Consultant Obstetrician & Subspecialist in Maternal Fetal Medicine

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Mothers Experiences

Neonatal Care and Feeding Baby

Baby checks:

These will be performed in hospital by a midwife. If possible dr David Miller will also try and see your baby when you are in Royal Maternity. He will also arrange to see your baby for a 6-8 week check in 352.

Temperature. This is an assessment of how warm your baby feels to the touch. It is a good indication of how appropriate the temperature is around your baby. Your midwife can advise on the amount of clothing and bedding to use, whether in the house, car or pram etc.

Weight. Your midwife will weigh your baby at regular intervals and advise you about feeding according to your baby's weight gain. Your health visitor will give you information about local child health clinics, which have the facilities to continue assessing growth as your baby gets older. Most babies double their birth weight by four to five months and treble their birth weight by one year.

Tone (muscle tone - activity and reflexes). In the early days and weeks your baby will have some involuntary movements which are called reflexes. Typical reflexes are yawning, quivering, coughing, sneezing, stretching, and hiccoughing. One important skill babies are born with is the ability to suck and during the first few days they learn to coordinate their sucking and their breathing. They will also automatically turn towards a nipple or teat if it is brushed against one cheek and they will open their mouths if their upper lip is stroked. They can also grasp things like your finger with either hands or feet and they will make stepping movements if they are held upright on a flat surface. All these responses, except sucking, will be lost within a few months and your baby will begin to make controlled movements instead.

Jaundice (yellow colour). On about the third day after birth, some babies develop a yellow hue to their skin and whites of the eyes because of mild jaundice. It is a normal process and does no harm. The jaundice usually fades within 10 days or so, but it may last for up to two weeks. However, it is important to ensure that all is well if your baby is jaundiced and very sleepy with green or pale stools. In which case, a serum bilirubin blood test (SBR) may be recommended to detect the level of jaundice. If treatment is indicated this is done using phototherapy. The undressed baby is placed under a very bright light, usually with a soft mask over the eyes. This may continue for several days before the jaundice clears up. You will be advised according to your individual circumstances.

Eyes. The eyes are observed for any signs of stickiness, redness or discharge. Special cleaning of your baby's eyes is not required unless your baby develops an infection. This can occur for no apparent reason and appears as a yellow discharge in one or both eyes. If this happens, your midwife may take a swab or arrange for your doctor to prescribe treatment. Your midwife will also show you how to clean the eyes properly. It is common for a newborn to have poor control of its eyes and appear cross-eyed at times but this should decrease as the eye muscles strengthen. The eyes usually look blue-gray or brown. In general, your baby's permanent eye colour will be apparent within six to 12 months.

Mouth. The mouth is checked for redness or white spots or a white coating, which does not disappear between feeds. This may be a sign of thrush and can be avoided by good hygiene. If necessary, medicine can be prescribed by your GP.

Cord. The stump of the umbilical cord, which remains temporarily attached to the navel, requires no special attention, other than the normal careful washing and drying at bath time. The cord will separate naturally between 7 to 10 days following the birth. It is very common for the stump to bleed slightly as it separates and your midwife will advise you how to care for this. Usually all that is required is to ensure the nappy does not rub on the area. Any heavy bleeding, unusual discharge, redness, swelling, irritation or bad smell around the navel should be reported to your midwife or health visitor.

Skin. Your baby's skin is very sensitive in the early weeks. It will be observed for any signs of spots, dryness or rashes. For nappy rash, see below.

Urine and nappy rash. Your baby should have wet nappies every day. Occasionally a red stain is found on the nappy due to urates colouring the urine. This is quite normal and should resolve with normal feeding. Babies need their nappies changing fairly often, otherwise they become sore. Unless your baby is sleeping peacefully always change a wet or dirty nappy and change your baby before or after each feed, whichever you prefer.

