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Neonatology
India contributes 2.38 million of the global burden out of 10.8 million under five child deaths which is the highest for any nation in the world. Nearly 26 million infants are born each year, of whom 1.2 million die before completion of the first 4 weeks of life &1.7 million die before reaching the first birthday.
The present infant mortality rate in India is 58 as per 2004(SRS data).In India, a significant proportion of child deaths take place in the neonatal period. Apart from infections, other causes like asphyxia, hypotherma congenital defects and prematurity are responsible for neonatal mortality. Also about one-third of the newborns have a birth weight less than 2500 gram(LBW).A significant proportion of mortality occurs in low birth weight babies. Hence the further reduction of IMR will require focused attention on neonatal mortality.
In recent years neonatology care has improved by leaps and bounds across the country, but still lot needs to be done.The introduction of better neonatal ventilation and NICU care has added in better outcome of low birth weight and low gestational age (premature) newborns. New technologies & better medications for the treatment of premature babies has improved the outcome in premature babies. So this means increased demand for specialized neonatal care units & specialists in our country. Nowadays,a preterm of 26 weeks gestational age with less than 800gm weight, has survived with least complications, if delivered in a hospital with a well equipped nursery and specialized care.
With the advent of better quality surfactants, early parental nutrition, better understanding and refined ventilation, the Neonatal Mortality Rate (NMR) have reduced in India. However a lot needs to be done in this field, as we are still far away from the developed western countries. This could be due to the dearth of NICU facilities and specialists, in small cities, towns and villages.
Also 2-3 % of newborns are born with congenital anomalies (birth defect). The vast majority of them are correctable. However it is important to appreciate that the first chance is the only chance.
At our unit we have a team of doctors, trained Nurses, Staff who are passionate & dedicated in Neonatal care. We have attached Pediatric Cardiac Surgery, Orthopaedic doctors, Paediatric Urologist, Neurologist as well as paediatric surgeon. Dr Anil Vaishnavi is expert in Neonatal care & ventilator care of newborns. Management of neonatal surgical problems as well as post operation care is also taken care of by the Neonatal intensive team. The pre-operative preparation and post-operative management is critical for a successful outcome. We work closely with our colleagues to optimize the management and outcome in our patients.
What is vaccination?
Vaccination protects children against serious diseases by stimulating the immune system against disease germs.
How does vaccine immunity differ from natural immunity?
Normally in most disease the disease germ enters the body, produces the disease & the body mounts fighting power against the germ and lastly one recovers from the disease. Here immunity against disease is produced after one has suffered from the disease. A vaccine is nothing but whole or part to the disease germ, which has been processed or modified in such a way that it loses its capacity to produce disease but it can still induce fighting power in the body when administered. Hence by vaccination one develops immunity without suffering from the disease.
MYTHS SHATTERED
Myth: It is better to develop natural immunity than get vaccinated.
Fact: The difference between vaccination & natural infection is the price paid for immunity. The price for natural immunity (infection) is the physical, economical & mental agony the entire family goes through after one suffers from a disease. In comparison price paid for vaccination is negligible.
Myth: By replying on vaccines my child's immune system becomes weak or does not develop at all.
Fact: No, vaccines do not weaken immune system. As generally thought vaccines are not ready made protection. The body acts on vaccine germs and produces antibodies, which fight against disease germs when the child comes in contact with disease any time in future.
Myth: Vaccines are known to cause serious side effects.
Fact: In most cases, vaccines ause no side effects or only mild reactions such as fever or soreness at the injection time. Very rarely people experience more serious side effects like allergic reactions. Be sure to tell your doctor if you have health problem or known allergies to medications or food.
"Vaccines", Yes, But how many?
As you know- Prevention is always better than cure. Fortunately due to progress in vassine science & technology, it is impossible to protect children against several serious diseases through vaccination. Normally a baby is exposed to millions of germs daily. It is much better to protect them against diseases through vaccination that let them be at risk & suffer.
Myth: My child does not require vaccine as he/she is healthy active & eats well.
Facts: Vaccination is intended to help keep healthy kids healthy, because vaccines work by protecting the body before disease strikes. If you wait until your child gets sick, it will be too late for the vaccine to work. The best time to immunize kids is when they healthy.
Myth: Combination vaccines cause more side effects.
Fact: Combination vaccines are as safe & effective as individual vaccines. There are two practical factors in favour of giving a child several vaccines during the same visit. First to immunise children as early as possible to give them protection during the vulnerable early months of their lives.
Second giving several vaccines at the same time will mean fewer clinic visits & fewer injections, which save parents both time and money and may be less traumatic for the child.
Myth: Its ok to skip certain vaccines.
Fact: In general skipping vaccines is not a good idea. This can leave your child vulnerable to potentially serious diseases that could otherwise be avoided. If you have reservations about any particular vaccine, discuss your concern’s with your child’s doctor. If your child falls behind the standard vaccination schedule, catch up vaccination is also available.
Myth: Vaccine may not be 100% effective so why vaccinate?
Fact: Vaccines indeed are the most effective weapons we have against diseases. They work 85% to 99% of cases. Smallpox has been eradicated from the face of earth & a dramatic reduction in the disease like polio, diphtheria, peruses, measles & mumps are evidence of power of vaccines. Vaccine failure is rare & in such a case the disease is usually mild.
Myth: Vaccines are for babies only. There is no need to vaccinate after 2 to 4 years of age.
Fact: Disease continue to affect school going children, adolescents and adults. It is always better to keep your child protected. Few vaccines ( like DTP) do not provide life long protection. Protective efficacy of these vaccines wanes off over a period of time, so regular boosters are required.
There are some new vaccines (like HPV) for adolescent girls to prevent cancer. Some vaccines (like full) need regular vaccination as the virus keep changing. For most of the vaccines age is not a barrier. Ask your doctor if you have missed any vaccine as you can always catch up.
How do vaccines help my child ?
BCG Vaccine:
Protects against tuberculosis, mainly several forms of tuberculosis TB causes over 3.5 lac deaths in India.
Polio Vaccine:
Protects against poliomyelitis a dreaded childhood disease leading to permanent weakness or paralysis of legs, arms or both, which can lead to permanent disability and even death. India is one of the few countries where polio still exists. Two types of vaccines Oral Polio vaccine (OPV) & inactivated Polio Vaccine(IPV) which is available as an injection.
Hepatitis B Vaccine:
Protects against contagious liver diseases from infection with Hepatitis B virus. Disease can cause lifelong infection, liver cancer, liver failure and even death. Hepatitis B virus spreads through contaminated blood & body fluids.
