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Looking After Your Baby

Congratulations on the birth of your baby! The weeks ahead are likely to be hard work, but wonderfully rewarding at the same time. Babies don’t arrive with instruction manuals, so here is some advice and information that will help you to look after your new arrival. You can also view a selection of newborn videos in different languages on the Raising Children Network which is an Australian parenting website.

Baby's environment

This should be warm and clean. There is a vast array of consumer items in baby shops which are not always necessary. Talk to family and friends who have children - they can often help and give good advice about what is essential and what isn’t.

Clothing

Babies born at full term generally require one or two more layers of clothing than an adult. Premature infants will require another layer or so.

Here’s a way to check if baby is wearing enough:

  • Slip a finger down the back of the neck between the shoulder blades
  • If the skin feels warm, your baby is warm enough (even if hands and feet are cool)
  • If the baby feels hot, remove a layer
Hats must be worn for going out, especially on cold days. They are not usually needed indoors, unless the room is cold or you have been advised by a health professional.

Blankets and clothes made of natural fabric, such as cotton or wool, are more suitable than synthetic fabric - especially close to the skin.

Handy tips when choosing/checking clothes for baby:

  • Woollen clothes are generally warmer. Try putting socks over woollen booties - they stay on better
  • Look for clothes that are easy to put on/take off
  • Make sure there’s room to grow, or clothes won’t fit for long
  • Look for ‘low fire risk’ labels
  • Avoid clothes with cords/ribbons/loose ends, as they can strangle a baby. Long loose ends on booties can cut off circulation

Avoiding sudden unexplained death in infancy (SUDI)

Sudden Unexpected Death in Infancy (SUDI) is extremely rare for babies if the Ministry of Health guidelines shown here are followed. SUDI used to be call SIDS or cot death. Have a look at the PEPE (Place, Eliminate, Position, Encourage) safe sleep messages


In every place, for every sleep, check that baby is safe:
  • Face up
  • Face clear
  • Smokefree

Face up

Your baby was designed to sleep face up (on the back). The drive to breathe works best in this position and the airway is safer. A built-in alarm reminds baby to breathe, and strong gag and swallow reflexes protect the airway if baby vomits.

Face clear

Your baby was designed to sleep with a clear face. This helps baby to breathe freely and not get too hot. Your baby may fall asleep with his/her face clear, but will it stay clear? This will depend on position, where he/she is sleeping and how you make it safe.

Smokefree

Your baby was designed to grow and develop smokefree. All smoking harms babies, especially in pregnancy. Smoking takes oxygen and weakens vital systems as babies develop, e.g. breathing. When born, babies who have been exposed to smoke in the womb need extra protection.

Other ways to protect your baby from SUDI

Your baby was designed to need you close by (in the same room as you when you sleep); to be breastfed (this strengthens the drive to breathe); and to be handled gently (to protect the brain). 


You can also watch the video on "Safe Sleeping" Sourced from the Raising Children website, Australia's trusted parenting website. For more parenting information, visitwww.raisingchildren.net.au.

Bathing

Before you leave hospital or Birthcare, please ensure you have had help and support with bathing your baby. Baby should be in a settled mood and not too hungry. Bathing daily when the cord is still attached is helpful. Baby’s hair does not have to be washed daily, nor does baby need bathing every day – cleaning face, hands and bottom every second day should be adequate if your baby is well.

The room for bathing should be warm with windows and doors closed. Prepare the clothes for afterwards and wash your hands. Run cold water in first, then hot. Check the temperature of the water using the inside part of your arm.

Wipe your baby’s eyes first from inside to out and once only, then the face. Gently put baby in the water, feet touching the end of the bath, with a warm facecloth over the abdomen (this usually settles the baby).

Bathing should be a happy time. Hold your baby securely, wrist under the neck with a finger or two under the arm in a secure grip. A deep warm water bath will often settle a grumpy baby.

You can also watch the video "Safely bathing a newborn" Sourced from the Raising Children website, Australia's trusted parenting website. For more parenting information, visit www.raisingchildren.net.au.

