THE FIRST CONTACT AND FEED:
Start breastfeeding as soon as the baby shows readiness to suckle. Babies are very alert in the first hour after delivery and have a very active sucking reflex (tendency to suckle). It has been proved that the earlier a baby is breastfed, the easier it for the mother and the baby to establish regular breastfeeding. This also ensures that breastfeeding will continue for a sufficiently long period of time.
PRELACTEAL FEEDS (FEEDS GIVEN TRADITIONALLY BEFORE THE FIRST BREASTFEED):
Do not give glucose/ jaggery / sugar/ plain water or honey before the first breastfeed. These will cause infection of the baby’s digestive system. In addition, this practice will prevent successful establishment of breastfeeding because a baby with a full stomach will not be inclined to suckle at the breast.
BREASTMILK IN THE FIRST 3 DAYS (COLOSTRUM):
The thick yellowish early discharge from the breast is called Colostrum. Though scanty. colostrum is highly protective against infections. nutritious and sufficient for the baby. Hence do not give Prelacteal feeds during this period.
DURATION AND FREQUENCY OF FEEDING:
Breastfeed whenever your baby is hungry, and without any restriction of time (Demand Feeding). Night feeding is important. It does not harm the baby as believed by some. Feed at one breast for as long as possible because the initial milk (foremilk) is watery (contains sugar and proteins) and quenches the baby’s thirst while the milk that is secreted later (hindmilk) is rich in fats and satisfies baby’s hunger.
BREASTFEEDING DURING ILLNESSES:
Mothers suffering from common illnesses can continue to breastfeed their babies. In a similar vein ill children should continue to be breastfeed. Generally, sick children lose appetite for food and become entirely dependent on breastmilk.
NORMAL BEHAVIOUR PATTERNS UNTIL 6 MONTHS OF AGE:
Listed below are behaviour patterns considered normal in children below 6months and which do not require any treatment. In individual cases however parents may seek a medical opinion, especially if a child is not doing well otherwise.Sneezing:- Frequent sneezing does not necessarily indicate that the baby has a cold.
Hiccups:- Frequent hiccups are common occurrence and do not imply that the baby is thirsty.
Yawning:- Frequent yawning is common.
Breathing:-Sometimes the baby may breathe slowly and sometimes he may take a few fast breaths. Noisy breathing at night is common. This happens due to smaller size of nasal passages.
a) The first urine may be passed anytime up to 48 hours after birth. Medical opinion may be sought if the first urination does not occur even after 24 hours. Beyond this period investigations are necessary.
b) Urine may be passed infrequently in the first 7 days of life.
c) Crying or straining just before passing urine is normal and needs no treatment.
d) If an exclusively breastfeed baby passes urine atleast 6-7 times in 24 hours, it indicates that baby is getting enough breastmilk.
STOOLS & VOMITING:
a) It is routinely necessary to check for patency of anus at birth. The first stool called ‘meconium’ is passed within 24 hours.
b) Later babies may pass stool daily, or once in 2 to 3 days. Stooling can be as infrequent as once in 7 to 8 days. In such a situation, applying soup or oil at the anus, or making the child drink castor oil is unnecessary and dangerous. However if the stomach appears bloated, seek your doctor’s advice.
c) An exclusively breastfed baby may pass stool as frequently as once every 2 hrs. This may happen while breastfeeding or after every feed. In both the situations if the baby is passing urine more than 7 times in 24 hrs, is gaining adequate weight (a minimum of 500gms.in 1month) and is active and alert, then the child does not need any medicines.
d) Frequent stooling mentioned above is often interpreted as diarrhea due to intolerance to mother’s milk, and breastfeeding is stopped. This can be disastrous.
e) Straining, making noises and little crying while passing stool is normal.
f) The child may frequently bring out small amounts of fresh or curdled milk (this may contain mucus). This is normal. For very frequent vomiting keeping the head and chest in an elevated position (on a pillow) will reduce the vomiting.
