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Baby Clinic

Wednesday, 10 February 2010

If you're a mum with a young baby you, like many others, panic at the sound of a sniffle, and race to the hospital with every rash or bump that may appear. Our team are here to go through some of the common ailments that your baby can have, and how to treat them without panicking!

We'll also be answering our viewer's questions, so anyone at home with a question about your baby's health will get to ask our panel of experts, and may spare a trip to the doctors.

Why is it Relevant Today?
Mums the word when it comes to our audience and we want to give some help to all those mothers who are at home with their babies, and may need some help.

Who is the guest?

. Dr. Ball - Fairview Park Medical Centre
. Grainne Ryan - Public Health Nurse

. Case Study - Sonia Cole


Sonia Cole - 29 - Two Children
. Richard - 8 months
. Christopher - aged 2


Feeding and constipation- Her second baby Richard threw up the bottle all the time in the first few weeks coming home from the hospital. She was worried that he wasn't getting enough nutrients, but also he was screaming in pain of something, she just didn't know what it was, but presumed it was colic. The public health nurse called in then and let her know that he was constipated. She said it was to do with the formula she was giving him, and all she did was change brand and to give him a lot of water.

Dry Skin - Her first baby Christopher had dry skin patches on his face in particular, and on his arms. She though it was eczema but the public health nurse advised her to bath him in natural baby oils rather than the normal branded ones

Vaccines - Sonia said that Christopher, her first baby, took the immunizations with no problem. She was particularly scared then when Richard got his, as the wound became green and infected, and his arm was swollen. She was fine in the end, but she had no idea if this was a normal reaction.

Her personal tips - Sonia's top tip is to have an emergency baby bag with sterilized bottles, soothers etc for the baby in case you break down or get stranded somewhere. On her first baby she refused to go anywhere in the car in fear of her breaking down and not being able to get home on time with the baby to feed him!


Topics

1. Colic and Reflux


Grainne

Colic, what is it? - Excessive crying, irritability or fussiness, mostly caused by digestive problems.

What to do:

. Rule out wind by ensuring correct feeding technique.
. If bottle feeding, ensure there's no air in the teat; you might also need to check that the flow isn't too slow/fast.
. Wind your baby regularly throughout the feed. If the baby is difficult to burp, place her over your shoulder and rub her back gently.
. Some babies have difficulty in digesting lactose in milk and become very irritable. The use of lactose-free formula may help here or you could add Colief drops to formula before feeding. Ask your public health nurse, pharmacist or GP before changing formula.
. If breast feeding, it may be worth keeping a food diary and seeing what foods appear to make the baby unsettled. Common triggers are beans, eggs, onions, garlic, grapes, tomatoes, bananas, oranges, strawberries, milk and anything spicy.
. The concentration of breast milk changes during a feeding. The foremilk, at the beginning, is plentiful but low in calories and fat. The hindmilk, at the end of emptying each breast, is far richer. Sometimes you can reduce colic by allowing the baby to finish the first breast before offering the second.
. If the baby still seems uncomfortable, then offering only one breast, as often as desired, over a two to three-hour period, might give the baby more hindmilk, which is sometimes more soothing.

Some of the things that can help:

. Support their tummy When sitting down, place your infant along your forearm, face down, cradling the head in one hand. This takes practice to perfect the technique.
. Slings are invaluable when your baby is crying inconsolably. Just being nestled against your warm chest is comforting, as is your heartbeat.
. Soothe your baby by warming her tummy with a warm (not hot) hot-water bottle. Ensure that the hot-water bottle is covered, check the top is securely in position, then place on the baby's tummy while she sits on your knee. Do not leave a baby wrapped up in bed with a hot-water bottle in case it leaks or burns.
. Place your infant in a mechanical baby swing. For some reason, the continual and steady back-and-forth motion has calmed many distressed babies.
. Run the vacuum cleaner. The sound is like a lullaby to the ears of some colicky infants. Sometimes, colicky babies respond to the sound of a tumble drier.
. Cut down external stimuli. Sometimes, the more you try to calm a colicky baby, the more it seems to cry. This might be because the baby's nervous system is too immature to handle any noise. Just hold her in your arms and avoid making any noises or eye contact, which is a form of stimulation.
. Always consult your GP if crying is persistent, your infant is refusing to take bottles, has a fever, or if you're too stressed to cope.

Dr. Ball

Colic is not really a diagnosis but is a description of a healthy child crying recurrently . Its cause is not known.
It usually subsides by 3-4 months.

It can be very stressful for parents. Often occurs in evening times. If it is colic then your baby should be feeding well and growing well and be otherwise healthy.
Try to relax yourself as often the cycle is perpetuated when parents are stressful.

Check usual things: hunger/wet/cold/hot etc..

Things that are tried include: lactase/ stopping certain foods by mother if breastfeeding eg caffeine/ white noise/ car journeys!

1a Reflux

Reflux, What is it?
If the digestive system is working properly, the sphincter -- a type of muscle that opens and closes the stomach -- allows the baby's food to drop into the stomach and keeps it there.

With reflux, the sphincter is immature and doesn't close properly after opening. The food reaches the stomach, mixes with stomach acid and comes back up, burning your baby's oesophagus.

