ABC’s list to Common First Month concerns
Congratulations on your new baby. We understand that the coming weeks will be an exciting time and hopefully you and your baby will have a smooth transition to the home environment. You will get advice from many people, as well as the internet.
However, some advice may conflict with the current medical care which we provide for your baby as medical care progress over the years. Hence, by reading through this, we hope to provide with some practical advice on your baby’s care.
The following ABCs will help to address your baby’s immediate care.
Your baby will need an early jaundice check up within the 1st 5 days of life. If otherwise well, the baby will be next seen at either 6 weeks or later for the next vaccinations and health check-up.
In the hot humid weather, your baby will enjoy bathing and their hair can be washed as well. Use a mild soap to bathe the baby regularly. You may attend our post-natal parent craft class to learn how to bathe your little one.
We recommend breast feeding for all infants. And breast feeding should be given on demand. We recommend you refer to the breastfeeding information booklet available in your discharge bag entitled: “Mummy, you have milk” for some advice on breastfeeding. Alternatively, you may consult our lactation hotline at 97220376 for personalized advice.
Babies should be gently burped after feedings and occasionally during feeds. Do not let the baby continuously and then feed, this will increase the chance of the baby spitting up. Burp them so that the air will be released to decrease spitting up.
Car seats are mandatory for children under 8 years of age. The correct placement of infant car seats is rear facing in the second row. You may be fined by the Traffic Police and demerit points may be given if you failed to secure your child.
Babies can cry on average of 3-5 hours per day. However, you cannot “spoil” a newborn by carrying them. Crying is their only means to express their emotions and wants. Some babies cry when they are wet, tired, hungry, cold, hot, lonely, uncomfortable or overfed. If you are unable to console your baby and the crying episode is different or more prolonged than usual. Do check a temperature and seek medical opinion. Also if your baby is not crying / lethargic despite attempts to rouse him, please seek a medical opinion.
First month concerns D - J
Diaper rashes are common, and can be avoided by changing diapers soon after it is soiled. Always use water or wipes to clean the area thoroughly without abrading the skin. Allow the area to dry. Apply a thin layer of barrier cream (a fingertip should cover the entire buttocks) and put on the diapers. If persist, please seek medical care.
Clean the outer part of the ears daily, taking care not to let water drain in during a bathe.
Your babies cannot focus on specific objects at birth. Therefore they may be squinting, this should resolve by 6 weeks of life. You should clean the babies’ eyes regularly. Frequently, they may have some eye discharge, this is due to blocked tear duct and can be reduced by gentle massage at the inner corner of the eye. If the discharge becomes very sticky or there is any swelling, please seek medical attention immediately.
Fevers are medical emergencies in babies less than 3 months. The definition of fever is more than 37.5 degrees Celsius taken from the axilla, or 38.0 degrees Celsius from the ear temperature. Please bring your infant to the nearest hospital if this occurs.
If you wish to formula feed, please buy formula suited for infants below 6 months. Typically, the baby will need 60ml every 2-3 hourly. Please follow the instructions on preparation on the can. The amount will increase as the baby grows. Please test the temperature by dripping some on your hand prior to giving the baby. Should you need assistance with breastfeeding, please contact our lactation team.
Jaundice is very common amongst the Asians, 1 out of 4 babies will have some jaundice. This will start from the face and spread towards the limbs. Use the colour of your babies’ hand to compare with the parts of the body. Do get a jaundice assessment by the doctors within the first week of life. You should also get a review if the jaundice spreads to the thighs immediately. Treatment with phototherapy can easily treat this condition. Should the jaundice persist beyond one month or the stools are beige in colour, please seek medical attention as soon as possible as serious conditions may be present.
First Month Concerns M - S
Your babies’ stool will change from black to brown to yellow by the first week of life. They may also have a variety of colours, textures and odours. The normal stool frequency may vary from several times a day to once every few days. Babies may have funny behaviors when they defecate, this does not mean that they are constipated or in pain. Most babies are learning how to coordinate their bowel movements- they squeeze their bottoms closed when they pushed instead of relaxing. However, if you see blood, mucus in their stools, please seek medical attention.
Your baby would have been screened for (Glucose-6-Phosphate Dehydrogenase) G6PD deficiency, congenital hypothyroidism, hearing loss and inborn errors of metabolism. Your doctor will inform you if any are abnormal. Please inform them if there is a family history of these diseases and follow their instructions on how to take care of your baby.
All babies have the snuffles and sometimes they may make noises when they sleep. This is because they are unable to clear their nose passage which is blocked with dried mucus. Clean your babies’ nose regularly so that they can sleep better.
Pimply rashes are very common after the baby is discharged, these are due to hormonal changes in the body and they are very much like pimples. Clean these with water and they will improve. If they persist and the baby is unwell, please seek medical attention.
Always lay your newborn on their back, facing up to sleep. Vary the sleep position to avoid flattening the skull. Newborns can sleep up to 16 hours a day and frequently they may have day-night reversal. Please use the time to sleep with your newborn while she sleeps. We do not advice letting your newborn sleep in your bed.
First Month Concerns U - W
The umbilical cord has no sensation. Let it dry on its own and it should fall off within 2 weeks. We no longer recommend the use of cord spirit as this will delay the cord separation.Sometimes, bleeding may occur and there is also some discharge. If there is redness or urine coming from the cord, please seek medical attention.
Your baby should have at least 5 - 6 wet diapers on discharge from the hospital. If the baby is not taking enough fluids, the urine may turn pink in colour. Increase the fluid intake by giving the baby more expressed breastmilk or formula. Do not give plain water . If the urine output remains low, please seek medical opinion.
Your baby would have received vaccinations against tuberculosis (BCG) and Hepatitis B prior to discharge. If you are a carrier of Hepatitis B, they would have received the immunoglobulin as well. Vaccinations are important to protect your baby against these serious diseases. Frequently, pus may be seen discharging from the BCG site after 3-4 weeks. This is normal, just keep the area dry. Please refer to the handout from National Immunization Registry for the schedule of vaccines in your discharge bag.
For baby girls, please remember to wipe their bottom from front to back. It is common for girls to have a thin milky discharge from the vagina, some may even have bleeding, their uteri are responding to the maternal hormones.
Well baby visits:
The well baby visits are scheduled as follow 2-3 days post discharge if jaundice, 2 weeks, 6 weeks to 2months, 4 month, 6 months, 12 months and 18 months. At each of the visits, your child growth and development will be assessed. Physical checkup will be done and vaccination can be given at the same time.
Once again congratulations on your new bundle of joy. Our hospital website at http://www.nuh.com.sg/ucmi has other relevant details that may help you.