Handling Your Newborn Baby

Y​our new baby’s appearance will probably be a surprise to you. They may have wrinkly skin and be covered in a white, greasy substance called vernix caseosa. Their head shape may look squashed on one side and their eyes puffy because of the pressure of passing through the birth canal. All this will usually disappear in time. 

Take your baby in your arms as soon as possible to start bonding. 

Do not forget that your baby has already been listening to your voices for the past few months, and he/she will feel reassured listening to it again now, when in this new environment. Mums should try and establish breastfeeding​ as soon as possible. This will stimulate the flow of milk and enhance bonding. 

Newborn babies vary in how much they weigh and how long they are. Average weight of a baby ranges from 2.5 kg to 3.5 kg, length from 45 to 54 cm and head circumference is from 32 to 36 cm. 

Your baby’s doctor will usually check your baby within the first day of life. They will do a thorough examination, checking the growth as well as looking for abnormalities such as heart defects, eye abnormalities, developmental dysplasia of the hip​, undescended testes (if you have a boy) and other conditions.​ 

Your baby will usually pass his/her first urine within the first 24 hours of age and his first stool within the first 1–2 days of age. 

 

Newborn Screening 

Newborn screening is done to check your child for health problems. These conditions could prevent permanent damage or even death if detected early. 

In Singapore, newborns are screened for: 

  • ​G6PD deficiency (lack of an enzyme) 
  • Hypothyroidism (low thyroid function) 
  • Hearing loss 
  • Metabolic Disease (looking for Inborn Errors of Metabolism, which are disorders involving abnormalities in the breakdown of fats or proteins) 

Common Skin Conditions 

During the first few weeks, your baby will usually have a few of the common skin conditions. 

  • Milia: Small white dots that usually appear on baby’s nose and chin. They are the result of immature sweat glands and will disappear in time without any treatment. 
  • Erythema toxicum: This is a red rash with a raised white center that looks like pimples. They can appear anywhere on the baby’s body and tends to come and go within the first few weeks of the baby’s life. They too will disappear without treatment. The baby is very well with it, but as this rash can be confused with more serious rashes, it is best to check with your doctor. 
  • Seborrhoeic dermatitis(Cradle cap): This is dry flaky skin on the scalp, eyebrows and occasionally behind the ears. Massaging in some baby oil/ olive oil will help soften the flakes. 
  • Diaper rash: This occurs due to the ammonia and other chemicals in the urine/faeces. It is advisable to apply a protective emollient or barrier cream at each diaper change. If the rash does not improve, see your doctor as it could be thrush, which is caused by a fungus and would require medication to improve. 
  • Dry skin: This is common in babies, especially those who are born after their due date. If this occurs, apply some baby oil/ emollient to the skin. 

Other conditions that are common to newborns are: 

  • ​​Birthmarks: It is quite common to have small red marks on the baby’s skin, particularly on the forehead, upper eyelids and back of the neck​ ​(stork marks). They are due to enlargement of the tiny blood vessels near the surface of the skin. They tend to disappear within the first year of life. Another common birthmark is the strawberry mark. Though a birthmark, it may not be apparent at birth and only appear at one month in life. It tends to grow in size initially till about six months and then slowly fades. Ask your doctor for advice should your baby have one that is growing rapidly or tends to bleed. 
  • Mongolian blue spots are the blue-grey patches that can be found all over the body, but are especially common on the buttocks, back and limbs. 90% of Asian babies have Mongolian blue spots but few adults still do, which shows that these discolorations usually disappear with time. ​

Eye Discharge 

Ensure that your baby is able to open both eyes, and that it is not so sticky that they are unable to open their eyes. Clean the eyes using a cotton ball soaked in cooled boiled water and wipe each eye outward away from the nose. Gentle massages​ around the eyes can help clear the ducts. If the eye discharge persists, the eyeball looks red or the eyelid swells then consult your doctor to rule out any infection. 

Umbilical Cord Care 

Immediately after birth, the umbilical cord is cut and the cord is clamped. The cord tends to dry up and drop off within ten days of life. Clean the cord using cooled boiled water and keep it dry. Fold the nappy below the cord stump, keeping the cord stump above the nappy so that the cord does not get wet when baby passes urine. 

Umbilical Hernia 

Some babies develop a bulge in the region of the umbilicus. This is a common condition that nearly always resolves ​on its own, usually within the year. 

