Baby’s first 24 hours
It all begins with a baby
Becoming a parent for the first, second, or third time is a wonder and nerve-wracking at the same time. There is an extra person in the world - and that person is now your responsibility. Those first hours are a step into the unknown. Read on to learn what to expect in the first 24 hours after birth to help you relax and give your baby the best possible start in life.
As a father of three and a Pediatrician, these are (some of) the things, I wish I had known when we had our first child.
Skin-to-skin contact
Skin-to-skin contact initiates bonding and stimulates the production of oxytocin in the mother which stimulates breastfeeding. Skin-to-skin calms the baby and the mother. Skin-to-skin contact can also be with the father.
Feeding
Immediately after birth, your baby may be very alert and responsive. This is a good time for initiating breastfeeding, as term infants should be breastfed within the first hour after birth - if breastfeeding is possible. After the first feed, your baby may sleep for some hours. Sleeping as much as 18 hours of the first 24 hours is normal, but your baby should feed every 3-6 hours and may need to be woken up for feeds.
On a side note - Your baby consists of about 75% water. For term babies, a weight loss of about 5-10% of the birth weight is expected in the first 3-5 days of life. Term babies should regain birth weight by 7-10 days of life.
Temperature
Don’t let your baby get cold. Hypothermia will stress your baby and is associated with negative consequences. The newborn baby’s response to cold stress includes breathing up, poor feeding, and irritability, all of which can be confused with sepsis and bacterial infection. The best way for a newborn baby to stay warm is skin-to-skin with a parent. Also, have some clothes ready and use a blanket to wrap your baby.
Breathing
The respiratory rate in a newborn should be less than 60 per minute and while intermittent grunting sounds can be normal, persistent grunting is not
Infants are nose-breathers so clear any secretions, if needed you can use a few drops of sterile water
Some periodic breathing is normal, but if the rate is consistently above 60 per minute, if there is ongoing grunting, or if your baby is working hard to breathe this is abnormal and requires immediate medical attention.
Heart rate
If you feel your baby’s heart beating, it will be very fast compared to your own heart rate, perhaps leading you to wonder if this is normal. The normal heart rate in babies is faster than in older children or adults, roughly 80-180 beats per minute would be normal depending on the state of your baby - that is, lower when sleeping and higher when crying. The rhythm should be regular, but a few extra beats are normal.
Peeing & Pooing
[Urine] 90% of healthy babies void by 24 hours of age and 99% by 48 hours. The most common reason for ‘lack of urine’ in the first 24 hours is undocumented urine void in the delivery room but also physiologic stress after a difficult birth can stress the kidneys. If no urine is seen within 24-48 hours you should contact a doctor
[Stools] 98% of term infants pass the first stool by 24 hours of age. The first stool is meconium, the bowel content of the fetus which can be black or dark green. Delayed passage of meconium can have different reasons ranging from benign to serious and you should contact a doctor if there is no stool after 24 hours. Especially if there is also abdominal distension and vomiting this could be a sign of intestinal obstruction.
General Appearance
The single most important thing to pay attention to is the general appearance of your baby. It is also the most difficult thing. Particularly with your first child.
[Alertness] While sleeping for extended periods of time is fine, your baby, when awake should be alert to the world. This means interacting with you, crying when unhappy, and wanting to feed.
[Muscle tone] The normal resting posture of a term newborn is flexion of the arms and legs and there should be spontaneous movement of the limbs. There is no need for you as a parent to test your baby’s reflexes, but if you touch the roof of the baby’s mouth with a finger, pacifier, breast, or bottle nipple then the infant should begin to suck - this is the suckling reflex.
[Skin] The color of the skin, according to ethnicity, should have a pink undertone. For newborns, peripheral but not central cyanosis, meaning a bluish tint to the skin, may be normal. Jaundice, a yellow glean, is abnormal in the first 24 hours. Later it may be normal, but if your baby becomes increasingly yellow you should see a doctor to check the level of bilirubin, the cause of jaundice. This is particularly true if your baby becomes drowsy and less interested in feeding or jittery. Many rashes are normal, the most common being erythema toxicum, with numerous small areas of skin with a yellow-white papule in the center. This usually resolves spontaneously in a few days. Not counting more rare diseases associated with skin changes, the most important thing to identify is an infection in the skin. This would generally be red, warm, swollen, and evolve over time. Bleeding in the skin may also be of concern.
[Umbilical stump] The umbilical cord stump typically sloughs off at around 7-10 days.
Rounding up
Hopefully, by 24 hours you have a baby that is feeding, sleeping, and cuddling with you. Enjoy the journey :-)
Disclaimer
This is not medical advice. The content provided is for informational purposes only. It is not meant to be a substitute for professional medical advice, diagnosis or treatment. Always seek professional medical advice for any questions you may have regarding a medical condition or treatment, and before undertaking a new health care regimen. Never disregard medical advice or delay in seeking it because of something you have seen or read here.
Fever in Children: A Comprehensive Guide*
911 or Netflix?
