The first looks of your New Born Baby

Few newborns look picture perfect at birth. They have many variations in normal appearance - from color of the skin to its  texture to the shape of the head. Some of these differences are just temporary, part of the physical adjustments a baby goes through. Mentally, mostly all babies are awake and alert during the first few hours after birth.

Physical Appearance

Head
The head may look pointed due of pressure during birth. It would become normal in two weeks. When you touch on the top of your baby's head, you can feel a soft spot. This is the part where the bones of the skull have not joined together. It becomes normal when your child is 16-18months.

Skin
You will find little marks, spots and rashes, red or greenish blue on the skin of your new born baby. This is completely normal and some babies may have more than others.  Skin may be peeling on the hands and feet and some babies may have noticeable downy body hair. But all these will disappear on their own  accord.

Hands and Feet
The fingernails of the baby seems long at birth. The legs look bowed as he had been lying curled in the womb.

Eyes
The eyes may look as if they are squinting. This is very common in the first months. Puffy or blood shot eyes should be checked by the doctor.

Nose
The nose may appear flat as the bone hasn't yet fully developed.

Genitals
Most of the babies genitals look large. There may have a milky discharge from the breasts and sometimes blood or discharge from the vagina in a baby girl. This is because of  an infusion of mother's hormones from the placenta, just before birth. This is perfectly normal and will soon disappear.

Mental Ability :
Mostly all babies are awake and alert during the first few hours after birth. They are attracted to human sights especially faces and human sounds. They have a grasp reflex  and sucking reflex.  If an object is placed in his palm he involuntarily clenches his fists around it, likewise if the newborn is placed near his mothers breast, the baby will seek the nipple and begin to suck. Babies can see now, although objects may be blurred. They may respond to a sudden loud noise and to human voice, but not to ordinary sounds.

What to Do When Babies Cry

 

It's your job to try to figure out what your baby needs and fulfill those needs until he/she is developed enough to fulfill them him/herself.

"Colic" is a term used by doctors to define crying with no known cause. This doesn't mean that there isn't a cause. It just means that we don't know what the cause is. This term doesn't apply to babies that are simply fussy. A fussy baby can usually be calmed down by taking steps to alleviate discomfort and interaction. With colic, babies cry for hours, often during the same time every day, and their cries sound as though they are scared and/or in pain. It adds a major deal of stress to everyone's life. Without knowing what the cause is, it is almost impossible to get a colicky baby to calm down. If you find yourself doing everything on this list and anything else you can think of, but your baby is still crying, it is best to see your pediatrician to rule out any known underlying cause, such as illness. Then find a support group for parents with colicky babies; you'll be surprised by what you can learn from what other parents have tried.

