Monthly Archives: August 2013

Your baby: birth to 3 months

baby

Once the shock, relief and exhaustion of delivery have worn off a bit, you will probably find that caring for your new baby is a lot of work; wonderful, but still work.

Early feelings of parents are of mixed emotions:

They are happy, a bit scared, it takes time for the feeling of being mom /dad to sink in. Most of first time parents are scared of holding on to baby in their lap, just relax, Babies are not frail and enjoy your baby. Babies thrive on touch, so early contact and bonding is important. Lots of mothers are working these days, due to financial necessity and demanding careers and it puts huge pressure on them. But as a mother you should remember that’s it’s the quality time you spend with your child that will matter.

All of your baby`s senses are working:

  • Touch , motion:  baby calms done when holding, swaddling and rocking movement
  •  Smell: they prefer smell of their mother`s body.
  • Hearing: Baby prefers speech that is slow and musical- the way parents seem to naturally talk to them.
  •  Vision: baby can see at birth, but are they are near sighted. And their eyes are very sensitive, so they tend to keep them closed in normal light but open them when lights go down.

Individual Personality:

harperasleep

Every baby has his own personality. Some are calm, other are more excitable. Some are regular in their eating, sleeping and bowel habits: others are more erratic. Some can handle lots of stimulation: others need a quieter environment.

Feeding: 

Breast feeding is best possible option for baby; on demand feeding, day and night. Sucking is important pleasurable activity of baby along with getting nourishment for growth. Baby sometimes make sucking movement while in sleep also, it`s absolutely fine and does not mean that baby is necessarily hungry.

Bowel movement (potty):

Baby`s bowel pattern is very variable. At birth baby passes black to dark greenish motion (also called meconium) which changes to normal yellow color by day 3 to 4 of life. Baby can pass semi -loose motions, 10 to 12 times per day during 1st few weeks of life (also called transition stool). After around 4 to 6 weeks; pattern of motion again change. You will realize that same baby during his/her 1st year of life will have very variable motions; some time loose watery 8 to 10 times per day and sometimes well formed stool after 4 to 5 days even. So whole range is normal, and for all practical purpose forget about stool, if your baby is sucking well on breast and passing urine more than 10 times per day.

Many times baby cry during or just before passing motion or urine: this is mostly normal and do not warrant any cause of concern.

Sleeping:

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On an average baby can sleep from 12 to 18 hours. Practically speaking in initial few months, baby wakes up when hungry, passed urine or motion and goes to sleep again. Mostly awake in night and sleeping in day. Baby do not have orientation regarding day or night, they are least bothered when sun is going to rise. The main reason why your newborn baby is giving you sleepless nights for 1st few months; is when child was inside mother`s womb, she was surrounded by water (amniotic fluid), so when mother was doing her routine activity during day, that fluid used to move and give rocking movement to baby; whereas when in night mother lie down to sleep, that water become still and baby wakes up.  Every baby has different sleeping pattern (just like adults), so it`s best not to compare your child with anyone else.

Crying:   

Baby has virtually all the emotions which we have; they feel sad, happy, angry, frustrated, they want your attention; but they have only one way of communicating with you and that is crying. If the baby cries the moment you put her to bed but calms down in your arms or in your lap; then in all probability baby is fine. Because if baby is seriously hungry, no matter what you do, she will not stop crying unless feeding is given.

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Tips for comforting a crying baby

  • Offer a feeding.
  • Change the diaper (look for urine and motion, whether baby is wet).
  • Hold, swaddle and rock the baby (NEVER SHAKE the baby). Sometime baby just want to be in your arms and seeking your attention.
  • Change the noise level of surrounding i.e. if quiet room can play some music.
  • Darken the room and reduce stimulation.
  • Just take the child to open area for fresh air i.e. balcony or for a walk.
  • If baby still does not calm done and crying, better take the child in your car for a drive (most of the kids of this generation love the long drive); but if still baby is crying, change the direction of your car and drive to hospital and meet pediatrician/ child specialist in hospital.
  • Most important thing is to try to relax, it happens with absolutely every parents once in a while that baby give you sleepless night.

Other issues of regarding baby`s health will be dealt over next few articles. For any queries feel free to contact us.

Stay healthy and happy

Regards

DR. Rahul Varma

 

why is the incidence of jaundice in newborn baby rising?

Jaundice: why is the incidence of jaundice in newborn baby rising ?

Over the years , we all have seen lots of newborn baby diagnosed with jaundice on 3rd or 4th day of life, which turn out to be of great concern for most parents. First thing that comes to mind (esp. of grand parents ) that in old days jaundice was not so high, why is it now ? are doctors over diagnosing it ? is our baby kept unnecessarily in nursery?

Jaundice-In-Newborns 

I will try to answer these question in this article and will not go into too much technical details.

Facts: Jaundice is universal phenomenon i.e. it occurs in every baby who is born.

  • Normal trend is that Jaundice starts from day 2 or 3 and rises till 7th day and decreases gradually by 14th day of life. If its goes beyond a certain level then we need to treat , otherwise it will decrease on its own with time.
  • Sunlight can not decrease jaundice. Enough scientific data is there, as it requires particular wavelength of light to be given from close range in order to decrease it. Still some of the doctors (  who have not updated their knowledge ) might suggest sunlight exposure, which is incorrect. However giving sunlight exposure to your baby has various other advantage most important being Vitamin D3, hence it is advisable to give sunlight but not for jaundice.

