Theresa Huseboe

OB Teaching Due 11/15/10

Breast Feeding:

Appearance and stages of breast milk. There are three stages to breast milk called lactogenesis. Stage 1 starts at the beginning of pregnancy as the breasts prepare for milk production. Colostrum is produced and it is a clear, yellowish fluid. Colostrum gradually changes to mature milk referred to as “the milk coming in” in stage II. By the third to fifth day after birth expect to experience a lot of milk coming in. By about the 10th day after birth you will be in stage III of lactogenesis. (Wong, 2006)

At the beginning of the feeding, the milk is bluish and contains lactose and proteins, but little fat. Such milk is called foremilk. The end of the feeding produces hindmilk or cream (about 5%). The hindmilk contains more fat, the main source of energy for your baby. If breast milk is allowed to sit for half-an-hour after being expressed, the "cream" separates and settles on top of the watery part. This is because human milk isn't homogenized, like we get in the store, the process that makes the water and fat portion in milk stay blended. (http://www.nlm.nih.gov/medlineplus), (Wong, 2006, p 773)

Breast Care. Learn proper technique which is covered later. Use your finger to break suction before removing baby. Be sure to pat dry breast and allow to air dry. Use only cotton bra pad and change as soon as they get wet. Apply 100% lanolin to nipples after feeding and allowed to dry. Do not use harsh soaps or perfumed creams.( http://www.acog.org/publications/patient_education/bp029.cfm)

Nursing Procedure:

1) Hand washing. Wet hands. Apply soap. Lather and scrub for 20 seconds, be sure to clean between fingers, under nails and tops of hand. Rinse for 10 seconds. Turn off tap with paper towel and dry hands. (www.cdc.gov/clean hand s / )

2) Position. The football hold is comfortable if you had a cesarean. The modified cradle works well for early feedings. The side-lying will allow you to rest and if you are experiencing perineal pain and swelling. Whatever position you choose be sure have support for your arms and back. The baby is at breast level and in good body alignment. (Wong, 2006, p 775)

(www.acog.org)

3) Try and have the baby nurse from both breasts at each feeding. When the baby finishes sucking the first breast, put your finger into the baby's mouth to release the sucking, and then offer the other breast. At next the feeding, start the other way round. When the baby has had enough, he or she will just fall asleep or stop sucking. (http://familydoctor.org/online/famdocen/home/women/pregnancy/birth/019.html)

4) Grasp nipple with your free hand, put your thumb on top of your breast and your other fingers below. Express a few drops of milk and spread over nipple. Using one of the positions from above bring baby to breast, not breast to baby. Lightly touch baby’s lower lip to nipple to open mouth. The mouth should cover as muck or the dark area as possible, not just the nipple. If latched on

correctly the nose, cheeks, and chin should be touching breast. If worried about breathing don’t push on breast around nose, but raise infants hip to change angle on breast.

5) Timing and frequency. Newborns need 8 to 12 feedings in a 24 hour period. Feed at least every 3 hours during the day and at least every 4 hours at night during the first few weeks. Once baby is feeding well and gaining the right amount of weight you can start demand feedings. This is when you notice feeding cues such as hand-to-mouth movements, sucking motions and tongue movements. Crying is a late sign of hunger. (Wong, 2006, P 775-776)

6)Remove infant from breast by breaking the suction, insert a clean finger between your breast and your baby's gums. When you hear a soft pop, pull your nipple out of the baby's mouth. (www.acog.org)

7) The baby is getting enough milk if content after each feeding. Your breast feels full and firm

before and less full after a feeding. Gains weight consistently after the first week. Your baby may

lose some weight in the first week. The baby should have 6 to 8 wet diapers a day. Baby has

about 2 to 5 stools a day at first then may have 2 or less a day. (www.acog.org)

8) Preventing/healing sore nipples: It is normal to feel nipples soreness the first few days of

breast feeding. The best way to prevent sore nipples is correct feeding technique. Reposition or

offer other breast. If sore nipples occur, apply ice to nipple for 2 to 3 minutes to numb before

feeding. After feeding, clean with water and express a few drops of milk and rub into sore area

and air dry. Or you can try a cooled steeped caffeinated tea bag for 1 to minutes. Or a warm

water compress may also help. They should allow to be aired dried as much as possible. If they

are too sore for breastfeeding try electric pump for 24 to 48 hours to allow for healing. Avoid using

flexible nipple shields on the market claiming to be a treatment for sore nipples. They can actually

cause chafing as the baby sucks. Also the baby may not get enough milk when using them.

