YOUR NEW BABY

Item

Title
YOUR NEW BABY
extracted text
A BRITISH MEDICAL ASSOCIATION PUBLICATION

Dr J G Bissenden

JAICO PUBLISHING HOUSE
Bombay • Delhi • Bangalore
Hyderabad • Calcutta • Madras

© Family Doctor Publications 1990

This is a Family Doctor booklet published in arrangement with the British
Medical Association, BMA House, Tavistock Square, London WC1H
9JR.

YOUR NEW BABY

First Jaico Impression: 1990

Published by
Ashwin J. Shalu^,
Jaico Publishing House—
121, M.G. Roaczz
Bombay 400

Contents
Introduction

5

Is he all right?

7

The baby in special care

9

Feeding your baby

12

Vomiting and possetting

19

Bowels

23

Crying

25

Sleep

31

Some anatomical features

34

More about illness

43

Immunisation and development surveillance

46

Cot deaths

47

Introduction

Newborn babies are wonderful, and at the same time
terrifying. Mothers can feel quite overwhelmed by the
responsibility of looking after such a tiny, fragile
looking creature, and although a baby can be the best
thing that ever happened to a family, there may be
times when even the most doting of parents would like
to drop their precious offspring out of the window.
This booklet aims to help you through the first
months. It gives you some guidelines to which you
should adhere and will, I hope, reassure you about any
worries you may have. But do remember that babies do
not always follow set patterns, so don’t panic and think
that you are doing everything wrong if your baby
insists on behaving differently.
Where to get help
The following people are there to help you look after
your baby:

• District midwife: she will visit daily for 14 days after
your baby’s birth and can be an invaluable support for
the new mother;
• Health visitor: she takes over from the midwife and
provides information and help on child care, in the
home and in the clinic;
5

a Child health clinic: the clinic doctor and health
visitor advise on any problems, will check your baby’s
weight and growth, undertake developmental and
screening examinations, and will usually carry out the
immunisation programme;

♦ Family doctor: he or she could be consulted if you
think your baby is ill. Some GPs undertake screening
and immunisation;
• Hospital casualty department: you can take your
baby to the casualty department in emergencies;

o Hospital paediatrician: these doctors specialise in the
care of children, but you must be referred by your
family doctor or the casualty doctor.

But don’t ask everyone
If you are worried about something don’t ask too many
people for advice—you are almost certain to get a wide
selection of different answers that will only confuse
you further. If in doubt, consult your health visitor; she
has a fund of training and experience to call upon and
can usually be relied on to give sound advice.
It is impossible to cover everything in a booklet of
this size so I have confined myself to the most import­
ant aspects of looking after a new baby and those
problems which are common and cause greatest con­
cern. I hope that mothers will forgive me if I refer to the
baby as "he”. This is for simplicity and does not reflect
any preferences or bias on my, part.

6

Is he all right?

One of the first questions that most parents ask after
the birth of their baby is, "Is he all right?" And happily
he usually is. Immediately after birth infants are ex­
amined for any abnormalities such as "bits missing" or
"extra bits" and for any evidence of problems caused by
the actual process of being born (birth trauma). The
baby is always given a score out of 10 for his condition
one minute and five minutes after birth. This "Apgar”
score is based on his colour, heart rate, breathing etc.
Clinical examination

Later—often on the morning after delivery—the baby
is given a thorough clinical examination. He is
checked again for any missing or extra bits; the doctor
listens to his heart, measures his head circumference,
looks at the fontanelles (the two holes in a baby’s
skull), and assesses the baby’s alertness; the genitalia
and skin are examined; the eyes are looked at carefully
in case of cataracts; and the baby’s hips are tested to
see if they are dislocated.

Dislocated hips
Dislocated hips are probably the most important
abnormalities to detect as early treatment is simple
and generally effective. The hip test is not very satis­
factory but there is nothing better at present. For every
7

baby with a true dislocated hip that is detected and
treated (with a splint) we find 20 with "wobbly” or
"dicky” hips (which are probably harmless) and have
to ask the parents to bring the baby back for a repeat
examination. This may seem very annoying for parents
but hips are so important that it is better to be safe
than sorry.

All’s well
If all is well the doctor may not have time to discuss the
routine screening examination with you and will not
mention odd marks like a red blemish between the eyes
or bluish marks on the buttocks of Afro-Caribbean or
Asian babies (see p. 36). These are normal birthmarks
that fade in time. Even so if you notice something that
you are not happy about do mention it to the midwife.
Blood tests

On about the 7th day of a baby’s life, and provided he is
feeding well, the midwife will take blood from his heel.
This blood goes to a laboratory where it is tested to see
that the baby’s thyroid gland is working properly. The
laboratory does another test (Guthrie best) on the same
sample of blood to rule out an extremely unusual
condition called phenylketonurea. Babies with this
rare disorder need a special diet to remain of normal
intelligence.
Sickle cell disease
In some parts of the country Afro-Caribbean babies are
tested for sickle cell anaemia, so called because the red
blood cells look like sickles under the microscope. This
is a serious condition causing severe anaemia.
Both the parents of a baby with sickle cell anaemia
"carry” the disorder in their genes but do not have the
disease. If they have a further child there is a 25%
chance that he will be anaemic, a 25% chance that he
will be normal, and a 50% probability that, like his
parents, he will be a healthy "carrier” of the condition.
8

The baby in
special care
Every hospital that delivers large numbers of babies
has a special care baby unit. The medical term for a
newborn baby is a "neonate” so the ward may also be
called a neonatal unit. Perhaps 10 out of every 100
babies born will have to spend some time in a special
care baby unit. Most of these babies are premature or
very small: they are not necessarily ill but their bodies
are not well enough developed to feed, keep warm, or
cope with the normal air and many need added oxygen.

Intensive care units

If babies are ill because they are very premature or
perhaps because they got into difficulty during deli­
very, they may need intensive care. These babies are
always in incubators and will be monitored by a bewil­
dering array of equipment that checks their condition.
Unfortunately, the equipment makes a lot of noise and
it is very difficult for parents to relax. The doctor and
the nurses understand this and will do everything
possible to leave you alone with your baby.
If his condition is up and down, as it often is in the
first few days, it may seem that every time you visit he
is surrounded by people. Do remember that he is your
baby and not the hospital’s. If neither the doctor nor
the nurses seem anxious to explain how he is and what
is going on, stand your ground firmly and ask them
what is happening. Occasionally the medical and nurs­
ing staff need reminding that in their anxiety to do the
very best for the baby they have forgotten to explain
everything to the worried parents.
9

Things are more relaxed now
There was a time when parents were separated from
their babies or could only view them through windows.
I can remember explaining a baby’s condition to his
parents through a little window just like the one
between the cashier in a bank and the customer! How
times have changed. Most units have free visiting for
any member of the family, though usually only two at a
time. Hats and coats must be left outside but only a
thorough wash of the hands is needed and parents don’t
have to wear- special clothing. If you are not well,
though, don’t visit: it’s not fair on your little one, or
perhaps on the other babies.
Feeding a baby in special care
Your baby will probably need to be fed by a tube passed
through his nose into his stomach (naso-gastric tube),
and if very small, he may even be fed through a tube
into a vein. He may be given dextrose at first but when
he is well enough to have milk down the tube there is a
choice. The mother can express her milk using a pump
and equipment provided by the midwives or the baby
can have a cow’s milk based infant formula. Many
doctors feel that, at least for the first few feeds,
mother’s own milk has great benefits. At these difficult
times, it can be a mother’s positive contribution when
everybody else seems to be caring for her baby. It may
also lead her on to establish successful breastfeeding.