Hepatitis A Vaccine:
Protects against contagious liver disease that results from infection with Hepatitis A virus. Hepatitis A mainly spreads through contaminated food and water. In India, hepatitis A is a common cause of liver infection resulting in jaundice. Besides jaundice other symptoms are vomiting, loss of appetite & abdominal pain which may last up to 4 weeks. In some children this may progress to liver failure resulting in hospitalization & even death.
Hepatitis A and B are two different forms of viral hepatitis caused by different viruses. Vaccination against hepatitis B does not protect against Hepatitis A and vice versa.
Oral Rotavirus Vaccine:
Protects against Rota virus, the common cause of severe diarrhea & dehydration in infants, resulting in more than 5 lac hospitalizations and unto 1.5 lac deaths annually in India. The disease is characterized by vomiting and explosive watery diarrhea (up to 10 times a day) for 3-8 days. Inspite of good hygiene, Rotavirus infection is unavoidable as almost every child is infected with Rota virus by the age of 5 years.
DTP Vaacine:
DTP is combination vaccines that protects against Diphtheria, Tetnus and Pertussis. Diphtheria causes a thick covering blocking the throat & respiration. It can lead to breathing problems, paralysis, heart failure and even death. Tetnus is a serious disease that causes painful tighting of muscels, usually all over the body.
Pertussis is a contagious disease respiratory tract caused by bacteria. Many children who contract pertussis have coughing spells that last four to eight weeks. The disease is most dangerous in infants.
Two types of vaccines:
1. Currently used DTP vaccines known as whole cell DTP vaccines. They are many decades old and are often associated with a range of side effects.
2. The latest and technologically advanced Cellular DTP vaccines (Gentle DTP). They are as effective and come with significantly lesser side effects.
Tdap vaccine Protects kids 10 years and above against Diphtheria, Tetanus and pertussis as immunity wanes following primary vaccination with DTP vaccine.
Hib Vaccine:
Protects against meningitis (an infection of the covering of the brain and spinal cord), pneumonia (lung infection), epiglottis (a severe throat infection) and other serious infections caused by a type of bacteria called Hemophilus influenza type b. The risk of disease is highest for children between 6 months & 2 years of age.
Pneumococcal Vaccine:
Protects against pneumonia and meningitis, leading to hospitalization and death caused by some strains of Streptococcus pneumonia. Young children (younger than age 5 years) have the highest incidence of serious disease.
Influenza (flu) Vaccine:
Protects against contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and can also lead to hospitalization & death.
Measles Vaccine:
Protects against measles a highly contagious and serious disease with 20% of reported cases experiencing one or more complications (Ear infections, Pneumonia). Complications from measles are more common among very young children (younger than 5 years of age). It is spread by droplets or direct contact with nasal or throat secretions of infected persons.
MMR Vaccine:
Protects against 3 common childhood viral diseases namely Measles, Mumps & Rubella(German Measles.)
Measles: See the Measles vaccine section.
Mumps causes fever, muscle ache and loss of appetite; followed by swelling of salivary glands. In some children complications such as inflammation of the brain and/or tissue covering the brain and spinal cord(encephalitis/meningitis), inflammation of the testicles(orchitis), inflammation of the ovaries(oophoritis) and/or breasts(mastitis), deafness(usually permanent) may be seen.
Rubella is an acute viral disease that causes fever and rashes. If a pregnant woman in infected, upto 85% of infants will be born with some type of birth defect, including deafness, eye defects, heart defects and mental retardation.
Chickenpox Vaccine:
Protects against disease caused by exposure to the Varicella Zoster Virus. A skin rash with blisters (250-500), covering the body but usually more concentrated on the face scalp and trunk. The virus can also lead to pneumonia or infection of the brain. These complications are rare, but serious. Almost every one suffers from infection once in life. Vaccination is an effective way of preventing suffering from Chickenpox and Herpes.
Typhoid Vaccine:
Protects against Typhoid fever, a life threating illness caused by the bacterium Salmonella Typhi. Patients suffering from typhoid fever usually have a sustained fever as high as 103 to 104 F with stomach pain, headache and loss of appetite.
Cervical Cancer (HPV) vaccine:
Protects against cervical cancer, the most common cancer amongst Indian women, even more common than Breast Cancer. Every Year 74,000 women in India die due to Cervical Cancer. The new HPV vaccine can be given after the age of 10 years and is given in 3 doses. Vaccination along with regular screening provides the best possible protection against Cervical Cancer.
Current Vaccine Info & Side Effects Present Information Sheet:
I have delivered today I don't have milk's?
The milk produced in the first 2-3 days (colostrums) is less in quantity but it is sufficient and very essential for the baby. The more the baby suckles the more milk will be produced. Colostrums is the milk which is produced in the first 2-3 days after delivery. It is thick yellowish in color. It is antibody rich (and has plenty of white cells) which protect against infection and allergy. It also contains certain growth factors which help the intestine to mature and prevent intolerance and allergy. The vitamin-A in colostrums reduces the severity of infection and prevents eye disease. It is a purgative, which helps clear meconium and prevents jaundice.
When should the baby be first put to the breast?
New born must be put to the breast within half to one hour of the delivery. Starting to breast-feed immediately after birth stimulates the production of hormones that help milk production. Early skin to skin contact even if the baby does not suckle stimulates milk production. It also helps in improving the mother child bonding.
Elders in the family want to give honey to the baby before I start breast-feeding Is it alright?
Prelacteal (any fluids given in the initial 2-3 days after birth) feeds should not be given as they replace the essential colostrums and the baby’s earliest feeds. Babies given prelacteal feeds are more likely to develop infections and allergies. Prelacteal feeds also interfere with sucking as the baby’s hunger is satisfied and he does not want to breast-feed. As a result breast milk takes longer to come in and it is more difficult to establish breast feeding. More if the prelacteal feed is given through a bottle there are more chances of infection. Babies who are fed using bottles also develop nipple confusion since it is easier to suck from a bottle than from the breast, babies prefer the bottle to the breast.
Why should i breast feed?
Breast milk has the following properties :
Prefect nutrients.
Easily digested and efficiently used.
Protects against infection.
Helps bonding (between mother and baby) and development.
Helps delay new pregnancy (if baby is exclusively breast fed.)
Protects mother’s health
Costs less than artificial feeding. Some studies suggest that breast-feeding may help a child develop intellectually and also prevent asthma and allergies in later years.
How often should I breast feed?
Babies should be fed on demand. (as and when they want to feed)
Advantages of demand feeding:
Breast milk “comes in" sooner
Baby gains weight faster
Fewer breast problems such as engorgement
Breast feeding more easily established
Feed at least 10 times in 24 Hours more if he/she is willing. You should let him suckle whenever he seems interested. The baby should also be breastfed during the night.