(Wong, 2006, p 784)

9) Engourgment: On the third to fifth day after baby is born the breast will engorge due to changes

in hormones and increased milk production and blood supply. The breasts are firm, tender,

swollen and hot. The nipples may also be flat which makes it difficult for baby to latch-on. This

engorgement lasts about 24 hours. During this time feed the baby every 2 hours on one breast

and pumping the other to soften. Also use ice packs 15 to 20 minutes on and 45 minutes off

between feedings. Large bags of frozen peas or corn work well. Cover both breasts. Ibuprofen

can also be used to reduce inflammation, achiness and temperature. (Wong, 2006,p783-784)

Nutrition and fluids for mom: Eat a balanced diet with plenty of calcium, minerals, and fat-soluble

vitamins. This means you should eat fruits, vegetables, whole-grain cereals and breads, meats, beans

and milk and dairy foods like cheese. You'll need to get enough calories, about 500 more per day than

usual. Drink plenty of fluids about 2 to 3 quarts.

A balanced diet that includes 5 servings of milk or dairy products each day will give you enough calcium.

If you don't eat meat or dairy products, you can get the calcium you need from broccoli, sesame seeds,

tofu and kale. Talk to your doctor about taking extra calcium if you don't think you're getting enough from

your diet.(familydoctor.org/online)

Problem foods and fluids: If you think a certain food is bothering your baby, stop eating it. If your baby

acts fussy or gets a rash, diarrhea, or congestion after nursing, let your baby's doctor know. This can

signal a food allergy. (www.acog.org)

Drugs while breastfeeding: There are few drugs that are harmful during breastfeeding. Discuss each

medication with physician and include any supplements you are taking.

Caffeine and alcohol can get into breast milk so either avoid or limit use. Caffeine can accumulate in the

baby’s system and cause irritability and sleep difficulties. It can also reduce iron content of milk causing

anemia in baby. If you do drink, to minimize effects consume right after feeding or wait 2 hours after

drinking to breastfeed. Smoking can cause you to make less milk and the chemicals can get into breast

milk. Also, never smoke in same room. This would be a good time to quit. (Wong, 2006, p783)

Bottle Feeding:

Positioning: Find a comfortable place to sit. Hold the baby close in a semi-upright position.

Support head. Be sure the bottle is tipped so that only milk and no air is in nipple. Don't feed

lying down; the formula can flow into the middle ear, causing an infection. Also the bottle should

not be propped up on a pillow or anything else because chocking can occur and deprives baby

and you of close bonding time. Also it has been shown to cause decaying of teeth.

It is important that the bottle is held so fluid fills the nipple so baby doesn’t take in additional air.

Frequency: Newborns should be feed at least every 3 to 4 hours, even if you have to wake the

baby up. This means six to eight feedings in 24 hours. The number of feedings will decrease as

the baby matures and drinks more at each feeding. The first feedings the baby usually takes in

10 to 15 ml. By the end of the second week it should be around 90 to 150 ml per feeding. A

predictable feeding pattern is usually seen by the 3 to 4 weeks.

You may notice an increase of appetite around 7 to 10 days, 3 weeks, 6 weeks, 3 months and 6

months. This is when growth spurts occur. During these times of increased appetite, increase

formula by 30 ml. (Wong, 2006, p787-788)

Burping: Burp your baby several times during a feeding, as most infants swallow air from a

bottle and can become fussy. The best 3 positions are:

1) Over the shoulder: Drape your baby over your shoulder and firmly pat or rub back.

2) On the lap sitting: Sit your baby upright, lean her weight forward against the heel of

your hand, and firmly pat or rub her back.

3) Lying down: Place baby stomach down on your lap and firmly pat or rub back.

(Wong, 2006, p788-789)

Types of Formula: There are four main categories:

1) Cow’s milk formula: Most infant formula are cow’s milk based that has been altered to

resemble human milk. This is done by removing butterfat, lowering protein and adding

vegetable oil and carbohydrate. This gives the right nutrient balance and is easier to

digest. Some babies are allergic to the proteins in cow’s milk and need another type.