Common Causes of Discomfort

• Uncomfortable Position Imagine being in an uncomfortable position and not having the ability to move around to get comfy. Try just changing her position. If she's on her tummy, put her on her back. Sometimes babies just want to be held, because in mommy or daddy's arms is often the most comfy place of all. (Notice if she acts as though any part of her body is tender and fusses even more when you touch her. Sometimes an arm or leg will fall asleep, giving them that pins and needles feeling if you touch it. If it doesn't get better after a couple of minutes, she might be injured or ill.)
• Hunger Offer baby something to eat or drink. If baby takes the food/drink and immediately quiets down, this may be the solution. (This is easiest if you're breastfeeding because you don't have to make up a bottle only to discover that your baby isn't hungry.) If you were already feeding your baby with a bottle, check the nipple to make sure it isn't clogged. If baby refuses to eat, move on to the next step.
• Needs to Suck Babies have a strong need to suck. It's an important urge because it allows them to feed, but sometimes a kid needs to suck even if he's not hungry. Try giving your baby something to suck on, like a finger, a toy, or a pacifier, if you're not opposed to it. (Don't abuse the pacifier. If baby is hungry, continually forcing the pacifier on her will just make her so upset that she won't be able to eat.)
• Wet or Poopy Diaper Yes, they really do mind sitting in their own filth sometimes. Change diapers as soon as you realized they are soiled, especially if baby has diaper rash, to avoid frustrated fits. (Always be sure to treat diaper rash to reduce pain that would otherwise cause additional crying after the diaper is changed.)
• Gas Work out any gas bubbles baby may have. Hold your baby upright and try to burp her. Feel her stomach to find out if it is distended. Hold your hand on her stomach to feel for gas bubbles moving around or gurgles. Move babies legs to help work out gas from the back end. Also try gently massaging the stomach. If gas comes out from the top (burp) and baby is still crying, try offering food again. If gas comes out from the bottom, check the diaper for poopies. You can also try try infant simethicone drops (anti-gas drops). Mylicon did wonders for our gassy baby.
• Boredom I know it doesn't seem like they do much, but babies really do play. Learn how to play with your baby and start entertaining her.
• Tired Babies don't always know that they need to sleep when they're tired, so it's your job to calm them down for nap time. Try soothing techniques.
• Too Hot / Too Cold Feel her hands, feet, and head. Look for signs of shivering or sweating. Bundle baby up or remove some layers to keep baby at a comfortable temperature. If your child seems unusually warm, take her temperature with a non-invasive thermometer (such as a ear thermometer, pacifier thermometer, or underarm thermometer). If the reading comes out a bit high, go ahead and take a rectal temperature.
• Uncomfortable Clothes Change baby's clothes. Sometimes clothes can just be uncomfortable. The fabric could be itchy. There could be a small pointy object poking at her (such as the plastic from a tag or a tiny splinter stuck in the fabric). Try putting baby in a different outfit or have some "naked time". Sometimes a kid just needs a little naked time. Take off all his clothes, keep him warm with a blanket or in a warm room, put him on an underpad, and let the naked time begin. It's amazing how well it works sometimes when you don't know what else to do.
• Itchy There were times when my baby would cry frantically, and I didn't know why. One day I decided to just scratch her all over, and I must have scratched an itch because it worked, and she stopped crying.
• Stress Babies get stressed out too, and we all know how uncomfortable stress feels. They have a lot to learn and adjust to, so it's easy for them to get over-stimulated or overwhelmed, which leads to frustration and crying. Try to soothing techniques. Sometimes children, even babies, are very sensitive to their parents emotions. If you've been stressed out lately, your baby may have picked up on it. Try calming yourself at the same time that you try to calm your baby. If you are relaxed, you have a much better chance of helping your baby relax.
• Sadness / Anxiety / Fear Babies have emotions too. Sadness, anxiety, and fear often occur from separation from a primary caregiver, not being able to play with something they wanted to play with, being scolded, or being left alone. Sometimes sadness, anxiety, and fear are just a part of life, but that doesn't mean they should have to learn how to deal with it during their first year of life. Keep situations that may trigger such emotions in your child to a minimum.
• Allergic Reactions If you're breastfeeding, did you eat something within the last day that could produce gas or that your baby is allergic to? Did you switch baby's formula or introduce any new foods? Do you smoke, drink, or take drugs or medication? Did your baby just start eating a new food? Keep a food diary and check your baby for diaper rash or unusual stools which may indicate food allergies. Eliminate possible problem foods to see if it fixes the problem in the future.
• Illness / Injury / Pain We all get uncomfortable when we're sick, and pain is never much fun. Assess if baby looks ill or injured (e.g. pale, vomiting or excessive spitting up, discharge from nose or eyes, excessive drooling, dry eyes, sunken fontanel, unusual swelling, not moving limbs normally, straining more than usual to poop, wheezing, etc.). Check your baby's temperature. A fever is an indicator of infection or inflammation. Babies will also cry because they're teething, or their diaper rash is bugging them. Quickly look for anything external that might be causing pain, such as a diaper pin that popped open, hairs tangled around fingers or toes (it happens a lot), a rough or sharp edge that she's laying on, etc. If you find such a situation, fix it immediately. Make sure that you address any possible symptoms of illness or injury by calling your pediatrician (that's what you pay them for).
• G.E.R. (Gastroesophageal Reflux) After eating, does your baby cry, spit up forcefully, or scrunch up and writhe as if in pain? Does your baby suddenly burst out in a painful cry during the middle of the night? Discuss this with your doctor. Your child may have gastroesophageal reflux (baby heartburn) which is painful and can cause damage to the esophagus over time. Try to keep your child upright or hold her slightly forward, give her smaller, more frequent feedings, and try to sooth her as much as possible until your doctor can see her and possibly prescribe medication for the problem. Some mothers swear that giving their baby rice cereal in a bottle helps too.
• U.T.I. (Urinary Tract Infection) If your baby cries whenever she urinate, she might have a urinary tract infection, especially if she has a fever. UTIs happen more in girls than in boys because girls have a shorter urethra. UTIs can be caused by lack of hygiene, introducing bacteria into the urethra from the anus by wiping back to front during a diaper change (always wipe front to back), and even soaps, bubble bath, and bath toys like soap crayons. Call your doctor and have her seen immediately for treatment. It won't go away on it's own and could develop into a kidney infection.

Amblyopia (Lazy Eye)

What is amblyopia?
Amblyopia (lazy eye) is poor vision in an eye that did not develop normally during childhood. It commonly affects one eye but may also involve both eyes. It is generally caused by lack of use of one eye, when brain 'favors' one eye over the other.