Young babies do not develop biological sleep patterns and have no concept of ‘day’ and ‘night’. Hence, they have variable sleep patterns. Some babies may sleep more during the day and keep awake at night. Others have reverse pattern. Still others wake up at regular intervals of 2-3 hours irrespective of day or night. Few will sleep for a long duration and then will feed frequently for long hours with frequent passage of urine. Babies learn to sleep at night between 3-12 months of age.
Babies lose about 5-10% of their bodyweight in the first 5-7 days of life. Subsequently weight gain is atleast 20 Gms.a day(a minimum of 500 Gms.a month). This is a good indicator that a mother is producing enough breastmilk for her baby. Usually a child doubles his weight in the first 5 months and triples his weight by the first birthday. However there can be a variation in this pattern.
SUCKING AT FINGERS:
The baby may suck its fist or fingers frequently but this does not mean that the baby is hungry. Hence do not start outside feeds.
Many babies develop jaundice (yellow coloration of skin and eyes) between first 2-4 days of life and this may not disappear till the 15 day of life. A pediatrician should be consulted in all cases of jaundice to decide the need for investigations and treatment that may be needed in a few of these babies.
Many babies have episodes of crying usually in the evening or at night .lasting for a few minutes or hours. The cause of these crying episodes is unknown. Gentle rocking and comforting a baby is all that is necessary. This problem usually disappears by the time child is 3 months old. Consult your doctor to look for other causes of crying.
It is imperative that everybody handling the child should maintain proper nail hygiene. Baby’s overgrown nails should be pared taking due precautions. This can be best done with a pair of small scissors or a small nail cutter when the child is asleep.
Applying oil (Patting oil into the fontanel) does not hasten the process of closure of fontanel (a diamond shaped soft space at the top of the head). This space closes by itself by 18 months.
NOSE & EAR:
Do not put oil into child’s nose/ears. The former may cause oil pneumonia /nose block, and the latter can damage the ear. Earwax need not be removed in infants.
Do not clean a child’s tongue/mouth with glycerine or by any other method. Some whiteness on the tongue is natural and does not interfere with feeding. Spotty /patchy white deposits on tongue and all over mouth are because of fungal infection (thrush). This needs treatment.
Due to mother’s hormones baby’s breast tissue may get a little enlarged and may start secreting milk. Expression of this milk is not necessary. It causes breast tissue enlargement and pus formation. Subsequently infection can spread in the blood. (similar hormonal effects in a female child can produce vaginal bleeding lasting 1-2 days. This should not worry the parents)
There is no need to add any disinfectant to child’s bathing water or for washing child’s clothes.
POWDER & OIL:
The use of talcum powder and oil for the child is not
necessary. While applying talcum powder, care should be taken that it
does not enter into child’s nose/ ears/ eyes, as this can cause
allergy, cough and wheezing. Minimal necessary quantity of talcum
powder should be used. Ordinary coconut oil is good for massage.
However oil massage can cause a skin rash, especially in hot weather.
Start oil massage after 6weeks.
The use of kajal
(kohl) is dangerous. Some types contain lead and can cause lead
poisoning. The kajal particles may cause blockage of the duct
connecting the eyes and nose, causing persistent watering of eyes. Do
not use eye drops routinely. If there is discharge or watering from the
eye, consult your doctor.
A baby should be clothed
in simple cotton material. Baby should neither be overwrapped, nor
underclothed. Former may cause fever and latter can cause hypothermia
(low body temperature).
Traditional cotton nappies
are more suited for our climate than disposable diapers. Use disposable
diapers as little as practical.
There is no need to
bathe the child everyday in waters. Similarly a child can be bathed
even twice daily in summer.
CLEANING AFTER STOOLS:
It is best to wash the area after passage of stool. Avoid using cotton or swipes. Be careful to wash in front to back direction i.e. do not allow any stool to come in the urinary area.