Baby care

Caring for premature baby

Babies born prematurely (before the due date) need special care during the first 2 years, especially if they were very small at birth.

Here's some advice on how to care for your baby when he or she comes home from the hospital.

Baby's growth and development :

* It's important to take your baby to your doctor's soon after the baby leaves the hospital. Your doctor will check your baby's weight gain and find out how your baby is doing at home.
* Talk with your doctor about feeding your baby. Your doctor may recommend vitamins, iron, and a special formula if the baby is bottle-fed. Vitamins are often given to premature babies to help them grow and stay healthy. Your baby also may need extra iron. After about 4 months of taking iron drops, your baby will have about the same amount of iron as a full-term baby. Your doctor may want your baby to take iron drops for a year or longer.
* Your baby may not grow at the same rate as a full-term baby for the first 2 years. Premature babies are usually smaller during this time. Sometimes they grow in bursts. They usually catch up with "term" babies after a while. To keep a record of your baby's growth, your doctor can use special growth charts for premature babies. Your doctor will also want to know things like how active your baby is, when your baby sits up for the first time and when your baby crawls for the first time. These are things doctors want to know about all babies.

Your baby's feeding schedule :

* At first, most premature babies need 8 to 10 feedings a day. Don't wait longer than 4 hours between feedings, because if you do, your baby may get dehydrated (dehydrated means lacking fluids). Six to 8 wet diapers a day show that your baby is getting enough breast milk or formula. Premature babies often spit up after a feeding. If your baby spits up too much, he or she may not gain enough weight. Be sure to talk to your doctor if you think your baby is spitting up too much.

Cradle cap

Cradle cap is a common condition for babies, where dry, white or yellow scales form a crusty 'cap' on the scalp. It can range from just a few scales affecting a small area to real crusts affecting a much larger area on top of the head. Cradle cap doesn't hurt your baby.

Shampooing a baby's head helps to prevent cradle cap by cleansing the scalp. Even if the baby only has 'down' and relatively little hair, shampooing is still necessary once or twice a week. If your baby has cradle cap, ask your pharmacist about products that will help to loosen and remove the crusts.

Teething

Most babies are between four and six months old when they start to get their first teeth. Occasionally babies are born with teeth while others may be one year old before their first tooth appears.


Every baby is different , some will get teeth without any problems while others are quite miserable each time a new tooth cuts through.


When a child is cutting a tooth, the gum area where the tooth is about to appear may be red, slightly swollen and painful and the child may dribble more than usual. Biting too hard on a sore gum may make a child cry or complain.


Teething is often also blamed for other problems such as colds, diarrhoea, fever and lots more. But teething is a normal process; it is not an illness itself so a child with other symptoms should be taken to a doctor - don't just ignore them and think it's "just teething".


Teething is not an illness. If your baby has diarrhoea, fever or vomiting see your doctor.


How to help your baby during teething.


Give him/her a plastic ring to bite on. Teething rings that contain cold water or gel and can be cooled in the fridge (not freezer) may also be useful.


Give crusts or rusks to chew on. Wrap pieces of apple or pear in muslin and give to baby to chew.


If the child seems to be in a lot of pain, ask your pediatrics about teething gels to rub on.Pain relieving medicines can also be used. Follow the instructions carefully and talk to your pediatrics about how much to rub on or give, and how often to use a gel or medicine.


A baby's skin under the chin and around the mouth may become red and chafed if the baby dribbles a lot. Ask your pediatrics to recommend a barrier cream to protect and soothe the area.

Nappy Rash

Nappy rash can range from slight redness around a baby's bottom to a bright red rash with sores and patches of rough red skin.


Most babies get some form of nappy rash at some time. Those aged between nine and 12 months are most at risk. It is unusual to see nappy rash in newborn babies, probably because their nappies are changed frequently.


Prevent nappy rash by changing your baby's nappy frequently and as soon as possible after a bowel motion.


Clean and dry your baby's bottom every time you change their nappy. Some baby wipes and soaps may irritate your baby's skin. If you think this is happening, use an alternative soap.


Let your baby play without a nappy on, eg lying on a towel, for as long as possible at each nappy change before you put a nappy back on. Take care if your baby is in the sun without a nappy on as a baby's skin burns very easily.


Use a barrier cream to protect your baby's skin. Make sure the skin is dry before applying a barrier cream.


If you are using cloth nappies sterilize and wash them carefully and rinse them well. Hang them out to dry in the sun.


