Newborn Care: The routine care of normal infants


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Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: resuscitation at birth, assessing infant size and gestational age, routine care and feeding of both normal and high-risk infants, the prevention, diagnosis and management of hypothermia, hypoglycaemia, jaundice, respiratory distress, infection, trauma, bleeding and congenital abnormalities, communication with parents

Newborn Care: The routine care of normal infants

  1. 1. 3 The routine care of normal infants 3. The 1 minute Apgar score is 7 or more and Objectives no resuscitation is needed after birth. 4. The infant weighs between 2500 g and 4000 g at birth. When you have completed this unit you 5. The birth weight falls between the 10th and should be able to: 90th centiles. • Manage a normal infant at delivery. 6. There is no soft tissue wasting. • Assess a newborn infant after delivery. 7. On physical examination the infant • Give routine care to a healthy infant. appears healthy with no congenital abnormalities or abnormal clinical signs. • Advise a mother about care of a normal 8. The infant feeds well. infant. 9. There have been no problems with the • Appreciate the importance of the road- infant since delivery. to-health card. Normal infants are at low risk of developing problems in the newborn period and, therefore, require primary care only. AboutMANAGING NORMAL 80% of all infants are normal.INFANTS Normal newborn infants are at low risk of developing problems and, therefore, require only3-1 What is a normal infant? primary careA normal infant has the followingcharacteristics: 3-2 What care should you give a normal1. Pregnancy, labour and delivery were infant immediately after delivery? normal. 1. Dry the infant in a warm towel then2. The infant is born at term. transfer the infant to a second warm,
  2. 2. 62 NEWBORN CARE dry towel. This will prevent hypothermia 3-4 When should you give the infant to the caused by evaporation after delivery. mother? Drying also stimulates the infant to cry. It is essential for the mother to see and hold2. Assess the Apgar score at 1 minute. The her infant as soon as possible after delivery. normal infant will have an Apgar score of 7 If the infant appears to be normal and healthy, or more and, therefore, does not need any the infant can be given to the mother after the resuscitation. It is not necessary to suction 1 minute Apgar score has been assessed, the nose and pharynx of a normal infant at the umbilical cord clamped and the initial birth. If the infant has a lot of secretions, examination made. After delivery, both turn the infant onto the side for a few the infant and mother are in an alert state. minutes. The infant’s eyes are usually wide open and3. An initial, brief physical examination looking around. should be done to assess the infant for size, gender, gross congenital abnormalities or The mother will usually hold the infant so that other obvious clinical problems. This is she can look at the face. She will talk to her usually carried out at the same time as the infant and touch the face and hands. This initial 1 minute Apgar score. contact between a mother and her infant is an important stage in bonding. Bonding is theGloves must be worn by the nurse or doctor emotional attachment that develops betweenwho delivers the infant and assesses the infant mother and child, and is an important stepimmediately after birth. towards good parenting later. Where possible, it is important that the father be present at3-3 When should you clamp the umbilical the delivery so that he can also be part of thiscord? important phase of the bonding process.The cord is usually clamped with surgicalforceps immediately after birth. However, it is Give the infant to the mother as soon as possiblepreferable to allow the infant to cry well a few after the deliverytimes before clamping the cord, as this allowsthe infant to receive some extra blood from theplacenta. The extra blood may help prevent iron 3-5 When should the normal infant be putdeficiency anaemia later in the first year of life. to the breast?Therefore, it is probably best to clamp the cordas soon as the infant has been well dried and If possible the mother should put the infant tothe 1 minute Apgar score has been assessed. her breast as soon as the infant has been dried and assessed at 1 minute because:The umbilical cord must be clamped or tiedabout 3 to 4 cm from the infant’s abdomen. 1. Studies have shown that the sooner theOnce the infant has been dried and assessed, infant is put to the breast, the greater is thethe surgical forceps can be replaced with a chance that the mother will successfullysterile, disposable cord clamp or a sterile breastfeed.cord tie. 2. Nipple stimulation by suckling may speed up the third stage of labour by stimulating NOTE A recent study shows that the umbilical cord normally stops pulsating about 2 minutes the release of maternal oxytocin which after birth. Delaying cord clamping until this causes the uterus to contract. time increases iron stores and reduces the risk of 3. It reassures the mother that her infant is anaemia at 6 months. healthy. Some women want to hold and look at their infants but do not want to breastfeed immediately after delivery. Their wishes
