Advice

Regular pre-scheduled baby checks are a vital part of your baby’s well being as advised by doctors trained in child health and development.

These checks are designed to…
» Monitor baby’s growth and development
» Advise on feeding your baby
» Immunize your baby when due
» Help you with any questions you may have

The Schedule

» 2 Weeks from birth
» 5 Weeks from birth
» 2 months from birth
» Monthly up to one year and then
» With the recommended immunization programme

Amazing but true, after 40 years of research into this common torment, science still doesn't know why some babies scream so much. Figures suggest that 10-40% of babies cry inconsolably on a regular basis, as if in pain. It usually occurs in the evening, starting in the first few weeks of your baby's life, reaching a peak around six weeks, with the last sobs easing off by three months. Babies with colic typically clench their little fists, pull up their knees and turn tomato red. No matter what you do, nothing seems to help. There are no miracle cures.

The good news is that colic is not medically harmful: babies develop and put on weight normally, despite the tears. However, it is acutely stressful for parents and can damage the relationship you have with your baby. Colic also puts a baby more at risk of abuse.

Most theories about colic focus on painful contractions in the gut. The tendency of the baby to curl up its legs, as if to relieve stomach cramp, would seem to support this view. There are a number of possible causes:

A baby's immature digestive tract might go into internal spasm as food is propelled through the digestive tract.
Theories about lactose intolerance are currently popular; it is suspected to result in undigested lactose building up in the baby's intestines.

There are also theories that, some babies may have intolerance to cow's milk protein (breast fed babies may be reacting to the cow's milk protein in their mother's diet). Switching to dairy-free formula milk has been shown to help some babies, although many are also found to be sensitive to soy protein as well.

Or it might be wind. Tiny bubbles of air are swallowed during the feed, which cause pain and spasm in the intestines.

What do they look like?
The most common varieties are:

• Raised, strawberry marks which appear on about 10 per cent of babies, tend to grow for several years and then usually disappear by age five.

• Cavernous haemangioma, a lumpy bluish or bluish-red mass which grows quickly in the first six months, then slows and starts shrinking by about 18 months, and is usually gone by the time a child reaches the teenage years.

• Brown marks, permanent dark or light brown flat patches which sometimes appear in clusters.

• Moles, which vary in size and may be raised or hairy.

• Bluish or greenish Mongolian spots on the back or buttocks, which usually disappear by school age.

• Bruise-coloured port-wine stains. Light ones may fade, but most endure and enlarge as the child grows.

Rather than seeing them as disfiguring or something to be removed, some parents consider birthmarks a sign of their child's uniqueness and find them attractive.

Hepatitis B is a serious viral disease that affects the liver. While about 50 per cent of infected adults may show symptoms in the initial stage of hepatitis infection (acute stage), young children often do not show any symptoms of the disease at all.

What are the symptoms of hepatitis B?
The symptoms of acute illness resulting from hepatitis B infection may include jaundice, fever, nausea or joint and muscle pain. There may also be pain in the upper right area of the abdomen. In a small percentage of cases, the infection may lead to progressive liver failure.

How can hepatitis B be prevented?
The most effective way of preventing the spread of hepatitis B is through vaccination.

It is worth remembering that all new-born babies 'wet the bed'.

Just as learning to walk and talk are normal stages of development, so too is learning to recognise, while sleeping, that you have a full bladder and need to wake up and go to the toilet. Just when that happens will vary from child to child. It is generally felt that no action is needed over bed-wetting before the age of 6. 10% of 5-year olds, 5% of 10-year olds and 1% of 18-year olds bet wet at night!

What causes bed-wetting?
The reason some children take longer than others to become dry at night is probably due to them being deep sleepers who are not awakened by the message from their bladder telling them that it is full. There is often a family history of being 'late-developers' in this area.

Medical advice to exclude rare cases where a physical problem such as infection, diabetic complications, or a mechanical problem with the bladder is the cause, should be sought in the following cases.

Where bed-wetting starts after a relatively long period of dryness.
- Day-time wetting past the age of 3 or 4
- Bed-wetting after the age of 6 or 7

Many people think that emotional causes are responsible for bed-wetting, but this is not often the case, except for short episodes that might coincide with the arrival of a new baby, a move to a new house or other events that might cause some temporary feelings of insecurity in a child.

Hunger/ Dirty nappy/ Illness/ Colic/ Lonely/ Tired/ Bored

It is important for babies to cry as this is how they express their feelings or their needs. Babies have different cries to represent their different needs.

