By Naomi Lloyd

In this chapter I will be describing the care routines for babies between 0-1 year, specifically I will be looking at birth, one month, three months, six months and one year. I will also be focusing on the physical care of the baby, the development of relationships between the baby and the parents and also stimulating learning.

Birth

When your baby is born the midwife will carry out some health checks to make sure they are perfectly healthy. The most commonly known test is the Apgar score; this is a method of evaluating the health of a newborn baby by checking five vital signs (Meggitt. C 1999). The Apgar score is assessed at one and five minuets after birth.

Source www.sweethaven02.com/ObsNewborn/922les8_img_3.jpg

If the baby scores between 0-2 they have sever asphyxia, which is impaired or impeded breathing (Webster’s New World Medical Dictionary) and they need resuscitation, 3-4 means the baby has

moderate asphyxia and needs treatment such as an oxygen mask to help

them breathe, between 5-7 the baby has mild asphyxia and may require treatment, between 8-9 the baby is in good condition and 10 means they are in the best possible condition. Most babies score nine, losing one point for having blue extremities (hands and feet).

    Shortly after this the midwife will weigh your baby measure their head circumference, this is considered very important as the growth of the head reflex’s the growth of the brain and therefore could indicate a brain abnormality. Your baby’s length may also be measured, however many hospitals have abandoned this practise, as it is difficult to measure accurately. Yet the average length of a full term baby is about fifty centimetres. These measurements will later be recorded in the developmental charts in your baby’s Personal Child Health Record, which the health visitor will give you when they come to see you.

     Another test carried out is the Guthrie or more commonly known as the heel prick test. In this test a small amount of blood is taken from your baby’s heel and is tested for an enzyme deficiency (phenylketonuria) and also a thyroid deficiency.

     A full examination will also be carried out within four to forty-eight hours after birth, this maybe done by a paediatrician, your midwife or if it is a home birth your general practitioner. During the examination the spine will be checked for any signs of Spina Bifida (a neural tube defect). The mouth is examined for cleft palate (a gap in the roof of the mouth). The head is checked for size and shape; it is very common for newborns to have a squashed or slightly elongenated head, due to being pushed through the birth canal. The eyes are checked for cataracts. The heart and lungs are listened to using a stethoscope to make sure there are no heart murmurs and to ensure that air is entering both lungs. The abdomen is examined for any abnormalities also the umbilical cord is checked for any signs of infection. Your baby’s hips will be examined in order to check the stability of the hip joints; this is done by using Barlow’s test. The genitalia and anus are checked for any deformity. Your baby’s genitalia may appear swollen when they are born; this is due to the maternal

hormones he or she was exposed to before they were born. The hand and feet are also checked for webbing and talipes (club foot) “in which one or both feet are twisted out of shape or into the wrong position”

(www.bbc.co.uk/health). The skin will also be examined for any birthmarks, such as stork marks, strawberry marks and Mongolian spots. Your baby’s skin will most likely be covered in vernix; this is a whitish, greasy substance which should be left to be absorbed by the skin, as it protects them from minor skin irritations such as pealing. Lanugo may also be present, this is fine hair which covers the whole body, this is not a cause for concern as the lanugo will disappear within a few weeks.

Physical care

Your newborn baby is completely dependant on you to survive and requires a lot of physical care.

    When your baby is born you will notice that the head is large in proportion to the rest of the body, as well as this your baby has weak neck muscles and therefore they will have very little head control. This means that supporting the head is very important. When picking up your baby use both arms, one to support their back and bottom and the other against their head or if you are cradling your baby in your arms, ensure that their head is resting in the crook of your elbow. Swaddling will also help support the head it is also a means of soothing your baby as it provides them warmth and security. Swaddling is a way of wrapping babies in blankets which restricts the movement of the limbs; it can also help babies to get of to sleep.

     On average newborns sleep between seventeen to eighteen hours a day, however they hardly sleep for more than three to four hours at a time. This is because babies are not born with a twenty-four hour clock (circadian rhythm) and this can take four to six weeks to develop. So your sleeping pattern maybe just as irregular, it is a good idea to take it in turns to get up and feed as well as change the baby’s nappy, so you don’t become over tired. As new parents you maybe worried about the risk of cot death, I will be looking into this in more detail in chapter four; however the foundation for the study of infant deaths recommends that you put the baby on their backs to sleep, never place them on their front.

Pictures from www.abc.net.au/parents/parenting_in_pictures/safe_sleeping.htm

Also keep the baby’s room temperature at around eighteen degrees C and feel their stomach to check that they are not too hot or cold.

      In the past mothers were told to feed their babies every four hours, however sticking to such a strict timetable only means that the baby is still hungry and very distressed. Nowadays women are recommended to feed on demand, this simply means feeding your baby when they signal that their hungry e.g. crying. There is a big debate these days on whether breast or bottle is best and I will be looking at this in more detail in chapter three. However during the late stage of pregnancy and the first few days after labour the breasts produce colostrum, which is a creamy yellowish fluid that is full of antibodies and helps protect your baby from infection. This makes up the first couple of feeds, so even if you decide to bottle feed consider breastfeeding for the first few feeds, it is also a great way of bonding with your baby. If you do decide to breastfeed make sure you and your baby are in a comfortable position as feeds can take anywhere between seven to thirty minuets.

Pictures from www.abc.net.au/parents/parenting_in_pictures/breastfeeding_techniques.htm

With bottle feeding it is a little more difficult to feed on demand, so offer the bottle every two to three hours and whenever your baby seems hungry. Formula milk is a substitute for breast milk as babies are unable to digest cow’s milk. Formula contains fat, protein, carbohydrates, vitamins, minerals some formula’s also contain polyunsaturated fatty acids, these are believed to boost brain development (askbaby.com). With bottle feeding you need a lot of equipment such as six to eight bottles, at least six teats, bottle and teat brush, formula milk and sterilising equipment, this is very important as during the first year of life babies are very vulnerable to viruses and infections.

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     After feeding your baby, they may need help to bring up wind. This can be done by simply leaning them forwards on your lap or against your shoulder and gently rubbing their back. If they haven’t brought up wind after a couple of minuets or are showing signs of discomfort such as grimacing, it could be that they don’t need to bring up any wind. Trapped wind is not harmful, however it can cause discomfort so it is best to try and bring up wind after a feed.

     Your newborns nappy will need changing every couple ...

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