  3. 3. THE ROUTINE CARE OF NORMAL INFANTS 63should be respected. Mothers should be erythromycin or tetracycline will also decreaseencouraged to start kangaroo mother care the risk of conjunctivitis due to Chlamydia.when they are given their infant. During acomplicated third stage or during the repair of 3-9 Should all infants be weighed andan episiotomy some mothers would rather not measured?hold their infants. Yes, it is important to measure the infant’s weight and head circumference after birth.3-6 When do you identify the infant? The parents are usually anxious to knowOnce the parents have had a chance to the infant’s weight. An assessment of themeet and inspect their new infant, formal gestational age should also be made, especiallyidentification by the mother and staff must if the infant weighs less than 2500 g. Usuallybe done. Labels with the mother’s name and head circumference is also measured andfolder number, together with the infant’s sex, recorded. In low birth weight infants (lessdate and time of birth are then attached to than 2500 g), these measurements should bethe infant’s wrist and ankle. Twins must be plotted on a size for gestational age chart. It islabelled ‘A’ and ‘B’. Once correctly identified, difficult to measure length accurately withoutother routine care can then be given. Do not a measuring board.identify the infant before the mother has had a The routine management of the newbornchance to meet her newborn infant. infant (identification, vitamin K, eye prophylaxis and measurement) does not3-7 Should all infants be given vitamin K? have to be done immediately after birth. TheYes. It is essential that all infants be given 1 mg infant should be given to the mother to holdof vitamin K1 (Konakion) by intramuscular and put to the breast. Once the third stage isinjection into the anterolateral aspect (side) completed, these routines can be carried out.of the mid-thigh after delivery. Never givethe vitamin K into the buttock as it may 3-10 What care and management shoulddamage nerves or blood vessels that are very be documented?superficial in infants. Vitamin K will prevent Accurate notes should be made after thehaemorrhagic disease of the newborn. Be infant has been delivered. It is important tovery careful not to give the infant the mother’s document the following observations andoxytocin (Syntocinon) in error. To avoid this procedures:mistake, some hospitals give vitamin K inthe nursery or postnatal ward and not in the 1. Apgar scorelabour ward. Do not use oral vitamin K as it 2. Any action taken to resuscitate the infanthas to be repeated to be effective. 3. Estimated gestational age, especially if the infant appears to be small NOTE An injection of oxytocin or ergometrine into the infant by mistake results in severe apnoea 4. Whether the infant looks healthy or sick after a few hours. As a result, the infant may 5. Any abnormality or clinical problem require ventilation. noticed 6. Identification of the infant3-8 Should antibiotic ointment be placed in 7. Administration of vitamin Kthe eyes? 8. Whether prophylactic eye ointment was givenYes, it is advisable to place tetracycline, 9. Birth weight and head circumferencechloromycetin or erythromycin ointmentor drops routinely into both eyes to preventGonococcal conjunctivitis. The use of
  4. 4. 64 NEWBORN CARE3-11 Should the infant stay with the 3-13 When should the infant receive themother after delivery? first bath?Yes. If the mother and infant are well, they There is no need to routinely bath all infantsshould not be separated. The infant can stay after delivery to remove the vernix. Vernixwith the mother in the labour ward and should will not harm the infant and disappearsbe transferred with her to the postnatal ward. spontaneously after a day or two. VernixKangaroo mother care (skin-to-skin care) protects the skin and kills bacteria. Manyshould be encouraged. If the infant is cared infants also get cold if they are bathedfor by the mother, the staff will be relieved of soon after delivery. The only indicationthis additional duty. Most mothers want their for an infant to be washed or bathed sooninfants to stay with them. after birth is severe meconium staining or contamination with blood or maternal stool. A sick or high-risk infant should never be If at all possible, the mother and her infant bathed soon after delivery. should not be separated It is, however, important that all primiparous mothers learn how to bath an infant before3-12 Should all normal infants room-in? they are sent home. If these infants have to be bathed on the first day of life, it is preferableYes, all normal infants should room-in. that this be delayed until they are a few hours‘Rooming-in’ means that the infant stays with old. A carbolic soap (e.g. Lifebouy) is suitablethe mother and does not get cared for in the as it kills bacteria. Make sure the room isnursery. The infant is given kangaroo mother warm and the infant is well dried immediatelycare or nursed in a cot (bassinet) next to the after the bath.mother’s bed.The advantages of rooming-in are: 3-14 What is the appearance of a newborn1. The mother can be close to her infant all infant’s stool? the time and get used to caring for her For the first few days the infant will pass infant. This strengthens bonding. meconium, which is dark green and sticky.2. It encourages demand feeding and avoids By day 5 the stools should change from green all the complications of schedule feeding. to yellow, and by the end of the first week the3. It promotes kangaroo mother care. stools have the appearance of scrambled egg.4. It prevents the infant being exposed to the The stools of breastfed infants may be soft and infections commonly present in a nursery. yellow-green but should not smell offensive.5. It reduces the number of staff needed to care for infants. Some infants will pass a stool after every feed6. It builds up the mother’s confidence in her while others may not pass a stool for a number ability to handle her infant. of days. As long as the stool is not hard, the7. Each infant will receive individual attention. frequency of stools is not important.The disadvantages of rooming-in are that 3-15 How many wet nappies should anthe infant may keep the mother awake and infant have a day?that the excessive crying of some infants maydisturb other mothers. In practice this can be A normal infant has at least 6 wet nappies aavoided by removing an occasional infant for a day. If the infant has fewer than 6 wet nappiesshort while. However, this is seldom necessary. a day, you should suspect that the infant is notRooming-in is the modern way of providing getting enough milk.good care. It is not dangerous for the infant tosleep with the mother.