2) Soy-based formula: This is used if the baby is intolerant to lactose to cow’s milk

protein. However, babies that are allergic to cow’s milk may also be allergic to soy. This

can also be used if you want to exclude animal proteins in your baby’s diet.

3) Casein- or whey-hydrolysate formula: This is for babies that have allergies to milk or

soy. It is easier to digest. It is also called hypoallergenic formula.

4) Amino acid formula: specialized formulas are available for premature infants and babies who

have specific medical conditions.( http://www.mayoclinic.com) (Wong, 2006, p789)

These formulas can come in three forms: powder, concentrate, and ready to feed. The powder form is

the most economical. If you use the concentrate of ready to feed be sure to refrigerate and use within

24 hours. (Wong, 2006, p789)

Care of bottles and nipples: Wash all bottles and nipples in warm soapy water using a bottle and nipple

brush. Rinse thoroughly and then air dry. Be sure to check nipples regularly to ensure the formula drips

out slowly. Rubber nipples need to be replaced every 2 to 3 months. Silicone nipples give baby better

control of milk flow and fewer odors. (www.cpmc.org) (Wong, 2006, p788)

New Stools:

Meconium is the infant’s first stool and is sterile and it is greenish black. It usually passes within

the first 24 to 48 hours. In very low-birth-weight is can take up to 7 days. Transitional stools

come after the third day of feeding; it is greenish brown to yellowish brown and thinner in

consistency of the meconium.

Breast fed: Yellow to golden, are pasty in consistency, and smell like sour milk.

Bottle fed: Pale yellow to light brown, firmer, and smells bad. (Wong, 2006, p 697)

Abnormal: Chalky white could indicate no bile from liver to digest food. Tarry black stool if not

the meconium could indicate blood in digestive tract. Bright red blood could mean a tear close to

anus and constipation if hard pellets. (http://www.mayoclinic.com/health/baby-poop/AN02044)

Infant Bath:

Behavior of infant during bath: Some babies take to a bath and some are fussier. The

temperament will likely determine the length of time. Be sure you are in a warm room with no

drafts. If they stay warm they will likely be remain calm.

(www.womenshealthcaretopics.com/bathingbaby.htm)

Where to give bath: A warm flat surface such as bathroom or kitchen counter, be sure to have

all supplies and never leave baby unattended. A blanket on floor will work, if warm enough.

(www.mayoclinic.com/health/healthy-baby/PR00041)

How often to give bath: A daily bath is not necessary. If you keep diaper area clean and clean

face after feedings and burps you have the areas that need the most attention. Bathe two to

three times a week for the first year. (www.mayoclinic.com/health/healthy-baby/PR00041)

(Wong, 2006, p762)

Time of day to give bath: relationship to feeding: Anytime that convenient except right after

a feeding. The increased handling may cause spitting up. (Wong, 2006, p763)

Type of bath: sponge or tub: A sponge bath is used until the umbilical cords falls off,

circumcision is healed and the navel is healed completely. This usually takes about 1-4 weeks.

After that a tub bath is appropriate.

(http://kidshealth.org/parent/pregnancy_center/newborn_care/guide_parents.html#)

List of equipment:

-Soft washcloth

-Cotton balls

- Mild unscented baby soap and shampoo

- Towels and blankets

-Infant tub with 2- 3 inches of water

-Clean diaper

-Clean clothes

(kidshealth.org) (Wong, 2006, p763)

List of equipment that should NOT be used: During the first 4 days, do not use alkaline

soaps and oils, powders and lotions. This will alter the acid mantel in skin providing a medium

for bacterial growth. (Wong, 2006, p. 762)

Safety factors: Warm water temperature, be sure to test. Never hold infant under running water

as the temperature may change. Never leave infant alone in water or in a high place on a

counter. If you have to leave, place baby in warm towel or blanket and take the baby with you.

(http://kidshealth.org/parent/pregnancy_center/newborn_care/guide_parents.html# )

Water Temperature: Water should be warm 36.6 to 37.2 C. Test with inner wrist. (Wong, 2006,

p763)

Bath sequence:

-Bring baby to area after you have gathered all the supplies.

- Check water temperature. No running water.

-Clean eyes from inner canthus outward with clean part of washcloth each time using

only water.

-Wash face, behind ears, and neck.

-Wash scalp with water and mild soap, rinse and dry.

-Undress baby and wash arms and legs

-Clean perineal area.

