially serious condition that must urgently be corrected with a small operation.
WHAT YOU CAN DO
❯ Hold your baby upright after feeds. ❯ Ensure your baby doesn’t dehydrate because of vomiting.
❯ Keep on nursing him. ❯ Don’t give over-the-counter meds without your doctor’s permission.
GO TO THE DOCTOR WHEN
❯ It’s 12 hours later, and your baby is still vomiting. Go immediately when it looks like he’s dehydrated or losing weight, if he has extra symptoms like fever or diarrhoea, or refuses to eat. ❯ It’s been an unusually long time without a stool, or if baby’s tummy is swollen.
DIRTY NAPPY
Your baby’s first soiled nappy after birth is sticky black meconium. After that, his stool will be mustard coloured, and he could have six dirty nappies in a day – or one every six days.
Bottle babies have more solid stools that are yellow-brown and happen once a day usually.
If it looks like your baby is constipated (his poo will be hard), consider prune juice, or cycle his legs. You’ll recognise diarrhoea from its very watery appearance, often green colour, and foul smell.
WHAT YOU CAN DO
❯ Keep on feeding baby, so that he doesn’t dehydrate.
❯ You can give water with added electrolytes if it looks like he’s dehydrating.
❯ Make sure to wash your hands after every nappy change, to control for infection.
GO TO THE DOCTOR WHEN
❯ There’s blood or mucus in baby’s poo, or if he has diarrhoea.
❯ He hasn’t made a poo for an unusually long time.