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Problems in babies after birth

Spots and rashes

Spots and rashes are common in newborns, and usually disappear fairly quickly. Birth marks are longer lasting and may be of more concern.

Causes

Small white spots called milia are caused by blocked sebaceous glands, while baby acne is caused by the mother’s hormones remaining in the baby after the birth. Both disappear in time without treatment. Erythema toxicum is a rash of unknown cause that appears in the first day or two and disappears within a few days. It consists of red splotches with raised yellowish centers. The spots shift positions and eventually vanish with no treatment. Wash your baby’s face every day with water and baby soap and avoid lotions. If your baby’s acne doesn’t clear up on its own within three months, call your pediatrician.

Slow weight gain

All babies lose weight in the first days after the birth, but most are back to their birth weight by the 10th day. After that, most babies gain about 1 oz (30 g) each day. Breast-fed babies may take a little longer to regain their birth weight and generally gain weight more slowly. If a baby loses more than 10 percent of his initial birth weight or is not putting on weight as expected, you will usually need to see a doctor to check why this has happened and what you should do.

Causes

Slow weight gain is occasionally due to problems with breast-feeding; for example there may be problems with positioning and latching on, which mean that both mother and baby find it hard to establish breast-feeding. Another possible cause of poor weight gain is excessive vomiting.

What to do

If you’re breast-feeding, make sure you have an adequate intake of fluids and calories (you need an additional 500 calories a day), since too little of either can affect milk supply. Getting enough rest is also important for a healthy milk supply. You may be asked to give your baby “top-up” feedings until breast-feeding is well established, and will need advice on how to do this and maintain a good supply of breast milk.

Jaundice

This is a common condition in newborns that gives the skin a yellowish hue. Neonatal jaundice is usually caused by an excess of bilirubin, which is a substance normally produced during the breakdown of red blood cells. There are several types of neonatal jaundice: physiological jaundice, pathological jaundice, and breast-milk jaundice.

Physiological jaundice

This is the most common type of jaundice in newborns and is rarely of concern. Newborn babies have an excess of red blood cells. Since the baby’s liver is immature, it is unable to metabolize red blood cells quickly enough, which leads to a buildup of bilirubin. This type of jaundice often resolves on its own without treatment. However, if bilirubin levels are very high, this can damage part of the brain, so to avoid this, treatment is given with phototherapy lamps. The baby is placed, naked, under a special light or wrapped in a fiber-optic blanket. The lights help break down the bilirubin. Treatment is done for a few days, in the hospital or at home. Physiological jaundice usually appears two or three days after birth and goes away within two weeks.

Pathological jaundice

This is a more serious type of jaundice that can cause a rapid breakdown of the red blood cells and is usually due to an incompatibility between the mother’s and the baby’s blood. This may need immediate treatment in a neonatal unit.

Breast-milk jaundice

The most usual cause of prolonged jaundice is breast milk. This is thought to be caused by a substance in the milk that can make bilirubin levels rise. The recommended treatment depends on the bilirubin level. Your baby may not need any treatment. Doctors often recommend nursing the baby at least 8 to 12 times a day, initially, to help her body get rid of the bilirubin.

If jaundice continues beyond two weeks of age and is not thought to be due to breast milk, this should be investigated.

Vomiting

All babies vomit to some extent in the first weeks after the birth, but you should contact your doctor if your baby has prolonged or excessive vomiting, isn’t gaining enough weight, or you’re concerned. Serious vomiting can have several causes, including conditions such as gastroesophageal reflux and pyloric stenosis.

Other symptoms that may accompany vomiting can suggest particular conditions and will need investigating. If a baby seems lethargic or floppy, this could indicate an infection; if his abdomen is swollen, this could suggest an intestinal obstruction; if vomit is bright yellow or green, there could be a twisted bowel; and if there is also diarrhea, there may be gastroenteritis.

Gastroesophageal reflux

If your baby is miserable, in pain, arching his back, refusing feedings, or vomiting large amounts after each feeding, he could be suffering from gastroesophageal reflux. This occurs when the valve between the bottom of the esophagus (gullet) and top of the stomach is immature, allowing the stomach contents to come back into the esophagus. Acid from the stomach can burn the lower end of the esophagus, and if the reflux is severe, a baby can refuse feedings.

What might be done

Mild gastroesophageal reflux that involves vomiting but no problems with weight gain or pain, usually needs no treatment. More severe reflux will need treatment, usually with medicines to stop or prevent the acid production, and prevent the vomiting. For bottle-fed babies with mild reflux, it’s worth asking your pharmacist for an anti-reflux formula.

Pyloric stenosis

In this condition, which occurs most commonly in first-born male babies, the exit at the bottom of the stomach is thickened, meaning that milk cannot leave. It causes so-called projectile vomiting in which a feeding is vomited with so much force that it can land a foot or so away from the baby. The baby is constantly hungry and will demand another feeding immediately after vomiting. Vomiting becomes progressively more severe.

What might be done

Pyloric stenosis is diagnosed with a blood test and ultrasound, and treatment is surgical. The surgery is straightforward and the improvement remarkable. Babies usually leave the hospital within two or so days.

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