Jun 4, 2011

Preparing for Your Newborn

Note: This is a previous TPG post from 2007 that we are re-posting. 

Preparing for Your Newborn, by Dr. Che, Pediatrician

Of course you are excited about the arrival of your new child. And of course the child is going to be sound and healthy, a beautiful girl just like Mom or a handsome boy just like Daddy. It is important to relax, not worry too much and keep oneself healthy. There are plenty of books and magazines available, but they can often be confusing for the new parents. Some articles could be polar opposites of the other. Many discuss the forest and wilderness of child birth and child rearing. Here attention is paid to the individual ‘tree’! No matter how trivial the question may be to the experienced, but not so to the novice, no snappy answers no matter how stupid the question may appear to be. In this article, the little, minute, points which were brought up by parents-to-be will be discussed. The purpose is to help you relax, solve small problems and not to confuse you. 

Dr Che has been a pediatrician for many years and over ten thousand moms and dads have listened to him! 

Professionals are not always in agreement on specific child-rearing and feeding recommendations. Consult your physician or nurse if you receive conflicting information. The material in this guide is based on literature from the Department of Health from the Sates of Hawaii, California, New York, OHME General Hospital and Dr Che’s own personal experience with his wife and children. 

Mothers Diet
Eat a balanced diet. Avoid gaining too much weight. Try to avoid salty foods as they may raise blood pressure unnecessarily. Try to fortify your meals with calcium. Although supplements might do the job, it is best if you can have a glass of milk every morning. If you cannot tolerate cow’s milk for any reason, substitute it with fish if you can. Consult your obstetrician for advice. 

Mother’s Medication
One must be very careful with oral medication. Always alert your obstetrician and your baby’s pediatrician if you must continue to take oral medicine. Some drugs of concern are anti-thyroid medications, anti-malignancy medications, and anti-epileptic medications. Most antibiotics do not have any effect on the baby, but you must alert your doctor if you have to take them. Most drugs for URI are safe too. Some blood thinners and anti-cancer drugs should be terminated, at least temporarily before conception. 

You must be careful with the dosage of some drugs because there may be a postpartum change in metabolism. 

Your Parents & Your Partner's Parents
The Grand Parents may be very excited about the arrival of the new child. They would love to tell you what to do. They might be telling you a little too much too. They might want to tell you certain things that might not suit your intentions. They might insist on purchasing goods and clothes not suited to your taste. Your parents may be telling you the exact opposite of what your partners parents are telling you. If in doubt, remind your partner that you are going with your parents suggestions unless there is a definite social consequence. Bringing your parents to the child’s doctor is one idea. It has worked well in the past. 

Birth Weight, Feeding and Weight Gain
Usually a baby is born after forty weeks uneventfully weighing about 6lbs 9oz, (3000g) and is 20 inches (50cm) tall. If the child eats well, sleeps well and smiles a lot (especially while sleeping!), he or she will gain an average of 30g per day or about 1000g in a month. Whether the child is breast or bottle fed will be the parent’s choice. Nutritionally there will be no major difference as formula milk has improved dramatically over the last thirty years, although, most obstetricians; midwives and pediatricians strongly recommend breast feeding. Do your best to breast feed and if you have to discontinue don’t feel guilty about it. It is very important for the mother to feel secure about herself in order to comfort the newborn. Always ask for help if you have any problems or questions. 

Japanese nurseries will be kept at a temperature of 25 degrees year round. The babies usually wear only one piece of clothing. When you bring the child home, even in the winter, a room temperature of 20 degrees is adequate. Newborns tend to have cold hands and feet, but if you are worried about the child’s temperature touch the abdomen and check the baby’s activity. If you feel comfortable and the baby seems comfortable you do not need to adjust the room temperature. Babies frequently find over-heated rooms more uncomfortable than cooler rooms. You do not need to dress your baby with layers and layers of clothes. Your child will need room to wriggle and move too. The child will want to check out his fingers and toes, so save socks, mittens, gloves and shoes for special occasions and outdoor use only. 

If you are really really lucky you might be able to sleep a few hours each night, but it will be highly unlikely. Most babies will wake every two to four hours for feeding. This will most likely continue until the child is six months old. But going through this rough ordeal enable the child to implant gratitude to his/her own mother in the subconscious level of the child’s mind. Your hard work and effort will be rewarded later on. Don’t try too hard to do all the chores around the house, if you need to catch up on your sleep. Sleep while your baby sleeps. 

Make sure you are comfortable with the baby. If your positioning is simply not comfortable, the strain on your lower back will be significant. Keep the environment clean and hazard free. When the baby is small you can always consider a clean sink as an alternative to a baby bath. Keep the water lukewarm. Your baby will not appreciate water that is too hot. The baby’s skin is very sensitive to heat and pain. Have an extra wash cloth or gauze for the baby to hold on to while he/she is in the water. Almost all baby products these days are very safe for your baby, avoid using adult products. There is no need to bathe the baby for a long time. Always dry the baby thoroughly and quickly with a clean towel. 

