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How to Provide Care for Ill or Premature Babies

Neonatal care in hospital

Special care is sometimes provided on the ordinary postnatal ward and sometimes in a specialist newborn (neonatal) area. Having a baby in neonatal care is naturally worrying for parents and every effort should be made to ensure that you receive the information, communication and support that you need. Not all hospitals provide specialist neonatal services, so it may be necessary to transfer your baby to another hospital.

Why babies need special care

Babies can be admitted to neonatal services for a number of reasons:

  • they are born early – one baby in 13 (8 out of 100) is born early, and babies born before 34 weeks may need extra help with breathing, feeding and keeping warm
  • they are very small and have a low birthweight
  • they have an infection
  • their mother has diabetes
  • the delivery was very difficult or they have jaundice
  • they are waiting for, or recovering from, complex surgery

Contact with your baby

The environment of the unit may seem strange and confusing, especially if your baby is in an incubator or on a breathing machine. There may also be tubes and wires attached to their face and body. Ask the nurse to explain what everything is for and to show you how you can be involved in your baby’s care. Once your baby is stable, you will be able to hold him or her. The nurses will show you how to do this and your baby will benefit greatly from physical contact with you.

Feeding

To begin with, your baby may be too small or too sick to feed themselves. You may be asked to express some of your breast milk, which can be given to your baby through a tube. A fine tube is passed through his or her nose or mouth into the stomach. This won’t hurt them.

Breast milk has particular benefits, especially for sick or premature babies, as it is enriched with proteins (notably antibodies), fats and minerals. If your baby is unable to have your breast milk to begin with, it can be frozen and given to them when they are ready.

When you go home, you can express milk for the nurses to give while you are away. There is no need to worry about the quantity or quality of your milk. Some mothers find that providing breast milk makes them feel that they are doing something positive for their baby.

Find out about expressing your breast milk.

Incubators

Babies who are very small are nursed in incubators rather than cots, to keep them warm. You can still have a lot of contact with your baby. Some incubators have open tops, but if your baby’s incubator doesn’t you can put your hands through the holes in the side of the incubator to stroke and touch your baby.

When your baby is stable, the nurses will be able to help you take your baby out of the incubator and show you how to have skin-to-skin contact. You should carefully wash and thoroughly dry your hands before touching your baby. You can talk to your baby as well – this can help both of you.

The charity Bliss has information explaining the equipment on a neonatal unit.

Newborn babies with jaundice

Jaundice in newborn babies is common because their livers are immature. Severely jaundiced babies may be treated with phototherapy (light therapy). The baby is undressed and put under a very bright light, usually with a soft mask over their eyes. The special light helps to break down the chemical that causes jaundice. It may be possible for your baby to have phototherapy by your bed so that you don’t have to be separated.

This treatment may continue for several days, with breaks for feeds, before the jaundice clears up. In some cases, if the jaundice gets worse, an exchange transfusion of blood may be needed (some of your baby’s blood will be removed and replaced with blood from a donor). This is not common. Some babies have jaundice because of liver disease and need different treatment. A blood test that checks for liver disease is done before phototherapy is started.

Find out more about treatment for newborn jaundice.

Babies with jaundice after two weeks

Many babies are jaundiced for up to two weeks following birth. Jaundice can last up to three weeks in premature babies. It is more common in breastfed babies and does no harm. It is not a reason to stop breastfeeding.

It is important to see your doctor if your baby is still jaundiced after two weeks. You should see the doctor within a day or two. This is particularly important if your baby’s poo is chalky white. A blood test will distinguish between “breast milk jaundice”, which will go away by itself, or jaundice that may need urgent treatment.

Babies with disabilities

If your baby is disabled in some way, you will be coping with a lot of different feelings. You will also need to cope with the feelings of others, such as the baby’s father, your relations and friends as they come to terms with the fact that your baby has a disability.

More than anything else at this time, you will need to talk to people about how you feel, as well as about your baby’s health and future.