Eventually, new parents will be able to identify what is wrong with the baby by the sound of the cry. Until you can identify what your baby needs, you will have to rely on trial and error. The first thing you should do is pick the baby up. Babies need to be held and cuddled. Don't worry about spoiling your baby: holding and nurturing will not spoil a child. Babies that are repeatedly left crying may begin to feel neglected or insecure.

If holding your baby doesn't stop him from crying, go down the list of possible problems. Try changing his nappy, feeding him or talking to him. He may just be bored or lonely and need to hear your voice.

Prolonged crying may indicate that something is wrong. If your baby displays any signs of illness such as fever, vomiting, diarrhea, or any other abnormal symptom, contact your Paediatrician to assess the baby. Sometimes babies that don't normally cry much will cry a lot when they are ill.

Extra sleepy babies
In a very short time, you'll get a sense of how much sleep is normal for your baby. If you find that he's sleeping a lot more than usual, talk to your doctor to help find out the cause.

Baby's delicate eyes
Babies are often born with one or both tear ducts blocked. They usually open in a couple weeks, when the baby starts producing tears. If not, you may notice mucus around the eyelid. This usually isn't harmful, but it could lead to infection if the duct remains blocked. Inform your Paediatrician if you notice anything unusual around his eyelids.

Fever
If your baby seems irritable or feels especially warm, take his temperature. If his temperature is over 100° F or 37.8° C inform your Paediatrician.

Vomiting
It's common for babies to spit up now and then, especially very young ones. The cause might be gas, overeating, or over stimulation. But when vomiting becomes forceful or, if it's accompanied by fever or diarrhea, contact your Paediatrician. And for more information on issues that may be feeding related, see tolerance issues.

Rash
Scaly patches on your baby's scalp might be "cradle cap." Sometimes just washing the hair and gently brushing off the flakes every day helps control it. The condition will usually go away after your baby's a few months old.Try applying baby oil or olive oil.

Infections
A common yeast infection is called "thrush." You'll know it by white patches in the mouth. It's a yeast infection that's easily treated, so inform your baby's doctor.

With fingernail, toenail or umbilical infections, you'll notice redness around the area. Again, inform your Paediatrician.

Colds and Sniffles
Many babies get colds before they're three months old. If your baby has a cold, he may have a slight cough, runny nose, and a temperature a little higher than normal. A blocked nose is especially uncomfortable for young babies, who can't breathe well through their mouths.

You can help your baby through a cold by using 0.9% Normal Saline nose drops by applying one drop to each nostril as often as required. Other medication available in the market for coughs and colds are not recommended as they cause drowsiness.

A gentle reminder about a serious subject: SIDS
There's another health-related issue for young babies that's really important to talk about. That's SIDS: Sudden Infant Death Syndrome. That's the term for babies who die unexpectedly during sleep.

You've probably heard about SIDS, and you've probably been given some advice about how to prevent it. Here are the main things you really should do to help prevent SIDS:
Most importantly, put your baby on his back to sleep, not on his stomach.
Keep the temperature in your baby's room warm, but not hot. A comfortable temperature for you is fine for him, too.
Use a firm mattress.Do not use a pillow for the head until one year old.

Also, if you ever notice that your baby stops breathing, even for a few seconds, let your Paediatrician know immediately.

SIDS affects one or two babies out of a thousand in their first few months of life. . So take precautions to make sure both you and your baby have a healthy, restful sleep.

As always, if you have any concerns, from a rash to a runny nose to a change in your baby's temperament, call your Paediatrician. Remember,there's no such thing as a silly question when it comes to your baby's health.

Measles
German Measles (Rubella)
Chickenpox
Fifth Disease: 'Slapped Cheek' Disease (Erythema Infectiosum)

What causes the disease?
Rubella, which is commonly known as German measles, is caused by the rubella virus which is a togavirus.

How is it caught?
German measles (rubella) is caught in the same way as measles. An infected person coughs or sneezes and so spreads droplets containing the virus, which other people breathe in and, if they are not immune, become infected with rubella.
The incubation period for German measles is 12 to 23 days—that is the time between being exposed to the virus and developing German measles.

What does the rash look like?
The rash is pink and flat. The spots are very small, giving the rash a fine appearance. It is similar to the measles rash but less extensive and fades more quickly.

Where is the rash?
The rash starts around the hairline and affects the face and neck first. It will then spread to the body and the arms and legs.

When is my child infectious?
A person with rubella will be infectious from one week before the rash starts until 4 days after the rash has started. However, newborn children who are infected may be infectious for a few months.

How long will it last?
The rash usually lasts between 3 and 5 days and starts about 2 days after the person starts to feel unwell. Rubella is generally a much milder and less infectious illness than measles. Some cases are so mild that they are hardly detectable—these are called ‘sub clinical' infections.