Going home

Sadly, some babies are just too small and poorly to
survive, and for one reason or another about 4 or 5 in
every 1000 die. For most parents, however, there are
the joys of looking forward to their baby coming home.
It seems to take a frustratingly long time for him to
grow and take all his feeds without a tube. Make sure
you feel confident about handling your baby and try to
10

live-in for 24 hours before he comes home. The nurses
on the baby unit may underplay how much your baby
cries because they are not so emotionally involved.
Remember too that babies are spoilt in hospital —they
are fed often by their full-time "nannies”.
The hospital will probably have a policy that babies
are fed as often as they want, "demand fed”, or at least
four hourly so the baby coming home from special care
expects his feeds promptly and will let you know all
about it if he is hungry. With luck he will have slept in
a darkened nursery away from the bustle of the special
care unit before coming home. If not, he may not
appreciate soft lights and quietness in his new abode.
11

Feeding your
baby
By the time you read this booklet you will have decided
how you are going to feed your baby—and I hope you
will breastfeed. If this is your second baby you will be
influenced by what happened with the first. If breast­
feeding went well, it almost certainly will again; if it
was not a great success, you may have mixed feelings.
Why not try again, if only for a couple of weeks? You
can always change from breast to bottle but it is rather
difficult the other way round!
Breast is best ... but
On balance, doctors and midwives will always say
breast is best. Years ago, when the alternatives to
breast milk were less satisfactory, one could be dogma­
tic about this but now all the manufacturers of formula
milks have modified the basic cow’s milk to make it as
close to human breast milk as possible. These formula
milks are all as good as each other and to the baby
there is no advantage or disadvantage in using Cow
and Gate Premium, SMA Gold Cap, Aptamil, or Osterfeed. There is no question about the amount of nutri­
tion they provide and babies will grow just as well on
infant formula as on breast milk.
Although one could write forever on the advantages
of breastfeeding, this is not the purpose of this booklet.
I will, however, list the points in favour (and against)
breastfeeding and bottlefeeding.
12

Breastfeeding

Advantages
• Breast milk is the perfect food for your baby;
• Breastfeeding is natural, convenient, and breast milk
is ’’free”;
• Breast milk offers some protection against allergies
and against infections such as gastroenteritis in the
early months;
• Breastfeeding may help mothers to lose any excess
weight they gained during pregnancy;
• Breastfeeding can be emotionally rewarding;

Disadvantages
• Breastfeeding may be less convenient for the working
mother;
• It is not always as easy to establish as bottlefeeding;
• Fathers and babysitters are not able to do it;
• Breastfed babies may wish to feed more often than
bottlefed ones.
13

Bottlefeeding

Advantages
• The technique of bottlefeeding is easier to learn;
* Mothers know exactly how much milk their baby is
getting;
& Fathers and babysitters can help feed the baby.
Disadvantages
• Infant formula milk is more expensive;
a Preparation of milk and bottle hygiene can be time
consuming;
• There are no protective properties in formula milk;
The emotional reward of breastfeeding will be missed.
14

Some further points
There is no truth in stories that breastfeeding protects
against cot death. There may, however, be an advan­
tage in breastfeeding a baby who stands a strong
chance of developing an atopic condition such as
asthma or eczema because of a strong family history of
these disorders.

A positive two-way relationship
The main advantage of breastfeeding is the develop­
ment of a two-way mother-baby relationship whereby
both participate in this pleasurable process. Because of
the closeness and the physical contact, the mother has
more feeling and awareness of her baby’s mood, tem­
perament, and health. If this successful union cannot
be achieved and if the mother derives no pleasure out
of it, she should change to bottlefeeding. The chances
are that both she and her baby will be happier as a
result.
Problems
If you are breastfeeding and having difficulty, the
midwife or health visitor are vital allies—a visit to the
doctor’s surgery cannot usually serve to diagnose the
cause of problems. If technique is at fault, study of a
feed may help. The breast may be too full or there may
be insufficient milk. The baby may not be '’latched on”
properly. The mother’s nipples may be sore or cracked.
Perhaps the mother is over tired and stressed. This
reduces the amount of milk she makes thereby causing
added anxiety that further diminishes the supply.
Babies should be demand fed, which is the way nature
intended it. The problem with breastfeeding, as prac­
tised today, is that babies were never meant to wait
three to four hours before their next access' to the
breast, lying horizontally between times. It is import­
ant that mother and health visitor discuss and agree
whether the objectives of successful breastfeeding can
be achieved, and if not switch to the bottle.
15

More about bottlefeeding
If you have elected to bottlefeed, this is a reasonable
decision and should not be regarded as second best —
certainly the milk isn’t. Feeding time must be regarded
as a time of contact between mother (usually) and
baby, when he is held and cuddled and kissed, with as
much eye to eye contact as possible. I believe that one
positive advantage of bottlefeeding is father’s involve­
ment. Why shouldn’t he bond with his little one too?

