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Most new mothers are prone to anxiety over some common concerns with regard to their newborn babies. The following are the usual concerns, and some tips on how they need to be addressed.
1. Umbilical cord: Usually, the umbilical cord falls off from the base in about 1 to 2 weeks. If this does not happen even after 2 weeks, the doctor will need to look into the pathological reasons for the stump of the umbilical cord not falling off. After the stump falls off, the raw area heals by itself, and there is nothing to worry. Some minimal attention may be needed in the form of an antibiotic powder or lotion that may be applied on the area to keep it safe from infection.
2. Reddish black stools: Meconium, a sticky dark reddish black substance, is the first stool a baby passes after birth. This stool is a build-up of material gained during pregnancy, and it must be expelled after birth. The baby will clear out all the meconium in their bodies during its first week of life. So, the baby’s stool will be a sticky reddish black color for up to a week. By the end of one week, the color of the baby’s stool will turn yellow.
3. Diarrhea: Some mothers are concerned that their babies pass extremely watery yellow stools, about 10-12 times a day. This is a normal occurrence, and is called transitional diarrhea, which occurs from the time when all the meconium is being emptied from the gut. After passing out all the meconium, the baby may produce the transitional stool. This lasts for 10 days to 2 weeks, and after that phase, the stools become more semi-solid. The color too changes to a different yellow. From then on, passing stools of normal consistency, twice or thrice a day is normal.
4. Constipation: Many babies have constipation. Usually, this is a more common occurrence among babies who are not breast fed, but are formula fed. Mothers need not worry about it because babies can tolerate constipation up to 7 to 10 days, and still be comfortable. But usually, constipation lasting 2 or 3 days is totally acceptable, and need not be a cause for worry. Mothers must desist from inducing a motion to relieve the constipation, especially by using oil or other laxative agents. Such practices can cause more harm to the baby than just leaving the baby alone for the body’s natural process to take place.
Normally, constipation gets cured over a period of time, and the symptoms are very rarely accompanied by medical causes for the constipation. In case there is a medical cause, it could be hypothyroidism caused by under-activity of the thyroid gland, or the baby might have Hirschsprung’s disease, a disease of the large intestine. Such babies might require further investigations, though the investigations are not carried out in the initial phase of the constipation. If the constipation is persistent, lasting for a few months, then it needs to be probed.
To relieve the usual occurrence of constipation, you could give the baby some amount of plain water which is well boiled and cooled. A few spoons of water in a day, even to a newborn, can help relieve the baby’s constipation.
5. Skin rash: Another concern in newborn babies is skin rash. More than 90% of babies have small reddish rashes which are very normal. These are due to certain allergies, particularly to new clothing, or even an allergy to touch. These rashes are natural, and need to be left alone as they usually subside in the next 48 to 72 hours.
6. Hiccups: Babies having hiccups is very normal. In fact, babies have more hiccups than adults. Every time before a feed or after the feed, babies may have hiccups, and it can get very scary for the mother to see the hiccups as the baby’s chest wall is so narrow and stretchable that it goes very deep inside when shaken with hiccups. Giving water usually does not make any difference, and the hiccups stop by themselves after sometime. Babies can have up to 10 episodes of hiccups every day, and they cause no harm.
7. Sneezing: Sneezing is actually a protective phenomenon. Even in adults, if there is some small obstruction in the nostril, it is cleared through an involuntary sneeze. Babies too clear their nostrils through sneezing.
8. Sleeping too much: Babies sleep for more than 20 hours in a day during the first few days of their life. This is absolutely normal.
9. Noisy breathing: The nostrils and airways of babies are very small and they are bound to have a lot of blockage due to some secretions. Breathing through this will produce noise when the baby is sleeping or lying down. Sometimes, when the amount of blockage is more, the baby struggles to breathe and feed at the same time. Then, you could give some saline drops, on prescription by a doctor. This will clear the passage, though it may not be normally recommended.
10. Jaundice: More than 60% of term babies are jaundiced by the first 36 to 48 hours after birth. This is mostly a physiological jaundice, and peaks by 4th or 5th day. It starts coming down by the 7th day, and comes down to almost normal levels by the 10th day or the 2nd week.
In pre term babies, however, this jaundice is a little exaggerated. The liver in pre term babies is not mature enough to liberate certain enzymes that are required to control jaundice, so the jaundice takes a little longer to subside. Generally, the jaundice in pre term babies appears a little earlier than it does for term babies, and also disappears a little later.
What we need to worry about is the extent of jaundice, and whether it is increasing day by day. While at the hospital, doctors do the serum bilirubin test, which helps assess the condition. To control the jaundice, doctors may advise treating the baby with phototherapy, which helps bring the jaundice down. But in case the jaundice deepens after discharge from hospital, mothers should be informed to come back to hospital if needed. Signs to watch out for are if the baby is extremely lethargic and irritable, and is not feeding at all. These are dangerous signs because even though the jaundice may be physiological, there are certain circumstances that could exaggerate the jaundice.
Knowing the extent of the jaundice is vital to deciding whether the baby needs medical attention. The general guidelines for this are:
- If the mother finds that the pale yellow color of jaundice is limited to only the face and the neck of the baby, then it probably co-relates to a serum bilirubin count of 5 mg/dL.
- If the jaundice is extended to the trunk and the face, it probably corresponds to 10 mg/dL.
- If it extends to below the leg, but does not involve the soles of the feet, then it corresponds to a serum bilirubin count of 15 mg/dL
- If the entire body - including the soles of the feet - is stained, then there is cause for alarm. We are probably looking at a bilirubin count that is over 18-20 mg/dL, which is dangerous because once it reaches that stage, it crosses the blood brain barrier, and then it starts staining into the brain. What stains into the brain is permanent and it cannot be erased. It can cause a lot of damage like deafness, or cause kernicterus where certain areas of the brain are affected, and functions of that part of the brain can be lost permanently.
One of the most effective ways to bring down the jaundice is to breastfeed the baby. Breastfeeding triggers the liberation of those enzymes which are required to bring down the jaundice. So, it is important for the mother to begin breastfeeding the baby within the first 48 hours of birth. Once discharged, it is advisable to expose the baby to some sunlight. This is similar to phototherapy. However, exposing the baby to direct sunlight in cold, windy weather is not a good idea. Mothers are advised to expose the baby to sunlight through a glass window, between 8 and 9 am in the morning, for about 15 to 20 minutes.
Apart from physiological jaundice, there could be pathological jaundice which needs to be investigated. This is the kind of jaundice that appears within the first 24 hours or after one week of birth, or it may be a persistent jaundice that lasts beyond 1 or 2 weeks. This kind of jaundice requires a battery of tests to find out the causes, and is a rare occurrence.
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