Dry, put on diaper and clean warm clothes.

Care of genitalia: For the female separate the labia and gently wash from pubic area to the

anus.

For uncircumcised males, gently retract foreskin until resistance is felt. Gently wash with soap

and warm water and return foreskin. Most newborns the foreskin cannot be retracted. By age 3

years in 90%, the foreskin can be retracted easily.

Circumcised baby, change diaper and inspect at least every 4 hours. Wash penis gently with

warm water to remove urine and feces. Apply petroleum to glans at each diaper change unless

Plasitbell was used. Only use soap after 5 to 6 days to allow for healing. Fanfold clean diaper to

keep diaper from pressing on circumcised area. (Wong, 2006, 755)

Cord care: Use a clean cotton swab dipped in the solution provided and clean around base of

cord and skin. Keep the stump dry by keeping the diaper folded down to avoid covering stump.

Stick with sponge baths until it has fallen off. Let it fall off on its own. Resist temptation to pull off

even if it’s just hanging by a thread.

Contact your doctor if baby has fever, it is red and swollen around the cord, continues to bleed,

oozes yellow pus, or is producing a terrible smell. (http://www.mayoclinic.com/health/umbilical-

cord/PR00046/NSECTIONGROUP=2)

Taking Temperature:

Taking axillary temperature, which is the armpit.: You can use a regular digital

thermometer. This method is not as accurate. The American Academy of Pediatrics (AAP)

suggests that you not use this method for babies under 3 months of age, when an accurate

reading is most important.

Undress baby to gain access to armpit. Make sure the underarm is dry. Slip the bulb of

thermometer into armpit. Hold baby’s arm firmly against side or bent across chest. When beeps

take out and read. Normal under the arm readings are 97.5 to 99.3 degrees Fahrenheit.

Taking rectal temperature: Use a blunt tipped rectal thermometer coated with petroleum jelly.

Gently insert into rectum, no further than ½ inch. Old in place until it beeps. Take out and read.

Normal rectal temp is 100.2 degrees Fahrenheit or less.

(http://www.babies.sutterhealth.org/afterthebirth/newborn/nb_fever.html)

Care of nails: Nails should be kept short by using blunt scissors, but be sure nails have grown

out enough from the skin first so that the skin is not mistakenly cut. If they are not long enough

and baby is scratching self, apply loosely fitted mitts or socks. (Wong, 2006, p. 763)

Clothing: A simple rule of thumb is to dress the baby as you would dress yourself. A cotton

shirt and diaper may be sufficient. Baby should wear a cap in cool weather to keep warm. Wear

a bonnet or hat to protect against sunburn and shade eyes if it is sunny. Wrapping the baby

snugly in a blanket to keep warm and gives a sense of security. Look for flame-retardant

clothing. (Wong, 2006, p. 760)

T-shirts, onsies, a few outfits, socks and hats is what is recommended for babies. Avoid

drawstring, which are strangulation hazard. No extra buttons, ribbons or decorative items that

could come off and become choking hazard. Reviewing clothing recalls from the Consumer

Product Safety Commission can help you make sure that you don't have any unsafe clothing in

your home. Also avoid tight elastic bands that could cut off circulation at arms and legs.

Wash all clothes before first wear. Unless your baby has eczema or sensitive skin your normal

detergent should be fine. If your baby does have sensitive skin, try Dreft or Tide free.

(http://pediatrics.about.com/od/babyproducts/a/08_baby_clothes.htm)

Diapers Types: You have a choice between cloth and disposable diapers. The advantage of

disposables is that they are convenient and an inner lining next to skin to help baby’s skin stay

dry and less chance of contamination. They have been becoming thinner and lighter.

Disposable diapers add 1 to 2 percent to municipal solid waste. On the other hand the cloth

diapers are reusable. However, they don’t keep the skin as dry and cloth diapers use more

energy and water in laundering and contribute to air and water pollution.

(www.healthychildren.org)

Diapering: You will need a diaper or two or two if boy, fasteners if using cloth, warm water and

cotton balls or clean washcloth or baby wipes, diaper ointment or petroleum jelly to prevent and

treat rashes. Never leave baby alone on changing table.

