Tag Archives: Dr Shan Narayanan – Paediatrician

What Is a Newborn Baby’s Job? (Part 2)

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Dr Shan Narayanan – Consultant General Paediatrician

Dr Shan Narayanan – Consultant General Paediatrician

Child Health

By Dr Shan Narayanan

“Life is really simple but we insist on making it so complicated.”Confucius

Babies lead a simple life. They eat, sleep and fill the nappy. Their life is thus pretty straight forward. However, their parents get very worried over these matters. The worry is out of their love for their baby.

In the last article, we looked at feeding. The best feed for the baby is breast milk. Some mothers, for various reasons (health, work or out of own choice) are not able to breastfeed partly or completely. They opt for formula feeding. In such situations, mums need to learn how to prepare the milk and sterilize the bottles to ensure babies do not develop infections.

Working mothers, who are breastfeeding, can express their milk and store it. Breast milk must always be stored in a sterilized container. If you use a pump, always sterilize it before and after use. In general, the milk can be stored as follows:

  • in the fridge for up to five days at 4°C or lower
  • for two weeks in the ice compartment of a fridge
  • for up to six months in a freezer.

Most newborns sleep for 16 to 20 hours a day. The sleep is intermittent with the need to feed outweighing the need to sleep and hence they sleep for 2 to 4 hours at a time. Breastfed babies get hungry more frequently than bottle-fed babies and may need to be nursed every 2 hours.

Their biological clock at this stage is not yet established. Many newborns tend to sleep all day and are awake at night. This is extremely tiring for the parents/caregivers. Thus it is not surprising if parents/caregivers lose their cool under these circumstances. Support and turns taken in caring for the newborn is important but not always available.

Every baby is different as to when he or she will sleep through the night. In general, by 2 months of age, most babies are sleeping 6 to 8 hours through the night.

Breastfed babies’ stool

Breastfed babies’ stool

Meconium

Meconium

It is recommended that babies are placed on their backs to sleep and not on their stomachs.  Babies who sleep on their stomachs tend to have a greater tendency towards blocking their breathing. There is a chance they may suffocate on softer bedding, as well. Once the babies are fed, they sleep, then they poop and pee to complete their job!

The urine is usually pale yellow in colour.  In the first week, as the feeding is establishing, the baby passes urine only 3 to 4 times per day. After this, both breast and bottle fed babies should pass 6 to 8 times in a day.

The initial stool passed by a newborn is called meconium. It has a thick, black and sticky consistency. The colour changes as the baby is fed. Breastfed babies have yellowish watery stools with some “seeds”. Formula fed babies have firmer stools which may be yellow to green in colour.

Stooling patterns vary from baby to baby. It is normal for babies to grunt and grimace when they stool. Breastfed babies pass more frequent stools; it may be 6 to 8 times per day. They tend to stool as they feed. Formula fed babies may stool 1 to 3 times per day.

Traditionally, fathers like well-fed and clean babies leaving the hard work to mothers. This practice is changing with younger dads getting involved in the hands-on care of the newborn – a credit to gender equality!

For more information, call Dr Shan’s clinic at Hospital Fatimah 05-546 1345 or email shaniea02@gmail.com.

What is a Newborn Baby’s Job?

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Dr Shan Narayanan – Consultant General Paediatrician

Dr Shan Narayanan – Consultant General Paediatrician

Child Health

“Life is really simple but we insist on making it so complicated.”  — Confucius.

Babies lead a simple life. They eat, sleep and fill the nappy. This is their job. However for young parents it can be very daunting. Caring for a newborn baby is a full time job thus understanding the needs of the newborn makes their care less complicated. In this article, we look at the feeding of a newborn baby.

Newborn babies can be breastfed and/or formula fed. Breast milk is the ideal form of nutrition for babies. Breast milk is the perfect food for a human baby’s digestive system. It contains the vitamins and minerals that a newborn requires, and all of its components – lactose, protein and fat are easily digested by a newborn’s immature system.

BreastfeedingBreastfeeding requires a substantial commitment from a mother. It also meets a variety of emotional needs for the mother and baby. It burns calories and helps shrink the uterus, so nursing mothers get back in shape quicker.

Maternal health both physical and mental health, is key to successful breastfeeding. Mothers, need to be calm and relaxed. It is important they eat a healthy diet, drink plenty of fluids and rest as much as possible.

During the first few days after delivery, mothers produce colostrum, thick and yellowish or thin and watery. Colostrum contains antibodies that help protect infants from a wide variety of infectious diseases.

After about 3 to 4 days of nursing, the breasts will start to feel less soft and more firm as milk is produced. The milk supply is determined by the stimulation the body receives. The more one breastfeeds, the more milk the body produces. If possible, nursing is started straight after delivery or within an hour after the birth. This timing takes advantage of the newborn’s wakefulness as they will spend the rest of the day sleeping. If the mother is unwell or has had caesarean section this may not be possible.

It s important that that baby latches with a wide-open mouth and takes as much as possible of the mother’s areola (the dark-coloured area of the breast) in his or her mouth (not just the tip of the nipple). Mothers may need support in getting babies to latch onto them. This may come from the elders in the family or the midwife who has attended the delivery. In some institutions they have a lactation consultant that advises mothers on breastfeeding.

Sometimes, mothers with inverted nipples have difficulty with feeding. Mothers should avoid using pacifiers and bottles as these are known to cause “nipple confusion” and the baby may give up on breastfeeding.

When one is breastfeeding, one can’t measure the amount of milk the baby drinks during each feeding. If the baby is having four to six wet nappies per day and gaining weight then the baby is getting enough.