Bowels (stools, constipation, diarrhoea). The baby's first bowel movements are comprised of a sticky, greenish-black material called meconium, which is present for about two days following birth. It is the waste that has collected in the bowels during the time spent in the womb. Later, it is normal for babies to have yellow or slightly brown-yellow stools. The number of stools per day and their consistency varies from baby to baby, and with the method of feeding. A breastfed baby will generally have loose, yellow, seedy stools and a bottle-fed baby will have stools which have a more pasty appearance. Your baby is not constipated if the stools are soft, even if the bowels have not been opened for a few days. It is normal for your baby to have one to ten stools per day. However, diarrhoea is when your baby has more frequent and/or looser stools than usual. If you have concerns ask your midwife or GP for advice.

Colic. A baby who cries excessively and inconsolably and either draws up his or her knees, or arches his or her back, especially in an evening, may have colic. You should tell your midwife so that an assessment can be made to rule out other causes. Your midwife will then advise you according to your individual circumstances.

The fontanelle. On the top of your baby's head near the front is a diamond shaped patch where the skull bones have not yet fused together. This is called the fontanelle. It will probably be a year or more before the bones close over it. You may notice it moving as your baby breathes. You need not worry about touching it as there is a tough layer of membrane under the skin.

Bumps and bruises. It is quite common for a newborn baby to have some swelling (caput) and bruises on the head, and perhaps to have bloodshot eyes. This is the result of the squeezing and pushing that is part of being born and will soon disappear. A cephalhaematoma is a bump, on one or both sides of the head due to friction during the birth, which can persist for weeks but will resolve naturally and no treatment is usually required.

Breasts and genitals. Quite often a newborn baby's breasts are a little swollen and may ooze some milk, whether the baby is a boy or a girl. Girls also sometimes bleed slightly or have a cloudy discharge from the vagina. All this is a result of hormones passing from the mother to the baby before birth and is no cause for concern. The genitals of male and female newborn babies often appear rather swollen but will look in proportion with their bodies in a few weeks.

Birthmarks and spots. Marks or spots that you notice mainly on the head and face of your baby usually fade away eventually. Most common are the little pink or red marks some people call 'stork bites'. These V shaped marks on the forehead, upper eyelids and nape of the neck gradually fade, though it may be some months before they disappear. Strawberry marks are also very common. They are dark red and slightly raised, appearing a few days after the birth, sometimes getting bigger. These too will disappear eventually.

Early development. Newborn babies can use all their senses. From birth your baby will focus on and follow your face when you are close infront of them. They will enjoy gentle touch and the sound of a soothing voice and will react to bright light and be startled by sudden, loud noises. By two weeks of age babies begin to recognise their parents and by 4 to 6 weeks start to smile. Interacting with your baby through talking to, smiling and singing are all ways of making a real difference in helping your baby feel loved and secure.

GENERAL BABY CARE

Baby led feeding. It is important to feed your baby whenever he or she feels hungry, for as long as he wants. Crying is a last resort to start a feed and this can be avoided by looking for feeding cues such as rooting, tongue movements, rapid eye movements and the baby sucking his or her fist.

Skin-to-skin contact. Spending some time quietly holding him or her in skin-to-skin contact (baby naked against your bare chest) straight after the birth is very important because: it helps to calm your baby; keeps him or her warm; steadies your baby's breathing; and gives you time to bond. It also helps to get breastfeeding off to a good start. Provided you are both well, you will be able to hold your baby straight away. A blanket over both of you will help keep your baby warm. If you have had a caesarean delivery, or have been separated from your baby for a while after the birth, you will both still benefit from skin-to-skin contact as soon as you are able.

Rooming-in. Even whilst in hospital babies are encouraged to sleep next to you in a cot, 24 hours a day. That way you will get to know them well and will quickly know when they need feeding. This is especially important at night when you can feed your baby as soon as he or she is ready without either of you being disturbed too much. When you go home it is recommended that your baby shares a room with you, particularly at night, for at least the first six months, as this helps protect against cot death.

Sleeping position. Your baby should be placed in the cot, on his or her back with their feet against the foot of the cot. This is to ensure that your baby's head does not become covered by bedding, leading to overheating. This is commonly referred to as the 'feet to foot' position.

