Mothers can become experts in newborn care in just days
Nascent motherhood is a mixed bag of joy, excitement, anxiety and dilemma. The new mother, loaded with responsibility and concerns of bringing up her new found treasure, is often confused about the very fundamentals of newborn care.
A great start to motherhood can be had with breast feeding. The baby shall be breast-fed in the first half an hour of delivery or at the earliest time possible. During the first few days, colostrum, the thick yellowish precursor to breast milk only will be available for the infant. The quantity of colostrum, which is very rich in calories and immunity supplements, may be small but sufficient for the newborn.
Adequacy of breast milk available to the baby can be vaguely assessed by various ways like passing urine four to six times minimum but eight to 10 times/ day would be very reassuring, change of stool colour from black to yellow in the initial four to six days. Also, good feed-sleep cycle — feed for 20 to 30 minutes and sleep for two to two and half hours is considered ideal.
However the best assessment of adequate nutrition can be had by monitoring the body weight of the new born. During the initial few days babies tend to lose up to a maximum of 10 per cent of the birth weight. Any weight loss more than this limit, needs to be addressed by the pediatrician.
The baby should regain birth weight by day 10. Therefore a three kilogramme baby can lose up to 300gms during the initial few days but should weigh the same by the 10th day. They should gain a minimum of 30 grams every day or 300 grams in every 10 days. The baby is expected to double his birth weight in four to five months and triple his birth weight by one year. A baby born with low birth weight will grow slowly and pushing them hard to reach higher weights may lead to infant obesity.
Latching — the way your baby takes your nipple and areola into his/her mouth to suckle is an important aspect of breast feeding. Without proper latching, the baby will not get the milk he needs and the breasts won’t be stimulated to produce more, initiating a vicious cycle of poor milk demand and poor milk supply.
By the second week, the babies are sometimes found passing watery stools as many as 10 to 15 times per day, called transitional stools, which is normal especially if the babies are only breast-fed.
Newborns tend to develop some jaundice, symptomatic with yellow eyes and skin in the first two weeks, peaking around day five in some babies. Jaundice on the first day is abnormal, as is jaundice after 14 days, and has to be evaluated by the pediatrician. The colour of the stools of the new born babies after initial few days should be golden yellow and pale stools need to be monitored and evaluated.
Breast engorgement may be seen in babies randomly due to the influence of maternal hormones passing over to the baby through placenta. They are of little concern and should settle on their own. In few female babies, white vaginal discharge and sometimes even bleeding may be seen, again due to maternal hormone influence and is normal.
Umbilical cord may take up to three weeks to six weeks to fall but in the majority, it falls within the first week of life and is not a painful process. Redness or pus from umbilicus needs to be addressed by the pediatrician. Towards the end of first month, lot of babies tend to be constipated, passing stools every alternate day or even once in seven days.
It is best to avoid lotions, creams and powders in the initial few months of life unless medically indicated. Babies need to be properly covered and kept warm.
Major concerns in babies include fever, poor feeding, poor response to touch, too much sleepiness and lethargy, persistent fast breathing, laboured breathing, persistent vomiting with abdominal distensions.
Outings leading to external contacts may be avoided in the first three months, as the baby’s immunity is at its lowest during this period.
Dr Sabitha Ramachandran Nair is a specialist pediatrician at the International Modern Hospital