Milks suitable for babies and young children
Baby’s age
0-6 months

6 months 1 year

Breast milk +
vitamin drops

Breast milk +
vitamin drops

Follow on formula

or

or

1-2 M?ars

or
Whey based infant \
formula (such as
\
SMA Gold Cap,
\
Cow & Gate
\
Premium, Aptamil,
i
Osterfeed)
|

or
Casein based
infant formula such
as (SMA White
Cap, Cow & Gate
Plus, Milumil,
Ostermilk
Complete Formula)

or

*
1

1
\
> Infant formula
f
f
1

i

Soya based
/
formula for babies
/
allergic to cow’s
/
milk (such as
/
Wysoy, Cow &
/
Gate Formula S)

.A/.
miiv
^hole cow s milk
+ v,tam,n drops

or

Follow-on formula
milks (such as
Progress)

or
Whole cow’s milk
+ vitamin drops

Formula milks
Whichever of the popular brands of formula milk is
chosen, they are essentially the same. All the manufac­
16

turers market at least two milks. The first is a whey­
based infant formula which contains all that is neces­
sary for the first year of life (of course some solid foods
should be introduced in addition from months 4 to 6
onwards). The second type of formula is casein (curd)based and is advertised "for use when baby does not
seem satisfied”. This is a marketing device—a means of
selling more milk. The formula has never been shown
to be more "satisfying” but such is the competition
among manufacturers that if one company markets a
milk for unsatisfied babies all the others will too. So
don’t be tempted to blame the formula for any problems
and keep switching milks, and always discuss any
changes you propose to make with your health visitor.
Some manufacturers also make a soya-based formula
for babies who are allergic to cow’s milk. Do not give
this to your baby in order to prevent any possible cow’s
milk allergy: only use it on the advice of your health
visitor or doctor.
A special formula milk is now available for babies
older than 6 months. It should not be given to younger
babies nor should you give ordinary doorstep cow’s
milk before this time. No child under 2 should be given
skimmed milk. The table gives details of milks suitable
for babies and very young children.
Weight gain

Weighing is one very simple measure of health in a
baby, especially in conjunction with measuring him,
but remember that each baby is an individual and
babies do grow at different rates.
Babies usually lose a few ounces at first but it should
not be more than 5 to 10% of their birthweight and they
should be back to birthweight by the 6th or 10th day. In
the first 3 months an average baby gains 5 to 7 oz (150 to
200 g) each week and in the second 3 months about 5 oz
(150 g) each week so that they have doubled their
birthweight by the age of 5 to 6 months.
17

Vitamins, iron, and weaning
The Department of Health and Social Security lay
down guidelines as to how babies and children should
be fed. Included in these guidelines are when to give
vitamins and iron. Doctors recognise that supplements
may be given unnecessarily, but they do no harm and in
attempting to generalise, the DHSS will inevitably
recommend supplements to ’’groups” of babies. Here
are the suggestions:

Premature babies
Babies born more than three weeks early need extra
iron and vitamins until they are established on solids.

Breastfed babies
These babies need vitamin D and fluoride. European
babies, when established on solids, can drop the supple­
ments. Asian mothers may not have as much vitamin D
and calcium in their bodies and if the babies are not
exposed to sunshine, extra vitamin D should be given
until the age of 2 years.

Babies on infant formulas
Formula fed babies will receive the vitamins through
the milks but this is not so if ordinary cow’s milk is
used.
Babies on vegetarian diets
It is particularly important that babies on vegetarian
diets be given an infant formula milk for their first year
of life. If they are breastfed initially, ordinary cow’s
milk should not be used as follow up. All babies of
vegetarian mothers or who will be vegetarians them­
selves, should have vitamin drops from age 1 month
until they are 2 years old.

18

Vomiting and
possetting

It is very distressing to see your little baby being sick.
You may feel that this tiny body cannot survive with­
out the nourishment of milk and if you have breastfed,
there may be a feeling that he is rejecting your milk or
your milk is not suitable. These emotions are quite
understandable, but illogical. To a baby, vomiting is
not the catastrophe that it is to his mother. To an adult,
vomiting is very unpleasant—to a baby it’s part of life
and some even do it deliberately. There are, however,
two conditions I would like to mention here in connec­
tion with vomiting.

Intestinal blockage
Some babies are born with a blockage in the bowel. If
the blockage is high up, the vomiting will occur on the
first day and will be bile (green) stained. If the blockage
is lower down the bowel nearer the back passage, the
stomach will usually blow up and vomiting will take
place on the second day. There will have been no
significant bowel movement. An intestinal blockage
will be obvious, therefore, in the first two days and
most mothers and babies will have not been discharged
from the maternity unit by then.
19

Pyloric stenosis
Pyloric stenosis is a condition in which there is a
narrowed outlet to the stomach. This problem is not
normally evident before the second week of life. It
usually occurs at about 6 weeks of age and is more
common in boys than girls. Pyloric stenosis may be
suspected if vomiting is very forceful—if for example,
at the end of a feed the milk is projected some distance
out of the mouth like a fountain. The diagnosis is
confirmed by feeling the baby’s stomach while he feeds:
there is a small lump in the upper part of his tummy
just as he vomits. A simple operation cures pyloric
stenosis. The condition is not dangerous so there’s no
need to call the doctor in the night but if your baby
vomits in a ’’projectile” way for a whole day, then you
must get medical help.
Possetting (gastro-oesophageal reflux)

The human body is amazing. I remember once in my
university days standing on my head after drinking a
pint of beer in a childish sort of team race. None of the
team vomited (it was early in the evening) which shows
that children and grown-ups have a valve mechanism
at the bottom of the gullet (oesophagus) where it enters
the stomach. When the valve is leaky, this causes
backflow of the contents of the stomach into the oeso­
phagus giving heartburn or vomiting. If part of the
stomach lies in the chest, not the abdomen, this gastrooesophageal backflow (known as reflux) is caused by a
so-called hiatus hernia. The point of this medical back­
ground is that gastro-oesophageal reflux is very com­
mon in babies because of an undeveloped valve system
at the bottom of the oesophagus. The typical baby feeds
well and during, or at the end of a feed, may bring up a
little milk. All babies do this to some extent but the
’’possetter” will do this half an hour later while lying
in the cot. This sort of baby is ruinous on clothes and
carpets and his parents have a characteristic milk
stain down the back of their left shoulder!
20

What to do
There are two things to do. One is to ignore the
problem, live with it in the sure knowledge that it will
improve. The other approach is to thicken feeds and
most parents who get as far as seeing me have gone
beyond reassurance. There is no need to treat the baby
if weight gain is adequate, it proves that the vomited
milk was extra to requirements. Which thickener one
chooses depends a little on age. There are at present
two—one is gelatin-based and is called Nestergel, the
other, which is easier to dissolve, is called Carobel.
Both work by thickening the feeds which presumably
then sit more firmly in the stomach making reflux more
difficult. You must follow the instructions carefully,
particularly with Nestergel, as it clumps if given in
excess and makes the feed set like a jelly. Remember
too that a larger hole will be required in the teat.
Another preparation, particularly for babies over 1
month of age, is Gaviscon, a powder which seems to
thicken feeds but actually works by a different
mechanism. This is equally effective and may be used
for the breastfed baby. Obviously breast milk cannot be
thickened, but it is possible to dissolve, say, one third
of a sachet of Gaviscon in a little water and give this
before a feed. Introduction of solids often helps (but
these should not be given before 3 months).
At an angle
Finally, babies who posset shouldn’t lie flat after their
feeds. In an ideal world they would be nursed in an
upright position for 10 to 15 minutes and then placed in
a chair that keeps them semi-upright. This is easier
said than done, for the little ones slither down ending
up at a strange angle certainly not designed to help
vomiting.