Sometimes, mothers are unable to breastfeed as they may be unwell, had a difficult delivery or a caesarean section. In these instances, babies are fed with formula milk till the mother is well enough to breastfeed. Finally, it is the choice of the mother whether she wants to breastfeed or formula feed her baby.

“A newborn baby has only three demands. They are warmth in the arms of its mother, food from her breasts, and security in the knowledge of her presence. Breastfeeding satisfies all three.”Grantly Dick-Read

 

For more information, call Dr Shan’s clinic at Hospital Fatimah 05-546 1345 or email shaniea02@gmail.com.

Why do newborn babies have to cry?

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Dr Shan Narayanan – Consultant General Paediatrician

Dr Shan Narayanan – Paediatrician

Child Health

Dr Shan looks at the care of term newborn babies in this article.

“Sometimes, the smallest things take up most room in your heart.” – Winnie the Pooh.

How true…both my boys filled my heart as soon as they “arrived”.

Arrival of a newborn brings along with it a barrage of activities and excitement. On the other hand there is a lot of stress and fatigue. Caring for a newborn is a full time job…no rest…thus support, both physical and emotional, is very important. Knowing what to expect helps to ease the anxiety and stress and gives you confidence to handle the small fragile ‘new thing’ in your life.

Babies born when the mother has completed 37 weeks of gestation are called “term babies”. Babies born earlier are “preterm babies”.

Immediate care of preterm babies varies from care of term babies. We will look at the immediate care of term newborn babies in this article.

Most newborn babies are vigorous (active + crying). About 10 per cent require some assistance and only 1 per cent need major resuscitation, that is, intubation (inserting a tube in the windpipe to ventilate), chest compression and medications to survive.

Most babies are delivered normally (vaginal delivery), while some may need instrumentation (vacuum/forceps) and others are delivered by Caesarean section. The newborn is covered with vernix caseosa.

Vernix caseosa, also known as vernix, is the waxy or cheese-like white substance found coating the skin of newborn human babies. Vernix starts developing on the baby in the womb around 18 weeks into pregnancy. It is composed of sebum, cells that have sloughed of the fetus’s skin and shed lanugo hair (first hair to be produced by fetal hair follicles).

Once the Obstetrician has delivered the baby (usually onto the mother’s abdomen) s/he, would clamp the umbilical cord and then cut it.

This is one time when everyone is “happy” when the baby cries. Without crying the mood is somber. Crying indicates a healthy newborn but WHY?

Why do newborn babies have to cryWhen the baby is in the womb the lungs are compressed and filled with fluid. Physiological changes occur as soon as the baby is born to adapt to the environment outside the womb (extrauterine environment).

In simple terms, when the baby cries, s/he takes a deep breath, called inspiratory “gasp”. This deep breath together with the contraction of the diaphragm and intercostal muscles brings about the following changes in the lungs:

  1. expansion
  2. reabsorption of fluid
  3. air rushing  in
  4. increased blood flow.

This sparks off the breathing process. HENCE EVERYONE WAITS FOR THE BABY TO CRY!!!

The baby is wrapped in a warm towel and shown to the mother. Then the weight, length and head circumference is taken. The baby is given an injection of Vitamin K (to prevent bleeding) and Hepatitis B vaccination.

The baby is then placed under a radiant warmer. When the baby is warm, s/he is bathed and fed. BCG vaccination is then given.

In the next part, I will discuss other aspects of the care of the newborn.

For more information, call Dr Shan’s clinic at Hospital Fatimah 05-546 1345 or email shaniea02@gmail.com.

Child Health

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Consultant General Paediatrician, Hospital FatimahBy Dr Shan Narayanan
Consultant General Paediatrician, Hospital Fatimah

Introducing our new column dedicated to creating awareness on various aspects of children, childhood and parenting.

“Children are not the people of tomorrow, but are people of today. They have a right to be taken seriously and to be treated with tenderness and respect. They should be allowed to grow into whoever they were meant to be. ‘The unknown person’ inside each of them is our hope for the future.”

– Janusz Korczak (Polish Paediatrician, educator and children’s author)

How aptly, Pan Doktor (“Mr Doctor”) has phrased it!

A child is a human being between the stages of birth and puberty. A child is defined by the United Nations Conventions of the Rights of the Child as “a human being below the age of 18 years unless under the law applicable to the child, majority is attained earlier”.

Children are not “little adults”, they are physically and emotionally different. They need adult protection, supervision, love and nurturing to develop and bring out their potential.

A child grows and develops with age. Growth is the gain in size and attaining puberty. Development is the process in which they acquire skills.

Child development is a continuous process; the various periods in the process of development are as follows:

Stages

Age

Newborn

Recently born child

Neonate

Child less than 4 weeks old

Infant

One month to one year of age

Toddler

1-3 years

Preschooler

4-6 years

School Age

6-13 years

Pre Adolescence

10-12

Adolescent

12 to 18 years

The various domains of child development are: Gross Motor, Fine Motor, Speech & Language, Communication, Hearing, Vision, Cognition, Social and Behaviour & Emotion.

Every child develops at his/her own pace, no two children are the same. Their development is influenced by the genetic endowment and the environment.

The health of the child is also an important factor affecting a child’s development. The physical, mental and emotional health are equally important.

Well, has anyone of you wondered what a child’s job is? A baby’s job is to eat, sleep and fill the nappy!!  An important job of a young child is play. Play is a very powerful learning tool. Children learn through play.

Children are a joy and on the other hand can be the cause of heartache. One may be lost, especially “new parents”, as to how to deal with the different situations. One may wonder how to support their child to bring out his or her potential.

There is no course to make one a perfect parent. There are many parenting websites that provide information on caring for and supporting children to achieve their potential. However in my opinion, nothing is better than experience. Sometimes we get it right and at other times we learn from our mistakes.