Sometimes nappy rash doesn't clear up and it becomes infected. Thrush is a relatively common infection of the nappy area and looks like a bright red shiny rash, possiblly with raised red spots. It may spread to the skin folds, eg in the groin and at the top of the legs. You may need to use an antifungal cream to treat thrush - your pharmacist or doctor can advise you about this.

Scrapes and Cuts

If the wound doesn't appear to need stitches and isn't bleeding heavily, wash it with gentle soap and water, then pat dry. Apply an over-the-counter antibiotic (like Neosporin) and cover with a Band-Aid. If you notice any signs of infection (like redness, swelling, or pus), see your pediatrician.

Minor burns

Run cool water over the affected area to soothe pain (don't apply ice-it damages skin tissue, causing more discomfort). To protect the skin, apply a thin layer of petroleum jelly, and cover with a bandage. If blisters appear, don't drain them-open ones are easily infected.

Sun burn

When outdoors, infants and toddlers should always be protected from the sun with a hat and 30 SPF sunscreen (Sunscreen isn't recommended for infants under 6 months; instead, keep your baby out of direct sunlight and dress her in protective clothing.) But if your baby gets a sunburn, soothe it with an aloe vera-based cream. You can also administer over-the-counter pain relievers, like Tylenol. If vomiting or fever occurs, it means the burn is severe and you should see your pediatrician.

Bug bites

Most insect bites and stings look like firm, raised bumps. Care for a bee sting by gently scraping out the stinger with a sterile pin or tweezers. Put a cold compress on the area to relieve pain. (Note that many kids are allergic to bee stings-if rapid swelling or wheezing occurs, get medical help immediately.) Mosquito bites are especially common in babies -- the bugs are actually attracted to the hemoglobin in infant blood. Clean and dry the bite, then apply an over-the-counter itch relief cream, like Benadryl ointment. To keep your child from scratching, cut her fingernails and keep them clean.


Knots and bruises

Apply an ice compress to the area to help numb pain and reduce swelling. To relieve soreness, administer an over-the-counter pain reliever like Tylenol or Ibuprofen. If your child seems lethargic, disoriented, or vomits after bumping his head, seek medical care to check for a concussion.


Motion sickness/Nausea

It's best not to give babies and toddlers medication for nausea -- doctors say it can make stomach upset worse. Simply let your child rest and call your pediatrician if symptoms worsen or don't subside within a few hours.

Infancy is a period of rapid growth. Plenty of energy and nutrients are needed for the new tissue development. When it comes to feeding infants, parents universally agree that breast milk is the best. Not only is breast milk superior nutritionally, it also contains all the immunological properties that formulas can never contain. Breastfeeding ideally should continue for at least 12 months and thereafter for as long as mutually desired. But for some reason if breastfeeding is not possible for medical, psychological or practical reasons, it is of paramount importance to ensure sufficient nourishment for your baby by responding appropriately to the nutritional guidelines and also understanding the trick of translating nutritional advice into infant foods on the table. An appropriate diet for infants under the age of one should provide all the essential energy and nutrients needed for normal growth and development, whilst including a variety of foods and tastes.

During the early months, concern about the well being of the child is acute, so the anxiety (specially for first time parents) reigns supreme. Confusion over what is suitable for children has been fuelled by a heightened awareness of the need for a healthy diet.


Following guidelines can be applied while choosing infant foods –


Pediatricians recommend using prepared infant formulae containing iron and vitamins for the first year. Infant formulae are considered as nutritionally complete meals for babies until about six months of age so it is recommended to wait till then to start solid foods. If pureed foods are started earlier, a baby is likely to spit it out, as they are not neurologically ready to accept solids by then.
0-6 months – Infant formula or cow’s milk or goat’s milk.
6 months onwards – Dal water, diluted rice water, mashed banana, fruit juice etc.


Home cooked foods can provide variety of tastes and textures when started. Milk products, yoghurt and custard can be introduced. Gluten containing cereals should be delayed till the infant is six months of age. Single grain cereal is often the first one added. New foods should be added one at a time to allow them to get used to the flavour of the food and also get him to agree with it. The most important thing to remember when starting solid foods is to use your common sense.

A few children may have food intolerances like milk intolerance. Alternative products like soy based infant formula can be used for them.

Avoid These – Some foods like nuts are unsuitable for children as they might lead to choking. Also it would be wise not to include honey as it contains microorganisms to which small infants are particularly sensitive.

Do Not Compare- Infant appetites vary. No two babies would require to be fed the same amount of food. Their feeding pattern would vary considerably so comparing your child’s intake with another will not give you any accurate indications. As long as your child’s growth is as per the schedule and he is not cranky, there is no reason for you to worry about his intake even if small amounts are being eaten.