What can I do to help?
German measles is such a mild disease that usually none of the symptoms needs to be treated. If children get a middle ear infection then the doctor will usually prescribe antibiotics. See your doctor if you think your child has any complications of German measles infection.
German measles in a pregnant woman, though, is very serious and may result in miscarriage or stillbirth or permanent damage to the growing baby.

back to Childhood Rashes

What causes the disease?
Chickenpox (also known as varicella) is caused by a member of the family of viruses called the herpes viruses. The virus that causes it is called the varicella-zoster virus.

How is it caught?
Chickenpox is extremely contagious. Chickenpox infection is spread between people by tiny droplets infected with the virus being sprayed out by the infected person when they cough or sneeze. These droplets are then inhaled and taken in to the respiratory system of another person. If this person is not immune to chickenpox they will become infected.
The fluid-filled blisters (called vesicles) on the skin and mucous membranes are also full of infectious virus.
The incubation period can vary between 10 and 21 days, but is usually 14 to 21 days—that is the time between being exposed to the virus and developing chickenpox.

What does the rash look like?
Chickenpox rash evolves through 3 stages, and a person may have examples of each type of spot at any one time. New crops of spots appear over a period of 2 to 4 days.
• The rash starts with small, flat red spots.
• These flat red spots then become raised and very itchy and form round, fluid-filled blisters (called vesicles) against a red background.
• The vesicles crust over.
Chickenpox rash is intensely itchy.

Where is the rash?
The rash starts on the trunk (body) and then later appears on the face, arms and legs. It is unusual for the rash to affect the palms and soles. Chickenpox spots (lesions) can sometimes be found on the eyelids and inside the mouth and the vagina.

When is my child infectious?
Your child will be infectious from a few days before the symptoms start until all the vesicles have crusted over. So, until the last crop of vesicles has all crusted over, your child will be infectious.

How long will it last?
The rash will last for between a few days to 2 weeks.

What can I do to help?
Chickenpox is usually a fairly mild illness of childhood. Sometimes the skin may become secondarily infected with bacteria through scratching of the spots. Should this happen, your doctor may prescribe antibiotics.
• Cut your child's fingernails short to avoid bacterial infection of the skin and to help your child from inflicting too much damage on themselves.
• Keep your child's hands clean to avoid them infecting the spots.
• Daily baths or showers will keep the skin clean.
• Make sure your child is wearing clean and dry clothing that keeps them comfortable.
• Bathing your child in warm water and using wet compresses should help to relieve the itching. Sometimes antihistamines are used to relieve the itching. Your pharmacist or doctor will also be able to recommend some anti-itch preparations if your child is distressed. Calamine lotion can also be useful.
• Paracetamol (but not aspirin) should be given as directed on the bottle to reduce the fever and ease headaches. Do not give your child aspirin.
• Ask your child to drink plenty of clear fluids (juice, lemonade or ice cubes). Don't worry if they don't eat much while they are sick—this will be fine for a day or 2.

back to Childhood Rashes

Slapped cheek disease, which is also known as fifth disease or erythema infectiosum, is caused by a virus called human parvovirus B19.

How is it caught?
Fifth disease is caught by breathing in tiny droplets of moisture that are infected with the virus from a person who has the infection. The tiny droplets of moisture may be spread via a cough or sneeze by the infected person.

What does the rash look like?
The rash is bright red and slightly raised. It gives the characteristic look of slapped cheeks on the face. This is followed by a lacy appearance which gives a blotchy look to the rash. The rash is not usually itchy.

Where is the rash?
The rash starts on the cheeks, but quickly appears on the body and arms and legs.

When is my child infectious?
Your child will be infectious a few days before the rash appears and will continue to be infectious until a few days after the rash has gone.

How long will it last?
The rash should go after about a week but can come and go for a few weeks after that. Exposure to sunlight may reactivate the rash.

What can I do to help?
Fifth disease is a mild illness and does not usually need any treatment. A child infected with fifth disease will have a mild fever, which may need treating with children's paracetamol (not aspirin), and very rarely may have aching joints.

back to Childhood Rashes

It is time to visit the doctor for the well-baby exam. You are trying to remember all those questions you've filed away in your mind to ask the doctor when she checks out your child. Hopefully, your concerns will be addressed without you having to ask, but undoubtedly there may be some questions you will still need to ask. The well-baby exam is your chance to get an overall view of the health and welfare of your child. Here is a list of some questions you should have answered by the end of the visit:

1. Is my child's growth appropriate and expected?
It doesn't necessarily matter where your child falls on the growth curve as much as how the trend has been over time. The child who has always been at the 5th percentile for height is less concerning (if there is even any concern) than the child who used to be at the 75th percentile and is now at the 10th. The child who has held steady at the 95th percentile for weight is not as worrisome (if there is any worry at all) as the one who has gone from the 25th to the 90th percentile. Keeping track of this trend on the growth curves is an absolute essential for any professional who cares for children. See your child's growth curve to get a general idea of the trend.