What causes amblyopia?
The visual system of the child is not fully developed at birth. The visual brain cells of a child are developing during their first decade of life. Any insult to the child's vision during this time period can lead to amblyopia.

Following are the common causes of amblyopia:

• Squint: This is the commonest cause of amblyopia. The brain to avoid double vision ignores the image from the deviating eye. This leads to poor visual development of the deviating eye and hence amblyopia.
• Unequal refractive error (anisometropia): In this condition, the two eyes have different refractive errors. Because the brain can not "balance" this difference, it picks the eye that is "easier" to use and develops a preference for this eye only. The eye with greater refractive error is suppressed and thus gets amblyopic. An early treatment by giving the right glasses for correction can prevent and correct this problem.
• Stimulus deprivation: Any form of stimulus derivation to either one or both eyes in early childhood may lead to a severe form of amblyopia. These causes for stimulus deprivation may be ptosis, cataract, glaucoma, patching or any other obstacle that blocks the vision in the eye.

How can we detect if the child has amblyopia?
Detecting amblyopia in child is difficult, as the child may not be aware of having one strong eye and one weak eye. If the child has a squint or some other abnormality, the parents may notice that something is wrong. The vision of the child can be tested by the ophthalmologist by special tests. Poor vision in an eye may point towards a possibility of amblyopia. Remember, poor vision in an eye does not always mean amblyopia. It is important to rule out other causes of poor vision in child.

Is it treatable?
Yes. In most of the cases the amblyopia is treatable. The treatment involves 'forcing' the brain to use the weaker eye and thus stimulating its visual development. This is done by patching the better eye. The schedule of patching is decided by the ophthalmologist depending upon the degree of amblyopia and the age of child.

When should it be treated?
As soon as possible. The earlier the amblyopia is detected and the treatment started, the better are the results. The aim is to stimulate the brain to use the suppressed eye before permanent change has occurred, so that it gets a chance of normal development. Generally speaking, an amblyopia that is not treated by 10 years of age has a poor chance of recovering the vision.

Why is it important to treat amblyopia?
If an amblyopic eye is not treated by 10 years of age, the amblyopic eye may permanently stay weak. This has many disadvantages like:

• Both eyes can not be used simultaneously and hence depth perception (three-dimensional vision) is not present. Many occupations are not open for people who have good vision in one eye only.
• It is important to give best possible vision to the amblyopic eye even if the other eye is seeing well. The importance of this becomes obvious, in case the person loses the other (better) eye, sometime later due to some injury or disease.

What are the factors that determine the success of treatment?
The success of amblyopia treatment largely depends upon the motivation of parents and the cooperation of the child. Patching of the better eye, especially when the amblyopic eye has very poor vision is not tolerated well by the child. The parents have to understand the importance of this treatment and should explain the same to the child to ensure better cooperation.
The other factors that determine the success of treatment are:

• The severity (depth) of amblyopia
• The age at which the treatment is started: The earlier the treatment is started, the better are the results
• Any other complicating factor in the eye preventing sufficient gain of vision, e.g., glaucoma, cataract, retinal or optic nerve disorders

My child has squint and amblyopia. Which should be treated first?
Amblyopia has to be treated first in all these cases. Once the amblyopia has been taken care of, the surgery may be done for squint correction.

Breast Feeding Myths

These things are heard from the neighbors or from the elders and have no scientific basis. Some of these are explained below-

More milk is to be drunk to produce more milk
This is not true. Any type of food taken in sufficient quantity is enough for the required milk production. The more the baby sucks the breasts, more is the flow of milk.

Small breasts do not give sufficient milk
Successful breast feeding does not depend upon size of the breasts. The size of breasts depends upon the layer of fat beneath the skin. Milk production depends upon special glands in the breasts, which are sufficient in all women.

During breast-feeding you have to stop eating certain food products
You can eat your favorite dishes during breast-feeding. Certain people may have some problems with some food products but others may not. If a certain thing causes some problems to your child, you can try eating it in small quantities. If it causes a problem always then you can stop eating it.

Using cold water while you are breast feeding is harmful
This belief does not have any scientific basis. It can only be proved wrong by experimenting on yourself. The belief that the baby can catch cold if mother works in cold water, is not true.

If you have not breast-fed your first baby, you will not be able to feed your second baby
This is wrong and you can rest assured that you can feed your second baby even if you have not breast-fed your first baby.

Mother's milk production starts after three days
This is not true. The initial yellowish, thick milk called 'colostrum' is very important and good for the baby; and is sufficient for the baby for the first three days.