One or two episodes of spitting up should not send out alarm bells. If reflux is truly present, your baby will have difficulty getting through her feed. She might splutter and fuss because the sphincter has stayed shut, making it impossible for her to get food down in the first place.

She might spit up or even projectile vomit a few minutes after eating, because the sphincter didn't close once the food went down. In a minority of cases, babies have pain and the problems of reflux without constant spitting. Sometimes, you might see a watery, cottage-cheese spit-up up to an hour after a feed, as the stomach is in spasm and whatever is on top comes back up the oesophagus.

Babies with reflux are hard to wind and are most comfortable when sitting upright or held upright on a shoulder. Lying them down results in hysterical crying (often misdiagnosed as a spoilt baby). When adults have a bout of heartburn, would they like to lie down?
With reflux, the more bothered a baby is, the more likely that she'll have spasm and that the acid will come up her digestive tract. The important thing is to watch your child's growth: some babies with reflux are slow to gain weight.

Other things you can do:
. Elevate the cot mattress to 45 degrees.
. Do not pat your baby's back when burping her as this can irritate an already-inflamed area. Gently rub in circular motions on the left side of back, or rub upwards with baby's arm straight over your shoulder.
. Burping your infant several times during feeding will help minimise gastric pressure, and the reflux it can cause.
. Look at the feeding technique and ensure the teat is not too free-flowing -- I recommend medium flow. If she has taken a good feed and is still fussy, use a dummy to calm her rather than feed again, which will only make her more distressed.
. Sometimes, it may be necessary to change to a special formula that thickens in the gastro-intestinal track. Infant Gaviscon helps reduce acid in the stomach.
. Don't be too concerned with trying to get into a routine with feeding and sleeping. A baby suffering from reflux can have random good and bad days. Initially, you may need to let her dictate, until you start to see an improvement with the tips I have given you.

2. Immunizations and aftermath

Grainne:

What is it?
Children and young people in Ireland are entitled to certain vaccinations and immunisation services free of charge under the Childhood Immunisation Programme. Vaccination is a safe and effective way to help the body prevent or fight off certain diseases.

What will my child be immunised against?
It is recommended that children be immunised against tuberculosis, diphtheria, tetanus (lockjaw), pertussis (whooping cough), haemophilus influenza B (Hib), polio, meningitis C, mumps, measles and rubella (German measles). These are all covered under the Childhood Immunisation and school booster programmes.

When should my child be immunised?
Under the Childhood Immunisation Programme, the following vaccinations are given free of charge, by your GP/family doctor:
. At birth: The BCG vaccination
. At 2 months: (the "6 in 1"), and the first pneumococcal conjugate vaccines.
. At 4 months: The second of three "6 in 1" injections is given. The first of two meningococcal C vaccines is provided.
. At 6 months: The third of three "6 in 1" injections is given. 2nd pneumococcal conjugate vaccines and the second of two meningococcal C vaccines are administered.
. At 12 months: MMR and PCV

3. Dry Skin

Dr. Ball

What is it?
This is very common. Not the same as eczema which tends to occur in older infants. Cane use simple emolients/moisurisers ranging from e45 to emulsifying ointment; can use in bath also. If just dry skin then little to worry about. If inflamed angry red patches then may be Eczema and should get checked out by your doctor (may be family history).Lots of skin conditions in early babies; Such as "milia" blocked skin ducts etc..

Creams on Display:
Botanics Baby Gentle and Mild Intensive Cream €5.79
E45 Cream 125g €7.39
Johnson's Baby Moisturising Cream €2.79

4. Constipation

Dr. Ball

What is it?
Need to know what the normal is for your child as may be different but not abnormal. Bowels more frequent in breast fed babies. Make sure no small tears /sore at babys bottom.
Also, if persisting it may be worth changing from cows-milk. Usually the more serious causes for constipation can are picked up some after birth e.g. nerve or muscle problems/ thyroid problems etc. Watch input and that baby is getting adequate hydration

Grainne:

The frequency of bowel movements in babies can vary a great deal depending on whether they are breast or bottle fed. Sometimes babies can appear to strain and grunt or go red in the face when they have their bowels opened but this does not mean they are constipated unless the stools are hard. True constipation is rare in young babies and if suspected further advice from a health practitioner should always be sought.

How to recognise constipation
. A baby who is passing hard poo which appears to cause pain or discomfort

. The consistency of the stool is more important than the frequency. Breast fed babies can poo from several times per day to less than once per week and as long as the poo is soft the baby would not be considered to be constipated

Causes of constipation in babies could include
. Not enough water in made up formula milk
. A change in formula feed (particularly to 'follow on' formula or at the introduction of cows milk/weaning)
. Not enough drinks particularly in hot weather

How to help
. If the baby is formula fed, check the formula is being made up properly with the correct ratio of powder to water
. Offer extra cooled boiled water in between feeds
. If mum is breastfeeding, look at your diet may need to add more roughage.
. For older babies (over 5 months old) offer fruit juice or small amounts of stewed fruit (e.g. prunes) or steamed vegetables
. A warm bath and gently rubbing the baby's tummy clockwise may help
. Gentle exercise. 'Cycling' the babies legs can help stimulate bowel movements
. Laxatives should not be given unless prescribed by a doctor.

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