My Baby and Me

1 MyBaby Me MyBaby Me

A CSR initiative by: Himalaya BabyCare Dr. Ranjan Kumar Pejaver MyB by Me MyBaby Me

Copyright © Himalaya Wellness Company, 2023 DISCLAIMER The content of this book is for informational and educational purposes only and is not intended to replace the advice or medical care of a doctor. As new findings become available through research, some of the recommendations herein might be subject to change. You are encouraged to seek up-to-date information on child care from your physician or your child’s pediatrician. All rights reserved. Copyright of this material/book and its content shall subsist with Himalaya Wellness Company. Copying this material/book and its content without the permission of Himalaya Wellness Company is a punishable offense. MyBaby Me MyBaby Me

It all began in 1930 in the forests of Burma. Mr. M. Manal, the founder of Himalaya Wellness Company, curiously looked on as villagers fed the roots of a local herb to calm a herd of agitated elephants. This herb was Rauwolfia Serpentina, the inspiration that led to the creation of Serpina®, the world’s first natural antihypertensive drug which was launched in 1934. Mr. Manal embarked upon the journey of discovering the mysteries of Nature at a time when herb-based health care was considered skepticism. Fuelled by his vision of bringing the best of Nature’s solutions backed by scientific research, he was determined to contemporize Ayurveda through modern technology. With a single hand-operated tableting machine bought after pawning his mother’s bangles, he strode ahead on the road less traveled and full of challenges. It took him four years of extensive research to formulate the first offering, Serpina®, which laid the foundation for Himalaya’s strong foothold in research. In 1955, came the historic breakthrough that established Himalaya as a symbol of trust in the Indian health care landscape. Liv.52, a liver formulation, became the best-selling, flagship offering and a name synonymous with brand Himalaya. Ever since, as a problem-solving head-to-heel brand, Himalaya has introduced many other iconic products such as Septilin, Cystone, Bonnisan, and Rumalaya forte, which reinforced the trust of millions of customers, making Himalaya a household name. Broadening horizons, Himalaya diversified into Personal Care, BabyCare, Wellness, and Animal Health while consolidating all portfolios under one umbrella “Himalaya Since 1930”. Today, Himalaya is a leading global health and personal care brand with close to 500 products sold in over 100 countries – touching millions of lives every day and realizing the promise of Happiness through Wellness in every home and heart. OUR STORY


Dear Moms, With great pleasure, Himalaya BabyCare is bringing out this book, My Baby and Me. A complimentary copy of the book will be given to every mother getting discharged from the postnatal ward. It comes with best wishes from Himalaya Wellness Company. It is indeed a memorable occasion when a mother gets discharged from the hospital with her baby. Every mother will relish this moment, considering this moment as an unforgettable milestone in her life. However, she will undoubtedly be anxious thinking about whether she can cope with this added responsibility of looking after her baby and recognizing when her baby is unwell or uncomfortable. She may have several questions in her mind, which she did not find the time or opportunity to ask while in the hospital. Moreover, in the present circumstances of COVID, the stay at the hospital is shortened to a minimum, and interactions with health care providers may also be less. In this context, the discharge booklet will be of great value to new mothers. This book is created by experienced and expert pediatricians. Most of the questions that new mothers ask during discharge and other problems that a mother may encounter are covered in this book. Recognizing the early signs of illnesses are also mentioned, and in many instances, reassurances are offered where relevant. Please note that this book is not a substitute for regular consultations with the family practitioner or pediatrician. Regular check-ups and immunization visits should be followed meticulously. Any cause for concern, which is beyond the scope of this book, should be discussed with healthcare providers. We wish new mothers and their newborn babies good health for years to come. With warm regards, Dr. Ranjan Kumar Pejaver FRCP, FRCPCH(UK), FIAP, FNNF Professor of Neonatology, Bengaluru, India