2. Is my child due for any immunizations?
Colds, low grade fevers, and minor illnesses are no cause to delay immunizations. Does the doctor recommend the chicken pox vaccine?

3. Is my child's diet appropriate?
Most parents are concerned that their child's diet is lacking in something. The well-child visit is the perfect time to either confirm these concerns and get some guidance on how to correct them or be reassured that the diet is indeed appropriate. Suggestions about the diet come from a lot of sources: magazines, the grandparents, friends, and books. The well-baby check is the time to confirm whether this advice is good guidance or not.

4. Is this thing on my child's body normal?
The thing may be anything, but many parents have certain minor concerns that they aren't really worried about but wonder if it is normal. A toenail that is shaped funny, a birthmark that seems different, or perhaps how ears are shaped are all examples of things that parents usually suspect are normal but need some reassurance. The well-baby exam is the perfect time to inquire about these concerns.

5. Is my child's blood pressure normal?
Starting at three years of age, it is recommended that each child has the blood pressure checked as part of the well-child exam. High blood pressure typically causes problems without causing a whole lot of symptoms, and it may be the first sign of something that needs further investigation.

6. Is that test really necessary?
There are very few "routine" tests that are recommended in children. A hemoglobin, usually done once at 9 or 12 months and an analysis of the urine, done once anytime between the ages of four to six years, are the only recommended routine tests. A pelvic exam and pap smear are recommended for sexually active adolescent females. A lead test at one year of age, a tuberculosis skin test and a cholesterol test are done only for those with risk factors. Aside from these, no other additional tests have been seemed to be necessary for routine care.

7. Does my child's development seem appropriate?
Development is generally broken down into four categories:
• Gross motor skills
• Fine motor skills
• Social skills
• Speech and Language Development

Babies reach, grasp, roll, and eventually crawl. As a result, it's easy for them to roll off changing tables, sofas, and beds. Keep your baby safe by never leaving her where a fall can happen. If the doorbell rings and your baby is on the changing table, bring her with you while you answer the door. If you must leave her for a moment, put her on the floor, in a playpen, or a cot - never a place high off the ground from which she could fall.

Another way to prevent falls is to make sure you use a safety gate at the door of your baby's room to prevent her from reaching the top of the stairs. It only takes a moment for a curious child to peer over the edge and tumble down. Placing a gate at the top of the stairs allows for the possibility that your baby will climb the gate and fall from an even greater height, so take a few minutes to properly install a safety gate in the correct place. Using baby walkers are hazardous because they could cause fatal accidents.

Burns and drownings are also common accidents in the home, so you should take special precautions when your child is around water. Always test the temperature of feeding bottles and bath water. In addition, never leave your baby alone near water. Drowning can happen very quickly and in less than 1 inch of water, so filled bathtubs, swimming pools,paddle pools, buckets of water, and sinks can be dangerous. A child can drown in the water in a toilet, so be sure to purchase and install toilet locks that prevent accidents.

The time when your baby starts to crawl and stand presents different dangers. Shut the doors to all rooms your baby shouldn't enter to prevent her from wandering into places that haven't been properly baby proofed. To keep your young adventurer out of cabinets that may contain poisonous substances, make sure all cleaning agents and toxic substances - including paint - are in cabinets with safety locks. Because your child will constantly be putting items in her mouth, remove all breakable items and items small enough to fit in her mouth. Finally, take a look at your houseplants - are they poisonous or otherwise harmful to your child?

"Be sure to get down on your hands and knees and check your home from a child's perspective" . Making sure all electrical cords are out of reach and paying attention to what you have on low shelves and piled in corners now, can save you from a trip to the accident and emergency department later. Furthermore, using safety covers for electrical outlets can prevent electrical burns, shocks, and fires.

Your baby will spend a lot of time in her cot. It's your job to make sure it's safe, with no protruding screws and sides that latch securely. The mattress should fit snugly against the sides to prevent a suffocation hazard and should be kept at its lowest position once your child can stand. Soft toys and pillows should be kept out of the cot as well, because these items can suffocate a baby. Remember also how easy it is for her to grab anything - keep the cords of curtains and window shades well away from her little hands to avoid strangulation.