  5. 5. THE ROUTINE CARE OF NORMAL INFANTS 653-16 Should the mother breastfeed her small volume of breast milk being produced.infant? Colostrum, however, will meet the infant’s nutritional needs. Once the breast milk ‘comesYes. There are many benefits to both the in’, between days 3 and 5, the infant will startmother and her infant from breastfeeding, to gain weight. Most breastfed infants regainespecially exclusive breastfeeding. HIV- their birth weight by day 7. This weight losspositive mothers should be counselled about is normal and does not cause the infant anytheir feeding options before the infant is born. harm. The normal infant does not lose more than 10% of the birth weight. Formula-fed3-17 What routine cord care is needed? infants may not show this initial weight loss.The umbilical cord stump is soft and wet afterdelivery and this dead tissue is an ideal site for It is normal for an infant to lose some weightbacteria to grow. The cord should, therefore, during the first few daysbe dehydrated as soon as possible by 6 hourlyapplications of surgical spirits. It is important NOTE To prevent dehydration during the firstto apply enough spirits to run into all the folds few days of life, when the mother’s breastaround the base of the cord. There is no need milk production is still limited, all infants haveto use antibiotic powders. If the cord remains physiological oliguria.soft after 24 hours, or becomes wet or smellsoffensively, then the cord should be treated 3-20 Is it necessary to weigh a normalwith surgical spirits every 3 hours. Do not infant every day?cover the cord with a bandage. Usually thecord will come off at between 1 and 2 weeks No. The normal infant should be weighedafter delivery. at delivery and again on days 3 and 5 if still NOTE Alcohol is not used to clean the cord in in hospital. Weight at discharge must be some first world communities where cord sepsis recorded. At every clinic visit the infant’s and neonatal tetanus are rare. This practice is not weight should be measured and recorded. appropriate in poor communities. Test weighing is not needed in normal infants. After the first week most infants gain about3-18 When should the normal infant be 25 g per day.fully examined? 3-21 How should the infant be dressed?It is an important part of primary care tocarefully examine all normal infants within It is important that the infant does not get24 hours of delivery. The examination should too hot or too cold. Usually an infant wears abe done after the mother and infant have cotton vest and a gown that ties at the back. Arecovered from the delivery, which usually disposable or washable nappy is worn. If thetakes about 2 hours. The infant must be room is cold, a woollen cap should be worn.examined in front of the mother so that she Woollen booties are sometimes also reassured that the infant is normal. It also It is important that the clothing is not toogives her a chance to ask questions about tight. Infants should be dressed so that theyher infant. A quick look to exclude major are comfortable and warm. Usually a singleabnormalities is done when the infant is dried woollen blanket is adequate.immediately after delivery. 3-22 Should an infant sleep in the mother’s3-19 Is it normal for an infant to lose weight bed?after birth? If the room is cold then an infant can be keptYes. Most breastfed infants will lose weight warm by sleeping with the mother. Sharing afor the first few days after birth due to the bed does not increase the risk of a ‘cot death’.
