Routine Care of Newborn Baby

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Scenario:

The wait is finally over. Seema and Suresh are now proud new parents! 

The delivery was normal and the adorable baby girl came into this world with a loud, lusty cry. Today is the second day of her life. The doctor has examined her and found her to be ready to be discharged home.

The new mother and father are once again facing the familiar blues. How are we going to manage this bundle of joy at home, on our own?

Discussion:                                                                                    

Taking care of a normal newborn baby till her first birthday is not at all difficult if you follow these simple guidelines.

1. Relax and enjoy the parenthood. 

• Don’t burden yourself with worry and anxiety.

• Everything is so new for you now, so you may get worried about so many things in your baby’s physical appearance or breathing/crying/feeding/sleeping pattern. But rest assured that most of these observations do not indicate that there is something wrong with her.

• (Later on, read the next chapter ‘When abnormal is normal in your newborn baby’!)

2. Warmth: 

Your baby is going to need plenty of warmth – both, physically and emotionally. Your loving presence is enough to provide her with emotional warmth but for keeping her physically warm, these are the steps.

1. Room Temperature: 

• If you have an air-conditioner, then keep the room temperature between 20*C and 22 *C.

2. Layered clothing: 

• In the early months, she will mostly need multiple layers of clothing (undershirt, nappy, pajamas and a wrap-around blanket) to keep her warm. 
• If the room feels too cold to you, then also make her wear a cap, gloves and socks. 
• In hot room temperatures (above 24*C), single-layered clothing may be enough.
• A simple rule will be to add one more layer of clothing for the baby to what clothing you are comfortable wearing in that temperature.
• If your baby is feeling hot to touch, then probably you are overclothing her.
• Do not overclothe her as that may lead to overheating, excessive sweating and dehydration. 

3. Skin Care:

1. Bath: 

• Till the baby’s umbilical cord falls off by 7- 10 days, just give her sponge-baths. Later on, you could start bathing her daily. If you are living in one of the cold places, then you may bathe her on alternate days.
• Use comfortably warm water for giving baths and make sure that it is not too hot. 
• Use mild baby-soap. 
• In the early months, keep the baths short (5-10 minutes) and after the bath, immediately pat dry the baby with a towel, without exposing her too long to outside temperatures.

2. Applications and massage:

• Apply some fragrance-free moisturizing baby-lotion immediately after toweling the skin.
• Do not use baby talcum-powder as its small particles may enter baby’s lungs and cause problems. 
• Do not use skin-care products that are not specifically made for babies.
• Don’t apply ‘Besan’ (Chick-pea flour) in the hope of making the baby fairer! Neither does it make the skin fairer nor does it remove the facial and body hair.
• Don’t apply Kaajal or Surma (Kohl) in baby’s eyes. They may contain harmful chemicals.
• Don’t put oil in nose or ears in the hope that it would ‘clean’ them. These practices can sometimes cause serious medical problems. Remember, babies are naturally clean and beautiful. We don’t need to do all these needless things, just because they have been popular customs.
• Oil body-massage is another popular long-standing Indian custom and is okay to do if there is no skin reaction like redness or rash afterwards. Plain olive, almond or coconut oil is as good as any other expensive baby oil. 

• Beware of massage-ladies though! These masseurs, who are usually old ladies with a truckload of massaging tales to tell, will often give needless potentially harmful baby-care suggestions and indulge in harmful practices such as milking baby-breasts. 

• So it is better that the mother does the baby-massage herself. The baby will enjoy it much more and it will also help in better mother-baby bonding.

3. Hair and nails

• If you want to apply oil to scalp, do it half an hour prior to bath. Once again, plain olive, almond or coconut oil is as effective as any other expensive baby oil.

• Use a mild baby shampoo for washing hair and make sure to wash off oil.

• Dry the washed hair immediately and then, gently comb them to keep them tangle-free. 

• Shaving off hair completely in infancy is a popular Indian custom, sometimes for religious reasons and sometimes in the hope of stimulating better hair-growth. It is a custom which can cause scalp/hair infection from unhygienic blades and it anyways, plays no role in hair-growth. In fact, this shaving process may damage the hair-roots and cause future hair-problems! 

• Carefully trim the baby’s nails with baby nail clippers or blunt nail scissors. Baby’s finger-nails grow fast and may need to be cut once a week or sometimes even twice a week. Her toe-nails grow slowly and usually need a monthly trimming.

4. Umbilical Care: 

• Properly clean the umbilicus with a spirit swab till the cord falls off and the area becomes dry. 
• If there is any redness, discharge or foul smell, show it to the doctor, who would prescribe an antibiotic ointment to apply.

5. Eye Care

• If there is any eye discharge, then wipe it with lukewarm water. 
• If it continues or increases, then put eye drops/ointment according to doctor’s advice.