What should be the duration of one feed. Should I feed from both breast at one feed?
The baby should be allowed to feed from one breast till he/she is satisfied. Foremilk is the milk that is produced early in a feed. Hind milk is the milk that is produced later in a feed, this milk contains more fat with provides energy and satiety so it is important not to take the baby off the first breast till he had enough hind milk-otherwise he will not be satisfied after the feed. Let the baby suckle from only one breast at each feed. But if he wants more milk shift to the other part.
Note: - Let a baby feed when he wants and for as long as he wants.
Should I give water to my baby, as it is very hot?
Babies do not need other drink (of water) before they are 4-6 months old, even in hot climate. Babies get a large amount of water from foremilk, this is all that the baby needs. Moreover if babies satisfy their thirst with water they may take fewer breast feeds.
I have had a caesarian section so I am in pain. How do I breast feed?
You can breast fed in whatever position you and the baby are comfortable. You can feed in the lying down position keeping in mind four key points, you can turn to one side and feed if it is comfortable. Or if your obstetrician allows you may sit in propped up position and feed normally.
Four key points are:-
With his head and body straight
With his face facing her breast, and his nose opposite her nipple
With his body close to her body
Supporting his bottom (if newborn)
As I have undergone a caesarian section my baby is in the nursery. How do I breast feed.
Express your breast milk to be fed to the baby by Katori spoon
Till when should exclusively breast feed?
Breastfeed exclusively for 4-6 months, Break milk is adequate for the baby till the age of 4-6 months if the baby is growing well. If babies are given other foods or drinks, even in small amounts some of the advantages of breast milk may be lost. Babies may get diarrhea, upper respiratory infection otitis media and allergies when started on other foods or drinks.
I have flat / inverted nipples can I breast feed successfully?
Tell the mother during pregnancy flat / inverted nipples sometimes improve after delivery and these women can actually breastfeed successfully moreover the baby suckles the areola and not the nipple.
Tell the mother after delivery before you start breastfeeding you should try to make the nipples stand out by using finger thumb/ pump / syringe.
If the nipples cannot be made to stand out even after manipulation and the baby is unable to suckle give the baby expressed milk.
Is it necessary for me to breast fed at night? What difference will one bottle feed (at night) make?
Breastfeeding at night gives the baby extra time for suckling. More Prolactin (which is a hormone that helps in milk production) is secreted at night than during the day. So it is always better if you breast feed the baby during the day and night. This helps to keep up the milk supply. Moreover even one bottle feed at night may cause infection. The easiest way to do so is to let the baby sleep with you so that he can breast feed without disturbing you.
My baby cries too often, especially at night. I feel he is not satisfied.
A baby may cry because of several reasons. He may want to be held and cuddled more, some babies need to suckle the breast for comfort. Another baby may have a wet nappy, have colic may not be well or may be uncomfortable. It is necessary to determine the cause and manage accordingly. If the baby is passing urine 6-8 times for daily & gaining weight adequately then he is getting enough breast milk.
How do I know that my baby is getting enough milk?
An exclusively breast fed baby who is getting enough milk usually passes dilute urine 6-8 times in 24 hours. Also for the first 4-6 months a baby will again 125 grams (500 grams / month) if adequately breast-fed. If the baby is gaining enough weight and passing dilute urine 6-8 times a day he / she adequately breast-fed.
My baby is passing watery stools is it because I am breast feeding him?
Breast milk is safe. Some exclusively breast fed babies pass frequent watery stools at times green or with mucus but they are normal, active and pass urine frequently. This is physiological and breast feeding should be continued. Similarly some normally thriving breastfed babies pass a motion once every 3-5 days this too is normal.
I am working woman so do I have to get my baby used to the bottle?
Breast feed exclusively and frequently for the whole maternity leave period. Do not start other feeds before you really need to. Even when you have to start working before 6 months explore whether the baby can be brought to you so that you can continue to breastfeed exclusively. If it is not possible for you feed the baby during the day you can do the following:
Continue to breastfeed as frequently as possible at night, in the early morning and at any other time that you are at home.
Learn to express your breast milk
Express your breast milk before you to go to work and leave it for the carer to give to your baby with katori and spoon. Breastfeed your baby after you have expressed.
HOW TO EXPRESS BREAST MILK BY HAND:
Teach a mother to do this herself. Do not express her milk for her.
Touch her only to show her what to do. Be gentle
Teach her to:
Wash her hands thoroughly
Sit or stand comfortably, and hold the container near her breast.
Put her thumb on her breast ABOVE the nipple and areola and her first finger on the breast below the nipple and areola, opposite the thumb She supports the breast with her other fingers.
Press her thumb and first finger slightly inwards towards the chest wall. She should avoid pressing too far, because than can block the milk ducts.
Press her breast behind the nipple and areola between her finger and thumb. She must press on the lactiferous sinuses beneath the areola. Sometimes in a lactating breast it is possible to feel the sinuses. They are like pods, or peanuts If she can feel them, she can press on them.
Press and release, press and release
This should not hurt-if it hurts, the technique is wrong.
At first not milk come, but after pressing a few times milk starts to drip out. It may flow in streams if the oxytocin reflex is active.
Press the areola in the same way from the SIDES, to make sure that milk is expressed from all segments of the breast.
Avoid rubbing or sliding her fingers along the skin. The movement of the fingures should be more like rolling.
Avoid squeezing the nipple itself. Pressing or pulling the nipple cannot express the milk. It is the same as the baby sucking only the nipple.
Express one breast for at least 3-5 minutes until the flow slows then express the other side, and then repeat both sides. She can use either hand for either breast, and change when they tire.
To express breast milk adequately takes 20-30 minutes, especially in the first few days when only a little milk may be produced. It is important not to try to express in a shorter time.
HOW TO STIMULATE THE OXYTOCIN REFLEX
Sit quietly and privately or with a supportive friend.
Some mothers can express easily in a group of other mothers who are also expressing for their babies.
Hold her baby with skin to skin contact if possible.
She can hold her baby on her lap while she expresses. If this is not possible, she can look at the baby. If this is not possible, sometimes even looking at a photograph of her baby helps.
Take a warm soothing drink
The drink should not be coffee
Warm her breasts
For example she can apply a warm compress or warm water or have a warm shower.
Stimulate her nipples
She can gently pull or roll her nipples with her fingers
Massage or stroke the breasts lightly
Some women find that it helps if they stroke the nipple and areola gently with fingers tips or with a comb.