Dangers of sleeping with your baby. The safest place for your baby to sleep for the first 6 months is in a cot in your room. Once a feed or cuddle is finished, it is safest to put your baby back in the cot before you go to sleep. This is because of the risk that you might roll over in your sleep and suffocate your baby, or that your baby could get caught between the wall and the bed, or could roll out of an adult bed and be injured. You are advised not to sleep on a sofa or armchair with your baby especially if you or your partner are smokers or have recently drunk alcohol, because of the link with cot death. Use of a dummy should not be stopped suddenly.

Ways to wake a sleepy baby. If there are concerns about how long your baby has slept, gently rouse your baby by providing tactile stimulation such as: changing the nappy, massaging hands and feet, rubbing the back or walking your fingers up and down his or her spine. Your baby can also be placed in skin-to-skin contact (see kangaroo care).

Kangaroo care. Dressed only in a nappy, the baby is held against your chest between your breasts, snug inside your clothing, often for hours. Fathers can do this too. Advantages include: more stable breathing, heart rate and temperature; less crying; better weight gain; and increased milk supply.

Ways to settle a crying baby

1. Offer a feed

2. Holding and comforting

3. If possible lie down with the baby in skin-to-skin contact (see kangaroo care)

4. Check to see if the nappy needs changing

5. Wrap in a blanket so your baby feels warm and secure

6. Play calm music and walk with your baby in your arms to the rhythm of the music

7. Your baby may respond to being cuddled and stroked in a warm bath

8. Babies like to be with their mother and often cry when separated, carrying your baby in a sling close to you may be soothing

Taking your baby out safely

Your baby is ready to go out as soon as you feel fit enough to go out yourself. Walking is good for both of you. It may be easiest to take a tiny baby in a sling. If you use a buggy, make sure your baby can lie flat on his or her back.

In a car. It is illegal for anyone to hold a baby while sitting in the back or front seat of a car. The only safe way for your baby to travel in a car is in a properly secured, backward-facing, baby seat, or in a carry cot (not a Moses basket) with the cover on and secured with special straps. If you have a car with air bags in the front your baby should not travel in the front seat (even facing backwards) because of the danger of suffocation if the bag inflates. Some areas have special loan schemes to enable you to borrow a suitable baby seat when you and your baby first return from hospital. Ask your midwife or health visitor for details

In cold weather. Make sure your baby is wrapped up warm in cold weather because babies chill very easily. Take the extra clothing off when you get into a warm place, including the car, so that your baby does not overheat, even if he or she is asleep.

In hot weather. Babies and children are particularly vulnerable to the effects of the sun, as their skin is thinner and they may not be able to produce enough pigment called melanin to protect them from sunburn. The amount of sun your child is exposed to may increase his or her risk of skin cancer in later life. Keep babies under six months old out of the sun altogether, by making the most of the shade such as trees or using a sunshade attached to the pram, and dressing them in loose baggy clothing. let your child wear a floppy hat with a wide brim or a 'legionnaire's hat' that shades the face and neck. During summer, cover exposed parts of skin with a sunscreen, even on cloudy or overcast days. Use one with a sun protection factor (SPF) 30 or above and which is effective against UVA and UVB. Re-apply often.
BREAST FEEDING
Benefits of breastfeeding
Baby. Breast milk is the only food naturally designed for your baby, with all the nutrients in the right proportions. It contains antibodies and other protective factors, which are transferred from you to your baby to help him or her fight infections and build up long-term resistance. Breast milk is easily digested and absorbed and helps to avoid constipation in your baby. It also contains growth factors and other substances which help your baby's growth and development. Some studies have found that children who are breastfed have better dental health and eyesight. Very tiny premature babies who are given breast milk have less risk of serious complications while they are gaining their strength. Breastfed babies may be easier to wean because they have already tasted, through your breast milk, traces of what you have eaten and drunk.