6. Feeding: 

• Breast feeding is best feeding and it should be the first and only type of feeding whenever possible. In the first 2-3 days, the mother usually has yellow, thick milk in small quantities. But remember, that is not the reason to start outside milk feeds. This early milk is called ‘Colostrum’ and is perfectly enough to take care of your baby’s needs. Plus, it is going to provide your baby with protective antibodies.
  
• Bottle feeding is a compromise and its pitfalls need to be understood before starting that. Never start bottle-feeding or for that matter, any form of additional or replacement feeding, without discussing with your doctor.
  
• The schedule of feeds should be semi-demand schedule- that is to regularly offer the feeds around every 2-3 hours when the baby is awake and to give additional feeds if the baby demands them in between the regular scheduled feeds.

7. Stools: 

• The first baby-stools are thick, dark black or dark green and are called meconium. The baby will pass meconium within first 24 hours.
• Afterwards her next few stools will be yellow-green.
• Breast baby-stools are yellowish with runny, curd-like consistency. They are also sometimes described as light mustard colored with seed-like particles. 
• Formula-fed baby’s stools are slightly firmer and look tan or yellow. 
• Once the baby is weaned off on other foods, the stools may become more firm and look light yellow – brownish in color. They may sometimes show undigested food particles.
• There may be some day-to-day variations in colour, consistency, smell and number and if the baby is otherwise active, feeding and growing well, then such changes shouldn’t worry you. 
• Similarly a milk-fed baby (particularly the baby on mother’s milk), may pass stools only once in 4-7 days. It is considered normal if the stool consistency is soft and the baby is not showing any discomfort, vomiting or abdominal distension. Check up with the doctor id any of these associated symptoms are there.
• Seek immediate medical attention if the stool is with frank blood; if it looks like currant-jelly; if it is colorless or white or in form of frequent, watery motions.

8. Urination:

• A well-fed baby will pass urine 6-8 times in a day. 
• The usual color of urine will be light to dark yellow. 
• Sometimes if the baby is passing urine after long time or in situations like hot weather or fever, the urine may be concentrated and appear dark yellow. 
• Sometimes highly concentrated urine may leave a pinkish or red-orange (Brick-colored) spot on the nappy. This is because of the colored crystals formed by chemicals (urates and calcium), and not because of blood-staining.
• Presence of actual blood in urine, dark cola- colored urine, seemingly painful urination, foul smelling urine, poor urine flow, double urine stream or not passing urine for many hours are symptoms, which need medical attention.

9. Sleep: 

• The average sleeping time is around 18-20 hours in newborn period but it may vary from baby to baby. Expect that baby might stay awake during nights and sleep throughout days. 

• Be prepared for some sleepless nights but don’t worry- it would just be a passing phase!

• (For other sleep-related queries, read the chapter – ‘Go to sleep my baby’!)

10. Clothes: 

• Preferably use pull-down type of cotton clothes without beads, buttons or knots. 

• Wrapping in a sheet is a popular Indian way and the babies usually enjoy that. But beware of the fact that in warm weathers, this wrapping practice can lead to excessive sweating and dehydration.

• Using either a cotton diaper or a readymade marketed diaper as a nappy is entirely an individual decision. But make sure that you keep changing the nappies regularly at least 5-6 times in the day. 

• Clean the soiled nappy area with water. Do not use the marketed wet-wipes on a regular basis as they often cause skin irritation and allergy. You could use them occasionally when you are outside and do not have an access to washroom.

• Apply a protective barrier cream every time a soiled nappy is changed.

11. Consult a doctor. 

• Many symptoms in infants such as occasional spitting up/bringing up of milk, noisy breathing (because of small size of airways) and warm forehead are harmless. Occasional coughing and sneezing are normal physiologic reflexes.

• But immediately seek a medical opinion when there is any disconcerting persisting or severe symptom such as lethargy, refusal to feed, poor sucking, fever, excessive cough, breathing difficulty, bluish discoloration of tongue/ lips, discharge from eyes/ears/umbilicus, vomiting, abnormal jerky body movements and excessive loose motions.

12. Regular ‘Well-Baby’ Visits:

• The earliest well-baby visit will be when your doctor will ask to bring your baby for Neonatal Screening tests on 2^nd or 3rd day. On that day, baby’s blood sample will be taken by pricking her heel. 

This sample will be checked in laboratory for ruling out important congenital (by birth) problems such as hypothyroidism, G6PD enzyme deficiency, galactosemia, phenylketonuria, congenital adrenal hyperplasia or cystic fibrosis. Diagnosing these problems early will make sure that they are treated immediately and are not allowed to harm the baby.

• Later, even if your baby is perfectly fine, schedule monthly visits to your doctor for first 6 months and bi-monthly for the next 6 months.

• These visits will help you to check your baby’s growth and development; screen for any potential health problems; carry out necessary vaccinations; understand weaning process and allow you to discuss any other concerns.