Welcome to Ipswich Hospital
Our Passion, Your Care

Monday, 11 December 2017
Caring for your Baby
newborn baby with mum

First weeks
Looking after a new baby can be daunting at first. You will be looking out for reassuring signs that your baby is thriving. You may be anxious about signs of discomfort or illness. This section will help you to learn about the comfort and health of your baby in the early days so that you are better informed about when to talk to your midwife or doctor and when there is no cause for concern.
This information applies to healthy, full-term babies. If your baby has been on the Neonatal Unit the staff may have given you different advice. If this is the case, please follow the advice given by the Neonatal team.

Safer Sleeping – The Lullaby Trust
Six simple steps to keep your baby safe.
1    Keep your baby smoke free during pregnancy and after birth.
2    Place your baby to sleep in a cot, crib or Moses basket – never fall asleep with them on a sofa or chair.
3    Never fall asleep with your baby after drinking or taking drugs or medication.
4    Put your baby to sleep on their back with their feet at the foot of the cot.
5    Keep your baby’s head and face uncovered and make sure they don’t get too hot – room temperature should be 16 – 20°C.
6    Breastfeed your baby if you can – support is available    

Bed Sharing – The Lullaby Trust
Some parents choose to bed-share with their babies. This means that their baby shares the same adult bed for most of the night, and not just to be comforted or fed. It is very important for you to know that there are some circumstances in which this can be very dangerous.
Bed-sharing increases the chance of SIDS and is particularly dangerous if:
•    either you or your partner smokes (even if you do not smoke in the bedroom); or
•    either you or your partner has drunk alcohol or taken drugs (including medications that may make you drowsy).
Similarly, bed-sharing with a baby of low birth weight (2.5 kg or 5½ lbs or less) or a premature baby (37 weeks or less) is strongly linked to an increased risk of SIDS.
You should never sleep together with your baby if any of the above points apply to you, or even if you just feel very tired. You must be especially careful when giving feeds that you are not in a position where you could both fall asleep in the bed, an armchair or on the sofa together.
Parents may still choose to bed-share with their baby. If this is your choice, it is important that you are informed about how to minimise the risks. It is important to note that a high proportion of infants who die as a result of SIDS are found with their head covered by loose bedding. Ensure that no pillows, sheets, blankets or any other items are in the bed with you that could obstruct your baby’s breathing or cause them to overheat.
The safest place for your baby to sleep for the first six months is in a separate cot or Moses basket in the same room as you.
This and more information is given in a leaflet provided at discharge from The Lullaby Trust and Health and Wellbeing Suffolk.
 
Jaundice
Jaundice is very common in newborn babies, especially breastfed babies. It commonly occurs 2 – 3 days after birth and can vary in how long it lasts, but should be improving by 7 – 10 days. Jaundice is not a reason to stop breastfeeding or to start to give formula milk.
Your baby’s skin will look slightly yellow and the whites of the eyes may also look yellow. In babies with darker skin the soles of the feet and palms of the hands will appear yellow. Jaundice usually starts on the head and face and may spread to the chest and stomach. Other signs of jaundice may be the colour of your baby’s urine and stools (poo). Normally, your baby’s urine should be colourless and the stools should not be pale.
If your baby appears jaundiced, he or she may be sleeping more than normal and appear disinterested in feeding. It is important that your baby feeds more frequently. If your baby looks jaundiced before they are 24 hours old, you must contact your midwife urgently.
Speak to your midwife about any concerns that your baby may need to be tested for jaundice levels. This may be initially done by a monitor which indicates how severe the jaundice is, this can be done at home in some cases but, in most, it will require referral to hospital for the test to be performed. Depending on this result, a blood test may need to be taken at the hospital. In some cases a blood test may be the first investigation done.
If the jaundice levels need treatment, your baby will need to be in hospital. If the jaundice continues for more than two weeks, you will need to see your GP, who will arrange a review and further tests if they are needed.

Vomiting
Babies often bring up some of their milk with a burp after a feed. This is called posseting and is normal. Babies often posset small amounts frequently in the early weeks. Your baby should not vomit repeatedly and in a violent manner – this is called projectile vomiting and, if this occurs, your baby must be seen by a GP. If your baby’s vomit is green or if you are concerned that your baby’s vomit is ‘different’ to normal, contact your GP or seek urgent medical attention at your nearest Emergency Department.

Temperature
If your baby is unwell, one of the first signs may be a high, or low, temperature. To check your baby’s temperature place a digital thermometer under your baby’s armpit. If the temperature is less than 36°C or above 37.5°C please seek further advice from your GP or seek urgent medical attention at your nearest Emergency Department – new born babies can become extremely unwell very quickly.

Constipation
All babies should have passed meconium within 24 hours after birth – let your midwife know if this is not the case.
Constipation is a condition where your baby’s stools becomes firmer and harder. Exclusively breastfed babies will very rarely get constipation because breast milk is easily digested. Bottle-fed babies may become constipated, as formula milk is harder to digest. If your baby has firm, hard pellet-like stools that seem to hurt him or her, check that the formula is made up correctly. If you think your baby is constipated tell your midwife, health visitor or GP and they will advise you further.

Diarrhoea
If you notice your baby is having frequent dirty nappies and the content is runnier than usual and quite watery this may be diarrhoea. Diarrhoea in babies can lead to dehydration. Babies with diarrhoea often do not feed very well. They may pass less urine, get a high temperature, and may be very sleepy or irritable. If you think your baby has diarrhoea consult your GP.