  6. 6. 66 NEWBORN CARELow birth weight infants should be given COMMON MINORkangaroo mother care. PROBLEMS3-23 Must the birth be notified?The birth of every infant must be notified by 3-26 Can a vaginal discharge be normal inthe hospital, clinic or midwife. The parents an infant?later must register the infant’s name with the Yes. Many female infants have a white, mucoidlocal authority. vaginal discharge at birth which may continue for a few weeks. Less commonly the discharge3-24 Should all infants receive a ‘road to may be bloody. Both are normal and caused byhealth’ card? the secretion of oestrogen by the infant beforeYes. All newborn infants must be given a and after delivery.‘road to health’ card as this is one of the mostimportant advances in improving the health 3-27 May normal infants have enlargedcare of children. The relevant information breasts?must be entered at birth. Mothers should be Yes. Many infants, both male and female, haveinstructed as to the importance of the card. enlarged breasts at birth due to oestrogenExplain the idea of the ‘road to health’ to her. secreted by the fetus. The breasts may enlargeShe must present the card every time the infant further after birth. Breast enlargement isis seen by a health-care worker. It is essential normal and the breasts may remain enlargedthat all immunisations are entered on the card. for a few months after delivery. Some enlargedA record of the infant’s weight gain is also very breasts may secrete milk. It is very importantimportant as poor weight gain or weight loss that these breasts are not squeezed as this mayindicates that a child is not thriving. introduce infection resulting in mastitis or a breast abscess. All infants must be given a road-to-health card 3-28 Are erections of the penis normal in infants?3-25 Should newborn infants beimmunised? Yes. All newborn, male infants have erections of the penis. They also have larger testesThe schedule of immunisations varies slightly than older infants. These signs are due to thein different areas of southern Africa but most secretion of male hormones by the fetus andnewborn infants are given B.C.G. and polio usually disappear within a few months.drops within 5 days of delivery. It is safe togive polio drops to preterm infants but BCG 3-29 Should the foreskin of an infant’smay cause problems in some HIV-infected penis be pulled back?infants. Sick infants and preterm infants aregiven B.C.G. and polio drops when they are No. The foreskin is usually attached to theready to be discharged home. underlying skin and, therefore, should not be pulled back to clean the glans. There are no NOTE The use of BCG in HIV-exposed infants is medical indications to routinely circumcise all controversial as local BCG infection can result in HIV-infected infants. It has been suggested that male infants. the decision on BCG immunisation should be postponed until after PCR testing at 6 weeks. 3-30 Which birth marks are normal? 1. A blue patch over the sacrum is very common and is called a ‘mongolian spot’.
  7. 7. THE ROUTINE CARE OF NORMAL INFANTS 67 It is seen in normal infants and is due to severe bleeding. Refer the child to a surgeon if the delayed migration of pigment cells in the tongue does not appear normal by 2 years. the skin. It is not a sign of Down syndrome It is very rare for tongue tie to interfere with (mongolism). Sometimes similar patches speech development. are seen over the back, arms and legs and may look like bruises. They need no 3-34 Does an umbilical hernia need treatment and disappear during the first few treatment? years of life. Unlike bruises, these patches do not change colour after a few days. Infants commonly develop a small umbilical2. It is common for an infant to have a few hernia after the cord has separated. This does small pink or brown marks on the skin at not cause problems and usually disappears birth. These are normal and do not fade if without treatment when the infant starts to they are pressed gently for a few seconds. walk. If the hernia is still present at 5 years Some will disappear. the child should be referred for possible3. Many infants also have pink areas on surgical correction. the upper eyelid, the bridge of the nose and back of the neck that become more 3-35 What is a coccygeal dimple? obvious when the infant cries. These marks Many normal infants have a small dimple or are called ‘angel’s kisses’, ‘salmon patches’ sinus in the skin at the top of the cleft between or ‘stork bites’. They are also normal and the 2 buttocks. If you put your finger on the usually disappear during the first few years. dimple or sinus you will feel the ridge of the3-31 Are cysts on the gum or palate coccyx underneath. Both a dimple and sinusnormal? are normal and do not need to be removed. NOTE A sacral dimple or sinus is situated in theSmall cysts on the infant’s gum or palate are midline over the sacrum. These infants mustcommon and almost always normal. They do all be referred urgently to a neurosurgeon asnot need treatment and disappear with time. they are at high risk of developing meningitis orThey must not be opened with a pin or needle abnormalities of the spinal this may introduce infection. 