Sit it out
My advice on vomiting is that if the baby’s weight gain
is adequate and he is a happy smiling chap, sit it out
ChlDO

21

because the chances are it will have gone by 6 to 9
months.
And check the feed volume
The milk requirements of a normal baby are 150 ml/kilo
per day or 21 oz/lb per day. Calculate the amount your
baby is actually given in 24 hours and if your
mathematics shows him to be taking much more than
this and he’s being sick, then you are overfeeding him.
22

Bowels

I regard bowel actions as very personal and it is
unusual to discuss the subject outside the medical
arena, unusual that is unless you are a baby. This is
because for a large part of their life babies either sleep,
feed, pass urine, or open their bowels. The fact that a
dirty nappy is involuntarily inspected at each change
may lead many mothers to the doctor, worried about
what could be a normal variation.

Normal bowels
It’s pretty obvious when a baby is opening its bowel.
The concentrated expression, the red or even blue face,
and the explosion in the pants tells all assembled that
nature has worked. I am not worried about a history of
’’straining” when opening the bowels unless the baby’s
stools are rock hard or there is bleeding from the back
passage. Breastfed babies are so variable that it is
virtually impossible to describe the normal bowel
action. It is usually looser than normal—and may be
very loose indeed. In the first month the babies often
open the bowels while feeding and the stool could be
described as diarrhoea. It is bright yellow in colour and
there may be some mucous. Later on the baby may miss
days and then have a large bowel action as a result.
The bottlefed baby tends to produce a more adult-like
stool which is yellow brown in colour. In the summer
months, when perhaps he needs extra fluids, he may be
slightly constipated. The stool may be green but once
again colour is not important.
23

Problems
Failure to gain weight and diarrhoea
This should be investigated, particularly if the baby
has a badly excoriated (raw) bottom. Maybe he is
allergic to cow’s milk or the sugar content of the breast
or formula milk.

Bleeding
The commonest causes of bleeding per rectum (from the
bottom) are a crack in the anus and constipation.
Examination by a doctor will confirm this, and a gentle
laxative such as Lactulose is all that is needed. A small
amount of blood in the stool on one or two occasions
only can be dismissed. If it is a regular feature, blood
tests and x-rays should be carried out. Sometimes
gastroenteritis or even cow’s milk allergy, can cause
bleeding per rectum. Generally, if it is recurrent seek
medical advice.
Constipation
In the first few days of life? the contents of the bowel
have nothing to do with the feeding. Black sticky
mucus (meconium) occupies the bowel of the baby
developing in the womb and only when this is flushed
out after birth can there be a change in the quality of
the stool. If your baby is late in opening his bowels and
he is stubborn from the word go, he needs investigat­
ing. It is particularly important if the tummy swells up
or there is vomiting. If his bowels work well for a few
weeks and then become less frequent, there isn’t the
same urgency to investigate. Traditional remedies such
as adding brown sugar to the feeds are helpful. With
bottlefed babies it is important to check that the feeds
are not too concentrated and your baby is taking his
2| oz/lb per 24 hours. At 3-4 months of age the addition
of solids may help the bowels and vegetable or fruit
purees are better than rice or cereal for the ’’consti­
pated” baby.
24

Crying

Crying is one of the most difficult subjects to write
about. I can only give suggestions and guidelines as
there are no absolute treatments and solutions. I sense
that the problem of crying babies is very real in our
society and I can only think that tension and lifestyle
are the root causes. It is said that the babies of working
African women and traditional Eskimos rarely cry.
These babies seem to have constant contact with their
mothers and are probably seldom bored. A baby spend­
ing the first few months of his life in the British winter,
semi-isolated on the top floor of an inner city tower
block may, on the other hand, have much more to cry
about—as will his mother. This is why it is important
to plan pregnancy, to know what to expect when your
baby is born, and to try and organise your life so that
you and your baby are not stuck indoors every day
looking at each other.

What can make a baby cry?

There are certain situations in which a baby will
predictably cry. He will cry • when he is hungry, • if he
is uncomfortable, • if he has colic, • when he is bored,
• if he is ill.
25

Hunger
Babies should be fed on demand and the breastfed baby
may wish to feed more often than one who is bottlefed.
Babies do have hungry days too when they want to feed
more often than usual and mothers should not get into
a panic and feel that they are not producing enough
milk or that something else is wrong. Quite often they
are particularly hungry on the 4th day of life and many
develop a voracious appetite when they first get home
from hospital.
At first the cry of hunger is the cry of a baby waking
from sleep. He does not sound in pain but if his milk
takes too long in coming the crying can build up to
quite a crescendo. Feeds should be relaxed, unhurried,
and enjoyable times when mother or father can talk
and smile with their little one, breaking the feed so that
the baby can bring up wind if he wishes. After the feed
and some cuddling the baby should be propped up in a
chair where he can see his mother until he shows signs
of wanting to go back to sleep.

Is he uncomfortable?
It is rather difficult to generalise about whether a baby
will cry when his nappy is wet or soiled. Most small
babies do not seem to care at all but a few may object.
Babies do not have a well developed system for
regulating their temperature and if they are not
dressed sensibly may become too hot or cold. Mothers
often dress their babies too warmly, so consider how
many layers of clothing you would feel comfortable in
on any particular day and dress your baby accordingly.
Many small babies like to feel secure and may benefit
from being wrapped in a shawl.
Colic
Colic is a name given to a condition which may begin at
about 2 weeks of age and has usually stopped by 4
months. The infant screams, draws up his legs, and
cannot be comforted by anything. It often happens in
the early evening. We believe that colic is caused by a
26

27

spasm of the bowel, for babies with colic do seem to
have abdominal pain, but we are no better at treating it
now than we were 50 years ago. There are a few
theories about colic, most of which I do not believe,
but, for what it is worth, here they are.

Wind
Firstly, there is the belief that some babies get colic
because they swallow too much air—perhaps because
of inadequate winding, the hole in the teat being too
small, crying too long before a feed, or because their
basic personality causes them to rush everything.