Our Purpose Babies have always been a top priority at Himalaya BabyCare, and we are committed to bringing wellness and happiness to babies via head-to-heel baby care solutions based on science. We are devoted to offering continued support to moms and parents across the initial critical years of parenthood through education and awareness on baby care, facilities, and amenities to ensure convenient care for babies on-the-go, delivering a hassle-free experience for parents. The period of six to eight weeks post birthing (postpartum) is crucial for the baby and the mother, with mental and emotional care for the mother and overall care for the newborn. Indeed, childbirth is a life-changing event that brings delight to the family. But, at the same time, handling a newborn can be an overwhelming experience for the parents. It could cause unprecedented stress and anxiety as they try to navigate through the unknown terrain of baby health care. We believe that interactions and advice of health professionals is critical for new parents. This book is an ongoing effort from Himalaya BabyCare to educate parents on baby care, common health problems in babies, and vaccination schedules. This book’s content is created based on frequently asked questions from parents. With this book, our focus is to be the guiding partner through early parenthood, for a positive and enriching baby experience.

We understand that your precious little one's delicate skin needs special care. Keeping this in mind and your baby's safety at the forefront, we have thoughtfully crafted a range of baby care products based on the Ayurvedic discipline of Kaumarabhritya. Our products are gentle, research-based, and free from harsh chemicals, formulated to help nourish and protect your baby's skin. Himalaya BabyCare Gentle • Safe • Researched


Maternal Nutrition 12 Feeding the Baby 15 Burping the Baby 20 Care of the Umbilical Stump 23 Dressing the Newborn 26 Watch the Urine of Your Newborn 31 Stool Pattern of the Baby 34 Yellow Baby - Jaundice in the Newborn 38 Temperature Management of the Baby 44 Weight Matters - What You Need to Know 47 Infant Supplements 51 Crying Baby 56 All You Need to Know About Diapers 59 Benefits of Baby Massage 65 Breast Care for Mothers 71 Principles of Breastfeeding 76 Skin Care 84 Protection for Your Baby- Immunization Needs 88 Newborn Sleep Patterns - How Much to Expect? 94 Infantile Colic 99 C O N T E N T S

12 What foods are recommended for a new mother? A new mother needs to eat a healthy diet. The severe stress of pregnancy and delivery is combined with the demands caused by lactation on the mother's body. Breast milk contains the nutrients which are the only source of nourishment for the newborn infant. What the mother eats has a direct impact upon the baby's growth. Hence, the mother needs to eat a diet rich in all food groups. What nutrients should be present in the mother's diet? The mother must eat a diet which is rich in energy, proteins, and fats. In addition, it should contain nutrients like iron, calcium, zinc, magnesium, and other elements. It should also be rich in all the vitamins that help the infant's normal growth and development. Moreover, the mother needs to stay well hydrated. What vitamins and supplements are needed by a breastfeeding mother? The mother's diet must meet all the daily vitamin and mineral requirements. In addition, it is recommended that she takes M A T E R N A L Nutrition

13 regular iron supplements. An extra calcium supplement is generally advised to cover the different demands placed by lactation. Multivitamin supplements may be given in case the diet consumption does not cover all the recommended nutrients. Are there any natural foods that are a good source of calcium? Foods like milk, cheese, eggs, and paneer contain high calcium content. In addition, ragi which is a type of millet, is also rich in calcium. These foods should form a part of the diet of a lactating mother. Is there a way to improve the quality of mother's milk? A wel l -ba l anced diet will ensure that the milk produced contains al l the required nutrients. In addi t ion, eat ing good quality protein is essential to produce good qual ity milk. Healthy fats will ensure that the mi lk contains the recommended fats which will assist in the infant's brain development.

Is it essential to have multivitamin supplementation? B-complex vitamins are essential for the normal growth and development of the infant. Low levels of vitamin B6 may have an adverse impact on the mother and infants, particularly in the form of neurological symptoms in infants. Thiamine requirements are also higher during lactation and in case of low intake, its level falls in the mother's blood. Folate is another nutrient that is required to be supplemented, as the levels fall during lactation. Are trace elements also important during lactation? Besides calcium and iron, other elements in the diet are also important for the normal growth and development of the infant. These include zinc, magnesium, selenium, and manganese. Nuts, legumes, and seeds are rich in magnesium. Seafood, eggs, poultry, and whole grains are rich in zinc. Trace elements are needed for the skin, membranes, and enzymes in the body. New mothers should consult with their health care providers before taking any supplements.