*Children > 3 months that are otherwise healthy
Introduction
It’s been two days and your child still has a fever. You’re starting to feel a bit anxious and considering whether you should take her to the doctor? Most parents recognise this scenario. Is the fever high? Is it low? What can you do that will help? Will there be a long wait at the doctor’s? What does Google say? Is it 911 or Netflix?
Doctors who are parents are not exempt to this, in some cases quite the contrary. However, as you consider the significance of the continued fever, but also that two-year old Julie did play for 30 minutes this morning it does help to know about normal versus more worrying signs she might be showing you. This article aims to provide a comprehensive understanding of fever in children, including its causes, symptoms, and effective management strategies. Read on for a paediatricians take on this all too common dilemma.
Definition and Causes of Fever in Children
Fever is defined as a body temperature above the normal range, i.e. above 38.0 degrees celsius / 100.4 Fahrenheit or more. Fever is the body’s normal response to an infection, meaning that Julies immune system is working to fight the infection. Fever is very common in young children, and usually lasts 3-4 days. Most often, fever is caused by viral infections such as a colds, flu, upper airway- or stomach infections that will pass by themselves without treatment with antibiotics. That’s because antibiotics are only effective against infections caused by bacteria. The immune system will also take care of many bacterial infections, but for some bacterial infections antibiotics may be needed to help conquer the infection. Examples are strep throat and urinary tract infections. Immunizations may also cause a fever, while there is no good evidence to support that teething in itself cases fever.
What can you do to help your child and when should you contact a doctor or seek medical advice?
The temperature in itself is less important than how Julie is doing. Therefore you need to observe her general condition, meaning that you have good contact with her, that she can play a little and drink. If there is a ‘secret’ to being a seasoned paediatrician who has seen many children in various stages of illness, it is how important the general condition is in assessing the need for further medical attention. Julie will be more tired and sleep more, but when awake eye-contact should be good. When you check on her during the night she should respond as she normally would to your touch. If not, wake her to check.
When children have a fever the pulse rate and rate of breathing increases - this is normal. Other normal symptoms during a fever include shivering, cold hands and feet, muscle aches, light head aches and having less energy.
It is important that she gets enough to drink. If Julie is urinating less she needs to drink more. Encourage her to drink little and often. Children with sore throats may appreciate cold drinks or ice lollies. If you’re breastfeeding continue to do so and remember to drink well yourself. If Julie has diarrhea or vomiting fluid intake is all the more important. The appetite will often be reduced and its okay if she eats less for a few days.
Dress your child lightly to keep cold. If your child is uncomfortable and over 2 years of age you can give paracetamol. This may lower the fever and help your child to feel better and drink more. Find the right dose for your child on the packaging and make sure you don’t exceed the maximum daily dose. Wait a few hours and see if it helped and your child is better. It is a good sign if your child plays and interacts with you after receiving medicine for discomfort. Fever medicine such as paracetemol will not help on the disease itself.
Your child can return to nursery, daycare or school when the fever is gone, and the child is eating, drinking and playing as usual.
There is a lot you can do at home. If your child is generally well, and can play and drink you can usually wait a little for improvement at home. It is reassuring if your child once in a while is reacting more normally and feeling better. Often, the disease will pass by itself.
Serious signs and situations you should react to
Call Emergency Services (e.g. 112 (European U) or 911 (USA)) as per national guidelines if your child
has seizures
develops a rash that does not disappear when a glass is pressed to the skin
does not give good eye-contact
gets a stiff neck and cannot bend the head forward
finds it hard to breathe
See your primary health care provider or emergency department if
your child is less than 3 months
persistent vomiting, diarrhea, or decreased fluid intake may lead to dehydration and warrents prompt medical advice
your child reacts less to its surroundings or becomes increasingly drowsy
your child has severe pain or continues to be unsettled
your child drinks very little and does not urinate for more than a few hours
if your child has a fever for more than 3 days with no improvement
pain, redness or swelling in a localized area, such as a red swollen knee, a severe sore throat or severe ear pain
You know your child and should generally contact a doctor if you are concerned about your child
Preventive Measures
While it may be challenging to prevent all instances of fever in children, there are certain preventive measures that can help minimize the risk:
Immunizations: Ensuring that children receive their scheduled vaccinations can protect them from various infections that may lead to fever.
Hand Hygiene: Encouraging regular handwashing helps prevent the spread of infectious agents that can cause fever.
Proper Nutrition: A well-balanced diet supports a child's immune system, making them less susceptible to infections.
Adequate Sleep: Ensure that children get sufficient sleep to maintain overall health and resilience against illnesses.
Conclusion
Fever in children is a common and generally manageable occurrence. Understanding its causes, recognizing symptoms, and implementing appropriate home care measures can help parents navigate through this concern with confidence. While most fevers are self-limiting and resolve without complications, it is crucial to be vigilant and seek medical attention when necessary. By staying informed and proactive, you can provide your children with the care and support needed for a speedy recovery from fever-related illnesses.
Disclaimer
This is not medical advice. The content provided is for informational purposes only. It is not meant to be a substitute for professional medical advice, diagnosis or treatment. Always seek professional medical advice for any questions you may have regarding a medical condition or treatment, and before undertaking a new health care regimen. Never disregard medical advice or delay in seeking it because of something you have seen or read here.