Newborn examination

The newborn examination is a full ‘top to toe’ check of your baby. This examination, usually performed by your LMC, is both visual and physical.

Your baby will be examined a few hours after birth, at one week, and at around three to four weeks old.

This examination looks for any irregularities or abnormalities in your baby e.g. marks on the skin or problems with baby’s hips, heart or lungs.

If your LMC has any concerns, your baby will be referred to your GP or a paediatrician for further review.

Baby’s head shape

It is normal for your baby to have an unusual head shape after birth. This is caused by pressure when the baby was moving through the birth canal. It will soon correct itself. Sometimes there is soft swelling on one or both sides of the head (cephalhaematoma); this can take up to a few months to disappear. To reduce the risk of SUDI (sudden unexplained death in infancy), your baby should sleep on his/her back – this may cause temporary flattening at the back of the head. This will not cause problems to the brain growth or development.

Soft spots (fontanelles)

Your baby has soft spots, known as fontanelles, on top of his/her head. These are normal and allow for the rapid growth of the head. They are where the skull bones have not yet fused together. You will not hurt the baby by gently washing or touching the head. Sometimes you will notice a pulse in the fontanelles; this is nothing to worry about. If your baby is dehydrated (not drinking enough), the fontanelles might be sunken. If you notice this, please seek medical advice.

Eyes

Babies can see after birth, but they have to learn to make meaning of the images around them. Your baby will already be familiar with your voice and smell, so will connect with your face to know you as mum or dad. You can sometimes see a relaxed newborn watching people and surroundings intently.

Your baby’s eyelids can be swollen and puffy for a couple of days after the birth from the pressures of being born. This will disappear by itself.

Your midwife will check the eyes within the first two weeks for cataracts, which can change the colour of the pupils to grey or white. She will shine a light into the eyes and look for the red reflex, a red appearance which you sometimes can see on photos.

As baby’s tear ducts are often narrow, it is not unusual that you see sticky eyes with a white or yellow discharge. You can gently clean the eyes with a clean cloth or cotton wool and pre-boiled warm water. Carefully wipe the eye from the inside to the outer corner. Your LMC, midwife, Plunket nurse or GP can take a swab to check for infection if it seems to persist. Breast milk has antibiotic properties - you can squeeze a few drops into the eyes after feeding.

Your newborn baby's blood test

Newborn metabolic screening is recommended for all babies. The newborn metabolic screening programme detects rare disorders which if detected early can be treated for the best outcome for your baby. The test is taken at 48hours after birth or as soon after as possible by a sample of blood from the heel. Information for this screening programme will be given to you during your pregnancy by your LMC so you can give consent to the blood test being taken and the storage or return of the sample when testing is complete. Sometimes a second sample is requested. Your LMC will receive a report and notify you of the results within 4 weeks of your baby’s birth. For more information please refer to the National Screening Unit Website www.nsu.govt.nz

Immunisation - the immediate postnatal period

Vaccination for tuberculosis is offered to newborns who are at risk in their communities of contracting TB. Please ask your LMC for further information.
Hepatitis B vaccination is given to newborns whose mothers are hepatitis B positive.

Ongoing immunisation

We provide booklets on immunisation - please ask your LMC for further information. This website is helpful http://www.health.govt.nz/your-health/healthy-living/immunisation


Your baby’s skin

At birth your baby’s skin is covered in a creamy substance called vernix. This protects the skin and is a good moisturiser. It does not need to be wiped off and will absorb gradually over the first few days.

Overdue babies often have dry, cracked skin - especially on their feet and hands. This may persist in the first few weeks. Massaging baby’s skin with a non-complex oil, such as olive or almond oil, is a nice way to bond with your baby and care for his/her skin.

Hormone spots may range from a few spots to an acne type rash on the face, head and upper body. These are generally caused by hormones from mum and will resolve by themselves without treatment. If they become crusty or infected, see your doctor.

Septic spots are commonly caused by bacteria which are normally present on the skin and may present as blisters or pus filled spots, especially in the neck and arm creases or nappy area. Contact your midwife or doctor.