Wiping: Using the wet washcloth, cotton balls, or baby wipes, gently wipe your baby clean from the

front to the back (never wipe from back to front, especially on girls, or you could spread the bacteria

that can cause urinary tract infections). You might want to lift your baby's legs by the ankles to get a

better reach. Don't forget the creases in the thighs and buttocks.

For boys, keep a clean diaper over the penis during changing because exposure to air often causes

boys to urinate — on you, the walls, or anything else within range.

Once you've finished wiping, pat your baby dry with a clean washcloth and apply diaper ointment.

Disposable Diapers

If you're using disposable diapers:

Open the diaper and slide it under your baby while gently lifting his or her legs and feet.

The back part with the adhesive strips should be about level with your baby's bellybutton.

Bring the front part of the diaper up between your baby's legs and onto his or her belly.

Bring the adhesive strips around and fasten snugly. Be careful not to stick the tape onto

your baby's skin.

Here are a few extra tips to keep in mind:

Garbage should be emptied regularly (about once a day) if you're using disposables. Not

only does this prevent a stinky diaper pail but also prevents the growth of bacteria.

If you find any marks around your baby's legs and waist, the diaper is too tight. Go for a

looser fit next time.

If a rash develops at the diaper openings around your baby's leg and waist, change the

brand of diaper you're using. Sometimes babies become sensitive to certain brands of

diapers.

If diapering a boy, place the penis in a downward position before fastening the diaper. This

will help prevent leaks from creeping up above the waistline.

Fold down the waistline of the diaper if your baby's umbilical cord has not fallen off yet to

keep that area dry. Continue to do this for a few days after the cord has fallen off to

prevent irritation.

Always wash your hands well after changing your baby's diaper to prevent the spread of

germs.

Cloth Diapers

Cloth diapers come in many shapes and sizes. Traditional cloth diapers usually come prefolded or in a

square and require pinning. More modern types are fitted or contoured like disposable diapers, and

come with Velcro closures or snaps. Other cloth-diapering accessories include absorbent liners (some

are flushable), diaper doublers for extra protection at night, and diaper covers to help prevent leaks.

If you're using traditional cloth diapers, there are several ways to fasten them. One of the more

commonly used ways is the triangular fold:

Fold the square in half to form a triangle. (For newborns or smaller babies, you might need

to fold the long side of the triangle down a few inches so it fits your baby better.)

Place your baby in the diaper by gently lifting the baby's feet and legs and sliding the

diaper under. The longest side of the triangle should be behind your baby's back, with the

opposite corner pointing down toward the feet.

Bring the front part of the diaper up between your baby's legs and onto his or her belly.

Bring one side around so it overlaps the center part.

Bring the other side around so it overlaps the other two parts. Fasten all three parts

together with a safety pin.

Another method is the rectangular fold, which is similar to the fold of disposable diapers:

Fold the diaper into a rectangle. Some parents find it helpful to make an extra fold in the

diaper so that extra material covers the area the baby will wet the most — in the front for a

boy and on the bottom for a girl.

Position the diaper under your baby, with the long sides facing the same direction as your

baby.

Bring the bottom up onto your baby's belly.

Bring one side around and fasten with a safety pin, then do the same on the other side.

Here are some tips to keep in mind when using cloth diapers:

If using diapers that require pinning, use oversize pins with plastic safety heads. To prevent

pricking the baby, keep your hand between the pin and his or her skin. If this makes you

nervous, use diaper tape that comes in a dispenser.

Wet diapers can be tossed right into the diaper pail, but soiled diapers should be emptied

into the toilet first — especially if your baby is formula-fed or on solids. Some people rinse

the diaper before washing it. You may also choose to spray the diapers with water and

baking soda for better odor control.

If you're washing the diapers yourself, wash them separately from other laundry, using a

mild detergent that is hypoallergenic or recommended for infant clothing. Don't use fabric

softener or antistatic products, which can cause rashes on babies' sensitive skin. Use hot

water and double rinse each wash.

Always wash your hands well after changing your baby's diaper to prevent the spread of

germs.

(http://kidshealth.org)

Position of infant when lying down: The American Academy of Pediatrics (AAP) recommends that

healthy infants be placed on their backs to sleep, not on their stomachs. The incidence of SIDS has

decreased by more than 50% since this recommendation was first made in 1992. It is now also

recommended that premature infants sleep only on their backs. (http://www.healthychildren.org)

Importance of establishing a routine: Brining home a newborn is exciting, exhausting and

stressful. Establishing a routine can minimize the stress. The newborn needs to set the pace. Sleep

when the baby sleeps. If you have a partner, work out a night schedule. Establish visiting rules, many

people will want to see your new bundle of joy. Be sure to take care of yourself.