Your GP* (doctor), a neonatologist (doctor for newborn babies), paediatrician (children’s doctor) or your health visitor can all help you. You can also contact the hospital Patient Advice and Liaison Service (PALS)** or your social services department for information about local organisations that may be able to help. You can contact your social services department in the UK through your local authority (in the UK)**.

The organisations listed here can offer help and advice – many are self-help groups run by parents**:

Talking to other parents with similar experiences can often be the most effective help.

Worries and explanations

Hospital staff should explain what kind of treatment your baby is being given and why. If they don’t, ask them. It’s important that you understand what is happening so that you can work together to make sure that your baby gets the best possible care. Some treatments require your consent to go ahead and the doctors will discuss this with you.

It is natural to feel anxious if your baby needs special care. Talk over any fears or worries with the hospital staff. Hospitals often have their own counselling or support services, and a number of charities run support and advice services.

The consultant neonatologist or paediatrician should arrange to see you, but you can also ask for an appointment at any time if you wish. The hospital social worker may be able to help with practical issues such as travel costs or help with looking after children.

Read more information on serious conditions and special needs in children.

The charity Bliss has information and support for parents of babies being cared for in a neonatal unit. You can find out more at:

healthtalk.org has video interviews and articles on women talking about their experiences of having a baby in special care.

Editor’s Note: *clarification provided for our US readers.

** Resources in the United States

  • US Hospitals typically offer similar Patient Liaison services – ask for Patient Relations or Patient Representatives
  • Social Services in the United States can provide information to help with costs and treatments
  • Children with Disabilities: UNICEF
  • Genetic Alliance is the US affiliate of Genetic Alliance UK
  • Note: several of the UK based organizations listed above like Bliss, Group B Strep Support, etc. have extensive websites offering detailed information that will be of assistance to parents worldwide.





How to Manage Your Diabetes for a Safer Pregnancy

Diabetes and your unborn baby

Diabetes is a condition in which the amount of sugar (glucose) in the blood is too high.

Glucose comes from the digestion of starchy foods, such as bread and rice. Insulin, a hormone produced by your pancreas, helps your body to use glucose for energy.

Three types of diabetes can affect you when you’re pregnant:

The information on this page is for women who have pre-existing diabetes in pregnancy.

Most women with diabetes have a healthy baby, but diabetes does give you a higher risk of some complications.

If you already have diabetes

If you already have type 1 or type 2 diabetes, you may be at a higher risk of:

People with type 1 diabetes may develop problems with their eyes (diabetic retinopathy) and their kidneys (diabetic nephropathy), or existing problems may get worse.

If you have type 1 or type 2 diabetes, your baby may be at risk of:

  • not developing normally and having congenital abnormalities, particularly heart and nervous system abnormalities
  • being stillborn or dying soon after birth
  • having health problems shortly after birth, such as heart and breathing problems, and needing hospital care
  • developing obesity or diabetes later in life

Reducing the risks if you have pre-existing diabetes

  • The best way to reduce the risk to your own and your baby’s health is to ensure your diabetes is controlled before you become pregnant.
  • Ask your GP or diabetes specialist (diabetologist) for advice. You should be referred to a diabetic pre-conception clinic for support before you try to get pregnant.
  • Find diabetes support services near you (UK)**.
  • You should be offered a blood test called an HbA1c test, which helps assess the level of glucose in your blood.
    • It’s best if the level is no more than 6.5% before you get pregnant, as long as this does not cause problems with hypoglycaemia (*hypoglycemia).
    • If your HbA1c is higher than this, you would benefit from getting your blood glucose under better control before you conceive to reduce the risk of complications for you and your baby.
    • Your GP or diabetes specialist can advise you on how best to do this.
    • If your HbA1c is very high (above 10%), your care team should strongly advise you not to try for a baby until it has fallen.

Folic acid

  • Women with diabetes should take a higher dose of folic acid. The normal daily dose for women trying to get pregnant and for pregnant women is 400 micrograms.
  • Diabetic women should take 5 milligrams (mg) a day. Your doctor can prescribe this high-dose folic acid for you, as 5mg tablets are not available over the counter.
  • Taking folic acid helps prevent your baby developing birth defects, such as spina bifida. You should take folic acid while you are trying to get pregnant, until you are 12 weeks pregnant.