15 F E E D I N G How soon after birth can the baby be fed? The newborn baby will cry after birth; this is the best time to wrap the baby and place her/him at the breast. The baby will snuggle up to the breast and begin sucking at the breast immediately; this is known as the newborn reflex. Is it helpful to start feeding the baby as soon as possible after delivery? The milk let-down reflex involves several hormones which act to make the milk flow into the baby's mouth after sucking. The oxytocin that is produced at this time is a hormone that affects the mother's uterus also. Under the influence of oxytocin, the uterus will contract better, and this will help to reduce the post delivery bleeding. Hence, the early initiation of breastfeeding is also helpful to the mother. the Baby

16 My baby is premature.Will my milk be sufficient, or do I need to give supplements to my baby? In case of prematurity, the baby is born early and is deprived of the benefits of staying inside the uterus for a longer time. Certain nutrients transferred during the last part of pregnancy are unavailable in the baby's body. These nutrients need to be supplied to the baby. Mother's milk is usually best suited for the baby even in case of prematurity, as the milk contains higher levels of fats and other required nutrients. Hence, it is ideal that the premature baby receives mother's milk. My baby is unable to latch on to the breasts. How can I give my feeds? Sometimes the baby finds it difficult to latch on to the nipples; this may be due to various reasons. Some developmental defects may interfere with breastfeeding. Flat or inverted nipples, large nipples, or sore nipples can hinder correct latching onto the nipple. In these cases, the baby must not be deprived of the benefits of breastfeeds. You can express the breast milk and feed it to your baby. What is effective suckling? The next step for an infant with a good attachment would be to assess suckling. If the infant takes several slow deep sucks followed by swallowing and then pauses, the infant is suckling effectively. Can the collected breast milk be stored for later use? Breast milk banking is a fairly recent concept. When there is extra milk or if the baby

17 How can breast milk be expressed? There are different methods of expressing breast milk. » Manual expression is achieved by pressing around the areola region and milking the breast towards the nipple, so that the milk flow occurs. This method may be difficult, as it is painful and time-consuming. » Hand-held breast pumps can be used to express the milk. The pumps usually have a collecting chamber, where the milk flows and gets collected. » Electrical breast pumps do not require any effort from the mother. The milk flows out into the collection chamber and can be used to feed the baby. skips a feed, the mother is encouraged to express the breast milk. Guidelines to be followed: • Milk can be collected in collection bags available for the baby at a later time. • If it is frozen, it can be stored for later use for the following durations: » Room temperature – 6 to 8 hours » Refrigerator (non-freezer compartment) – 24 hours » Refrigerator (freezer compartment) – for up to 2 weeks • Never heat or microwave the breast milk. • Refrigerate the frozen container the night before you intend to use it. • You can also gently warm the milk by placing it in a bowl of warm water or under warm running water.

18 What if my breast milk is not sufficient? "Not enough milk," most of the time, is a perception rather than a fact. Every mother can produce enough milk needed for her baby. Some of the reasons, as mentioned below, can be managed with simple measures: » Not breastfeeding often enough – feed frequency to be 2-3 hourly » Too short or hurried breastfeeding – get adequate breastfeeding guidance » Night feeds stopped early » Poor suckling position – need to know about recommended positions and opt for a comfortable one » Poor oxytocin reflex (anxiety or lack of confidence) – calm down and create a positive and comfortable environment » Engorgement or mastitis is a sign of improper feeding — of not emptying the breast In case your baby is not growing well as per the recommended milestones, or you cannot produce adequate breast milk, consult your doctor.

How often should I feed my baby? Your baby has a tiny stomach. Therefore, the baby can consume only a particular amount of feed. Once this is digested, the baby will demand for a feed again. It is good to allow the baby to decide the frequency of feeds; this is called an “on demand” feeding schedule. Usually, the newborn baby will demand feeds every 1.5 hours to 3 hours; this is a normal interval. At night, there may be a slightly longer gap between the feeds. How will I know if my feeds are sufficient for my baby? Your baby will decide how much and how often she/he needs to be fed. There will be adequate weight gain when the milk feeds are sufficient. The baby passing a good amount of urine, with at least 6-7 diaper changes in the initial period after birth, and if the baby sleeps well after the feeds for at least 1.5 hours, this will indicate that the baby is getting enough milk. 19