Tension
Because colic usually occurs in the evening, the tradi­
tional view of the cause was that mother was in a hurry
to get her husband’s meal ready and therefore rushed
the evening feed and offered the baby less affection so
that he screamed for attention. The advice was to try
and delay the evening feed until the rest of the family
or husband and wife had eaten together. Quite what
Cosmopolitan would make of this theory of angry, hard
working husbands marching in and demanding their
meal I cannot think. The message which does come
through, however, and which holds for both the tradi­
tional family with the father out at work and the
unsupported mother by herself, is that stress and rush
and insufficient attention do cause a baby to cry. If you
are happy and relaxed, fit and confident, then there is
more chance that your baby will be contented and that
colic will not be a problem.
The milk
Please do not keep changing from one formula to
another because you think that another milk might
improve the situation—formula milks are all very simi­
lar and none has any benefit in the treatment of colic.
Predictably, the Americans have said that some colic is
caused by cow’s milk allergy. Hence, American babies
with colic find themselves on "non-cow’s milk” for28

miula, that is formula based on soya protein. I have had
n«o success in treating colic by prescribing soya for­
mula nor is there any scientific evidence to support this
adlergy theory of causation. But if you and your doctor
aare desperate, a soya milk may be worth a try.
Medicines for colic
Ilf all else fails, is there any medication to offer?
'Merbentyl (dycyclomine hydrochloride) was always
the favourite but the manufacturers were told not to
recommend it for babies because of a few reports of
babies becoming unwell as a result of taking it. Some
doctors do still prescribe Merbentyl and I would not
criticise this. Oval drops are similar and may be of help,
but again cannot be recommended by the manufac­
turers. Quite what gripe water does, I do not know. All
these treatments probably make us feel better because
we have done something but I am not sure that the
baby derives any benefit.
Other measures
Some parents give their baby a warm bath, others take
him out for a walk or a drive in the car (which is fine as
long as the baby’s favourite crying time is not 2 am). At
the end of the day, when all else fails, lie your baby on
his tummy on your knees, massage his back, and count
the days or weeks left until the colic phase passes, as
pass it will!
Boredom

Although a small minority of babies hate being fussed,
most like a lot of physical contact and stimulation.
They may cry for this reason and will stop as soon as
they are picked up. Once he is a few weeks old a baby
will have periods of waking and may hate being left
alone in a pram or cot. A harness which allows him
close physical contact with his mother or a bouncing
chair placed in a safe position so that he can watch
what she is doing may make him happier.
29

Is he ill?
When your baby is inconsolable and his crying is a
continuous scream, the question of illness must be
considered. Whereas colic comes and goes and is sug­
gested by the drawing up of the legs and the passage of
wind down below, the pain of an obstructed bowel is
more likely to be continuous. Look for other symptoms
and signs: • when did he last open his bowels? • was the
stool normal? • was it loose and was mucous or slime
present—or even blood? • is he being sick? I am not
suggesting that you can play doctor and objectively
assess your own baby but if his tummy feels soft and
there are no swellings in his groin such as a hernia,
this is reassuring.
Whimpering
If a baby is ill in other ways the crying may be that of a
moan or a whimper, not a full blown scream. The quiet,
whimpering baby is, however, every bit as worrying as
the screamer. When you call the doctor, it may help to
have thought over the points I have mentioned: it may
make the difference between being seen that night or
the following morning.

General advice on crying
Get a break
Few things are as wearing and distressing as looking
after a crying baby. Try to organise your life so that
you can get a break from time to time to do something
you want to do.
Routines
Attempt to get your day organised into a routine as
soon as possible. Babies love activity and routines—
they may even like the afternoon soap opera but not in
preference to a walk in the pram. Inconsistency upsets
a baby. If he knows that he has a bath at a certain time
... then always goes out... has a feed ... then mummy
puts her feet up ... etc, life is better for everyone. Get
into a routine that suits you and stick to it.
30

Sleep
SSleep is another area of debate with dogma, anecdotes,
:and rules flying in every direction to confuse the most
• organised of parents. All babies have different sleep
patterns and different requirements. Some newborn
babies sleep almost continuously between feeds where­
as others spend quite a bit of time awake. The rough
pattern of the day, however, is that a baby will feed
every four hours but should drop one feed in the night.
With luck there will be a feed between 10 pm and
midnight and he will then sleep through until 6 am. I
think you are fortunate if your baby gets into this
rhythm straight after coming home from hospital. It is
more likely that he will want a feed at 2 am (and we
hope not too much play) for a few weeks.
One cannot stress enough the importance of mother
getting some quality sleep. To rise between 6 and 7 am
after an awful night only to face the housework,
shopping, and the baby can be an incomparably bad
feeling. It may be made worse by the sight of your
partner leaving for work and then complaining about a
busy day when he comes home in the evening. This can
be a period of strained relationships as the confused,
sleepy mind is not the most understanding. If you are
not getting enough sleep at night do try to take a nap
during the day, rest is much more important than
housework at this time.
Routines again
I go back to the statement that there should be a
routine to a baby’s life. If the pattern of the feed, the
nappy change, the cuddle, and the song is the same, so
sleep will be expected. Hence the lullaby on a string
31

from a plastic moon or cuddly toy tells him that this is
the time he is expected to sleep because mother has
other things to do, even if its only sleeping. But do
remember that you cannot expect a baby who is not
tired to go to sleep because you would like some rest.
Some scenarios

He is put to bed but will not sleep and screams
Ignore the crying for 5 to 10 minutes but if it persists go
to see him, cuddle and calm him, and then put him
firmly down again. If he goes on crying this sleep will
have to be abandoned but beware, this may be the
beginning of a battle which I hope you can win with
firm kindness. Always try’to be consistent, something
which is more easily said than done.
He won’t sleep but doesn’t cry
This is fine but don't go back into the room to check all
is well. When he does eventually drop off to sleep, this
may be accompanied by whimpering and periodic weak
crying which again can be ignored.

He doesn’t want to sleep at all at night

I think most parents can live with a baby who doesn’t
sleep in the day so long as he is not screaming his head
off at night. There are some babies who will just not
sleep. I don’t believe it is your fault, these babies are
just a fact of life. Although if you have broken all the
rules and looked in every half an hour to see he is
breathing or picked him up every time he cried, then
you could have brought the situation on yourself. Most
families, however, have had a non-sleeper or certainly
have known one. In these situations the various alter­
natives are:
•Bring the baby into your bed
I have nothing against this towards the end of his first
year. It’s natural for babies and children to be more
secure when in the family bed but if the baby is very
small, I don’t think it’s safe in case you smother him in
your sleep.
32

• Get up alternately
"This is a form of ’’time-sharing” where you and your
partner share the shifts in the small hours of the
morning. At least both of you get some sleep at some
stage and you have shared the pleasure(?) of seeing the
dawn rise.
• "Knock-out drops”
Trichlofos, chloral, Phenergan (promethazine), and
Vallergan (trimeprazine tartrate) are medicines used to
sedate children and they are not addictive. The prob­
lem is that they don’t work on the true non-sleepers. I
think they work better on the occasional basis, for
example when there is a babysitter. Another problem is
that the dose your baby needs is probably so great that
by the time he goes to sleep, having fought the effects of
the medicine, he doesn’t wake up until lunch time the
following day. I certainly do prescribe these medicines
when mothers are desperate but their action is not
impressive.
• Company
If he merely wants company and he’s too young for
your bed or that hasn’t worked out, you may .wish to
move a temporary camp bed into the baby’s room. It’s
possible that with you by the cot he will sleep. Once
again, I don’t think this is a good plan of action for the
single mother but it is a desperate measure which
mother and father can use alternately.