Mother. The extra fat laid down by your body during pregnancy is used up when breast milk is made. This can help you get your shape back sooner - and it is important not to cut down on food, but maintain a healthy, well-balanced diet when breastfeeding. Breastfeeding helps your womb to contract and return to its usual size more quickly and if continued for three months or more may reduce the risk of developing breast or ovarian cancer later. The Food Standards Agency recommends that whilst breastfeeding, you should take supplements containing 10 micrograms of vitamin D each day.

Benefits for mother

Benefits for baby

Lower risk of breast cancer Protection against ear infections
Lower risk of ovarian cancer uupsets
Faster return to pre-pregnancy figure Less smelly nappies
Stronger bones in later life Protection against chest infections and wheezing
No cost of preparation & lower risk of contamination Lower risk of diabetes
Milk always available at the right temperature Less allergies
Getting breastfeeding off to a good start

As soon as possible after the birth your midwife will show you how to hold your baby for feeding and how to make sure that he or she attaches properly to the breast. This is very important as it will help you to breastfeed successfully - most of the problems experienced by breastfeeding mothers in the first few weeks (sore nipples, for example) happen because the baby is not attached to the breast in the best way. It is important to feed your baby whenever he or she seems hungry. This will make sure you produce plenty of milk to meet his or her needs. That is because each time he or she feeds, messages are sent to your brain, which then sends signals to your breast to produce more milk. You may find it helps to breastfeed in bed at night, however your baby should be returned to the cot after the feed. Your midwife can advise you on how to share a bed safely with your baby.

More feeding              More signals              More milk

Breast milk contains all the food and water your baby needs. Giving other food or drink could be harmful and may also make him or her less interested in breastfeeding. If you give your baby a bottle:

1. He or she may be at greater risk of infection

2. He or she will be at greater risk of developing allergies if you have a family history of allergies

3. You may produce less milk for future needs

4. Sucking on a teat (or dummy) may make it more difficult for your baby to latch on to your breast properly.

Expressing, winding and weaning

Expressing breast milk. Your midwife will be able to show you how to express your breast milk once breastfeeding is established. In the early days, it can be used to stimulate a baby to feed or to produce colostrum or milk if you are separated from your baby. There are 3 main methods of expressing breast milk: by hand, hand pump and electric pump. The milk can be expressed into a sterilised bottle, covered securely and kept in the fridge for up to 24 hours. You can freeze breast milk for up to I week in the freezer compartment of the fridge or up to 3 months in a freezer. Thaw frozen milk in a fridge or by placing the container in luke-warm water. When it is thawed, use within 24 hours. Never refreeze.

Wind and possetting. Swallowing air whilst feeding can lead to trapped wind. If you think your baby has wind after a feed, it may help to hold your baby upright against your shoulder or propped forward on your lap. Then gently rubbing your baby's back should release any trapped air to find its way up and out easily. Some babies are never troubled by wind, but others seem to have discomfort after every feed. Many babies sick up a mouthful of milk during or just after a feed. This is called possetting or regurgitation and is not unusual. If you need further advice or information - ask your midwife.

Weaning. Exclusive breastfeeding is recommended for the first 6 months of an infant's life, as it provides all the nutrients a baby needs. Six months is the recommended age for weaning babies. When weaning your baby, carry on breastfeeding beyond the first six months.

General principles of breastfeeding

1. Feed your baby as soon as possible after the birth

2. You will be shown how to maintain your milk supply even if you and the baby are separated

3. No other food or drink should be given to your baby for the first 6 months, unless medically indicated

4. You and your baby should stay together 24 hours a day

5. Breastfeed on demand

6. Give no artificial teats or dummies

7. You can feed your baby in different positions as long as correct attachment on the breast is achieved

8. If suckling causes pain, take your baby off the breast, reposition and re-attach

9. It is important to offer unrestricted feeding on one breast, before starting the second

10.Join a breastfeeding support group

Attachment and positioning

1. Your baby's mouth should be wide open

2. There should be less areolar visible underneath the chin than above the nipple

3. Your baby's chin should be touching the breast with the lower lip rolled down and the nose free

4. There should be no pain

5. If your baby is not attaching well, tease your baby's lips with your nipple to open his or her mouth

6. Swallowing should be audible and visible

7. There should be a regular rhythmic suck

8. Your baby's arms and hands will be relaxed

9. Your baby's mouth will be moist

BOTTLE-FEEDING YOUR BABY

Always wash your hands before preparing or giving a feed and have everything ready before you start feeding. Get into a comfortable position so that you can cuddle your baby close as you feed. Give your baby time and let him or her take as much milk as they want. Some babies drop off to sleep and then wake up for more. At the end of a feed throw way any left over milk. Your baby will gradually settle into a routine. Respond to your baby's needs and feed him or her when they are hungry.

