We missed the lecture scheduled for the November group, so we made up for it by attending this month’s lecture on Thursday night. The session began with a paediatrician, Dr Yong (I think his name was…) taking us through some of the conditions babies might develop immediately after birth and during those first few months. The pictures were pretty gruesome, but I suppose it sent the message home.
The first few pictures were of babies with distortions of the scalp due to the need for vacum extractions. According to Dr Yong, the distortion is limited only to the skin and there is no damage to the cranium. This condition normally resolves itself and there is often nothing to be concerned about. A few cases may continue to progress into early childhood but once the baby has adequate hair cover, it is no longer so noticeable. The concern for this usually more aesthetic than anything else. Even a normal vaginal delivery can result in a conical head shape if the delivery takes too long and the baby has been “stuck” inside the birth canal for a number of hours.
The risk of serious damage resulting from assisted deliveries (i.e. vacum or forceps extraction) is generally quite low. Dr Yong mentioned about the posibility of fractures resulting from excessive force used during forceps extraction but assured us that the incidence of this is negligible. Wow… I feel so much better already. Note to self: something to talk to Dr Wong about at my next check-up.
Babies are generally “floppy” (lacking muscle tone) after birth, so Dr Yong advised us not to be overly concern if we observed this in our own baby.
We also saw pictures of some severe cases of diaper rash, to which Dr Yong advised the use of barrier creams to help prevent it. He also seems to be from the school of thought that cloth nappies resulted in a reduced incidence of diaper rash (Sorry Dr Yong, but a lot of the references I read seem to indicate frequency of nappy change rather than type of diaper used is more important). The pictures of the cases he showed us were the result of infrequent nappy changes. In some pictures, the poor baby’s skin was raw to the point of bleeding.
Some babies were born with curved legs and this was usually due to insufficient space inside the womb. The pictures reminded me of a few cases of rickets I’ve seen during my Uni lectures. Basically, the baby looks like he/she has bow legs. Thankfully, this condition also corrects itself, though parents can also perform some massages to help the baby.
Common among Asian descent are Mongolian birth marks which is a bluish mark often found around the lower back and buttocks (however it can be found on other parts of the body) that looks like a bruise. It can be mistaken for child abuse for there was a case over in the UK where the parents were brought to court and had to prove their innocence. These birth marks will generally fade but usually over many years.
Other problems that develop – infections around the belly from improper cord care. This is generally resolved by frequent cleaning of the area with alcohol swabs. Some babies develop whitish spots on their nose and this is usually due to blocked pores. Once the baby starts to sweat, it will also disappear on its own.
Whitish formations over the tongue, roof of the mouth and cheeks are an indication of a fungal infection (called Candida or thrush). This needs to be differentiated from the whitish milk stains that are normal and common among babies. If a baby is found to have thrush, both mother and baby will need to be treated. In the baby’s case, sometimes the fungal infection can spread all the way down the oesophagus, making it hard for the baby to feed. Common symptoms are vomitting and a refusal to take milk. These fungal infections are commonly due to improper cleaning of bottles used to feed the baby and can be prevented by observing stricter hygiene practices when handling milk bottles.
It can also occur in breastfed babies from mothers who have the fungus on their breast. Dr Yong advised mothers to clean the breast before breastfeeding, although we were taught in the breastfeeding class that cleaning the nipple before a feed was not necessary. There are glands around the edge of the areola which secrete a substance that keeps the nipple clean, however, the advice was that if we had been sweating, then cleaning the breast before a feed might be necessary. None of the books or sites I’ve checked seem to be very informative over this point so it would be helpful if any breastfeeding mothers can provide some input on this.
Another point to note is that there is no need to clean the baby’s mouth of the whitish milk stains because the mouth at this point is self-cleansing. In fact it is not advised to put anything into the baby’s mouth other than a nipple for feeding (milk bottle or breast). Cleaning of the mouth only begins once the baby has his or her first tooth and even then all that is required is a clean cloth and a quick wipe of the teeth.
We also saw pictures of babies with cleft lip and cleft palate. Nowadays, such conditions can be detected even before the baby is born. Regardless of whether you are aware of your baby having either of these conditions before or only after birth, the common treatment is plastic surgery after the baby is born. Dr Yong also told us that there were some cases of cleft lip/palates that were treated while the baby was still in utero. I can’t imagine why a cleft lip or palate would require such urgency that the doctors couldn’t wait until the baby was born. It seems rather risky to be operating on the baby while he/she is still in the mother’s uterus.
One other case that Dr Yong showed us was a baby with a sixth finger. Although the additional finger doesn’t have any symptomatic issues, it can be removed for aesthetic purposes later on in life.
The general message I seemed to take out of this lecture was that there are a number of conditions that may affect the baby, especially immediately after birth, but most of them are not usually very serious and will resolve themselves without treatment. There may have been some more slides shown, but I can’t recall the cases.
After birth, the baby will receive some immunisations, such as BCG and the first course of the Hepatitis B vaccination. The BCG vaccination can be giving on the baby’s arm or buttock (the latter being opted by parents who don’t like the keloid scarring associated with the vaccination). Parents will also receive a little booklet (which will be the baby’s passport to for every visit to the paediatrician). Every vaccination the baby receives will be recorded into the booklet for future reference. The booklet also contains a timeline of “firsts” outlining when the anxious parents can expect to see the baby perform certain actions.
The next part of the lecture was on the care of the newborn. The lecture was given by Sister Elizabeth who taught us how to bathe the baby and change the baby’s nappy. I won’t go into it here because the explanation can be quite long and tedious, especially without diagramatic aids. There are some books that cover this topic quite well with diagrams, such as “Asian Parenting Today”, which can be found in MPH for about RM40.
Sister Elizabeth advised us that the hands-on component of how to bathe the baby and change the baby’s nappy is taught to the parents after the baby is born and the parents are able to “practice on the real mccoy” rather than a plastic doll which is obviously a lot easier to handle. Pantai also offers a series of three baby massage courses to be taken after the baby is born. Each session costs RM50 and the first one is free. The massages taught are supposed to help reduce colic, improve the growth of the baby and create better bonding between parent and baby.
She also gave us some tips on a few practicalities:
- Don’t buy newborn clothes, size 0-6mths is okay, but definitely NOT 0-3mths
- Don’t buy blankets and comforters, babies should be put to bed in all the clothes they need to keep warm for the night (air conditioning of the room should not be lower than 23 degrees celcius)
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