Some women find that it helps to gently roll their closed fist over the breast towards the nipple.
Ask a helper to rub her back
The mother sits down leans forward, folds her arms on a table in front of her, and rests her head on her arms. Her breasts hang loose, unclothed. The helper rubs down both sides of the mother’s spine, she uses her closed fist with her thumbs pointed forwards. She presses firmly making small circular movements with her thumbs. She works down both sides of the spine at the same time, from the neck to the shoulder blades for two or three minutes.
HOW TO HELP A MOTHER TO POSITION HER BABY
Greet the mother and ask how breastfeeding is going.
Assess breastfeed
Explain what might help, and ask if she would like you to show her.
Make sure that she is comfortable and relaxed.
Sit down yourself in a comfortable, convenient position.
Explain how to hold her baby, and show her if necessary
The four key points are:
with his head and body straight
with his face facing her breast, and his nose opposite her nipple
with his body close to her body
supporting his bottom (if new born)
Show her how to support her breast:
with her fingers against her chest wall below her breast
with her first finger supporting the breast
with her thumb above
her fingers should not be too near the nipple
Explain or show her how to help the baby to attach:-
touch her baby’s with her nipple
wait until her baby’s mouth is opening wide
move her baby quickly onto her breast aiming his lower lip below the nipple.
Notice how she responds and ask her how her baby’s suckling feels.
Look for signs of good attachment
If the attachment is not good, try again.
The present infant mortality rate in India is 58 as per 2004(SRS data).In India, a significant proportion of child deaths take place in the neonatal period. Apart from infections, other causes like asphyxia, hypotherma congenital defects and prematurity are responsible for neonatal mortality. Also about one-third of the newborns have a birth weight less than 2500 gram(LBW).A significant proportion of mortality occurs in low birth weight babies. Hence the further reduction of IMR will require focused attention on neonatal mortality.
In recent years neonatology care has improved by leaps and bounds across the country, but still lot needs to be done.The introduction of better neonatal ventilation and NICU care has added in better outcome of low birth weight and low gestational age (premature) newborns. New technologies & better medications for the treatment of premature babies has improved the outcome in premature babies. So this means increased demand for specialized neonatal care units & specialists in our country. Nowadays,a preterm of 26 weeks gestational age with less than 800gm weight, has survived with least complications, if delivered in a hospital with a well equipped nursery and specialized care.
With the advent of better quality surfactants, early parental nutrition, better understanding and refined ventilation, the Neonatal Mortality Rate (NMR) have reduced in India. However a lot needs to be done in this field, as we are still far away from the developed western countries. This could be due to the dearth of NICU facilities and specialists, in small cities, towns and villages.
Also 2-3 % of newborns are born with congenital anomalies (birth defect). The vast majority of them are correctable. However it is important to appreciate that the first chance is the only chance.
At our unit we have a team of doctors, trained Nurses, Staff who are passionate & dedicated in Neonatal care. We have attached Pediatric Cardiac Surgery, Orthopaedic doctors, Paediatric Urologist, Neurologist as well as paediatric surgeon. Dr Anil Vaishnavi is expert in Neonatal care & ventilator care of newborns. Management of neonatal surgical problems as well as post operation care is also taken care of by the Neonatal intensive team. The pre-operative preparation and post-operative management is critical for a successful outcome. We work closely with our colleagues to optimize the management and outcome in our patients.
MUST KNOW
What is vaccination?
Vaccination protects children against serious diseases by stimulating the immune system against disease germs.
How does vaccine immunity differ from natural immunity?
Normally in most disease the disease germ enters the body, produces the disease & the body mounts fighting power against the germ and lastly one recovers from the disease. Here immunity against disease is produced after one has suffered from the disease. A vaccine is nothing but whole or part to the disease germ, which has been processed or modified in such a way that it loses its capacity to produce disease but it can still induce fighting power in the body when administered. Hence by vaccination one develops immunity without suffering from the disease.
MYTHS SHATTERED
Myth: It is better to develop natural immunity than get vaccinated.
Fact: The difference between vaccination & natural infection is the price paid for immunity. The price for natural immunity (infection) is the physical, economical & mental agony the entire family goes through after one suffers from a disease. In comparison price paid for vaccination is negligible.
Myth: By replying on vaccines my child's immune system becomes weak or does not develop at all.
Fact: No, vaccines do not weaken immune system. As generally thought vaccines are not ready made protection. The body acts on vaccine germs and produces antibodies, which fight against disease germs when the child comes in contact with disease any time in future.
Myth: Vaccines are known to cause serious side effects.
Fact: In most cases, vaccines ause no side effects or only mild reactions such as fever or soreness at the injection time. Very rarely people experience more serious side effects like allergic reactions. Be sure to tell your doctor if you have health problem or known allergies to medications or food.
"Vaccines", Yes, But how many?
As you know- Prevention is always better than cure. Fortunately due to progress in vassine science & technology, it is impossible to protect children against several serious diseases through vaccination. Normally a baby is exposed to millions of germs daily. It is much better to protect them against diseases through vaccination that let them be at risk & suffer.
Myth: My child does not require vaccine as he/she is healthy active & eats well.
Facts: Vaccination is intended to help keep healthy kids healthy, because vaccines work by protecting the body before disease strikes. If you wait until your child gets sick, it will be too late for the vaccine to work. The best time to immunize kids is when they healthy.
Myth: Combination vaccines cause more side effects.
Fact: Combination vaccines are as safe & effective as individual vaccines. There are two practical factors in favour of giving a child several vaccines during the same visit. First to immunise children as early as possible to give them protection during the vulnerable early months of their lives.
Second giving several vaccines at the same time will mean fewer clinic visits & fewer injections, which save parents both time and money and may be less traumatic for the child.
Myth: Its ok to skip certain vaccines.
Fact: In general skipping vaccines is not a good idea. This can leave your child vulnerable to potentially serious diseases that could otherwise be avoided. If you have reservations about any particular vaccine, discuss your concern’s with your child’s doctor. If your child falls behind the standard vaccination schedule, catch up vaccination is also available.
Myth: Vaccine may not be 100% effective so why vaccinate?
Fact: Vaccines indeed are the most effective weapons we have against diseases. They work 85% to 99% of cases. Smallpox has been eradicated from the face of earth & a dramatic reduction in the disease like polio, diphtheria, peruses, measles & mumps are evidence of power of vaccines. Vaccine failure is rare & in such a case the disease is usually mild.
Myth: Vaccines are for babies only. There is no need to vaccinate after 2 to 4 years of age.