Infant Sleep Safety

Here’s how to make sure that your child’s sleep environment is safe, and your child is secure in his bed.

1] Your child should preferably sleep in his own crib. Bring him next to you only if he wakes up and cries or wants to be fed. Remember, don’t breastfeed him when he’s sleeping.

2] Don’t smoke in your child’s room. If you have a balcony, convert your home into a no-smoking zone and smoke only in the balcony.

3] Use a firm mattress. The mattress should be exactly the length of the crib base. There should be no space where your child’s head can get stuck, or he may get smothered.

4] When placing your child in the crib, cover him with a light blanket, even in the summer, if you are sleeping with the air-conditioner on. Make sure that his head is never covered with the blanket or sheet.

5] Make sure the sheets are clean.

6] Keep a soft light on, next to his crib.

7] No matter how adorable your baby looks surrounded by soft toys and stuffed animals, it’s best to avoid placing them inside his crib, especially when he’s sleeping.

8] Never ever put your infant to sleep by placing him on top of a pillow.

9] Similarly, avoid putting your child to sleep on a sofa. His head may slip in between the crevices, causing him to suffocate.

10] Don’t put your infant to sleep on his stomach.

11] Make sure your child’s room is well ventilated.

12] There are definite advantages to having your baby sleep with you in the same bed. If you put your infant to sleep on the same bed as you, it is likely that both of you will get better sleep, as you will not have to get out of your bed every time your baby wants to be breastfed. In addition, if your baby keeps waking up at night, putting him to sleep next to you may help him feel secure, and help him sleep through the night. However, considering the possibility of SIDS, you have to ask yourself that (heaven forbid!) should anything happen to your baby while he is sleeping with you, would you be able to handle the guilt, even if it wasn’t your fault (which, in all probability, it wouldn’t be)? So if you want to bring your baby into your bed, remember that while adult beds are not harmful per se for an infant, it’s best to take a few extra precautions just to be on the safe side. After all, adult beds were not designed keeping baby safety in mind.

13] If you are both working parents, you may feel better at the thought of spending time with your child at night by sleeping with him. This encourages parent-child bonding. However, don’t bring your child into your bed if you are intoxicated on alcohol, doped or heavily sedated for any reason. You should be in such a frame of mind, that you are able to respond to your baby’s slightest movement.

14] Don’t put an infant (less than ten months) to sleep on an adult bed with another sibling, especially if the sibling is just a couple of years older. Young children are unaware of the dangers of suffocation. Make sure that if your infant sleeps out of his crib, he sleeps with an adult.

15] If your child is in your bed, don’t cover him with your quilt. Place him in his own baby blanket.

For babies from 3 to 6 months

Just as all babies grow and develop at a different rate, each baby will have different sleeping requirements. Some babies will settle most easily in dark and quiet environments while others seem to prefer sound and light. Others will sleep more in the day than the night.

In the first few weeks, most babies sleep most of the time, waking only for feeding, including 2 or 3 times every night. By 3 months, many babies tend to be awake for longer during the day and sleep for longer periods at night, but most will still be waking once or twice at night to feed. A bedtime routine : You'll tune in to your baby's individual needs and should find a sleeping routine that suits you both best. Some babies settle easily while others may need help to relax into sleep. As soon as possible, try to establish a bedtime routine. After feeding, babies are usually relaxed and sleepy. Some babies, however, start waking frequently and will only sleep when they have had another feed. Feed, play, then sleep works well for some parents. Follow this routine during the day and your baby may wake less at night. At night when your baby will soon learn the difference between night and day. Singing, reading a story or a gentle massage can also be helpful. Setting : Settling your baby can be frustrating and exhausting. Remember, your calmness will be reassuring and comforting. If you feel your baby's sleeping patterns are making you over-tired and irritable, seek advice from your pediatrician. It's important that parents get sleep too. Many new mothers (and fathers!) say that the change to their own sleeping pattern is the hardest thing about having a baby. Try to sleep when your baby does if you need to catch up. Take the phone off the hook and take a break when you can. Friends, relatives and neighbours can be great for a helping hand. Here are some ideas you might like to try to settle your baby • Check that your baby's nappy is still clean and dry. Cuddle your baby while you gently rock back and forth, slowing down as your baby calms. Push your baby's pram or bassinette back and forth. Try rocking the pram over a bump in the floor. Swaddle or wrap your baby - your pediatrician can show you the best way to do this. Rhythmically pat your baby's bottom, quickly at first then slower as your baby calms. If you start to tire, or become aggravated, stop and try something else. Play music Change the baby's position. Avoid putting on their tummy. Check that your baby is not too hot or cold or that clothing is not too tight. Give a relaxation bath and/or gentle massage. Offer a top-up feed. Take your baby for a walk. Take your baby for a drive - with a capsule of course. Take care you are not too tired. As a last resort, and on the advice of your pediatrician, your baby may settle with a pacifier or dummy. Never coat the teat in honey or anything sweet as this can lead to tooth decay, even before the teeth have emerged.