Breast Feeding Tips

Are fruit juices, soups etc. recommended in the initial few months after birth?
No, after birth for 4 months nothing else except mother's milk is required. Other things can be harmful.

Should gripe water, ghutti etc. be given?
No, their use is unscientific and can be harmful.

Does my child need vitamins?

Breast fed babies do not need vitamins or tonics; but babies having top-feed might require some form of supplementation.

My baby is exclusively breast-fed, but he passes frequent loose stools. Is that OK?

It is normal in a breast-fed baby. But be observant regarding his hydration and whether he is passing enough urine.

Even after breast-feeding my baby, milk continues to flow. What should be done?
This is temporary problem. You can press your breasts and keep a clean soft cloth inside your bra.

Can I feed my baby if I am sick or if I am taking medicines?
Baby can be breast fed during any kind of sickness, even T.B. or Heprosy. Except anti-cancer drugs, most of the medicines are safe.

If my milk is not sufficient for the baby, then?
Almost all mothers can produce milk in sufficient quantity for their baby. You must breast-feed your baby more frequently, which will increase the milk production. Keep on taking nutritious diet in sufficient quantity, and fed the baby on demand. If the baby is passing urine 6 times in 24 hours, then it denotes sufficient milk production.

Can I feed my baby if I have a Caesarean section?
Yes you can. You can feed your baby, once the effect of sedatives and anaesthesia wears off. If might be difficult to feed initially but you can turn to your side, take someone's help and feed your baby.

Can I and my baby sleep on one bed?
Yes, you should make your baby sleep with you. It will be helpful in establishing an emotional bond with your baby, and also increase milk production.

My nipple hurts, when I breast-feed. What should I do?
This is because of faulty position of the body. The baby should be close to your body; his mouth and the chin should be close to your breast and he should be sucking on most of your arola and not only the nipple. Breast feed your baby frequently, and in correct position for small durations. Let some drops of your milk, to dry on your nipple. Do not use any creams or lotion.

Occasionally my breasts feel very hard and heavy. What should be done?
If there has been a long time gap between feeds or you have not breast-feed your baby, then you might get this feeling. You must feed your baby or express your milk with your hand.

If I have to go out, then is there any harm in giving one or two bottle-feeds?
Giving a top-feed substitutes for your breast-feed and so next time your milk will decrease in quantity. Also chances of contracting an infection are increased. You can express your milk in a clean utensil, which can later be given to the baby using a katori.

What is the harm in bottle feeding is properly boiled & used?
Firstly the child will stop taking breast feed; secondly while preparing a bottle of milk various other things like a spoon, sugar, bottle, lid, nipple and your hands are used which may not be clean and may introduce infection.
If a bottle has to be used, then remember
- To boil the bottle , nipple & lid for 20-25 minutes.
- Wash your hands properly before before touching the bottle.
- Do not dip your finger into the milk for checking the temperature.

Can I feed my babies if I have twins?
More breast-feeding leads to more milk production. You can feel both your babies together alternating them between the two breasts. If it is required you may feed them additionally using fresh milk.

How is milk expressed from the breasts?
Sit comfortably and gently massage your breasts. Using your thumb and index finger, press on the margins of the arola and collect milk in a clean & boiled katori. A breast-pump may also be used for this purpose.

How to store the expressed breast milk?
It can be stored in a closed lid utensil for 8 hours at room temperature & for 24 hours in a refrigerator. Do not warm the milk as it will kill the disease-preventing properties of the breast-milk.

Can top-feed be combined with breast milk?
If it is not possible to express the milk and keep then while the mother is away it is better to give fresh cow's/buffalo's milk using a katori, rather than a powder milk. When the mother comes back from work, she should breast-feed her baby as frequently as possible.

When & how to start food products other than milk?
You must start semi-solid food when the baby is 4-6 months old. Starting earlier than this can be harmful because the baby may not be able to digest it. The baby might then refuse to take breast-feeding leading to a excessive weight gain. Start from giving small quantity of a single kind of food. Gradually start giving mashed and semi-solid food of different variety preferably whatever is being cooked at home except spicy foods. Introduce new dishes, so that by twelve months, child starts eating and liking almost everything which is being cooked at home. Do not force him to eat, what he does not like. Keep on breast-feeding till the child himself stops breast-feeding.

Breast Feeding

Breast feeding practice is followed everywhere in India, except among higher socio- economic groups, who tend to look for alternatives to breast-feeding. Ignorance of the advantages of breast-feeding and the proper method often leads to discontinuation in most cases.