​​​Jaundice 

Note:

Putting your baby in direct sunlight is not recommended. It does not reduce the jaundice​ level and yo​ur baby might get overheated and dehydrated. ​​​

This is a common newborn condition. There are many causes. Usually it develops on the third day of life, and is known as physiological jaundice. It is due to the baby’s blood having a high content of primitive red cells which are broken down after birth. 

One of the breakdown products is bilirubin, which causes the yellow discoloration of skin and whites of the eye. Most infants have mild jaundice and this is harmless. 

However in some infants, the bilirubin level can be very high and this may cause brain damage if not treated. If your baby appears to have jaundice, get him assessed by your doctor. Your doctor may do a blood test to determine your baby’s bilirubin level. ​

Depending on the result, your baby may require treatment with phototherapy, which uses specific ultra-violet light that help break down the harmful products of jaundice, which is then excreted in the urine and faeces. 

In some occasions, the level of jaundice can rise so high that phototherapy may not be effective. A special procedure known as exchange transfusion might then be necessary. 

Jaundice can sometimes last for about two weeks, especially if your child is breastfed. (Breast milk is still the ideal food for your baby though.) 

If your child is still jaundiced more than two weeks after birth, then consult your doctor who will review your baby to see if any further tests are necessary, or to reassure you. 

Which babies require more attention for jaundice? 

Some babies are at a greater risk for high levels of jaundice. These risk factors include: 

  • Prematurity (less than 37 weeks) 
  • Jaundice that appears in the first 24 hours of life 
  • Breastfeeding that is not going well 
  • Bruising or bleeding under the scalp, which are related to labour and delivery 
  • Family history of jaundice (a parent or sibling who previously had high bilirubin levels that required treatment with phototherapy) 
  • G6PD deficiency 
  • Blood group incompatibility 

Crying Baby 

Your baby cries as a form of communication. Once you get to know your baby, you will realise that their cry varies for different needs. 

​Sometimes they may cry for long periods, inconsolably. This may start from about two weeks of age and last till about four months of age, and is often referred to as colic. It often occurs in the evening but can occur at any time, and may last a few hours. It is a diagnosis of exclusion when no identifiable cause is found, and your baby appears very well in between these crying bouts. Consult your doctor to rule out any possibility that your baby is unwell. Once reassured, try and keep calm in the knowledge that it will all resolve in a few months and that there will be no permanent damage. 

Infections 

Your newborn baby’s immune system is less developed than an older child, so sometimes a mild illness in an adult may result in a serious infection. However, for about the first six months of life, your baby has the benefit of protection from some illnesses as they have their mother’s antibodies. 

But be sensible! Do not put your baby in a situation where you cannot adequately control the environment around you, for example, a crowded place, till your baby’s immune status is at least “old enough” to fight off these germs. Remember to immunize your child, as this is the surest way of ensuring that they have some protection against some infectious diseases. 

Stools 

Baby’s stools always seem to be a source of worry for parents. Your baby’s first stools are usually sticky, tarry and dark green or almost black in colour. This is called meconium. 

Within the next few days, your baby’s stools will slowly change colour and consistency. Stool color can vary from green, yellow to brown and these are all normal. The number of times that your baby passes stools will also vary. 

Generally, breastfed babies tend to pass softer and more frequent stools than formula fed babies. As babies get older, they pass stools less frequently. It is normal for some babies to pass stools many times a day in the first few weeks of life and for the pattern to change so that they only pass motion once every 2–3 days.​


Review at 4 to 6 Weeks 

At 4–6 weeks, your baby is usually reviewed again by their doctor. They will assess baby’s growth, behavioral development and overall state of health. 

At 6 weeks, your baby will start to: 

  • ​smile responsively 
  • stare at their parents’ face and even start to follow when you move 
  • will startle to sound 
  • start to control their head a little bit more. 

While you feed, carry and even change your baby’s diapers, this is time spent bonding with your child. You gain confidence in handling your child and you and your baby get to know each other. 

Soon you will start to recognise what is normal for your child. If there is any doubt, always consult your doctor. Enjoy this wondrous time that you have with your child. 

Contact your doctor when your baby: 

  • ​Cries more than usual 
  • Screams as if in pain 
  • Is unusually quiet or drowsy 
  • Has diarrhoea or vomiting 
  • Has sunken or a bulging soft spot on the top of the head 
  • Breathes much faster than usual 
  • Has difficulty breathing 
  • Has fever 
  • ​Has cold, pale or clammy skin 

Acknowledgement

Source: Dr TAN Thiam Chye, Dr TAN Kim Teng, Dr TAN Heng Hao, Dr TEE Chee Seng John, The New Art and Science of Pregnancy and Childbirth, World Scientific 2008.

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