Congratulations! You are the proud parent of a baby and have spent many a hard month going to NCT class, learning all about breathing techniques, giving birth and now you have a demanding new role with no let up. I don’t think that anything can prepare you fully for having a child especially if it is your first time. You are both full of joy and thanks but can also be overwhelmed especially if there are difficulties with feeding or the baby does not settle. New-borns really do three main things, they eat, pass urine/stool and sleep and this is where the majority of the problems revolve around.
Breast feeding is the recommended way of providing the nutrition that your baby needs and there is lots of help to support this. If the latch is poor or it is painful to feed, then advice from a midwife or a lactation consultant is extremely valuable and can often put you on the right path swiftly. Many babies are born with tongue tie which is normal but in a small number this can hamper feeding and you may be advised to have this cut. This is especially helpful if the tongue tie limits the movements of the tongue and prevents a good latch but otherwise should not necessarily be rushed into. If the baby has poor weight gain, then a doctor should be consulted to make sure the baby is healthy. If breast-feeding, this can be supported, although top-up feeds of either breast milk or formula may be needed.
Babies often get colic, which could entail being very unsettled, often in the evening. If this is for 3 hours, more than 3 days a week treatment can sometimes help. It often starts after the first couple of weeks and can be a sudden and unexpected change. It is important to make sure a baby is properly winded as this can affect their sleep and make it difficult to settle. There are a number of over the counter treatments which work for some babies but not always. Following advice from a health care professional it may be advisable to exclude dairy (and soy). If this is to be done properly it is important to completely eliminate it from the mum’s diet as simply reducing will not stop cow’s milk (and soy) protein from going into the breast milk. All dairy products (including goat’s milk) need to be removed. If it helps then an improvement will often be seen within a week. If the baby remains very unsettled, then seeing your GP or a paediatrician can help to make sure there are no other reasons why the baby is very unsettled.
A new-born baby should always pass stool in the first 24 hours of life and this should be checked either before you leave hospital or if discharged quickly, by the midwife. If this has not occurred, it is important to discuss this with a doctor as soon as possible. The stool is initially black (meconium) and as breast milk is consumed it changes to yellow which is a good sign. If the baby is not passing stool especially if this makes them unsettled, please discuss this with a doctor. Straining to pass stool can be normal as can being windy and probiotics have been shown to be helpful for this although this should be discussed with a health professional. Babies will pass urine up to 20x a day and this should lead to lots of wet nappies. If you find that this is not the case especially if the baby is sleepy please see a doctor as soon as possible. It may be that the baby is not getting enough milk.
Every parent worries how to spot if there is something wrong. Mums and dads know their child the best and if they are worried this should always be taken seriously. Fever is a sign that there may be something wrong. In babies under 4 weeks, temperature should be measured with an electronic thermometer in the armpit and from 4 weeks to 5 years with the same method or an ear thermometer. Forehead thermometers are not considered reliable and should be avoided if possible. If there is fever under the age of 3 months, which is defined as a temperature above 38C, then a healthcare professional should always be consulted immediately. If there is a rash which does not go away when you press on it (non-blanching) this can be a symptom of serious illness and always should be checked by a doctor. If a child is more than 3 months with fever and there is no clear reason for it and especially if the baby is sleepier than normal or feeding is poor, then always have the baby checked by a doctor.
It is important that the baby is weighed every 1 to 2 weeks initially especially if it is the first child to make sure enough weight is being gained. If this is inadequate, then this can be addressed quickly if picked up early. Babies should have a routine exam at around 6 weeks with their GP (or paediatrician) although sometimes this is done at the same time as the first vaccines are given at 8 weeks. Further vaccines are given at 12 and 16 weeks all of which are very important, and the schedule followed as best possible.
All children bring much joy but also lots of responsibility. Most babies have very few problems but if worried it is important to seek help early. There is lots of help with both health professionals and on-line NHS advice available. There are always different challenges on the way but it is all very worthwhile.
By Dr Lee Noimark
Consultant Paediatrician – Royal London Hospital
Wellington Diagnostic Centre – 02074835148
St John & Elizabeth – 02070783831