Stork marks or bites

Many babies have these birthmarks or coloured areas (dark red or pink patches) on the back of the neck, eyelids or the bridge of the nose. These will fade over the first few months.

Strawberry naevus

These marks grow from red dots to form a reddish lump, which then begins to shrink and fade. By the second year, these marks are usually gone.

Port wine stains

These flat purple birthmarks are present at birth and are permanent. They can be treated with laser therapy by a dermatologist.

Jaundice

Jaundice is the medical term for the yellowing of the skin and the whites of the eyes. The yellow colour is caused by bilirubin, a normal product from the breakdown of red blood cells.

What causes jaundice?

When babies are born they have a high number of red blood cells. When these cells are no longer needed they are broken down and bilirubin (a waste product) is produced. Before a baby is born, the mother’s liver breaks down the bilirubin but after birth the baby’s liver has to adjust to breaking it down itself and can’t always process the bilirubin quickly enough. This is why they become jaundiced.

Is jaundice harmful?

For most babies jaundice is completely harmless, no treatment is required and it fades after a week or so. If the baby becomes very yellow or sleepy and slow to feed, a simple blood test maybe required to measure how much bilirubin is present in the baby’s blood. This result tells us if we need to treat the jaundice. Premature, small or very unwell babies almost always become jaundiced and will need treatment.

Prolonged jaundice is where the jaundice persists for more than two weeks. Further investigations need to be done as there are rare conditions that can cause jaundice to persist.

What is ‘breast milk jaundice'?

Jaundice is quite common in babies who are breast feeding. It is called ‘breast milk jaundice’ and is not harmful and certainly is not a reason to stop breast feeding. If the jaundice lasts for more than two weeks, which is common, it is important to take the baby to see a doctor.

How is jaundice treated?

If jaundice is mild, it is important that your baby receives adequate amounts of fluids. A good supply of breast milk is all the baby needs. Advice will be given to expose the baby to natural light, but you mustn’t leave baby in the direct sun as this can cause skin damage.

If baby is jaundiced on the first day of his/her life, or the level becomes higher after this, then treatment will be required in the form of phototherapy. Phototherapy means exposure to fluorescent light, which alters the bilirubin in the skin making it easier for the liver to process it.

Phototherapy can be managed in the hospital or at Birthcare if jaundice isn’t severe. Regular blood tests are done to check that the levels are reducing. Baby can be taken out for breast feeds and cuddles, but needs to stay under the light as much as possible for the treatment to work in a shorter period of time.

Bladder and bowels

A healthcare professional can tell a lot about the condition of a baby by looking at the urine and bowel movements. The colour, amount and smell all provide essential information.

If you’re not sure about your baby’s urine or stools (poos), save a nappy for your midwife or LMC to look at.

Babies normally pass small amounts of urine in the first day. This changes to at least six to eight really wet nappies a day. If the baby hasn’t passed urine for a while, it may have leave an orange/pink powdery deposit on the nappy. Though these ‘urates’ are quite common, they are an indication to make sure the baby has regular feeds. Let your LMC or midwife know.

If your baby hasn’t passed a first bowel movement (meconium - black/green sticky tar-like substance) in the first 24 hours following birth, please inform your LMC or midwife. Babies usually have meconium poos for the first three to five days following birth. This colour gradually changes from black/green to brown, then becomes a bright mustard yellow.

Breastfed babies

Breastfed babies usually poo at least once a day. It is normal for the baby to pass yellow watery poos (with pieces that look like sesame seeds) that have very little smell. Most breastfed babies poo at each feed; this is normal.
As baby grows, breastfed babies can go as long as 7-10 days without having a bowel motion. Again, this is normal due to minimal waste products formed from the digestion of breast milk.

Formula fed babies

Babies that drink formula usually poo every day or every second day. Poos tend to be more solid than breastfed babies, and there is a slightly more noticeable smell. Poos are yellowish in colour.