(http://www.mayoclinic.com/health/newborn/FL00107)

Reflexes:

Rooting: If you touch baby’s lip, cheek, or corner of mouth the baby should turn head and open mouth.

This will help the baby find breast or bottle for feeding.

Sucking: Rooting helps start the sucking when touched roof of mouth with nipple or a gloved finger.

Sucking is needed to draw in milk from breast or bottle.

Swallowing: When feeding the baby, swallowing follows sucking and the taking in of fluids. Check for

coordination with sucking and breathing. If the response is weak or gagging, coughing, apnea, or

vomiting occurs, this could indicate prematurity, effects of any drugs mom had on board or illness that

needs further investigation.

Grasp Palmer and Plantar: Place finger in palm of hand and again at base of toes. The infant’s fingers

curl around examiner’s finger, toes curl downward. This response lessens by 3 to 4 months and is

stronger in premature babies.

Extrusion: Touch or depress tip of tongue. Newborn should force tongue outward. This response

disappears about at fourth month as starts to develop muscles to accept solid foods.

Glabellar (Myerson): Tap over forehead, bridge of nose, or maxilla of newborn whose eyes are open.

Baby should blink for first four or five taps. If the blinking persists it is an abnormal sign and needs to be

investigated.

Tonic neck or “fencing”: With infant in a supine neutral position, turn head to one side. With head

facing left side, arm and leg on that side extend. The opposite if true if turn head to right. This response

should disappear by 3 to 4 months. Persistent response after 6 weeks is a sign of an abnormality.

Moro (or startle): Hold the infant in semi sitting position and allow head and trunk to fall

backwards with support. Place the infant on flat surface and make a loud noise. You should see a symmetric abduction and extension of arms and fingers forming a “C” with thumb and forefinger. Arms are adducted in an embracing motion and return to relaxed flexion. The baby may cry. This response is present at birth. Complete response may be seen until 8 weeks. Body jerk only in 8 to 18 weeks. Asymmetric could mean injury to brachial plexus clavicle, or humerus. Persistence response after 6 months could mean possible neurological abnormality.

Stepping or walking: Hold infant vertically under arms or trunk, allowing one foot to touch table surface.

The infant should look like they are walking by alternating flexion and extension of feet. Full term will

walk on soles and preterm walk on toes, this response in normally present for 3 to 4 weeks.

Crawling: Place the infant on stomach. The baby should make crawling movements with arms and legs.

This should disappear about 6 weeks.

Deep tendon: Use finger instead of percussion hammer. Baby should be relaxed. Tap on patellar to test

knee jerk. Should be present, if not it is abnormal and need further investigation.

Crossed extension: Lay infant on back, extend on leg, press knee down and tickle the bottom of foot.

Observe the opposite leg, it should flex, adduct and then extend. This is testing the contra lateral side of

the spinal cord.

Babinski (plantar): On the sole of foot, beginning at heel, stroke upward laterally on sole, then across

ball of foot. All the toes should hyperextend; this is normal response (negative babinski). If the big toe

should dorsiflex it is a positive babinski response. If this response is absent it requires a neurologic

exam.

Pull-to-sit: Pull infant up at wrists from supine position with head in midline. The head should come

forward with minimal lag, and then the head falls forward when placed in sitting position. The haed

should come up equally on both sides. This response disappears by forth week.

Truncal incurvation (Galant): Place baby on stomach on flat surface, run finger down back about 4 to 5

cm lateral to spine, first on one side and then the other. You should see the truck flex and pelvis is

swung towards the side you stroked. If no response this could mean general depression of nervous

system and should be investigated.

Magnet: Place baby on back, partially flex both legs and apply pressure to soles of feet. Both legs should

extend against examiner’s pressure. If no response it suggests damage to CNS. This reflex may be weak

after a breech birth.