General principles (these instructions apply, whether you are using expressed milk or formula)

1. As you feed, keep the bottle tilted so that the teat is always full of milk, otherwise your baby will be taking in air

2. If the teat flattens while you are feeding, pull gently on the bottle to release the vacuum. If the teat blocks, start again with another sterile teat

3. You may need to experiment to find the right teat and hole size for your baby

4. Although it is traditional to warm a bottle, many babies do not mind cold milk

5. To test the temperature of warmed milk squirt some onto the inside of your wrist

Safe bottle feeding

1. Never prop up a bottle and leave your baby to feed alone - he or she may choke

2. Do not add solids to bottle feeds. Your baby cannot digest them and may choke

3. It is dangerous to use a microwave to warm the milk as the uneven heating may scald your baby's mouth

4. If you use a jug or bowl of hot water to warm your baby's feed, take extra care that it cannot scald another child and keep the teat covered and out of the water

5. Do not keep the milk warm for more than 20 minutes before the feed as germs can breed in the warmth

6. If you use bottled water to make up a feed (e.g. when on holiday) it must be boiled and then cooled first. Use spring and not mineral water and 'still', not 'fizzy'.

Washing and sterilising equipment. It is important to keep bottles; teats and other equipment used in feeding absolutely clean to protect your baby against infection until your baby is at least 6 months old. This means washing as well as sterilising. There are various methods and your midwife will give you all the information you need.

Making up feeds. Always wash your hands with soap and water before you start to make up the formula. Boil some water in the kettle and let it cool. Then put the cooled water into the bottle first, before measuring the exact amount of powder required, adding it to the water, following exactly the instructions on the tin or packet. The milk powder has been very carefully balanced for your baby, so do not add extra powder or anything else as this could make your baby ill. It is recommended that each feed is made up as required. If you need to place a bottle in the fridge, it should be in the coldest part at 5_c. Do not keep it for more than 24 hours and, if your baby does not finish a bottle, do not keep the extra, throw it away.

GENERAL BABY CARE

Prematurity (less than 37 weeks of pregnancy). If your baby was born early, there is an increased risk of conditions such as prolonged jaundice, infection, a low blood sugar and Vitamin K deficiency bleeding. It all depends on how early your baby has been born and if admission to neonatal intensive care is required you will be advised according to your individual circumstances.

Prolonged jaundice. This is when jaundice is still present after 2 weeks. In which case, a serum bilirubin blood test (SBR) may be recommended to detect the level of jaundice. If treatment is indicated this is done using phototherapy.

Infection. Some babies are at increased risk of developing infections in the eyes, umbilicus, urinary tract or on the skin, if the mother has an existing infection such as Group B haemolytic streptococcus, rupture of membranes (waters breaking) for more than 24 hours or has had a temperature in labour greater than 37_ C. Symptoms of infections are what your midwife is looking for during the baby assessments, and can appear as sticky eyes, redness around the umbilicus and septic spots, which may or may not be accompanied by your baby being generally unwell. If you have concerns regarding any of these factors contact your midwife.

Low blood sugar. A low blood sugar (hypoglycaemia) in a normally grown term baby is unusual. However, screening for hypoglycaemia may be indicated if he or she was born prematurely, is very small or very large, had a difficult delivery or you have diabetes.