20 B U R P I N G the Baby What is the purpose of burping? Most babies swallow some air while feeding. This air tends to get trapped in the baby's tiny stomach. This air fills up the baby's stomach and produces gas. As a result, babies can develop colic, making them cranky and restless. Burping the baby after feeds helps to expel this gas and keep the baby comfortable after feeding. What happens if the baby does not burp? Sometimes, the baby does not burp after a feed or may just fall asleep during a feed. However, the baby may wake up later due to discomfort caused by gas in the stomach. Sometimes, just picking up the baby may provide comfort. The baby may also burp immediately on being picked up and feel comfortable and relieved. Till what age should the baby be burped? Usually, the baby needs to be burped during the first few months of life. During this period, the baby mostly sleeps and is in a flat and reclined position. Once the baby can roll over and sit up, the baby

21 burps on her/his own when the posture changes. This may happen anywhere between four and nine months. After this time, it may not be essential for the mother or caregiver to burp the baby. How to burp a baby properly There are different methods of burping a baby. You must select a method in which you and the baby are most comfortable. Sometimes, trying a different burping method is a good idea, as this may help the baby burp faster. » The most common technique involves placing the baby against your chest as you sit in an upright position. The baby's chin should rest on your shoulder as you support the baby with one hand. With the other hand gently pat the back of the baby, while making short rocking movements. » Hold the baby sitting up in your lap across the knees facing away from you. Support the chest and head with one hand by cradling the baby's chin in the palm of your hand. Grip the chin carefully and don't compress the throat. Gently pat the baby's back with your other hand. » Lay the baby on your lap on the belly. Support the baby's head and ensure that it is slightly elevated above the chest. Gently pat the baby's back until the burp is heard. It is a good idea to try burping the baby in between feeds, whether breastfeeding or bottle-feeding. This will make the stomach remove the swallowed air and allow the baby to get more feed.

22 Is it possible to burp a sleeping baby? The baby may drift off while feeding. This is especially true if the mother feeds the baby while lying down. During nighttime feeds, both the baby and the mother tend to fall asleep as soon as the feed is over. It is recommended that the baby is picked up and burped even while asleep before laying her/him down on the bed. Does burping mean that the baby's stomach is full? The baby burps in an attempt to remove the air that has been swallowed during the feed; this does not indicate that the baby's stomach is full. When the stomach is full, the baby will automatically stop feeding. Is it alright if the baby does not burp after every feed? Sometimes, the baby does not burp despite trying for a long time. Try to change the position and then again, try to make the baby burp. If the baby remains comfortable, despite not burping, it could indicate that the baby has learned to feed without swallowing air. You need not worry in this case. However, if the baby becomes cranky, it is suggested to try a different position to burp the baby after the feed.

23 What is the role of the umbilical cord in infants? The umbilical cord is the lifeline between the infant and the mother. It anchors the infant and carries all the required nutrients from the mother to the infant. It also removes the waste products generated in the infant's body back to maternal circulation. How soon does the stump fall off after birth? The umbilical stump usually dries up and falls off any time between five days and fifteen days after birth. If it persists beyond that, it indicates an infection in the stump. CARE OF THE Umbilical Stump

24 What precautions must be taken while caring for the umbilical stump? Don't be afraid to clean your baby's umbilical stump. The quicker the base dries, the sooner the stump will fall off. Make sure that you wash your hands before handling the cord. If it becomes soiled with urine or feces, clean the area while changing the diaper. To clean the stump, use a cotton swab or cotton round and wipe around the base of the cord with clean water. Is it recommended to keep the stump covered? No, it is better to leave the stump exposed unless your doctor has recommended that it must be kept covered with a sterile cotton swab. The stump area should always be kept dry and clean. If the diaper is high, fold it down. The cord area usually heals in about seven to ten days. Can we bathe the baby before the stump falls off? It is better not to place the baby in a tub or in a sink to bathe before the umbilical stump has fallen off. It is better to give a sponge bath at this time. However, in