Constipation

A baby’s motions should always be soft. When a baby gets constipated, the baby has difficulties passing stools. Your midwife or Well Child provider will give you the appropriate advice.
There are many different things that can affect your baby’s poos, most of which are of little concern. Sometimes the poos are still green four to five days following birth; if this happens you need to inform your LMC. This may be caused by a feeding problem, illness or mother’s medication. If the baby starts to pass white/grey cottage cheese like stools, please inform your LMC or midwife and make an appointment to see your family doctor.

Umbilical cord (belly button)

After birth the umbilical cord is clamped and cut. The clamp is removed a couple of days later, when the cord is dry and beginning to shrink. Separation of the cord from the belly button usually occurs within 7 to 10 days. A small blood loss from this area is normal, but contact your midwife if you are concerned.

Bathing and drying the base of the belly button and the umbilical cord will not cause your baby any pain - this area has no nerve endings.

A red sticky, smelly umbilicus may be a sign of infection. Inform your LMC or midwife who will check and advise you.

It is normal for a separating cord to smell, as the process is caused by gangrene. Once separated, it can have the appearance of not being completely closed.

Breasts and genitals

The breasts in newborn boys and girls may be slightly swollen. This is normal and due to the effects of mother’s hormones in the blood. The girls may also have a little milk secretion. This is also normal. Action may be required if the swollen breasts start to look red. See your doctor if this is the case.

Another normal hormonal effect on little girls is a blood-stained, mucousy vaginal discharge. This is also caused by the mother’s hormones. Just wash gently. If there is some residual vernix (the white waxy substance on some babies at birth), this can be left. Vernix is good for the skin and will eventually be absorbed.

With boys, your LMC will observe for undescended testes. Usually testes descend during the seven to nine months of pregnancy, but they may also descend up to six weeks after birth. It is important for the testes to descend from the abdominal cavity, to protect the function and development of the sperm manufactured after puberty.

If testes haven’t descended before your LMC discharges you from his/her care, baby will be referred to your family doctor. If surgery is required, it is usually done between eighteen months and three years.

Penis care

Newborn boys have some skin at the end of the penis called the foreskin. This doesn’t need to be pulled back (retracted) for cleaning. By the age of three to five years, the foreskin will be able to be pulled back for cleaning and this should be encouraged for health reasons.
You will need to see your doctor if the urine just dribbles or stops and starts; the foreskin is swollen when he wees; or if there is blood or pus coming out of the end of the foreskin.

Winding your baby

Babies swallow air (wind) when they are feeding, when they are crying and even when they are just breathing. Wind can make baby feel full before he/she has drunk enough milk. It can also make baby feel very uncomfortable.

Some babies don’t need to be winded after feeds; others become unsettled with wind and need ‘burping’ at every feed. If, during a feed, your baby stops sucking and cries or resists going on the other breast, try winding him/her. Babies with wind may squirm and grimace, particularly when they are laid down after a feed.

Breastfed babies tend to get fewer problems with wind than those having bottle feeds. This is because they can control the flow of milk at the breast and suck at a slower pace, swallowing less air with the milk. Breastfed babies are also more likely to have smaller and more frequent feeds and may be fed in an upright position, both of which can reduce wind. Yet, even breastfed babies will often need to be winded, especially if they are fast feeders and/or your milk flows particularly quickly.

Make the most of any natural breaks in a feed to wind your baby; do a final wind at the end of the feed. Patting or rubbing your baby’s back is the most effective way to bring up wind. The burp might come with a ‘spill’, so always have a soft cloth handy to protect your clothes. Your LMC or midwife will demonstrate the most effective winding positions.

Well Child Providers

This service is available for you and your child. This service aims to support you to ensure your child gets the best start in life by protecting against illness, detecting problems early and supporting patents and families.

From birth to 4 weeks — you will receive your Well Child/Tamariki Ora Service from your LMC, i.e. your midwife or your GP.

From 4 weeks to 4½ years — your Well Child/ Tamariki Ora care will be provided by a Well Child Provider. You can choose which provider will carry out the Well Child/Tamariki Ora care of your child. Your midwife will make arrangements for the Well Child provider to visit you or you can contact them directly.   

National Women's Health
Phone: 09 307 4949
Email:
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