Firm handling and common sense
Remember—all these measures are extreme. Firm
handling and common sense are usually all that’s
needed. People reading this section of the book have
usually tried these, so I have described some extreme
measures, not for recommendation but to prove that
you are not alone if you have considered them. You
wouldn’t be the first parents to load the baby into a
carry cot and take him out for a drive fn the night. Car
engines seem to put the most resistant of babies to
sleep.
33

Some
anatomical
features
Head, skin, and bottom
Head
The largest part of a baby’s body is his head. This is the
most difficult part to squeeze through the birth canal
and, of course, it sometimes gets stuck. When it comes
through with difficulty, it can be an amazing shape and
colour but this reverts to normal very quickly. If the
baby’s head does not return to the usual round form, it
is possible that there will always be a tendency for a
mild asymmetry (lopsidedness) of the face. This is
nothing to do with the delivery but probably is caused
by the way he was lying in the womb or one of the skull
bones fusing early. By the age of 2, with normal hair
growth, he will look as good as any toddler.

The fontanelles
Two holes in the skull —the fontanelles—are very vari­
able in size. The one at the front can be quite large and
pulsates with the baby’s heart beat. If baby is at rest,
sitting up, this fontanelle should be soft. It will be tense
when he screams but not otherwise. The smaller fonta­
nelle at the back of the head may be almost closed at
birth.
34

Skin

A baby’s skin is very delicate. If he is premature his
skin should be handled very gently. The skin of a baby
who stays inside his mother more than 40 weeks with­
out growing well is sometimes very rough. The hands
and feet have deep furrows in the palms and sole, and
sometimes the skin peels off like sunburn. One thing
you can rely on is that a baby’s skin never looks the
same two week’s running and the speed of change is
remarkable.

Spots
In the first few days of life, many babies develop minute
spots. These have a white, pinhead centre surrounded
by a red flare standing out from the surrounding pale
skin. They sometimes look so angry that they might
develop into a typical adolescent spot, but left well
alone they fade away. These spots are an allergic
reaction, not an infection, but we do not know to what
the baby is allergic. They are equally common in breast
and bottlefed babies and their medical name is eryth­
ema toxicum or toxic urticaria.^
35

Around the same time, another common rash occurs
called milia. This is on the face and particularly the
nose. It looks like blocked sweat ducts and you get the
impression that if you squeezed the skin, the matted
sweat could be expelled —not something I would recom­
mend. Once again this is purely a cosmetic problem, a
passing phase which should be treated by sensible
washing with the baby’s own face flannel and drying
with a soft towel. If soap is used, it must be pure and not
coloured or scented.
Birth marks
A birthmark is a discoloured patch on the skin caused
by pigment or a collection of small blood vessels under
the skin. Most babies will have a small, pink, spidery
stork mark between the eyes. Again, doctors have no
explanation of this mark so we are happy to go along
with the explanation that it is caused by the beak of the
stork which bears the baby. Consistent with this stork
theory are red marks (one or two) found on the back of
the head, sometimes covered by hair if the baby is
blessed with a good crop. Both the front and back
marks may be quite prominent on a very pale baby but
will have gone by his first birthday.
What does cause anxiety are the more unsightly
raised "strawberry" nevi (marks). These are a collec­
tion of blood vessels which grow alarmingly rapidly.
On the face they are so obvious that medical reassur­
ance is necessary. Whatever the site, the advice is:
•They will get bigger before they get smaller.
•They will go grey in the middle before starting to
fade.
•They will usually have gone by the age of 2.
Occasionally strawberry marks are very large, in
which case they do not fade. Treatment is not easy but
surgery should certainly be avoided.
Mongolian blue spots are patches of pigment over the
buttocks and lower back and are common in AfroCaribbean or Asian babies. They fade as the skin
darkens.
36

A port ivine stain is a red patch on the skin which is
usually quite large and, because it does not disappear,
can be most distressing. If the mark is very unsightly
your doctor may refer you to a plastic surgeon when
the child is older.
Cradle cap (scurf)
Cradle cap is a very common condition. A layer of waxy
material builds up over the scalp but is stuck to it so
that removal is difficult. Most babies develop a scurfy
scalp in the first week or two and possibly this develops
into cradle cap. It’s rather like dandruff in grown-ups.
The best treatment is to rub olive oil (better than baby
oil) into the scalp at night and shampoo out the
following day, repeating this until the cradle cap has
gone. A popular shampoo for occasional but not reg­
ular use is Polytar. Very often cradle cap is associated
with a skin complaint called seborrhoic dermatitis.

Seborrhoic dermatitis
This is a condition easily confused with eczema. It
seems more angry and scaly than eczema and attacks
the skin creases—the groin, armpits, and neck. It is
particularly common in the areas under the ear lobes
where cracks will appear as though the ear is starting
to come off. Various creams are available. The basic
cream is a moisturiser such as E45 or oily cream. If the
area of skin is infected, an antibiotic cream is appropri­
ate. When more severe, a steroid ointment or a coal tar
and salicylic acid preparation can be used.
Eczema
It is unusual for severe eczema to affect a baby in the
first 3 months. If it does, there is usually eczema in the
family. Mothers point out patches to me on their
babies’ skin, anxious that their children may be deve­
loping eczema. All that is usually necessary in these
cases is a moisturising cream. For true eczema, how­
ever, a steroid cream —the best being 0.5% hydrocorti­
sone— is normally required. Certainly you should ask
advice from the doctor about severe eczema, and prep­
37

arations you can buy "over the counter” from the
chemist should not be used. If the eczema or seborrhoic
dermatitis coincides with the introduction of cow’s
milk after breastfeeding has stopped these skin rashes
may possibly be caused by cow’s milk allergy. If this is
the case I would try a formula milk which is soya based
such as Cow & Gate S Formula or Wysoy, or a very
modified cow’s milk formula such as Pregestermil.
Some babies grow out of their eczema rapidly. Some do
not. It’s not possible to’generalise.

