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.
