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First few days

Immediately after a normal birth, the mother and father are encouraged to hold their newborn.image 34 Breastfeeding should be initiated as soon after birth as possible if the mother plans to breastfeed. Breastfeeding stimulates oxytocin, a hormone that helps the mother's womb to heal and promotes development of the milk supply. Some experts believe that early physical contact with the newborn helps establish bonding. However, parents can bond well with their newborn even when the first hours are not spent together. Mother and baby spend a day or two in the hospital during which time new parents are taught to feed, bathe, and dress the baby and become familiar with the baby's activities, cues, and sounds. In the United States, discharge from the hospital within 24 to 48 hours is common.

Having a new baby in a household requires a great deal of adjustment for all involved. For a household that has had no children, changes in lifestyle may be dramatic. When other children are present, jealousy can be a problem. Preparing other children for the new baby and being careful to pay attention to them and include them in caring for the baby can ease the transition. Pets may also need some extra attention to help them adjust to the baby. In some cases, keeping pets away from the baby may be necessary.

Umbilical Cord: The plastic cord clamp on the umbilical cord is removed within 24 hours after birth. The stump should be kept clean and dry. The stump falls off on its own in a week or two. Rarely, the umbilical cord can become infected, so any signs of swelling or discharge should be checked by the doctor.

Circumcision: Circumcision, if desired, usually is performed within the first few days of life, often before the newborn is discharged. The decision about having a newborn circumcised usually depends on the parents' religious beliefs or personal preferences. The main medical reason for circumcision is to remove an unusually tight foreskin that is obstructing the flow of urine. Although circumcised males also have a lower risk of cancer of the penis and urinary tract infections, these risks can be minimized with proper hygiene and are not by themselves sufficient reasons to perform circumcision. About 2 to 20 boys per 1,000 have some complication, usually minor bleeding or local infection. However, serious infection, scarring, and very rarely, accidental amputation of the penis tip can occur. An equal number of uncircumcised males require a circumcision later in life.

Circumcision should not be performed if the boy has not voided, or if the penis is abnormal in any way, because the foreskin may be used for any plastic surgical repair that may be needed later. Circumcision must be delayed if, during the pregnancy, the mother had been taking drugs that increase the risk of bleeding, such as anticoagulants or aspirin. The doctor waits until all such drugs have been eliminated from the newborn's circulation.

Skin: Most newborns have a mild skin rash sometime during the first week after birth. The rash usually appears in areas of the body rubbed by clothing—the arms, legs, and back—and rarely on the face. It tends to disappear on its own without treatment. Applying lotions or powders, using perfumed soaps, and putting plastic pants over the diapers are likely to make the rash worse, especially in hot weather. Dryness and some skin peeling often occur after a few days, especially in the creases at the wrists and ankles.

Newborns that are otherwise normal may develop a yellow color to their skin (jaundice) after the first day. Jaundice occurs because the newborn's immature liver has not fully developed the ability to process waste products. However, jaundice that appears before 24 hours of age is of particular concern and may indicate more serious problems. If the newborn develops jaundice, the doctors usually order a blood test to measure the level of bilirubin, which is the main pigment in bile. If the level of bilirubin is above a certain point, treatment with phototherapy, in which the newborn is placed without clothes under fluorescent bilirubin lights, is begun. Rarely, a newborn with jaundice may need to be hospitalized for a day or two to receive phototherapy.

Urine and Bowel Movements: The first urine produced by a newborn is concentrated and often contains chemicals called urates, which can turn the diaper pink. If a newborn does not urinate within the first 24 hours of life, the doctor tries to find out why. Delay in starting to urinate is more common in boys.
The first bowel movement is a sticky greenish black substance (meconium). Every baby should pass meconium within the first 24 hours after birth. If a baby does not do so, the doctor may perform tests to determine whether there is a problem. Occasionally, for instance, a birth defect may cause a blockage of the intestines.

Infants typically urinate 15 to 20 times per day. The urine varies in color from nearly clear to dark yellow. Stools vary a great deal among infants in frequency, color, and consistency depending on the nature of the individual infants and the contents of their diet. The number of times infants defecate varies from once every other day to 6 or 8 times a day. Stool consistency ranges from firm and formed to soft and runny. Stool color ranges from mustard yellow to dark brown. The stool of breastfed babies tends to be softer and of lighter color than that of formula-fed babies.

image 40 Diapers must be changed often to keep the underlying skin dry. Wet skin chafes more easily than dry skin and is more likely to develop diaper rash. Modern, super-absorbent disposable diapers contain a layer of gel that absorbs liquid and keeps it away from the skin. These diapers keep skin drier than cloth diapers after small to moderate amounts of urine, but diapers of any type should be changed when the skin is exposed to wetness. Bacteria normally present in stool can break down urea, a substance in urine, resulting in an alkaline pH that irritates the skin, so diapers should be checked frequently for stool and changed immediately. There are several environmental considerations related to diapers. Disposable diapers consume larger amounts of material than cloth and contribute a significant volume of landfill waste. Cloth diapers consume large amounts of energy and chemicals in the laundering process.

Baby powders help keep skin dry when the baby is sweating slightly, but they do not help keep the skin dry from urine or stool and are not essential. Powder made of talcum may cause lung problems if inhaled by infants, so parents should purchase baby powders that contain cornstarch instead.
 

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