Fact: Disease continue to affect school going children, adolescents and adults. It is always better to keep your child protected. Few vaccines ( like DTP) do not provide life long protection. Protective efficacy of these vaccines wanes off over a period of time, so regular boosters are required.
There are some new vaccines (like HPV) for adolescent girls to prevent cancer. Some vaccines (like full) need regular vaccination as the virus keep changing. For most of the vaccines age is not a barrier. Ask your doctor if you have missed any vaccine as you can always catch up.
How do vaccines help my child ?
BCG Vaccine:
Protects against tuberculosis, mainly several forms of tuberculosis TB causes over 3.5 lac deaths in India.
Polio Vaccine:
Protects against poliomyelitis a dreaded childhood disease leading to permanent weakness or paralysis of legs, arms or both, which can lead to permanent disability and even death. India is one of the few countries where polio still exists. Two types of vaccines Oral Polio vaccine (OPV) & inactivated Polio Vaccine(IPV) which is available as an injection.
Hepatitis B Vaccine:
Protects against contagious liver diseases from infection with Hepatitis B virus. Disease can cause lifelong infection, liver cancer, liver failure and even death. Hepatitis B virus spreads through contaminated blood & body fluids.
Hepatitis A Vaccine:
Protects against contagious liver disease that results from infection with Hepatitis A virus. Hepatitis A mainly spreads through contaminated food and water. In India, hepatitis A is a common cause of liver infection resulting in jaundice. Besides jaundice other symptoms are vomiting, loss of appetite & abdominal pain which may last up to 4 weeks. In some children this may progress to liver failure resulting in hospitalization & even death.
Hepatitis A and B are two different forms of viral hepatitis caused by different viruses. Vaccination against hepatitis B does not protect against Hepatitis A and vice versa.
Oral Rotavirus Vaccine:
Protects against Rota virus, the common cause of severe diarrhea & dehydration in infants, resulting in more than 5 lac hospitalizations and unto 1.5 lac deaths annually in India. The disease is characterized by vomiting and explosive watery diarrhea (up to 10 times a day) for 3-8 days. Inspite of good hygiene, Rotavirus infection is unavoidable as almost every child is infected with Rota virus by the age of 5 years.
DTP Vaacine:
DTP is combination vaccines that protects against Diphtheria, Tetnus and Pertussis. Diphtheria causes a thick covering blocking the throat & respiration. It can lead to breathing problems, paralysis, heart failure and even death. Tetnus is a serious disease that causes painful tighting of muscels, usually all over the body.
Pertussis is a contagious disease respiratory tract caused by bacteria. Many children who contract pertussis have coughing spells that last four to eight weeks. The disease is most dangerous in infants.
Two types of vaccines:
1. Currently used DTP vaccines known as whole cell DTP vaccines. They are many decades old and are often associated with a range of side effects.
2. The latest and technologically advanced Cellular DTP vaccines (Gentle DTP). They are as effective and come with significantly lesser side effects.
Tdap vaccine Protects kids 10 years and above against Diphtheria, Tetanus and pertussis as immunity wanes following primary vaccination with DTP vaccine.
Hib Vaccine:
Protects against meningitis (an infection of the covering of the brain and spinal cord), pneumonia (lung infection), epiglottis (a severe throat infection) and other serious infections caused by a type of bacteria called Hemophilus influenza type b. The risk of disease is highest for children between 6 months & 2 years of age.
Pneumococcal Vaccine:
Protects against pneumonia and meningitis, leading to hospitalization and death caused by some strains of Streptococcus pneumonia. Young children (younger than age 5 years) have the highest incidence of serious disease.
Influenza (flu) Vaccine:
Protects against contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and can also lead to hospitalization & death.
Measles Vaccine:
Protects against measles a highly contagious and serious disease with 20% of reported cases experiencing one or more complications (Ear infections, Pneumonia). Complications from measles are more common among very young children (younger than 5 years of age). It is spread by droplets or direct contact with nasal or throat secretions of infected persons.
MMR Vaccine:
Protects against 3 common childhood viral diseases namely Measles, Mumps & Rubella(German Measles.)
Measles: See the Measles vaccine section.
Mumps causes fever, muscle ache and loss of appetite; followed by swelling of salivary glands. In some children complications such as inflammation of the brain and/or tissue covering the brain and spinal cord(encephalitis/meningitis), inflammation of the testicles(orchitis), inflammation of the ovaries(oophoritis) and/or breasts(mastitis), deafness(usually permanent) may be seen.
Rubella is an acute viral disease that causes fever and rashes. If a pregnant woman in infected, upto 85% of infants will be born with some type of birth defect, including deafness, eye defects, heart defects and mental retardation.
Chickenpox Vaccine:
Protects against disease caused by exposure to the Varicella Zoster Virus. A skin rash with blisters (250-500), covering the body but usually more concentrated on the face scalp and trunk. The virus can also lead to pneumonia or infection of the brain. These complications are rare, but serious. Almost every one suffers from infection once in life. Vaccination is an effective way of preventing suffering from Chickenpox and Herpes.
Typhoid Vaccine:
Protects against Typhoid fever, a life threating illness caused by the bacterium Salmonella Typhi. Patients suffering from typhoid fever usually have a sustained fever as high as 103 to 104 F with stomach pain, headache and loss of appetite.
Cervical Cancer (HPV) vaccine:
Protects against cervical cancer, the most common cancer amongst Indian women, even more common than Breast Cancer. Every Year 74,000 women in India die due to Cervical Cancer. The new HPV vaccine can be given after the age of 10 years and is given in 3 doses. Vaccination along with regular screening provides the best possible protection against Cervical Cancer.