Your diabetes treatment in pregnancy

  • Your diabetic treatment regime is likely to need adjusting during your pregnancy, depending on your needs.
  • If you take drugs for conditions related to your diabetes, such as high blood pressure, these may have to be altered.
  • It’s very important to keep any appointments that are made for you so your care team can monitor your condition and react to any changes that could affect your own or your baby’s wellbeing.
  • Expect to monitor your blood glucose levels more frequently during pregnancy. Your eyes and kidneys will be screened more often to check they are not deteriorating in pregnancy, as eye and kidney problems can get worse.
  • You may also find that as you get better control over your diabetes you have more low blood sugar (hypoglycaemic) attacks. (*hypoglycemic) These are harmless for your baby, but you and your partner need to know how to cope with them.
  • Find out about treating a hypoglycaemic attack, and talk to your doctor or diabetes specialist.

Diabetic eye screening in pregnancy

You will be offered diabetic eye screening at recommended intervals during pregnancy if you had diabetes before you got pregnant (pre-existing diabetes).

This screening test is to check for signs of diabetic eye disease, including diabetic retinopathy.

Everyone with diabetes is offered diabetic eye screening, but screening is very important when you are pregnant because the risk of serious eye problems is greater in pregnancy.

Diabetic eye screening is strongly recommended in pregnancy. It is part of managing your diabetes, and diabetic retinopathy is treatable, especially if it is caught early.

If you decide not to have the test, you should tell the clinician looking after your diabetes care during pregnancy.

Read more about diabetic eye screening.

Labour and birth

If you have diabetes, it’s strongly recommended that you give birth with the support of a consultant-led maternity team in a hospital.

Read more about where you can give birth, including in hospital.

Babies born to diabetic mothers are often larger than normal. This is because blood glucose passes directly from you to your baby, so if you have high blood glucose levels your baby will produce extra insulin to compensate.

This can lead to your baby storing more fat and tissue. This in turn can lead to birth difficulties, which requires the expertise of a hospital team.

After the birth

Two to four hours after your baby is born they will have a heel prick blood test to check whether their blood glucose level is too low.

Feed your baby as soon as possible after the birth – within 30 minutes – to help keep your baby’s blood glucose at a safe level.

If your baby’s blood glucose can’t be kept at a safe level, they may need extra care. Your baby may be given a drip to increase their blood glucose.

Read more about special care for babies.

When your pregnancy is over, you won’t need as much insulin to control your blood glucose.

You can decrease your insulin to your pre-pregnancy dose or, if you have type 2 diabetes, you can return to the tablets you were taking before you became pregnant. Talk to your doctor about this.

If you had gestational diabetes, you can stop all treatment after the birth.

You should be offered a test to check your blood glucose levels before you go home and at your six-week postnatal check. You should also be given advice on diet and exercise.

Editor’s Note: *clarification provided for our US readers.

** Locate diabetes support services in the United States





A Pediatrician’s Unique Perspective on Dads and Babies

Most human Mom’s live with their babies developing in their uteri for about 9 months. During this time, they both experience the physiologic and personality changes associated with pregnancy. Dad too has been involved but in a much more subtle and marginal way. He has seen the remarkable changes occurring in the mother of his child almost on a daily basis and has looked on in awe and wonderment at her growing belly and occasionally has been lucky enough to have been present when the movement of the fetus can be seen and felt through the mother’s abdominal wall. If he was lucky enough to attend her prenatal visits he might even have caught a glimpse of the actual baby moving through the magic of sonography.

Some men, rarely, have expressed a feeling of disappointment at not having had the same experiences moms have. Most Fathers, however, have experienced the same joy and elation at seeing their newborn baby for the first time as Moms. There is that certain feeling of witnessing a miracle that doesn’t come along every day. Just imagine that little perfect person with everything an adult has but just in miniature. In fact, the production of a baby is, by all accounts, a miracle of such huge proportions that volumes of books and stories have been written and seen and read on this topic alone.