25 What are the signs of infection? It is important to recognize the signs of infection of the stump. These include: » Redness of the base of the stump. » Bleeding from the stump. » Yellowish discharge or pus from the stump. » Foul smelling thin liquid discharge. » Baby cries when you touch the stump. If you notice any of these changes, you must consult your doctor. case you give the baby a bath, make sure to dry the stump completely; this must be done gently, without hard rubbing. Is it necessary to apply any medicine to the umbilical stump? It is better to let the stump dry naturally, by ensuring that the base of the stump is dry and exposing it to air as much as possible. If there are signs of infection, your doctor will ask you to apply medicine to the umbilical stump. Is it recommended to wrap a coin around the umbilicus once the stump has fallen off? There is a belief that by placing a coin on the umbilicus and tying it in place with a cloth, the umbilicus will remain inside and not pop out; this is not true. The umbilicus usually pops out due to muscle weakness, which corrects itself as the baby grows. The coin application does not serve any purpose and must be avoided.

26 D R E S S I N G “Swaddling the baby” is the term used for wrapping and dressing the newborn. How to swaddle the baby Soon after delivery, the newborn is spread on a blanket and swaddled. The blanket is folded above the head, the arms are straightened, and the blanket is tucked around, while folding it. The blanket is then tucked under the baby, keeping it slightly loose around the hips. Do not pull the legs straight or force the joints, as this can cause injury to the hip joints. the Newborn

27 Do babies benefit from swaddling? Babies have a startle reflex which is normal during the initial period after birth; this could make them wake up with a sudden jerk from an otherwise peaceful sleep. Swaddling helps keep the newborn warm, reduces the sudden startles that may occur, and resembles the safe confines of the womb. Swaddling helps to provide a sense of safety and protection for the newborn, like the mother's womb. Is it necessary to swaddle all babies? Swaddling keeps your baby comfortable and snug while asleep. It encourages peaceful and uninterrupted sleep without disturbances due to the involuntary startle reflex. However, some babies do not like to be restricted by the tight layers of clothing, and would resist swaddling. For these infants, it is a good idea to avoid swaddling and just cover them in a manner that keeps them comfortable. When to stop swaddling It is essential to know when you must stop swaddling your baby, as it can cause a hindrance to the baby. Swaddling can interfere with the baby's motor development around the age of two months. Hence, it is a good idea to stop swaddling the infant around

28 this time; this will allow the baby to move comfortably and develop various age- appropriate motor skills. What sort of clothes are comfortable for newborns? It is important to dress your baby according to the weather and temperature. In the newborn period, it is a good idea to clothe the baby in something that will cover the entire body, especially the back and legs. A single dress called a onesie, or a wrap shirt is a good way to cover the baby. Also, the head must be covered, as it contributes to a large surface area of the infant. Covering the feet with socks may be essential if the onesie does not include the toes. The baby must be wrapped in a blanket or a thick sheet, depending on the weather conditions. Dressing for the winter

29 It is best to layer the infants to keep them warm. An undershirt with a shirt and a sweater is a good way of dressing. A sweater or a proper fitting jacket will ensure that the baby is comfortable. A warm blanket may be used, especially while traveling. A pair of mittens or gloves are essential to keep the hands warm. A woolen cap is needed to prevent temperature loss from the scalp. Summer dressing It is best to use soft cotton clothes during summer and not layer the baby too much, as it would make the baby sweaty and uncomfortable, besides raising the body temperature. The garments should be lightweight and loose but must not interfere with the baby's movements. Use cotton or lightweight caps for the head and cotton socks to cover the feet. Avoid clothes with buttons at the back or in places that can press the skin and cause discomfort.

30 Bedtime clothes Make sure that your baby's bedtime clothes are comfortable. Temperature fluctuations can occur throughout the night. Make sure you dress your baby to accommodate these changes. It is a good idea to dress the infant in a manner that will maintain the body temperature even without using a blanket. Avoid covering the baby's head while asleep, as it can make the baby uncomfortable due to increased body temperature. You could use a correct-fit sleeping bag for your baby; this will help maintain the body temperature and prevent the baby from rolling over on the stomach while asleep. It will also avoid the need for several layers of clothing.