Current Vaccine Info & Side Effects Present Information Sheet:
| Vaccine | Protects Against | No of Doses | Age Given | Side Effects |
| BCG | Tuberculosis | 1 | At Birth or within 4 to 12 weeks | Nodule Formation after 3-6 wks, Ulcer pus Discharge |
| OPV | Polio | 5 | At Birth, 4 wks, 8 wks, 14 wks, 20 wks | No Fever/Reaction. Mild Loose Stools |
| HIB | Meningitis, Epigloitis, Arthiritis, Septicemia | 3 + Booster | 8 wks, 14 wks, 20 wks | Slight Pain & Fever |
| Hep -B | Hepatitis-B Virus, Causing Jaundice | 3 | At Birth, 1 month & 6 month | No fever/ Reaction |
| DPT | Diptheria Pertusis Tetanus |
3 +2 Booster | 8 weeks, 14 wks, 20 wks | Slight Pain & Fever |
| Measles | Measles | 1 | 9 months | Mild Fever & Rash may appear after a week |
| MMR | Measles, Mumps, Rubella | 1 | 15 months | Mild Fever & rash may appear after a week. Swelling may appears after 10 days. |
| Typhoid | Typhoid | 1 | After 2 years | Fever in younger children |
| Chicken Pox | Chicken Px | 1/2 does in children>30 kg | After 1 year of age | Mild rash & fever after 3-4 days |
| Hepatitis- A | Hepatitis-A | 2 | After 15months of age and 2nd dose after 6 months from Ist dose | None |
| Rotavirus Vaccine | Rotavirus Diarrhoea | 2 | Ist dose before 3months, after 6 wks & 2nd dose before 6months | Mild Diarrhoea |
| Pneumococcal Vaccine | Streptococcal Pneumonia Meningitis | 3 + Booster | at 2months, 4months, 6 months & Booster at 18months | Fever, Pain, Mild swelling at the site of infection |
BABY’S HEALTH GUIDE
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Breast Milk is the Best for your baby. Keep your baby on breast milk as long as possible. |
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Consult your Doctor on when to introduce your baby to solid food. Gradually introduce fruits, cooked suji, khichri/dal and mashed vegetables, strained meat and eggs in consultation with your doctor. |
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Bathe your baby every day, Wipe with a clean towel. |
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Cut Baby’s nail straight across. Do not attempt to clean baby’s nose and ears. Wash soiled nappies every time in hot water. Dry nappies in the sun. |
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Take your baby to the Doctor at regular intervals for check-up. |
DON’TS FOR YOUR BABY
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Don’t put Kajal in baby’s eyes. |
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Avoid oil drops in eyes, ears & nose. |
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Give light massage, Avoid Vigorous massage. |
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Don’t squeeze baby’s breasts during massage. |
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Avoid unnecessary medication. |
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Don’t hurry for a change in diet. |
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Don’t introduce new food in hot weather, during teething or when suffering from cold and fever. |
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Don’t introduce more than one new food at a time. |
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In hot season, give water with sugar/honey once or twice a day only. Breast milk provides enough water for the baby upto 5 month's age. |
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Breast Milk provides enough water for the baby up to 5 month’s age. |
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Give well-cooked food. |
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When in doubt, consult your Doctor. |
FEEDING TIPS FOR YOUR BABY
| 0-4 Months | |
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Nurse baby at least 5-10 minutes on each breast. |
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Six wet diapers a day is good sign. |
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There's no need to force baby to finish a feed. |
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Putting the baby to bed with a bottle could cause choking and dental caries later. |
| 4-6 Months: | |
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May need to start baby on cereal (iron-fortified). |
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Feed only one new cereal each week. |
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There is no need to add salt or sugar to cereal. |
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Offer baby extra water. |
| 6-8 Months: | |
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Add strained fruits and vegetables at first. Add mashed or finely chopped fruits and cooked vegetables later on. |
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Feed only one new fruit or vegetable each week. |
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Try giving baby fruit juice in a cup. |
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Offer the following foods only when baby has a full set of teeth because they may cause choking: apple chunks or slices, grapes, hot dogs, sausages, peanut butter, popcorn, nuts, seeds, round candies, hard chunks of uncooked vegeables. |
| 8-12 Months | |
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Add strained or finely chopped meat now. |
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Wait until baby's first birthday to feed egg whites. Some babies are sensitive to the egg whites. It's ok to give yolk to the baby. |
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Be patient. Babies make a mess when they feed themselves. |
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Always taste heated food before serving it to the baby. |
| 12-24 Months | |
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Add whole milk now. |
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Offer small portions and never force toddler to eat. |
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Respect your toddler's likes and dislikes. |
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Make meal time fun and interesting. Serve colorful food that are crunchy, smooth or warm. |
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Ask your doctor which baby food is best for your baby. |
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By 2 years baby should take part in family meal. |
WEANING/ COMPLEMENTARY FOOD
| 1. What should be my baby’s first weaning / complementary food? | |||||||||||||||||||||||||||||
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Based on cereal like rice, wheat etc. | ||||||||||||||||||||||||||||
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Single grain like moong dal | ||||||||||||||||||||||||||||
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Soft and flowing | ||||||||||||||||||||||||||||
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Bland in taste | ||||||||||||||||||||||||||||
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Mashed or strained to homogenize | ||||||||||||||||||||||||||||
| 2. How should I introduce more solid foods? | |||||||||||||||||||||||||||||
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Offer one new food at a time, every two to three days. This helps you identify adverse reaction to specific foods should they occur. Gradually introduce variety through combination of cereals and fruits. | ||||||||||||||||||||||||||||
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Begin with semi-liquid foods and once the baby has accepted that, increase variety in taste texture and consistency of food in order to ensure that the baby accepts family foods by the time he is 1 year of age. For e.g. small, chopped pieces of food to chew can be mixed in the feed. | ||||||||||||||||||||||||||||
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Initially, a baby might spit out the food. That does not mean he does not like it. Learning to swallow semi solid food is difficult for a baby who only knows to suck at the breast. So you need to keep trying. | ||||||||||||||||||||||||||||
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Food should be given in small serving in the beginning and the quantity should be increased gradually as your baby develops liking for it. | ||||||||||||||||||||||||||||
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Babies should not be force-fed. If your baby dislikes a particular food, it should be removed from his diet for some time and re-introduced at a larger stage or mixed with another food that he / she likes. | ||||||||||||||||||||||||||||
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Food should be given only when your baby is hungry and interested in eating. | ||||||||||||||||||||||||||||
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If a food makes your baby sick or pale, it should be given till the baby is older, as he / she might be allergic to it. | ||||||||||||||||||||||||||||
| 3. Should I give nutrient fortified food cereal to my baby? | |||||||||||||||||||||||||||||
| Fortified food cereals after six months help meet increased requirement of growing baby along with home made complementary foods. | |||||||||||||||||||||||||||||