Resources for Relexes:

(Wong, 2006, p 703-706)

http://www.nlm.nih.gov/medlineplus/ency/article/003292.htm

http://www.otinfo.org/index.php?option=com_content&view=article&id=72:primary-primitive-

reflexes&catid=30:ot-pediatric-assessments&Itemid=40&limitstart=5

http://www.otinfo.org/index.php?option=com_content&view=article&id=72:primary-primitive-

reflexes&catid=30:ot-pediatric-assessments&Itemid=40&limitstart=5

Newborn Metabolic Screening:

Purpose of testing: It is your first step to a healthier tomorrow. The Minnesota Department of Health ,

along with you hospital and health care tem will test for over 50 hidden, rare disorders in a simple blood

tests. The disorders screened in Minnesota are treatable. Visit

http://www.health.state.mn.us/newbornscreening/whatis.html for complete information about the

tests and complete fact sheets for each disorder tested.

How blood is obtained: In the state of Minnesota we take a few drops of blood from baby’s heel before

you leave the hospital.

Where is test analyzed: The tests are performed at the Minnesota Department of Health.

List several metabolic disorders that are captured with this screening:

Phenylketoria (PKU): This can affect how the body breaks down protein. Successful outcome depends

on early detection. If an infant has PKU they may be late to sit, crawl and stand. If not treated, it can lead

to hyperactivity, restlessness, seizures and mental retardation.

Galactosemia: This is a person that doesn’t have enough enzymes to break down the sugar galactose.

This can build up in body and cause liver damage, mental retardation, poor growth and cataracts.

Sickle Cell Disease: This disease affects the red blood cells, so they can’t carry enough oxygen to body. If

not treated can lead to infection in blood, enlarged spleen, pneumonia, stroke, anemia, and painful

crisis.

Congenital Hypothroidism: This person doesn’t make enough thyroid hormone and the body can have

problems making energy and growing. If not treated can cause jaundice, poor feeding, sleepiness,

constipation, and poor growth and weight gain.

Medium-chain acyl-CoA dehydrogenase deficiency (MCAD): This person doesn’t have enough enzymes

to break fat down to energy. If not treated, it can lead to metabolic crisis, little energy, crying for no

reason, poor appetite, and coma.

Cystic Fibrosis: This disease effects breathing and digestion. If not treated, it can lead to coughing and

wheezing, lung infections, too much mucus, poor growth and weight, and greasy stools.

(http://www.health.state.mn.us/divs/phl/newborn/about.html)

Immunizations:

Attach immunization schedule:

http://www.cdc.gov/vaccines/recs/schedules/downloads/child/2010/10_0-6yrs-schedule-pr.pdf

Describe importance of staying on schedule: Not only are you protecting your own baby, it protects the

“herd”, the population in general. Vaccines have proven to control and even eradicate disease. An

immunization campaign carried out by the World Health Organization (WHO) from 1967 to 1977

eradicated the natural occurrence of smallpox. If everyone would stay on schedule we could possibly

eradicate even more diseases. ( http://www.who.int/mediacentre/factsheets/fs288/en/index.html)

Safety:

Alcohol- drinking in the immediate post partum period: This can be a potential risk factor for post-

partum depression. If you feel you have to drink to get by or feeling depressed, seek help from your

doctor. There are treatments available for depression.

If you are breastfeeding and drinking be sure to consume it immediately after feeding and only have one

drink to minimize the effects on baby. Alcohol may impair the milk ejection reflex. (Wong, 2006, p783)

Tobacco- use in the immediate post partum period. If you do smoke, smoke outside away from baby.

Secondhand smoke in children is responsible for increases in the severity of asthma in children, has been

linked to SIDS, respiratory tract infections, and increased risk for middle ear infections.

Secondhand Smoke isDangerousEveryone knows that smoking is bad forsmokers, but did you know:• Breathing in someone else’scigarette, pipe or cigar smoke canmake you and your children sick.• Children who live in homes wherepeople smoke may get sick moreoften with coughs, wheezing, earinfections, bronchitis or pneumonia.• Children with asthma may haveasthma attacks that are more severeor occur more often.• Opening windows or using fansor air conditioners will not stopsecondhand smoke exposure.• The U.S. Surgeon General saysthat secondhand smoke can causeSudden Infant Death Syndrome, alsoknown as SIDS.• Secondhand smoke also can causelung cancer and heart disease.(http://www.epa.gov/smokefree/)

Car seats- Recommendations:

Be sure to read manufacturer’s directions and follow exactly. Do not start car until everyone is securely

restrained. ALWAYS use restraints. The LATCH (Lower Anchors and Tethers for Children) universal child

safety seat system started in 2002. Seat belts will no longer be used to anchor child safety seats in

vehicles after 2002. (Wong, 2006, p. 1108)

Infants (less than 20 pounds and one year of age) must be in rear-facing safety seat. If car has air bag,

the infant seat should go in back seat. (Wong, 2006, p. 761)

20-40 pounds- Convertible safety seats, the seat are positioned upright and facing forward. They have

different types of harnesses, be sure to follow manufactures directions. (Wong, 2006, p 1004)

Children under age 8 and shorter than 4 feet 9 inches: Must use booster seat that meets federal safety

standards.