Vitamin K deficiency bleeding. We all need vitamin K to make our blood clot properly, so that we won't bleed too easily. Some babies have too little vitamin K. Although this condition is very rare, it can cause bleeding, which can become dangerous. This is called 'haemorrhagic disease of the newborn' or vitamin K deficiency bleeding (VKDB). To reduce the risk, your baby will be offered vitamin K. It is recommended that the vitamin K is given by injection.

Information about Health Professionals
Those who will take care of your baby in the postnatal period
Midwife: Your midwifery team are usually the main care providers throughout the early postnatal period, which lasts from the birth of your baby until at least 28 days later. They will ensure that your care is tailored to meet your individual needs and will work in partnership with you and your family to ensure you can make informed decisions about your baby's care. Visits are arranged usually at home or at drop-in clinics in the local community. This will be decided between you and your midwife. 24 hour support is available from the midwifery service and you will be given all the information to access that support if required. Your midwife also works in partnership with other health professionals and can refer your baby to the appropriate specialist where required.

Health visitor: Health visitors work within the NHS. All are qualified nurses who have done additional training in family and child health, health promotion and public health development work, and work as part of a team alongside your GP and other community nurses such as practice nurses, school nurses, as well as midwives. Your health visitor will visit you at home after you have had your baby, and subsequent contacts can then take place either at home, the local health centre / surgery or in the local community. They work largely with families and young children and all have special expertise in the everyday challenges of parenthood.

Family doctor / General Practitioner (GP): Family doctors are responsible for general medical care and you will need to register your baby as soon as possible after the birth. Your doctor will follow your baby's development closely through regular assessments in partnership with the midwife and health visitor. The immunisation programme which begins at 6 to 8 weeks, also usually takes place at the surgery and your health visitor can give you more information about this.

Specialists: If a problem arises with your baby in the postnatal period, the following are also available to help you: audiology for hearing; physiotherapy and orthopaedics for hips; and ultrasound scanning for kidney problems.

Child health clinics: Child health clinics are usually based in your local health centre or GP surgery. They are run on a weekly basis by your health visitor and provide information and advice on all aspects of health and baby care. Your health visitor will give you all the information about where and when these clinics are held.

Child health records: The Personal Child Health Record (PCHR) or 'Red Book' will be given to you, ideally within 3 days of the birth and is the main record of your child's health, growth and development and needs to be kept in a safe place. This ensures that you have a copy of your child's progress for your own information and for health professionals when and where you may need it. It also records your child's height and weight, immunisations, childhood illnesses and accidents.

Registering the birth
The baby's birth must be registered at your nearest registry office within 6 weeks from the date of birth. Your midwife will give you all the details you need to do this. If you are married, you or the father can register the birth. If you are not married you must go yourself, and if you would like the father's name to appear on the birth certificate he must go with you. You cannot claim benefits or register your baby with a doctor until you have a birth certificate and a National Health Service number, which is usually allocated at birth.

SCREENING

What is the physical examination of the newborn?

Your midwife will complete an initial examination of your baby immediately after the birth. The first detailed examination however, will take place within 72 hours by a specially trained midwife, nurse or doctor. The examination includes eyes, heart and lung sounds, nervous system, abdomen and hips.

Your participation in this process is welcome and any concerns you have can be identified and discussed. The second detailed examination will be done by your GP or health visitor when your baby is 6 to 8 weeks old. If any problems are identified during either of these examinations or at any time in between, your baby will be referred to the appropriate specialist baby doctor; such as a paediatrician or neonatologist.

The checking of your baby's well-being is a continual process however; and each time your baby is seen by your midwife a detailed review of growth and development is undertaken as well as a physical assessment. Consequently the progress of your baby is documented, which enables early identification of any problems so that appropriate management and referral can be arranged. All findings will be discussed with you in detail.

Newborn hearing screen

A small number of babies (1-2 in every 1000) are born with hearing loss. A quick screening test can be done, usually before you leave the hospital, to identify those babies with hearing loss, so that support and information can be given to you at an early stage. In some areas, the newborn hearing screen may be done at home or at a local surgery or health clinic in the first few weeks of life. Your midwife will be able to tell you where and when the test is likely to happen and will give you a leaflet with more information.