Bottoms

I wouldn’t mind betting that if grown-ups revealed
their bottoms to the world as much as a baby is forced
to, there would be a fair amount of pathology on
display. My point is that because this area of a baby’s
anatomy is inspected so regularly it is the source of
much concerned discussion.
There are two sorts of nappy rashes. One is simple
soreness caused by either a sensitive skin or infrequent
nappy changing. The other is the result of an infection
called thrush (Candida moniliasis). For the former
washing, drying, the application of a barrier cream
such as zinc and castor oil, and frequent nappy chang­
ing are all that is necessary. There are many excellent
creams available —find one that works for your baby
and stick to it. If the rash is slow to clear despite all
this and if it spreads and scales or there is slight
blistering, thrush is suggested. The two creams which
are then effective are either Nystan (nystatin) or Daktarin (miconazole). Take a look in your baby’s mouth: if
there is a white film on the tongue, cheeks, or gums he
has thrush there too. In this case he needs both the skin
cream and a suspension for the mouth. A five day
course should clear things up but make sure the teats
of his bottles are sterilised well and try to make him do
without a dummy (if he uses one) until the infection has
cleared.
38

Eyes, ears, nose and mouth
Eyes

Babies can see as soon as they are born. They are short­
sighted, however, and can only focus if you place your
face very close to them. Do try this with your baby. He
may fix on your eyes and even follow but I assure you
that he will have no interest in a cuddly toy. At the age
of 8 to 10 weeks most babies definitely follow movement
and at this stage it is easier to see whether there is a
squint (a condition in which one eye seems to wander
and not focus). One way of telling is to look at the
reflection of light (for example a window) in the baby’s
pupils (the black part of the eye). If the reflection of the
window remains in the same part of the pupil in both
eyes whichever way the eyes are looking, then the baby
has no squint. You should consult your doctor if the
39

apparent squint persists after the baby is three months
old.
Sticky eyes
In the first week or two babies will often have a sticky
eye. This happens for a variety of reasons:
• Babies spend a lot of their time with their eyes closed,
causing the secretions to matt the lids together.
• The tear ducts draining from the eye into the nose
tend to be blocked in babies.
• The eyes may be affected by organisms picked up
from the birth canal during delivery.
If the eye reddens or the discharge is profuse, this
needs medical attention. Ideally, a swab is taken and
an antibiotic eye preparation such as neomycin (nysta­
tin) or chloramphenicol is given. Very occasionally an
eye infection occurs during the first week of life and is
resistant to these antibiotics. In this case special swabs
are made to confirm an unusual infection called clamydia. In most babies sticky eyes are not caused by
serious bacterial infections and all that is necessary is
cotton wool, boiled water, and sensible bathing of the
affected eye.
Ears
Newborn babies can hear—they respond to sound by
blinking, starting, or drawing in breath. Babies can get
ear pain caused by infection and this is often a reason
for crying and waking at night in a baby who otherwise
sleeps well. Older babies may pull at their ear when it
hurts. You should never use cotton buds to clean wax
out of your baby’s ear. This is unnecessary and may
only serve to push it further in.

Nose
There cannot be many babies who have not had nose
drops from time to time. This is probably the most over­
rated treatment in medicine. It is true that a cold will
cause snuffles and difficulty with feeding, but what
most parents don’t realise is that nose drops themselves
40

can irritate the lining of the nostril, making the prob­
lem worse. Never use nose drops without your doctor’s
advice.
Mouth

If a tooth is present at birth it should be removed. This
tooth is an extra, two more will follow, and it has no
significance. An apparent tongue-tie, where the con­
nection of the underside of the tongue with the floor of
the mouth is short, has no importance in the first year.
It is never the cause of poor feeding and by the age of a
year it should hardly be noticeable.
Thrush
I have already mentioned the typical appearance of
thrush —it looks like milk remnants on the gums,
tongue, inner cheek, or roof of mouth but whereas milk
will easily separate from the tongue or inner cheeks by
gentle manipulation with the little finger, the thrush
fungi are firmly stuck. Thrush can certainly be a cause
of poor feeding. It is usually associated with bottlefeed­
ing where bottle hygiene is not perfect and antibiotics
such as ampicillin may predispose to it. Thrush is
easily treated—Nystan(nystatin) suspension or Daktarin (miconazole) gel is placed in the mouth after
meals and should clear up the condition in a day or
two.

Umbilicus
After delivery, the umbilical cord, which joins the baby
to the placenta is clamped and cut. It withers and falls
off towards the end of the first week by the process of
dry gangrene. This sounds awful but remember that as
long as it doesn’t get infected, there is no problem.
Once again cleanliness is everything. You should clean
the area and umbilical stump daily but over liberal use
of powder (Sterzac) should be avoided: sometimes you
see the powder all caked together at the base of a
smelly cord. If the skin around the naval becomes red
and shows signs of infection, contact the doctor.
41

Umbilical granuloma
Sometimes the umbilicus remains "sticky”. When the
skin around it is stretched to give a better view of the
centre, a small knuckle of material can be seen peeping
out. This is the base of the umbilical cord which has not
totally disappeared and the question arises as to which,
if any, treatment is necessary.
There are three approaches to these so-called "gra­
nulomas”. Firstly, there is a silver nitrate stick with
which to cauterise or burn the tissue (as with warts).
Secondly, a ligature can be tied around the base to
ensure that the stump falls off. Thirdly, do nothing. All
three approaches have merit but if leaving alone for
two to three months works, that is what I would do.

Circumcision
1 would not enter into the discussion of whether rou­
tine circumcision is beneficial or not in the long term.
In the United Kingdom circumcision is not performed
under the NHS on cultural or social grounds and
Jewish and Moslem communities have to make their
own arrangements.
The foreskin is normally adherent to the glans (tip)
of the penis in newborns but it can usually be drawn
back fully by the age of 3 years. The reasons for
circumcision at any age is recurrent infection under
the foreskin or ballooning up of the foreskin when
urine is being passed. It is unfortunate that circumci­
sion is left until later in many children who develop
these problems. I feel that complications are largely
preventable by good hygiene and correct observation
of the penis by the parents. There is a school of thought
that says leave the foreskin well alone and never try to
force it back. I would not totally support this. I believe
that from time to time (eg at bathtime) the retractility
of the foreskin can be gently tested with the smallest
bit of pressure. The golden rule is not to force the skin
back or to hurt the baby. This inspection may prevent
infection starting.
42

More about
illness
The most worrying thing for parents to decide is
whether their baby is ill. The main difficulty arises
when a baby doesn’t seem right, he’s crying too much,
but there is nothing very specific to describe. In the
middle of the night the doctor may ask several ques­
tions which are pointers to specific baby conditions.
Most serious conditions in babies arise from infections,
usually virus infections of the chest.
Conditions requiring surgery