| 4. What are the points to be kept in mind while preparing complementary foods? | |||||||||||||||||||||||||||||
| Complementary foods should be prepared from cereals like rice, wheat and maize, milk and root staples like potatoes. Variety should be introduced by adding food from one or more of the following groups: | |||||||||||||||||||||||||||||
| 1. | Pulse (lentils, beans, peas) | ||||||||||||||||||||||||||||
| 2. | Meat, chicken egg, fish | ||||||||||||||||||||||||||||
| 3. | Milk and milk products | ||||||||||||||||||||||||||||
| 4. | Fruits | ||||||||||||||||||||||||||||
| 5. | Oils and fats | ||||||||||||||||||||||||||||
| Use of foods in various combinations would help you to meet optimum nutrition for your baby. For e.g. cereal pulse / milk combination provides complete protein intake. Following table provides, information on the amount of food to be included from various food groups in your baby’s diet. | |||||||||||||||||||||||||||||
Balanced diet for infants and babies
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| 5. What should be the frequency of complementary feeds? | |||||||||||||||||||||||||||||
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When food is first introduced a small amount should be given 1-2 times a day and slowly increased to 3-4 times daily by one year. | ||||||||||||||||||||||||||||
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After one year complementary foods, should be given 4-5 times daily and breastfeeding continued at night. | ||||||||||||||||||||||||||||
| 6. Why is my baby hungry all the time? | |||||||||||||||||||||||||||||
| Babies ask for food because their bodies are telling them that they need to eat. Babies grow at a very fast pace. Also, at times mothers give foods which are very low on energy like rice water, dal water or they add too much water to prepare the food. This decreases the energy density of the food and the baby feels hungry all the time. Hence it is important that you give them energy dense foods like mix vegetable khichdi, dalia, mashed banana in milk etc. Fortified cereal food is also energy dense. | |||||||||||||||||||||||||||||
| 7. How do I check if my baby is getting the right kind of food in right quantities for healthy growth? | |||||||||||||||||||||||||||||
| Your baby’s growth is a good indicator, Growth can be measured several ways: | |||||||||||||||||||||||||||||
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Change in body weight is most reliable, healthy babies double their birth weight in 4-5 months and triple it by the time they turn 1 year | ||||||||||||||||||||||||||||
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Change in body length- healthy babies gain 25cc length in 12 months. | ||||||||||||||||||||||||||||
| Regular visits to your doctor will help ensure that your baby’s growth and development is healthy. | |||||||||||||||||||||||||||||
| 8. Which drinks should not be given to the baby? | |||||||||||||||||||||||||||||
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Packaged juices and herbal drinks | ||||||||||||||||||||||||||||
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Fruit squash concentrates | ||||||||||||||||||||||||||||
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Colas, lemonades and fizzy drinks | ||||||||||||||||||||||||||||
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Tea and coffee | ||||||||||||||||||||||||||||
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Bottled mineral water | ||||||||||||||||||||||||||||
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Whole cow’s milk in first 3 months | ||||||||||||||||||||||||||||
| 9. What are the foods that are choking hazards? | |||||||||||||||||||||||||||||
| It is very important that you take care of the texture and size of food. Chewy globs of food like white bread can be a choking hazard especially if your baby takes a big bite of it. Exercise caution during feeds or supervise him while he feeds himself. Never leave him alone to eat by himself. | |||||||||||||||||||||||||||||
| Here is a guide to foods that are a choking hazard: | |||||||||||||||||||||||||||||
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Paranthas, especially if big bites are taken | ||||||||||||||||||||||||||||
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Sprouts and other nuts | ||||||||||||||||||||||||||||
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Hard sweets | ||||||||||||||||||||||||||||
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Raisins | ||||||||||||||||||||||||||||
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Hard Fruit and raw vegetables e.g. apple, guava, raw carrot sticks | ||||||||||||||||||||||||||||
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Stringly food e.g. long piece of green leafy vegetables | ||||||||||||||||||||||||||||
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Whole grapes | ||||||||||||||||||||||||||||
COMMON QURIES BY MOTHRS
I have delivered today I don't have milk's?
The milk produced in the first 2-3 days (colostrums) is less in quantity but it is sufficient and very essential for the baby. The more the baby suckles the more milk will be produced. Colostrums is the milk which is produced in the first 2-3 days after delivery. It is thick yellowish in color. It is antibody rich (and has plenty of white cells) which protect against infection and allergy. It also contains certain growth factors which help the intestine to mature and prevent intolerance and allergy. The vitamin-A in colostrums reduces the severity of infection and prevents eye disease. It is a purgative, which helps clear meconium and prevents jaundice.
When should the baby be first put to the breast?
New born must be put to the breast within half to one hour of the delivery. Starting to breast-feed immediately after birth stimulates the production of hormones that help milk production. Early skin to skin contact even if the baby does not suckle stimulates milk production. It also helps in improving the mother child bonding.
Elders in the family want to give honey to the baby before I start breast-feeding Is it alright?
Prelacteal (any fluids given in the initial 2-3 days after birth) feeds should not be given as they replace the essential colostrums and the baby’s earliest feeds. Babies given prelacteal feeds are more likely to develop infections and allergies. Prelacteal feeds also interfere with sucking as the baby’s hunger is satisfied and he does not want to breast-feed. As a result breast milk takes longer to come in and it is more difficult to establish breast feeding. More if the prelacteal feed is given through a bottle there are more chances of infection. Babies who are fed using bottles also develop nipple confusion since it is easier to suck from a bottle than from the breast, babies prefer the bottle to the breast.
Why should i breast feed?
Breast milk has the following properties :
Prefect nutrients. Easily digested and efficiently used. Protects against infection. Helps bonding (between mother and baby) and development. Helps delay new pregnancy (if baby is exclusively breast fed.) Protects mother’s health Costs less than artificial feeding. Some studies suggest that breast-feeding may help a child develop intellectually and also prevent asthma and allergies in later years. How often should I breast feed?
Babies should be fed on demand. (as and when they want to feed)
Advantages of demand feeding:
Breast milk “comes in" sooner Baby gains weight faster Fewer breast problems such as engorgement Breast feeding more easily established Feed at least 10 times in 24 Hours more if he/she is willing. You should let him suckle whenever he seems interested. The baby should also be breastfed during the night. What should be the duration of one feed. Should I feed from both breast at one feed?
The baby should be allowed to feed from one breast till he/she is satisfied. Foremilk is the milk that is produced early in a feed. Hind milk is the milk that is produced later in a feed, this milk contains more fat with provides energy and satiety so it is important not to take the baby off the first breast till he had enough hind milk-otherwise he will not be satisfied after the feed. Let the baby suckle from only one breast at each feed. But if he wants more milk shift to the other part.
Note: - Let a baby feed when he wants and for as long as he wants.
Should I give water to my baby, as it is very hot?
Babies do not need other drink (of water) before they are 4-6 months old, even in hot climate. Babies get a large amount of water from foremilk, this is all that the baby needs. Moreover if babies satisfy their thirst with water they may take fewer breast feeds.
I have had a caesarian section so I am in pain. How do I breast feed?
You can breast fed in whatever position you and the baby are comfortable. You can feed in the lying down position keeping in mind four key points, you can turn to one side and feed if it is comfortable. Or if your obstetrician allows you may sit in propped up position and feed normally.