For Babies 6 to 9 months Most babies tend to sleep quite well once they're settled, but settling can be a challenge - your baby is craving constant company, wants to be awake to explore the world or could be anxious about being separated from you. Perhaps a bed time companion such as a teddy bear should be useful and you may like to leave the bedroom door open so your baby can hear you nearby. What's most important is that your baby feels secure and that you develop a consistent bed time routine.

Settling your baby It is normal for babies and children to wake in the night and this only becomes a problem when they have difficulty putting themselves back to sleep. If you're having difficulties settling your baby as sleep patterns change, or your baby is waking and not resettling in the night, here are some things you might want to try. Remember, consistency is important and you have to follow these guidelines for a few weeks. Ensure that your baby is clean, dry and comfortable and neither over or under dressed. A double nappy or a good quality disposable is a good idea at night. Comfort settling This method can be difficult for many parents to implementing, that they don't have a physical cause for waking, eg. An ear infection. Settling your baby can be frustrating and exhausting. Remember, your calmness will be reassuring and comforting. If you feel your baby's sleeping patterns are making you over-tired and irritable, seek advice from your pediatrician. It's important that parents get sleep too. Many new mothers (and fathers!) say that the change to their own sleeping pattern is the hardest thing about having a baby. Try to sleep when your baby does if you need to catch up. Take the phone off the hook and take a break when you can. Friends, relatives and neighbours can be great for a helping hand. Here are some ideas you might like to try to settle your baby Put your baby down in the cot, then leave the room for 2-5 minutes. At this point, your baby is likely to turn on the waterworks, screaming and crying for your attention. This can be just as traumatic for parents as it is for babies, so do try to stay as relaxed as you can manage. Return to the room, but don't turn on the light. Making as little eye contact as possible, speak firmly and quietly, gently urging your baby to lie down and sleep. Tuck your baby in again with a gentle stroke or pat for a moment when the crying has reduced to soft sobs and sniffles and then leave the room for 5-10 minutes. If your baby still won't sleep, keep repeating this process, gradually increasing the time that you are out of the room. Eventually, your baby will know that you will always come when needed but all that crying is just too much like bard work. These times are an indication only and you may need to start by leaving your child for shorter periods. Tips Some babies get even more distressed when parents come back into the room. You may want to check if baby's sleeping from the door, without entering. If your baby's distressed to the point of vomiting or soiling a nappy, attend to your baby without talking or turning on the main light. If possible, wash and change your baby in the comfort of the cot, before comforting and trying to settle once again. The same rules apply for settling your baby for daytime sleeps, but if you haven't had success after an hour or so, get your child up and start your settling routine only at the next sleep time. If you feel your baby has a sleeping problem that you can't cope with, remember that help and support are always available. Ask your Child Health Nurse or Doctor for advice.

For Babies from 10 to 12 months

Younger toddlers generally like a daytime sleep as well as a good 10-12 hours sleep every night. Of course, every household is going to have different times for waking up and going to bed, but what is important is that you establish a bed time routine now. By keeping a few things in mind, you can help your child to develop healthy, independent sleep patterns.

As babies, many infants are rocked to sleep or accustomed to falling asleep with a breast or bottle. It figures that this can become a habit and toddlers may have trouble going to sleep without these conditions. Be establishing a new bed time routine, you can overcome bed time problems such as dawdling or refusing to go to bed, crying after being put to bed, getting out of bed. Of course, you can not make your child go to sleep, but you can establish the conditions that will make sleep more likely. A bedtime routine : Children generally find security and comfort in routines. Set a regular bed time and a bed time routine. As bed time approaches, tell your child that it will be bed time soon and it's time to finish up any activities. Half an hour before bedtime is probably not a good time for rough and tumble play. Tickles and excitement. Help your child with each step of the bed time routine cleaning teeth, toilet, saying goodnight and so on - and check through the list with your child as you tuck them into bed. If everything's been done, then there should be no excuses for getting out of bed. Read a story, say goodnight and leave. If you stick to this routine, most children will quickly learn that you mean what you say, even though they're likely to test your limits at first.