Basic Facts:

1. The ability of the breasts to produce milk diminishes soon after childbirth, without the stimulation of breast-feeding.
2. The immunity factors in breast milk can help the body fight off infections.
3. Breast milk contains vitamins, minerals and enzymes, which aid the baby's digestion.
4. Breast and formula feeding can be used together.

Advantages of breast-feeding.

1. It is the simplest way to feed the baby.
2. It increases the period of lactation amenonhoes after childbirth.
3. Breast milk also contains infection-fighting anti-bodies from the mother.
4. Breast feeding in the initial 4- months of the baby's life reduces the chances of infection and increases the immunity of the baby.
5. The amino acids in breast milk, the building blocks of proteins, are well balanced for the baby. These proteins best aid the baby's intestinal tract.
6. The emotional bonding between the baby and mother is strengthened & gives a feeling of satisfaction and achievement to the mother.
7. It is much cheaper than artificial feeding.

The baby should be put to the breast as soon as possible after birth. The initial yellowish and thick fluid (colostrum) is rich in proteins and protective antibodies. The practice of giving ghutti should be discouraged, because the nourishment of the baby is delayed, increasing chances of infection and delaying the stimulation for milk production.

Some important points:

1. The mother should sit in a comfortable position, hold the baby in her arms and offer the baby her whole breast & not just the nipple.
2. The baby should be fed from a different breast each time so that both breasts produce the maximum amount of milk.
3. The baby should be fed, whenever she is hungry. Before offering the second breast to the baby, it should be ensured that the baby sucks the fat rich hind milk from the first breast.
4. A daily bath is sufficient to keep the breasts clean.
5. Frequent cleaning with soap removes the natural oils from the breasts, predisposing the nipples to develop fissures.
6. Burping the baby after every feed by holding her against the shoulder is advisable.
7. A mother who is feeding her baby should eat healthy foods to keep up her strength & feed the baby letter.
8. At times the breasts may feel hot, heavy and hard, due to accumulation of milk.
9. The mother should be encouraged to let the baby continue to suck as for as possible.
10. If still enough milk is not removed, the milk should be expressed in a clear (preferably) boiled cup using the thumb and the finger.
11. A warm compress on the breast or a warm bath is also helpful.
12. It the baby is fed frequently both during the day and night this condition (engorgememt of breast) is uncommon.
13. If nipples are cracked and painful, the mother is advised to leave a drop of hind milk on, the nipple after feeding as this helps in healing. Malai can also be can applied.

Jaundice in Newborn

Definition :
Jaundice refers to the yellow coloration of the skin and white of the eye. When it occurs in a newly born baby its called as Newborn jaundice.

What causes it:
It is caused by high amount of bilirubin ( a pigment formed as a result of the break down of the Red cells in the blood. Bilirubin is eliminated from the body by the liver. The Liver of the newborn usually takes some time to adjust to excrete all the billirubin and until then the bilirubin builds up in the body and produces jaundice.

Types of newborn jaundice :

Physiological jaundice:
Some degree of jaundice is evident in a lot of newborns usually on the 2^nd day of life. It peaks around the 4^th to 5^th day & the yellowness disappears by the end of the 1^st week.Technically speaking the bilirubin levels are between 10-16 mg%.

Pathological jaundice:
If the bilirubin builds up too high in the body that is more than 17mg% within the first week then it may be toxic to the brain and it can cause permanent brain damage. This can occur due to some infection to the baby, mismatch between the baby's and mother's blood group or due to some structural defects in the liver.

Jaundice of prematurity:
It occurs frequently in premature babies because the liver takes much more time to be able to handle the bilirubin levels.

Breast milk jaundice:
A particular compound in the mother's milk can lead to jaundice in a few babies. It usually occurs the 4^th day onwards. However sometimes it can reach high levels be prolonged.
Stopping breast feeding & feeding only formula for 2 days subsides the jaundice and then breast feeding can be resumed .

Treatment:
In case of physiological jaundice no specific therapy is required. The infant should be watched for any complications or a sudden increase in the jaundice . Simply putting the baby in the sun for half an hour or so in the morning & evening is sufficient. Care though must be taken to avoid putting the baby in too strong a sunlight and for too long because then the baby can become dehydrated quickly and also can get sun burnt.

Phototherapy:
Fortunately the bilirubin is converted to a water soluble type by the fluorescent or natural light and this then can be easily excreted by the baby. Eye patches one worn to protect the baby's eyes.

Exchange transfusion :
In extreme cases of jaundice which is not controlled by phototherapy an exchange transfusion is performed this involves removing the blood containing high levels if bilirubin and replacing it with blood with very little bilirubin.