Important points for parents:

  • Do not panic , it is very normal for babies to have jaundice  and it is easily treatable by giving Photo therapy in most cases.
  • But if there is significant delay in starting photo therapy and bilirubin level rises very high it can cause brain damage which cannot be reversed.
  • It cannot be predicted at birth how high jaundice will go i.e.most likely  you will be told about jaundice by your child doctor on day 3 or 4 of life (that unfortunately ,usually coincide with the timing of your discharge from hospital) .
  • There is no way that it can be prevented as it is a normal (or physiological) phenomenon.
  • As the treatment is so simple and risk if not treated is so high, its always better to be cautious and over treat rather then under treat.
  • Sunlight do not have any effect on jaundice as the distance is too far away and particular wavelength of light is required to decrease it.
  • Have faith in your doctor , not everyone is there to make money, most of the child specialist are honest and have soft corner for children.

Phototherapy charts

Given above  is the chart most commonly used by newborn specialist  and Pediatrician.

 

Further details  regarding Jaundice (if you wish to know in details,  otherwise you can skip it):

  • We as a doctor  has various cut off values for bilirubin level . ( Bilirubin levels is tested in blood which helps in assessing the severity of jaundice). These cut off guide us to decide whether your child need treatment or the level of bilirubin is with in normal limits and baby can be sent home. These cut off values varies as per , how old is your baby, what was birth weight, how mature your baby was i.e. born as per date or before that, blood group of baby and mother etc.
  • In most of the babies who are born on time and are good size babies and whose blood group matches their mother, jaundice is less likely to go above danger level (however photo therapy may be needed).
  • As the baby grows older, his liver starts functioning better and he can tolerate higher  level of jaundice. For eg a bilirubin level of 12 at 36 hours of life is more alarming than level of 15 at 60 hours of life.
  • Best thing which you as mother can do for your baby is breast feed, as feeding gets better child is able to metabolize and tolerated  bilirubin levels better.
  • This jaundice is newborn babies (indirect bilirubin is high)technically different from what usually occurs in adults (direct bilirubin is high). And it is not very dangerous unless until levels become too high.  A very high level of indirect bilirubin can cause brain damage, and once that damage occurs , its difficult to treat and child`s brain functions are hampered for life.
  • As medical science has evolved , we are able to diagnose more cases and start photo therapy early and actually prevent lots of cases of brain damage, which were there is past. (enough scientific data is there to suggest decrease in incidence of bilirubin induced brain damage).
  • Besides today most of us wants to have one baby or at the max 2, and do not want to take risk and want our children in best health.
  • Treatment of Jaundice is Photo therapy and in rare cases of very bilirubin Exchange transfusion.
  • Photo therapy:Special wavelength lights are given to babies from a particular distance. If level is high , we might give light from both side i.e.  one above the child hanging and one below the child. We give it continuously, interrupted only for feeding. We keep monitoring bilirubin levels and do repeat blood tests 12 to 24 hours usually but in some cases more frequently. It usually take around 48 hours to get jaundice in lower range but time taken to control jaundice is very variable.MK-BY847_LEDBAB_G_20121119162220 Baby-with-Jaundice-getting-Phototherapy
  • Exchange transfusion: In this we change the whole blood of baby gradually over few hours and replace it with blood from blood bank after cross matching. Its relatively serious process and is our last option when bilirubin levels are very high and neurological damage is suspected.

If you really want to go in for further detail then this is the link to know in detail regarding Jaundice.

Its virtually impossible to write everything here, so for any queries , feel free to contact us or your pediatrician. Its your right to discussion , the plan of care of your baby with treating pediatrician or Newborn specialist.

Stay healthy

Regards

Dr Rahul Varma

“ Healthy kids, happy family”

 

what is Complementary feeding (Weaning Diet ) ?

Complementary feeding: (weaning food)

It is defined as any non breast milk food or nutritious foods given to young children in addition to breast milk.( i.e. it is to complement breast milk, not to replace it.)

Age of Introduction: after 6 months

Attributes of Complementary feeds:

  • Soft and flowing
  • Thicker than Breast milk
  • Bland in taste
  • Homogeneous ( based on cereal or root staple foods)
  • 1 to 2 times a day to start with
  • Gradually increase frequency and quantity

Foods appropriate for complementary feeds:

  • Pulses (lentil, beans, peas), meat milk, vegetable oil and sugar
  • To increase dietary energy levels : oil, ghee, sugar
  • To increase quality of protein: milk product and animal food
  • Calcium: Milk
  • Iron: Meat, chicken, fish
  • Rich in Vitamin & Minerals: Vegetable and fruits

 

Conclusion:

Anything which is free flowing and well mashed and easy to swallow and calorie dense can be given. And you should always consult your Pediatrician at the start of weaning diet/ complementary feeding, so that he or she can guide you in best possible , culturally acceptable option.

Stay Healthy and eat healthy, For any queries do feel free to contact us.

regards

Dr. Rahul Varma