A father develops a special bond with his baby that can almost not be put into words. The presence of a father adds a certain amount of stability immediately to the family unit and, if Mom will allow the participation of the Father in an equal manner with her, then the family unit is strengthened even more- and the father feels less like an outsider and more like an active influence on the development of the baby.

In fact, fathers should be encouraged to take a very active role in the care of this infant right from birth. A father taking his baby to the Doctor’s office for regular visits is becoming far more common now than it ever used to be. I remember as a young intern and resident with a very busy day and night schedule I could not attend very many of my childrens’ doctor visits and could only listen in amazement at the reports my wife would give me in the evening when I finally got home. To this day I feel cheated of some of the elation that came when our baby’s doctor could confirm that our care was certainly correct and of great benefit for our child. After all, babies do not come with instructions or warranty manuals and it is important for parents to have their parenting skills recognized and confirmed by an objective third party.

Erin Pougnet’s studies of fathers’ influence on children’s cognitive and behavioural functioning have shown greater achievable IQ levels in children with whom the father has paid a greater role during early infancy and childhood. Fathers are known to contribute different ways of looking at non-verbal skills as they take part in the physical contact of their children (playing roughly) and offer another definition of reasoning. Recent evidence gathered from families in which the father is absent due to armed forces responsibilities show that there are more stresses, sadness, withdrawal and aggressive behavior when Dad is away for any significant time span. Families in older generations suffered from the father’s inability to express appropriate feeling toward his children; now it is felt that younger fathers have these skills.

A Father should never be a casual observer to the growth and development of his child but an active contributing member of the family unit. Prenatal classes of a different kind than those for expectant mothers should be offered to the father- to- be as well, so that his role can be more clearly defined. As research has shown, dad’s increasing involvement is making a difference.

What You’ll Want to Have In Your Baby’s First Aid Kit

More than 1 million children a year are involved in an accident in the home. Most aren’t serious, but it’s sensible to make sure your first aid box contains the essentials.

Choose a waterproof, durable box that’s easy to carry. It’s much easier to take the box to the child than the child to the box. The box should have a childproof lock and be tall enough to carry bottles of lotion.

Keep the box out of the reach of children, but handy for adults. You don’t want to be hunting for your first aid kit when a child is injured and frightened.

Either buy a first aid box, which is green with a white cross**, or, if making up your own box, write “First Aid” on it so that, if you aren’t around, other people know what it is. If someone else is caring for your children, let them know where the kit is kept.

First aid manual

An easy-to-use guide can help refresh your memory when panic and a crying child make it hard to remember what to do. Or you could print out a first aid guide and keep it with your first aid box.

Painkillers and babies

Make sure you have an age-appropriate painkiller, such as paracetamol (*acetaminophen) or ibuprofen, which can be used for headaches and fevers. You will also need a measuring spoon or, for younger children, a no-needle dosing syringe. Always follow the dosage instructions on the label.

Dressings for babies

  • Sticking plasters (*Band-aids). Buy them in a variety of sizes for minor cuts, blisters and sore spots.
  • Adhesive tape (*Medical tape). This can hold dressings in place and can also be applied to smaller cuts.
  • Bandages. Crepe (*Wrap compression) bandages are useful for support or holding a dressing in place. Tubular bandages are helpful when a child has strained a joint and needs extra support. You can also buy triangular bandages that can be used for making a sling.
  • Sterile gauze dressings. These are good for covering larger sore areas and cuts.

Antiseptic cream or spray

Antiseptic cream or spray can be applied to cuts, grazes or minor burns after cleaning to help prevent infection. Some may also contain a mild local anaesthetic to numb the pain.

Antihistamine cream

This can reduce swelling and soothe insect bites and stings.