3-36 Do normal infants commonly have a3-32 Can infants be born with teeth? blocked nose?Yes, some infants are born with teeth. These Yes, a blocked nose is common due to theare either primary teeth or extra teeth. small size of the nose in a newborn infant.Primary teeth are firmly attached and should Normal infants cannot blow their nose butnot be removed. Extra teeth are very small and can sneeze. Usually a blocked nose does notusually very loose. A tooth that is very loose, need treatment provided the infant appearsand is only attached by a thread of tissue, generally well and can still breathe and feedshould be pulled out. It will be replaced later normally. However, some infants may developby a primary tooth. apnoea if both nostrils become completely blocked. Nose drops containing drugs can3-33 Should ‘tongue tie’ be treated? be dangerous as they are absorbed into the blood stream. Normal saline or 2% sodiumMany infants have a web of mucous bicarbonate nose drops can be used.membrane under the tongue that continuesto the tip. As a result the infant is not able tostick the tongue out and, therefore, is said tohave ‘tongue tie’. This does not interfere withsucking and usually corrects itself with time.Do not cut the membrane as this may cause
  8. 8. 68 NEWBORN CARE3-37 Are wide fontanelles and sutures 2. Does the infant feed well?common? 3. If the infant is more than 5 days old, is it gaining weight?Many normal infants have wide fontanels 4. Can the mother feed and care for her infant?and sutures. This is particularly common 5. Has the infant been immunised?in preterm and underweight for gestational 6. Does the infant weigh 2000 g or more?age infants. The anterior fontanel may alsopulsate. If the fontanelle feels full and thehead circumference is above the 90th centile, 3-41 What advice should the mother bethe infant must be referred to a level 2 or 3 given about a normal infant at discharge?hospital as hydrocephaly is probably present. Before discharge all mothers must be advised about:3-38 Are extra fingers or toes normal? 1. Feeding their infantExtra fingers that are attached by a thread of 2. Bathing and dressing their infantskin are common and occur in normal infants. 3. Follow-up appointments and arrangementsThere is often a family history of extra fingers. 4. Reporting immediately if the infant appearsThese extra fingers should be tied off as close ill or behaves abnormally (danger signs)to the hand as possible with a piece of surgical 5. The importance of the ‘road to health’ cardsilk. If extra fingers or toes contain cartilageor bone and are well attached, they must not 3-42 Should normal infants be followed upbe tied off. These infants have a high risk of after discharge?other abnormalities and, therefore, should be If the infant is discharged before 7 days of age,referred to a level 2 or 3 hospital. The extra the infant should be seen at home or at a clinicdigits are removed surgically. on days 2 and 5 to assess whether: 1. The infant appears healthy or sick.3-39 Should an infant’s nails be cut? 2. The infant is feeding well and receivingIf an infant’s finger nails become long they may enough milk.scratch the face. Long nails should, therefore, be 3. The mother is managing to care for hercut straight across with a sharp pair of scissors. infant.Do not cut the nails too short. Never bite or 4. The cord is clean and dry.tear the nails. Nail clippers are dangerous. 5. The infant is jaundiced. 6. The mother has any problems with her infant.DISCHARGING A After the age of one week, the normal infantNORMAL INFANT should be followed at the local ‘well baby’ clinic to assess the infant’s weight gain and general development, and to receive the required3-40 When can a normal infant be immunisations. These details must be noted ondischarged from the hospital or clinic? the road-to-health card (preschool health card).Most normal newborn infants can bedischarged after 6 hours. CASE STUDY 1Before discharging an infant from either ahospital or clinic, you should ask yourself the An infant is delivered to a primigravid motherfollowing questions: by spontaneous vertex delivery at term.1. Does the infant appear normal, active and Immediately after birth the infant cries well healthy? and appears normal. The cord is clamped and
  9. 9. THE ROUTINE CARE OF NORMAL INFANTS 69cut and the infant is dried. The infant has a lot 5. Should the infant stay with the motherof vernix and a blue mark is noticed over the after delivery?lower back. The infant is placed in a cot and Yes, if possible the mother and her infantsent to the nursery for a bath. It is noticed that should be kept together after delivery.the child has a white vaginal discharge. 