Your baby’s skin and eyes (sclera) may turn yellow in his first few days. It is usually caused by Hyperbilirubinemia, a state in which the baby’s liver is not efficient enough to handle the entire metabolism of yellow coloured bilirubin, which is essential for the child’s digestive system. If you child is dark-skinned, attention must be paid to the white part of the eye and the colour of the child’ stool. Because Japanese babies are usually ‘yellow’ skinned, jaundice of the neonate is fairly well followed up. 

Ensure you tell your obstetrician or paediatrician if there is a family history of unusual blood types, hereditary blood disorders, liver, biliary duct and pancreatic diseases. 

A breast-fed child may have a prolonged period of jaundice compared to formula fed babies, but the condition is physiological and most often benign. If the baby spends the first seven days of his life uneventfully, it is usually safe to say that jaundice related congenital metabolic problem will be ruled out completely. However, a late onset liver disease because of a mechanical obstruction of ducts coming out of the liver is still possible if the stool colour is unusually white or has a green-grey tint. 

Baby’s Excretion 

If the baby is breast-fed, the child passes stool very frequently and it is often loose and sometimes watery. If the baby is formula-fed, the child will probably pass stool less than three times per day and the stool is usually almost solid. However, there are exceptions to the rule. As long as the baby is passing stool at least once a day your baby is not considered constipated. It is important to watch the colour of the stool. A greyish white stool passed more than once, might indicate a liver disease. A bloody stool, as opposed to a blood streaked stool, may denote a lower bowel problem. Tarry stool may indicate an upper gastrointestinal problem. 

Your baby may pass a pink /orange stained urine. The stain comes from urate (uric acid in salt form) and is a physiological phenomenon for the baby. It may happen on and off until the baby is about six months old, but it is benign and needs no medical attention. A more serious bloody, urine stained diaper will turn brown (tea coloured) when left for 20 minutes or more, whereas urate stained urine will not change colour. 

If in doubt save the stained diaper and consult your physician. 

Shape of Head
Often the shape of the baby’s head is distorted because of pressure in the womb or during birth. Unless there is an underlying trauma causing profuse bleeding the baby’s head will return to a normal shape, especially after the child is able to support his neck and head at about the age of four months. There is no need to force a baby to stop turning to one direction or support the head with cushions so that he cannot freely turn as he pleases. Being uncomfortable will just cause the baby to cry. 

Umbilical Cord
The umbilical cord will usually fall off within one week. The healing process should be uneventful if it is kept dry and the diaper is kept out of the way and not allowed to irritate the area. Some children may develop umbilical hernia, a benign protrusion from the belly button. 90% of these, no matter how large, will spontaneously correct itself by the time the child is one year old. Do not apply pressure in an attempt to enhance healing because it is not only pointless, but it may cause infection. 

Consult your doctor if the umbilical cord does not heal well or if the hernia is large. 

Japan has an unusually different immunization schedule for children. It is often unsatisfactory to almost all counties in Europe, America and Asia. It is strongly recommended that your child follow the schedule for his/her own country. Catching up is not easy and not knowing that the child’s immunization is incomplete may often create problems enrolling the child in the school system, including university entrance.

Screening Tests
The newborn blood tests (Guthrie Test) can find disorders that may cause serious health or developmental problems if not treated early. Babies with these metabolic disorders may look normal at birth even though they may be getting very sick. If found and treated before the symptoms appear they may lead a normal healthy life. 

In Japan, a refusal to have these screening tests has no penalty, but the tests are usually routine for all neonates born here. The tests should be done before the baby leaves the hospital and at the latest by the time the child is thirty days old (preferably before the baby is two weeks old). 

Only a few drops of blood on a special sheet of paper are required. The test paper will be sent to the approved laboratory (there is only one in Tokyo). Most health insurance covers the newborn test.
Because the test is highly sensitive, but not necessarily highly specific, some babies will need additional testing if false positive results are given. The screening results will be sent to the doctor’s office where the blood sampling was done. You should discuss the results with your doctor without delay. 

The following disorders are screened: PKU (Phenylketonuria), MSUD (Maple Syrup Urine Disease), Galactosemia, Congenital hypothyroidism (Cretinism), Hypermethionemia & Homocystinuria.
Haemoglobin disorders and histidinemia are no longer screened in Japan, if desired a separate test should be requested. 

A baby will be able to control his pressure build up in his ears after 30 days of age. It may not be a good idea to fly before this time, no matter how short the flight. Almost all pediatricians will agree. Ask your doctor what to do if the child needs to fly. Trains and buses pose no problem. 

Baby Car Seat
It is required by law both in Japan to provide an appropriate car seat for the baby. 
Never use the car seat in the front. Airbags pose a serious threat to the baby. 

Paperwork & Passport
Check in advance what is required for registration. Japanese authorities accept a birth certificate from the hospital as an official record. Look for a baby studio which can handle baby portraits for use in passports. Most passports require two passports with white background, with the baby facing the front with eyes open. 

If your baby eats well, sleeps well and smiles a lot the child is in good shape! After all you are the parents, how could anything go wrong?!