Thermometer

  • Digital thermometers. Digital thermometers are quick to use, accurate and can be used under the armpit (always use the thermometer under the armpit with children under five). Hold your child’s arm against his or her body and leave the thermometer in place for the time stated in the manufacturer’s instructions.
  • Ear (or tympanic) thermometers. Ear thermometers are put in the child’s ear. They take the child’s temperature in one second and do not disturb the child, but they’re expensive. Ear thermometers may give low readings when not correctly placed in the ear, so read the manufacturer’s instructions carefully and make sure you understand how the thermometer works.
  • Strip-type thermometers. Strip-type thermometers that you hold on your child’s forehead are not an accurate way of taking their temperature. They show the temperature of the skin, not the body.
  • Mercury-in-glass thermometers. Mercury-in-glass thermometers are no longer available to buy**. They can break, releasing small shards of glass and highly poisonous mercury. If your child is exposed to mercury, get medical advice immediately.

Calamine lotion

This can help to soothe itching irritated skin, rashes (including chickenpox) and sunburn. There are gels and mousses available for chickenpox rashes as well.

Baby first aid accessories

  • Pair of scissors for cutting clothes, and also plasters and tape to size.
  • Tweezers to remove thorns and splinters.
  • Ice packs or gel packs can be kept in the fridge and applied to bumps and bruises to relieve swelling. A packet of frozen peas is just as good, but wrap it in a clean tea towel before applying it to skin. Direct contact with ice can cause a “cold burn”.
  • Saline solution and an eye bath. This is useful for washing specks of dust or foreign bodies out of sore eyes.

Antiseptic wipes

Antiseptic wipes are a handy way to clean cuts and grazes and help prevent infection. To use them, take a fresh wipe and clean the wound, gently working away from the centre to remove dirt and germs.

Remember to keep your first aid box up to date. Replace items when stocks have been used and check use-by dates of all medicines. Throw away anything past its use-by date. You can take any out-of-date medicines to a pharmacy to be disposed of safely.

Editor’s Note: *clarification provided for our US readers.

** U.S. First Aid Kits are often white with a red cross or red with a white cross

** Mercury-in-glass thermometers are not available for purchase in the U.K. and in a number of States within the U.S., however they may still be purchased legally in some States. For more specific information about individual State’s mercury laws, click here.

 





Reflux in Babies: Symptoms, Causes, Treatment and Advice

Babies often bring up milk during or shortly after feeding – this is known as possetting or reflux.

It’s different from vomiting in babies, where a baby’s muscles forcefully contract.

Reflux is just your baby effortlessly spitting up whatever they’ve swallowed.

It’s natural to worry something is wrong with your baby if they’re bringing up their feeds. But reflux is very common and will usually pass by the time your baby is a year old.

This page covers:

Signs and symptoms

When to get medical advice

Causes

Tests

Treatments and advice

Signs and symptoms of reflux in babies

Signs that your baby may have reflux include:

  • spitting up milk during or after feeds – this may happen several times a day
  • feeding difficulties – such as refusing feeds, gagging or choking
  • persistent hiccups or coughing
  • excessive crying, or crying while feeding
  • frequent ear infections

When to get medical advice

Reflux isn’t usually a cause for concern and you don’t normally need to get medical advice if your baby seems otherwise happy and healthy, and is gaining weight appropriately.

But contact your midwife, health visitor or GP (*pediatrician) if reflux starts after six months of age, continues beyond one year, or your baby has any of the following problems:

  • spitting up feeds frequently or refusing feeds
  • coughing or gagging while feeding
  • frequent projectile vomiting
  • excessive crying or irritability
  • green or yellow vomit, or vomiting blood
  • blood in their poo or persistent diarrhoea
  • a swollen or tender tummy
  • a high temperature (fever) of 38C (100.4F) or above
  • not gaining much weight, or losing weight
  • arching their back during or after a feed, or drawing their legs up to their tummy after feeding

These can be signs of an underlying cause and may mean your baby needs tests and treatment.

Causes of reflux in babies

It’s normal for some babies to have reflux. It usually just occurs because a baby’s food pipe (oesophagus) is still developing.

It normally stops by the time a baby is a year old, when the ring of muscle at the bottom of their oesophagus fully develops and stops stomach contents leaking out.