6. Is a white vaginal discharge in a newborn1. When should the infant be given to the infant a sign of infection?mother? No. This is normal and common.As soon as the infant is dried, the cord cut,the Apgar score determined and a briefexamination indicates that the infant is anormal, healthy term infant. The father should CASE STUDY 2also be present to share this exciting moment.The infant should not have been sent to the A normal infant weighs 3000 g at birth. By daynursery as the mother and infant should not 4 the infant’s weight has dropped to 2850 separated. The infant has tongue tie and the mother thinks that this is preventing the infant from2. When should the mother be encouraged sucking well. The policy in the hospital is toto put the infant to her breast? keep all normal infants in the nursery where the mothers can visit at feeding time.As soon as she wants to. This is usually aftershe has had a chance to have a good look at 1. Is the weight loss of 150 g normal for thisher infant. She should be encouraged to use infant?the kangaroo mother care position of nursingher infant, skin to skin, between her breasts. Yes. An infant may normally lose up to 10%Many mothers put their infant to the breast of the birth weight in the first 5 days afterbefore the placenta is delivered. delivery.3. What is the blue mark over the infant’s 2. Does tongue tie prevent an infant fromback? sucking normally?This is common and normal. It is important to Tongue tie does not prevent an infant fromexplain to the mother that it is not a bruise. It sucking normally. It usually causes nodisappears over a few years. problems and improves spontaneously. It does not require treatment.4. Should the vernix be washed offimmediately after delivery? 3. Why is it important to assess whether an infant sucks well if the weight gain afterInfants should not be bathed straight after birth is poor?delivery, as they often get cold, while vernixshould not be removed as it helps protect If an infant sucks poorly and loses weight, itthe infant’s skin from infection. It would be suggests that the infant is not normal.better to bath the infant the following day, inthe mother’s presence, by which time most of 4. What do you think of normal infantsthe vernix will have cleared. She then has an being kept in the nursery?opportunity to learn how to bath her infant. Normal infants should room-in with their mothers. This is safer than remaining in the nursery where the risk of infection is higher.
  10. 10. 70 NEWBORN CARE5. When should this infant be immunised? kangaroo mother care. It is not dangerous if the infant sleeps with the mother.BCG and polio drops should be given beforethe infant is discharged. Later it will receivethe other routine immunisations at the wellbaby clinic. CASE STUDY 46. When can this infant be discharged A mother delivers an active infant weighinghome? 2400 g at a private hospital. Vitamin K is not given as the infant ‘is too small’. The staff forgetWhen the mother is ready for discharge. to give eye prophylaxis. The mother is notUsually a healthy mother and her normal infant given the infant to hold after delivery and onlycan be discharged 6 hours after delivery. Some visits her infant for the first time the followinghospitals may keep both for 1 or 2 days. day. The hospital does not allow rooming-in so that the mothers can sleep well and have a rest. The mother is worried because the infant has aCASE STUDY 3 blocked nose at times and also has small cysts on the gums.Starch powder is sprinkled onto the umbilicalcord of a newborn infant twice a day to hasten 1. Is this infant too small to be givendrying. The cord is then covered with a linen vitamin K?binder. The mother is worried that the infant No. All infants must be given vitamin K tohas enlarged breasts. As the ward is cold at prevent haemorrhagic disease. Vitamin K isnight, she puts the infant into her bed. The best given by intramuscular injection into thegrandmother says this is dangerous as she may side of the thigh.roll onto the infant during the night. 2. Why is it important that ‘eye prophylaxis’1. What do you think of the method of cord is not forgotten?care in this infant? Tetracycline, chloromycetin or erythromycinThe cord should be dried with surgical spirits ointment should be placed in both eyes afterand not covered with starch powder. Covering birth to prevent severe conjunctivitis due tothe umbilical cord with a binder is incorrect as prevents the cord drying out. 3. Should the mother and infant be2. What treatment is needed for the infant’s separated after delivery to give her aenlarged breasts? chance to rest?No treatment is needed and the mother must No. Every effort must be made to keep thenot squeeze the breasts. The mother must be mother and her infant together. Most mothersreassured that breast enlargement resolves want their infants to stay with them.spontaneously in a few months. 4. Do you think that private hospitals3. What would you advise the mother should practise rooming-in?about sleeping with her infant? Yes. Rooming-in promotes bonding and breast-If the ward is cold and there is no simple way feeding and helps the mother become confidentof keeping the infant warm, then the infant in caring for her infant. Many progressiveshould sleep with the mother. It is important private hospitals practise rooming-in because itthat infants do not get cold. The ideal is to give is the best way of providing good care.
  11. 11. THE ROUTINE CARE OF NORMAL INFANTS 715. Should a doctor be called to examine the 6. What is the correct management of guminfant as it has a blocked nose? cysts?No. Many normal infants have a blocked nose. Do nothing. Gum cysts are common andSaline or 2% sodium bicarbonate nose drops disappear with time. Never attempt to open acan be used if necessary. A blocked nose is gum cyst as you may introduce infection.only a problem if the infant cannot feed orbreathe properly.