For Minnesota state laws visit: http://www.dps.state.mn.us/ots/Laws_Legislation/child_restraints.asp

Bonding and Stimulation:

Methods: Hold your baby close. Give your baby eye contact. Talk to your baby; say his or her name.

Smile and sing to your baby. Inspect all parts of the baby; see if you can see family resemblances. Touch

and caress your baby and learn how your baby responds. Change diapers and feed. Feel free to ask the

nurses questions.

Benefits: Holding baby close will give your baby a sense of security, trust and love. Also your baby will learn your smell and learn that it means you are there to help. The baby will learn your voice as you talk and sing. You will soon learn that your baby has different cries as you spend more time with baby. The cries can mean hunger, pain, boredom, tiredness, and time to change diaper. As you start to touch and caress your baby you will learn what your baby likes and how to soothe. Seeing family resemblances is fun and exciting and can give a sense of community within your family. (Wong, 2006, p 630-634)

Postpartum Psychological Complications:

Postpartum blues:

Onset and length: It is normal to feel joy and well being in the first two days followed by a

feeling of “blue”. You may feel emotionally unstable and cry for no reason. Don’t worry this is normal. It

usually peaks around the fifth day and goes away round the tenth day. Some things you may feel are let-

down, restless, fatigue, not able to sleep, headache, anxiety, sadness and anger.

Treatment: Although we don’t know why this happens exactly, it is thought that it is caused by

lower levels of natural chemicals circulating in your body after delivery. The best things to combat these

feeling are to try and get enough rest; nap when baby does when possible. Let your friends and family

know when it is okay to visit. Use relaxation techniques that you learned in childbirth classes. Be sure

allow yourself some free time and let a trusted family member or friend take care of baby while you

soak in tub, go for a walk, talk with a friend or something else that you enjoy that will relax you. (Wong,

2006, p 638)

Postpartum depression:

Onset and length: If after the first few weeks you are feeling intense fears, anger, and anxiety

and irritable with little or no provocation. Also feeling jealous of baby because your partner gives all

attention to baby or thoughts about harming the baby or you seek help from your doctor. This occurs in

about 10% to 15% of new mothers. There is a natural course of gradual improvement over 6 months

after birth but waiting to get help can put you and baby at risk. Getting help from a health care

professional will allow treatment designed especially for you.

Treatment: Psychotherapy to focus on fears, new roles and any thoughts of suicide or

homicide. Medication is also needed by most. You doctor may prescribe antidepressant, anti anxiety or

electroconvulsive therapy based upon you symptoms. It is important to be honest about all your feelings

to receive the right treatment for you. (Wong, 2006, p 674-675)

Postpartum psychosis:

Onset and length: Symptoms can begin within days after birth, but usually 2 to 3 weeks and

almost always within 8 weeks of birth. You may feel all the same things as postpartum depression but in

addition you may feel like you can’t move, stand or work. Then feel suspicious, confused, irrational and

obsessive about the baby’s health and welfare. Delusions occur in 50% and hallucinations in 25% of

cases. In severe cases may hear voices commanding to kill the baby. When delusions are present you

may feel you baby is possessed by the devil, has special powers, or is destined for a terrible fate (APA,

2000). You may feel that something is wrong with the baby or that someone is hurting or poisoning. You

may also experience bipolar disorder which includes manic episodes.

Treatment: Hospitalization because postpartum psychosis is a psychiatric emergency. If mother

is not breastfeeding antipsychotics and mood stabilizer such as lithium is treatment of choice. If mother

is breastfeeding other mood stabilizers that are compatible can be used. Psychotherapy is then give

after the acute psychosis is past. This mood disorder can be episodic and can happen again within a year

or two of the birth. (Wong, 2006, p 675)