Blood spot test

All babies are offered a simple blood test to find the very few who may be affected by the disorders phenylketonuria, congenital hypothyroidism, sickle cell disorders or beta thalassaemia major. Babies with these disorders can then be given early treatment to prevent serious problems. These disorders would not otherwise be seen in the newborn baby, even after careful examination by a doctor. Your midwife will take a small sample of blood from your baby's heel onto a card. This is then sent to a laboratory for testing. These conditions are covered in more detail in the leaflet you will be given.

How the test is done

Your midwife can do the test at home, usually between the 5th and 8th postnatal day. The blood from a heel prick is collected on a special card and sent to the laboratory. The heel prick will only cause a moment of discomfort which your baby will soon forget. Repeat tests are sometimes necessary for various reasons: there may not have been enough blood taken at the first test; the specimen may have been damaged or contaminated; a problem may have occurred with laboratory testing and no result obtained; or there may be a 'borderline' or unclear result. There are several reasons for an unclear result and the repeat test is often completely normal. If the repeat test is still unclear, arrangements will be made for your baby to see a paediatrician.

Obtaining the results

The results are usually ready within one working week and your midwife or health visitor will record them on your child's record. If you have been tested during your pregnancy, please let your midwife know so that your results can then be matched up with your baby's results.

A positive result

The vast majority of results are negative. However, if your baby has one of these disorders, arrangements will be made for you to see a specialist team experienced in treating these disorders. Your GP will also be contacted. If your baby is a carrier for sickle cell disorder, you will be given further information and your baby will be offered a follow-up test.

Early immunisations

BCG (Bacillus Calmette-Guerin). This is a vaccine offered to babies who may be at risk from contact with TB (tuberculosis). Those at higher than average risk are travelers and the homeless, but also people who have arrived in the UK from Asia, Africa, South and Central America and Eastern Europe. TB is a potentially serious infection, which usually affects the lungs, but can also affect other parts of the body. Treatment is with special antibiotics and the BCG vaccination is usually given to the baby early in the postnatal period. Ideally it should be given before the age of two months.

Hepatitis B Some people carry the hepatitis B virus in their blood without actually having the disease itself. If a pregnant mother has hepatitis B, or catches it during pregnancy, she can pass it on to her baby. The baby may not be ill but has a high chance of becoming a carrier and developing liver disease in later life. Babies born to infected mothers should receive a course of vaccine. The first dose is given within 24 hours of birth, and two more doses are given at one and two months with a booster dose at twelve months old.

IMPORTANT SYMPTOMS

Baby's illnesses can become serious very quickly. You know your baby best; do not wait too long if you are worried. Ask for help sooner rather than later. The following symptom checklist can help you decide whether you need to seek medical attention for your baby by contacting your midwife or doctor.
1. High pitched or weak cry

2. Much less responsive or floppy

3. Pale all over

4. Grunts with each breath

5. Takes less than a third of feeds.
.      Passes much less urine

.     Vomits green fluid

.     Has blood in stools

.     High fever or sweating
Urgent medical attention can be obtained by dialling 999 if your baby:

1. Stops breathing or goes blue

2. Is unresponsive and shows no awareness of what is going on

3. Has glazed eyes and does not focus on anything.

4. Cannot be woken

5. Has a fit

Reducing the risk of cot death

1. Place your baby on his or her back.

2. Cut smoking in pregnancy - fathers as well.

3. Do not let anyone smoke in the same room as your baby.

4. Do not let your baby get too hot (or too cold). The room temperature should be between    16 and 20_C.

5. Keep your baby's head uncovered and place him or her in the 'feet to foot' position.

6. Do not share a bed with your baby if you or your partner smoke, drink alcohol or take    drugs.

7. Do not fall asleep lying on a sofa or armchair with your baby.

8. Immunisation reduces the risk of cot death.

9. If your baby is unwell, seek prompt advice.

Safety

Children most at risk from a home accident are in the 0-4 age group. See you health visitor for information on practical issues such as fitting smoke detectors and how to keep your baby safe generally.

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