Thrush
Oral thrush is a fungal infection. It is most likely to occur in babies over four weeks old, but can be earlier. One of the first signs of oral thrush is that your baby does not want to feed. There may be one or more white patches in your baby’s mouth. These patches look a bit like curd or cottage cheese. The patches can also join together to make larger ones. You may see these patches on your baby’s gum, on the roof of their mouth or inside the cheeks.
See your GP if you think your baby has oral thrush as they may prescribe treatment. If you are breastfeeding, the thrush may transfer to your breasts so do seek advice from your GP as you may need to receive treatment at the same time as your baby.
Babies can also get thrush on their bottoms or genitals. It will look red and sore. This could be confused with nappy rash so always make sure you discuss any concerns with your health visitor.

Nappy rash
Nappy rash is very common. A wet or dirty nappy that has been left touching the skin is the most common cause of the rash. If your baby has mild nappy rash, part of their nappy area will be covered in a pink rash usually made up of small spots or blotches. It will help if you change your baby’s nappy more often and only use warm water to clean the skin and drying carefully with soft material. A barrier cream may help to protect the skin, if the rash is not settling after a few days, talk to your midwife or health visitor. If your baby also has a temperature, see your GP immediately.
Baby wipes are not recommended in the first few weeks as a baby’s skin is very sensitive. Even when babies are older, baby wipes are not recommended for regular, frequent use.

Crying
All babies cry. It is your baby’s way of letting you know that they are hungry, tired, cold, or in need of a nappy change. Sometimes babies cry for no obvious reason, even though they are well-fed, clean and warm. Holding your baby close to you and gently rocking may help them to settle or having ‘skin-to-skin’ with you or your partner. Your baby recognises the sound of your voice, so talking to them or singing can provide reassurance and help your baby settle.
When your baby is crying and you can’t seem to work out why, do a quick check of the following, to help you work out what your baby is trying to tell you…

  • Has your baby had a feed recently? Have they got wind – might they benefit from you gently rubbing their back?
  • Has your baby got a full nappy?
  • Is your baby hungry? When did they last have a feed? Do you think they would settle from having a feed – if you do, why not try it, to see if it soothes them?
  • Is your baby tired? You could put them in a sling, pushchair, or even take them out in the car if it might help them settle. Never leave your baby on his or her own in a car seat or pushchair when asleep – always move them to their Moses basket or cot, so that they can sleep safely.
  • Are they over stimulated? When a new baby comes home, it’s natural that family and friends want to visit – but babies don’t understand things the way we do, and may find being passed around strangers, people other than mum and dad touching them and lots of excitement and noise, just too much for them. Some quiet time might help.

If you suspect your baby is unwell, or if you are worried about their symptoms, it is important to see your GP or seek urgent medical attention at your nearest Emergency Department.
For new parents a crying baby can be very stressful and it’s important to know you’re not alone in feeling this way. If you ever feel this is becoming too stressful place your baby down in their cot for a few moments and have a small break away. This gives you a few moments space to regain your composure and start again.
Always remember that this isn’t uncommon and it is OK to ask for help and support from those close to you and health care professionals who will understand.
Read Sophie’s story on the NSPCC website at https://www.nspcc.org.uk/fighting-for-childhood/childrens-stories-about-abuse/sophie-damions-story/ where further support and information on coping with crying can be accessed.   
For further advice and support, you can call the helpline run by the CRY-SIS charity: 08451 228 669, 7 days a week, 9 am to 10 pm. For more information visit
www.cry-sis.org.uk

Colic
Colic is very common in babies. Colic starts a few weeks after birth and may continue for the first 3 – 4 months. Your baby may cry intensely have a red face and may clench their fists and draw up their knees. Although you may worry that your baby is in distress, colic is not harmful and your baby will continue to feed and gain weight normally. If you suspect your baby is unwell, or if you are worried that their symptoms may be something other than colic, it is important to see your GP.

Cord care
The cord clamp will stay on your baby’s cord until the cord falls off. Keep the cord stump clean and dry by cleaning with soft material (gauze or cotton wool) and cooled boiled water at least daily. After a few days the cord stump will turn darker and dry up. Occasionally you may see a small amount of blood on the nappy when the cord starts to separate. It will fall off sometime between five and 15 days, leaving a small area that may take a few days to heal. Never try to pull the cord off.
If the area around the cord stump becomes red or swollen or the cord stump becomes swollen and very smelly, contact your midwife.

Breast enlargement in newborns
Breast enlargement can happen in both boys and girls and is usually noticed by the third day after birth. Breast enlargement is short lived and should go away by the second week. Do not squeeze or massage the breasts. You may notice some discharge from the nipples. This is also common but is not a cause for concern and will stop within two weeks. Should the breast area appear red or inflamed please contact your GP.

Pseudomenstruation
Baby girls sometimes have a vaginal discharge called ‘pseudomenstruation.’ The discharge is usually white but occasionally is tinged with blood. This condition is common, there is no cause for concern and it should not last beyond the first week of life. If this discharge is present you should continue to clean your baby at every nappy change as usual. A little light pink, orange, or even red stain on the nappy is seen occasionally with both boys and girls and is usually nothing to worry about if your baby is otherwise well. If your baby seems unwell or is not feeding well, contact your midwife, health visitor or GP.

Sticky eyes
‘Sticky eyes’ in babies is common. You can use cooled boiled water to clean your baby’s eyes. Prepare a small bowl of boiled water and allow to cool. Wash your hands thoroughly, dip a piece of clean gauze, squeeze it, then gently wipe your baby’s eye from the nose outwards. Repeat on the other side using a fresh piece of gauze. If the eye becomes inflamed, angry or red or if there is persistent green discharge, speak to your midwife or see your GP for advice.