Four key points are:-
With his head and body straight With his face facing her breast, and his nose opposite her nipple With his body close to her body Supporting his bottom (if newborn) As I have undergone a caesarian section my baby is in the nursery. How do I breast feed.
Express your breast milk to be fed to the baby by Katori spoon
Till when should exclusively breast feed?
Breastfeed exclusively for 4-6 months, Break milk is adequate for the baby till the age of 4-6 months if the baby is growing well. If babies are given other foods or drinks, even in small amounts some of the advantages of breast milk may be lost. Babies may get diarrhea, upper respiratory infection otitis media and allergies when started on other foods or drinks.
I have flat / inverted nipples can I breast feed successfully?
Tell the mother during pregnancy flat / inverted nipples sometimes improve after delivery and these women can actually breastfeed successfully moreover the baby suckles the areola and not the nipple.
Tell the mother after delivery before you start breastfeeding you should try to make the nipples stand out by using finger thumb/ pump / syringe.
If the nipples cannot be made to stand out even after manipulation and the baby is unable to suckle give the baby expressed milk.
Is it necessary for me to breast fed at night? What difference will one bottle feed (at night) make?
Breastfeeding at night gives the baby extra time for suckling. More Prolactin (which is a hormone that helps in milk production) is secreted at night than during the day. So it is always better if you breast feed the baby during the day and night. This helps to keep up the milk supply. Moreover even one bottle feed at night may cause infection. The easiest way to do so is to let the baby sleep with you so that he can breast feed without disturbing you.
My baby cries too often, especially at night. I feel he is not satisfied.
A baby may cry because of several reasons. He may want to be held and cuddled more, some babies need to suckle the breast for comfort. Another baby may have a wet nappy, have colic may not be well or may be uncomfortable. It is necessary to determine the cause and manage accordingly. If the baby is passing urine 6-8 times for daily & gaining weight adequately then he is getting enough breast milk.
How do I know that my baby is getting enough milk?
An exclusively breast fed baby who is getting enough milk usually passes dilute urine 6-8 times in 24 hours. Also for the first 4-6 months a baby will again 125 grams (500 grams / month) if adequately breast-fed. If the baby is gaining enough weight and passing dilute urine 6-8 times a day he / she adequately breast-fed.
My baby is passing watery stools is it because I am breast feeding him?
Breast milk is safe. Some exclusively breast fed babies pass frequent watery stools at times green or with mucus but they are normal, active and pass urine frequently. This is physiological and breast feeding should be continued. Similarly some normally thriving breastfed babies pass a motion once every 3-5 days this too is normal.
I am working woman so do I have to get my baby used to the bottle?
Breast feed exclusively and frequently for the whole maternity leave period. Do not start other feeds before you really need to. Even when you have to start working before 6 months explore whether the baby can be brought to you so that you can continue to breastfeed exclusively. If it is not possible for you feed the baby during the day you can do the following:
Continue to breastfeed as frequently as possible at night, in the early morning and at any other time that you are at home.
Learn to express your breast milk
Express your breast milk before you to go to work and leave it for the carer to give to your baby with katori and spoon. Breastfeed your baby after you have expressed.
HOW TO EXPRESS BREAST MILK BY HAND:
Teach a mother to do this herself. Do not express her milk for her.
Touch her only to show her what to do. Be gentle
Teach her to:
Wash her hands thoroughly Sit or stand comfortably, and hold the container near her breast. Put her thumb on her breast ABOVE the nipple and areola and her first finger on the breast below the nipple and areola, opposite the thumb She supports the breast with her other fingers. Press her thumb and first finger slightly inwards towards the chest wall. She should avoid pressing too far, because than can block the milk ducts. Press her breast behind the nipple and areola between her finger and thumb. She must press on the lactiferous sinuses beneath the areola. Sometimes in a lactating breast it is possible to feel the sinuses. They are like pods, or peanuts If she can feel them, she can press on them. Press and release, press and release This should not hurt-if it hurts, the technique is wrong. At first not milk come, but after pressing a few times milk starts to drip out. It may flow in streams if the oxytocin reflex is active. Press the areola in the same way from the SIDES, to make sure that milk is expressed from all segments of the breast. Avoid rubbing or sliding her fingers along the skin. The movement of the fingures should be more like rolling. Avoid squeezing the nipple itself. Pressing or pulling the nipple cannot express the milk. It is the same as the baby sucking only the nipple. Express one breast for at least 3-5 minutes until the flow slows then express the other side, and then repeat both sides. She can use either hand for either breast, and change when they tire. To express breast milk adequately takes 20-30 minutes, especially in the first few days when only a little milk may be produced. It is important not to try to express in a shorter time.HOW TO STIMULATE THE OXYTOCIN REFLEX
Sit quietly and privately or with a supportive friend. Some mothers can express easily in a group of other mothers who are also expressing for their babies. Hold her baby with skin to skin contact if possible. She can hold her baby on her lap while she expresses. If this is not possible, she can look at the baby. If this is not possible, sometimes even looking at a photograph of her baby helps. Take a warm soothing drink The drink should not be coffee Warm her breasts For example she can apply a warm compress or warm water or have a warm shower. Stimulate her nipples She can gently pull or roll her nipples with her fingers Massage or stroke the breasts lightly Some women find that it helps if they stroke the nipple and areola gently with fingers tips or with a comb. Some women find that it helps to gently roll their closed fist over the breast towards the nipple. Ask a helper to rub her back The mother sits down leans forward, folds her arms on a table in front of her, and rests her head on her arms. Her breasts hang loose, unclothed. The helper rubs down both sides of the mother’s spine, she uses her closed fist with her thumbs pointed forwards. She presses firmly making small circular movements with her thumbs. She works down both sides of the spine at the same time, from the neck to the shoulder blades for two or three minutes. HOW TO HELP A MOTHER TO POSITION HER BABY
Greet the mother and ask how breastfeeding is going.
Assess breastfeed Explain what might help, and ask if she would like you to show her. Make sure that she is comfortable and relaxed. Sit down yourself in a comfortable, convenient position. Explain how to hold her baby, and show her if necessary The four key points are:
with his head and body straight with his face facing her breast, and his nose opposite her nipple with his body close to her body supporting his bottom (if new born) Show her how to support her breast:
with her fingers against her chest wall below her breast with her first finger supporting the breast with her thumb above her fingers should not be too near the nipple Explain or show her how to help the baby to attach:-
touch her baby’s with her nipple wait until her baby’s mouth is opening wide move her baby quickly onto her breast aiming his lower lip below the nipple. Notice how she responds and ask her how her baby’s suckling feels.
Look for signs of good attachment
If the attachment is not good, try again.