Strangulated hernia and pyloric stenosis
Conditions requiring an operation are unusual but
worth mentioning. Firstly, a baby’s bowel may be
obstructed because of a hernia. Babies born prema­
turely are prone to hernias in the groin. In boys,
examination shows a swelling in the scrotum which is
considerably larger than the normal testicle and is
tender to touch. Baby girls may also have a strangu­
lated hernia but it is not so common. Because of the
blockage the baby’s bowels may not have opened for
some time and vomiting will also develop. So always
have a look in the groin for unusual swelling. The
second condition is pyloric stenosis which is described
under the section on vomiting.
Intussusception
Finally thereis a peculiar condition of the bowel called
an intussusception. In this case, the baby seems col­
icky-drawing up his legs and screaming with stomach
ache. Vomiting or the passing of blood or mucous from
the baby’s anus shows that this is not colic. So always
think about your baby’s bowels if you are worried and
if the last bowel action was normal be reassured.
43

Medical conditions

The '’medical”, as opposed to ’’surgical”, conditions
are less clear cut. Firstly, if you have a thermometer,
take your baby’s temperature. If you haven’t got one,
don’t go out and buy one—I’m not a great advocate of
home temperature measuring as it doesn’t add a great
deal to home diagnosis. In the hospital, babies always
have the indignity of their temperatures being
measured in their rectum because the thermometer is
at risk of being swallowed in the mouth or disappearing
from under the arm. In Europe, a great deal of use is put
to the bottom end of babies—not only are temperatures
measured there but half the common medicines, par­
ticularly those designed to bring down fever, are intro­
duced to this portal of entry. Nevertheless, if by some
means you record the baby’s temperature and it is high,
it is of some importance. Toddlers have always got
running noses and high temperatures but the same is
not so for babies.

A smile reassures
Secondly, and I believe most importantly can you get
your baby to smile or laugh? I’ve asked many of my %
colleagues if they have ever seen an ill baby smile: the
answer is usually no. If I can make a baby smile, I
practically always reassure the parents that he has
nothing serious. Another important question is, what
is the baby’s mood? Irritability, resentment of move­
ment, and drowsiness are important signs of illness.
The words irritability and drowsiness are of particular
importance when talking to a doctor.

Gastroenteritis
One of the commonest illnesses, summer or winter, is
gastroenteritis. The hallmark of gastroenteritis is diar­
rhoea, which may or may not be accompanied by
vomiting. If the stools are frequent and loose and there
is blood or mucous in them, the gastroenteritis is
accompanied by stomach ache. It doesn’t matter what
the offending bug is, the treatment is clear feeds (no
44

'

I

milk) given little and often. There are two or three
commercial preparations on the market to add to water
to give the correct sugar and salt mixture—Dioralyte
and Rehidrat are the best known. Please never add
double the strength on the mistaken grounds that it
will get baby better twice as quickly. I have known
these powders added to milk when the instructions
have not been followed. One or two days on clear feeds
should be enough before dilute milk is reintroduced
into the baby’s diet. When breastfeeding, extra fluid
can be given using one of these preparations but don’t
stop giving breast milk.

Bronchiolitis
Between October and February there is usually an
epidemic of bronchiolitis. This illness is caused by a
virus called the respiratory synctial virus against
which no vaccine has yet been manufactured. The poor
little babies cough, wheeze, and vomit and often find
their way to hospital. Mild cases can be treated at
home but hospital admission is often necessary so that
these sick babies can be fed through a naso-gastric
tube and for general observation.
Fits
Finally an important symptom in a baby is abnormal
jerky body movements or eye rolling. Fits in babies
under 6 months are not the harmless, feverish convul­
sions that affect the older age group, and always need
investigating. Sometimes it is difficult to know when a
movement is normal or not. The quivering of the ankle
while asleep (like a cat dreaming) is common; repeated
jerky movements, particularly if the baby seems else­
where, are definitely not normal.

A potted list
This is a potted list of what can go wrong and what the
symptoms are. So, if your baby is screaming and you
are worried remember that if his bowels are normal,
he’s not coughing, he’s taken his feeds, and he smiles
he is probably fine.

45

Immunisation
and
developmental
surveillance
Please get your baby immunised. Immunisation against
diphtheria, tetanus and pertussis (whooping cough)
(known as DTP) and polio (by mouth) is usually given
at 3, 4, and 9 months. But there may be slight variations
throughout the country. Measles immunisation is at 15
months. Premature babies are immunised at the same
stage from the date of birth and not from when they
should have been born. Children at high risk are
offered BCG against tuberculosis at birth. This infec­
tion produces a slight lump which leaves a very small
mark. The only reasons for not giving tetanus, diph­
theria, or polio are illness at the time immunisation
should take place or a proved lack of resistance to
infection. There are very few contraindications to
whooping cough vaccination —the only ones being • a
reaction to the previous injection; • convulsions (fits)
in the baby or close family members; or • illness on the
day of vaccination. A simple runny nose, egg allergy,
hay fever, asthma, or eczema are not reasons for not
immunising. You will be given an immunisation record
card which you should take to the clinic when you go
so the doctors have a record of the immunisation status
of your baby.
46

Developmental surveillance

In Britain all babies are examined at specific ages so
that any abnormalities can be detected early and
mothers can discuss any anxieties they may have. I
have already discussed the assessment that every new­
born baby has, subsequent examinations are under­
taken either by the family doctor or the community
medical officer at the child health clinic at 6 weeks, 7 or
8 months, and again at 18 months.

Cot deaths
One of the saddest comments on progress made in child
health is the inability of the medical profession to find
- the cause of cot deaths or sudden infant death syn­
drome (SIDS). Statistically, about 4 in every 1000
babies will die suddenly before the age of 1 year,
usually before 6 months. If there has already been a cot
death in the family, there is an increased (though not
high) chance of it happening again. Hence there is a
population of theoretically "at risk” babies, the
brothers and sisters of the ones who have died. Many
parents are now loaned monitors which make a loud
bleep when, and if, the baby stops breathing. These
monitors are not of any proven benefit but most parents
feel better for having one. Some parents are also loaned
special scales to weigh at risk babies as an association
has been noted between failure to gain weight and cot
death.
47

Causes
The possible causes of cot death are varied and
unproved. They include milk going down the wrong
way, sudden irregularities of the heart rhythm, babies
unaccountably forgetting to breath, serious virus
infections, rare congenital inabilities to metabolise
food, and babies being too warm or too cold. In a
nutshell, despite strenuous efforts doctors have not
come up with any one solution, which implies there are
a variety of factors which have the final, common effect
of making the baby forget to take its next breath. All
that parents can do is to know the signs of illness in
their baby and seek medical attention when necessary.

Babies are wonderful, and al the same time terrifying.
New parents can feel quite overwhelmed by the
responsibility of looking after such a tiny, fragile
looking creature. Your new baby, by consultant
paediatrician John Bissenden, aims to help parents
through the early months. It gives guidelines on car­
ing for new babies and considers areas that cause
greatest concern such as feeding difficulties, sleep­
ing, and crying, and the problems of illness and babies
in special care units.

Rs. 15.00

J-622

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