Melomed Articles

13 February 2019 - Dr. Leana van Dyk

Parenting a newborn - Common problems and what to expect

Expecting a baby can often be an overwhelming experience. It takes much preparation. Parents read many books on what to expect. They prepare for the delivery and babys room. Parents try to digest all the information from family, friends and the much confusing internet, but until baby arrives, no-one can fully prepare parents for what is about to happen. This includes first time or second time parents.  I often witness the overwhelming joy from the parents with that first cry. A joy that reflects the instant, unconditional love for their child. A love that will ensure that they take on this road with full commitment!

There are many ways to assist parents in preparing for the delivery itself. Ante-natal classes is essential for preparation for delivery, but also to inform parents on what to expect once their baby arrives. We urge all parents-to-be to attend ante-natal classes. It is informative, but you also build a comradery with other future parents and you have the opportunity to share your fears and expectations.

There are  many possible problems/illnesses in the newborn, but there are only a couple that is expected in all newborns and can be managed with great ease.

1. Feeding issues
Breast feeding remains the best feeding choice for your newborn. Breast truly is the best! But to some mothers, breast feeding can be a great struggle in the beginning.

The initial milk (colostrum) is thick and little. This is however enough for your infant in the first few days. Milk production usually increases on day 3. Weight loss over this period is common and normal. A weight loss of more than 10% of the birth weight needs to be addressed.

There are many ways to increase milk production. These include enough rest, increasing your fluid intake, no smoking, healthy eating, natural remedies ( ask your pharmacist) or request treatment from your Obstetrician that will increase your milk production. 

- Tender abnormal nipples is a common problem. This can occur from incorrect latching, or a local infection. Ask the nursing staff early to assist you with correct latching. 

-  Poor suck or biting is common. If your baby is well otherwise, this should resolve with enough stimulation and assistance. 

Most important is to remember that you are not the only one struggling and there is help available. Read during pregnancy on techniques and how to overcome challenges. Nursing staff and your Paediatrician can assist you in hospital and after discharge, contact one of many lactation specialists if any concerns. 

2. Neonatal jaundice
All babies have jaundice to a more of lesser degree. This is due to the short life time of the neonatal red blood cell and due to immature liver enzymes in all newborns.

Jaundice is a normal condition in a newborn, but once the level of Billirubin reaches a critical level, your baby will require phototherapy.

Testing for jaundice levels are easy and often non-invasive. This will be done in the hospital. After discharge, you can do the following to assess your baby:

- Look for yellow discoloration, especially of the sclera ( white of the eye). If it occurs, contact your nearest hospital / Clinic to do a screening test for jaundice.

- Feed your baby often. This will keep them well hydrated, and assist in decreasing the concentration of the billirubin ( responsible for jaundice)

Mothers with a "negative" blood group ( eg. A, B or O Negative) must be aware that their children can get severe jaundice. Regular testing is required. 

3.  Hypoglycemia
Low blood sugar can occur in the first few hours after birth. This will be monitored by the staff. It can be prevented by feeding often, but if it persist, a work-up will be done by your doctor and your baby might need additional "top-up" feeds or intravenous fluids.

This is a common problem in babies where mothers have Diabetes. For this reason, it is essential to be healthy and control you diabetes during pregnancy, 

3. Neonatal Sepsis
Infection during the first 3 months of life needs to be detected and managed with great urgency and priority. 

Some signs of Neonatal sepsis are the following:
- Fever 
- Irritability
- Lethargy ("Sleepiness" more than normal)
- Poor feeding
- Vomiting, diarhoea or abdominal distention
- Irregular breathing or apnoea (stop breathing for more than 15 seconds)
- Blue discoloration or "Mottled"
- Jaundice, especially longer than 14 days after birth

If any of the above occur, contact your nearest healthcare worker for a workup and necessary referral.
The causes for infection can range from urinary tract infection, meningitis, or general infection that is still related to birth. 

Finally, always surround yourself with a support system to help you on this journey! Remember that there is help and assistance available and seek medical advice if you are unsure or worried. Never ignore your parental instinct that will guide you along the way! 


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