In a small number of cases, reflux can be a sign of a more serious problem, such as:

  • gastro-oesophageal reflux disease (GORD) – a long-term form of reflux where stomach contents are able to rise up and irritate the oesophagus
  • a cows’ milk allergy – this can also cause a rash, vomiting and diarrhoea; many babies will eventually grow out of it and can be treated by removing cows’ milk from their diet
  • a blockage – rarely, reflux may occur because the oesophagus is blocked or narrowed, or there’s a blockage in the stomach and small intestine

Tests that may be needed

Most babies with reflux don’t need any tests. It can usually be diagnosed based on your baby’s symptoms.

In rare cases, the following tests may be recommended if your baby’s reflux is severe or persistent:

  • endoscopy – a narrow, flexible tube with a camera at the end is passed down their throat to look for any problems
  • barium swallow – this where your baby is given a drink containing a substance called barium before an X-ray is taken; the barium shows up on the X-ray and helps highlight any problems in their digestive system

These tests will normally be carried out in hospital.

Treatments and advice for reflux in babies

Reflux doesn’t usually require treatment if your baby is putting on weight and seems otherwise well.

The following treatments and advice may be offered if your baby appears to be in distress or their reflux has a specific, identified cause.

Feeding advice

Your midwife or health visitor may want to check how you feed your baby and suggest some changes to help with their reflux.

These changes might include:

  • burping your baby regularly throughout feeding
  • giving your baby smaller but more frequent feeds
  • holding your baby upright for a period of time after feeding
  • using thicker milk formulas that are less likely to be brought back up – these are available to buy without a prescription, but only try them if advised to by a healthcare professional

If your doctor thinks your baby could have a cows’ milk allergy, they may suggest trying special formula milk that doesn’t contain cows’ milk.

Read more general breastfeeding advice and bottle feeding advice.

Medication

Babies with reflux don’t usually need to take any medication, but sometimes the following medicines may be offered if your doctor feels the problem is severe:

  • alginates – these form a protective barrier over stomach contents, stopping them travelling up and irritating the oesophagus
  • proton pump inhibitors (PPIs) and H2-receptor antagonists – these reduce the level of acid in the stomach, so the stomach contents don’t irritate the oesophagus as much

Alginates may be used if changing the way you feed your baby doesn’t help. PPIs and H2-receptor antagonists may be recommended if your baby appears to be in discomfort or is refusing feeds.

Surgery

In a very small number of babies – most often, babies with serious underlying conditions such as cerebral palsy – an operation may be needed to treat GORD by tightening the ring of muscle at the bottom of the oesophagus.

Surgery may also be needed if there’s a blockage or narrowing in the oesophagus, stomach or small intestine.

 
Editor’s Note: *clarification provided for our US readers.





Video: What Pregnant Women Should Know About Pre-Eclampsia

In this brief video, NHS Midwife Suzanne Barber explains the warning signs of pre-eclampsia. Find out more about pre-eclampsia here

https://youtu.be/xyfGRDkqIVQ?t=3s

Editor’s Note: Video Highlights

  • Pre-eclampsia usually affects women in the 2nd half of their pregnancy. If left untreated it can put both the mother’s and the baby’s health at risk as it could lead to your child being born prematurely or failing to grow as expected in the womb.
  • Early indication are often detected by your community midwife or GP (*family doctor) during an ante-natal (*prenatal) check. Women with pre-eclampsia have high blood pressure and protein in their urine.
  • Pre-eclampsia could come on quickly. If it does, symptoms may include:
    • Swelling: face, hands, ankles
    • Severe headaches that don’t go away
    • Visual disturbances
    • Upper abdominal pain
  • You are more at risk of pre-eclampsia if you:
    • Are overweight
    • Have had kidney disease
    • Have diabetes
    • Have high blood pressure
  • If you are diagnosed with pre-eclampsia, you will have more active antenatal care and will be monitored more closely, however if there is cause for concern, you may need to be admitted to the hospital, and it may be advised that you have your baby earlier than expected.
  • Your GP or midwife may advise you if supplements can help lower your risk of pre-eclampsia.
  • If you feel unwell and experience any of the symptoms described above, see a midwife or GP.

Editor’s Note: *clarification provided for our US readers.

 





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