31 W A T C H T H E U R I N E of your Newborn Newborn infants pass urine soon after birth.The passage of urine is crucial, as it is indicative of the status of the kidneys and the urinary bladder. How soon do babies pass urine after birth? Most newborns pass urine within a few hours after birth. Almost all will pass urine within the first 24 hours after birth. In case there is no urine passed within the first 24 hours, the infant needs to be assessed by a pediatrician.

32 What is the normal color of a newborn’s urine? The normal newborn urine is pale yellow. Urination usually occurs after a feed but may also occur after some time. The infant may strain before passing urine; this is a normal reflex due to the small size of the infant's urinary bladder. In case this persists, it is advised to contact your doctor. How to assess if the urine output is adequate Generally, the amount of urine produced in a newborn depends on the quantity of feeds taken. It is a good indicator that points to the sufficiency of feeding. The number of diapers that must be changed each day is an estimate of the baby’s urine output. What is a“not normal” urine output? As you become aware of the normal amount of urine the baby passes, you will be able to recognize when the amount of urine is insufficient. During the initial six days, babies should wet as many diapers as the number of days since birth. For instance, a one-day-old baby should have at least one wet diaper in 24 hours; a two-day-old baby should have a minimum of two wet diapers in a day, and so on.

33 The diaper must get heavier with urine with each passing day, particularly after the third day. Once the baby is a week old, there should be 6 to 8 wet diapers in an entire day. A wet diaper should feel like two to four tablespoons of water on a dry diaper. Watch out for the following signs in your baby: » Your baby does not pass urine within 48 hours after birth. » Your baby is wetting less than the number of diapers as his/her age in days. » The urine is dark, or the color seems abnormal. If you notice any of these changes, please contact your pediatrician without further delay. What is the normal frequency of urination? In the initial days, the frequency of urination may be less, as the feeding pattern begins to settle into a definite routine. If your baby passes urine at least 2-3 times a day during the initial days after birth, it may be considered normal. Once the feeding pattern becomes well-defined, the baby will pass urine at least 5-6 times daily. If it is less frequent than this, it could point to inadequate milk consumption. During winter, the baby may pass urine more often, sometimes soon after every feed; this is normal and is not a cause of worry.

34 S T O O L P A T T E R N When will the baby pass its first stool? Around 99% of term infants and 76% of preterm infants pass stool within the first 24 hours, and almost all infants pass stools within the first 48 hours. After the baby has come to the side of the mother, and she notices that the baby has not passed stools for more than a day, the first thing is to ascertain from the labor room or the cesarean theater staff whether the baby has passed stool while under their care. Hence, it is essential that the nursing staff document when the baby passes stools. If the mother has been administered magnesium sulfate to slow down premature labor or as neuroprotective for the preterm baby, it may delay the passage of stools. Drugs given for pain control may also delay the passage of stools. of the Baby

35 What is the baby's first stool called? For the initial few days, the baby passes stool called meconium. It is a dark green, sticky substance consisting of mucus, lanugo (fine hair covering the baby's body), epithelial cells, and amniotic fluid. In most cases, it will be your baby's first bowel movement. As the baby ingests breast milk, the stool will change its color to yellow. It may take 2-3 days for it to happen. What is the normal frequency and nature of the baby's stools? The frequency of your baby passing stools may vary from once a day to two or even 8-10 times per day. Many times, as soon as the baby ingests milk, she/he will immediately pass some stool due to the exaggerated gastrocolic reflex, which usually settles down within a few days. It is essential to realize that constipation is diagnosed based on the consistency of the stool and not on the frequency. As mentioned,

36 for the first 2-3 days, the stools will be dark green and sticky. Gradually it turns to golden-yellow and then yellowish-brown. The consistency may be semi-solid to liquid. From time to time, the stools may appear greenish, and there is no need to panic. Stools that had a quick passage through the colon may be greenish as there was less time for the bile to be reabsorbed. Does a baby strain and make sounds while passing stools? Mothers commonly observe this, and many feel that the baby is in distress. However, one should remember that an infant always cries when pain or discomfort occurs. This behavior is normal as the infant is still not used to the peristalsis (wave-like movement of muscles in the intestine) and the feeling before and during the passage of stools. This behavior settles down with time. The mother of a newborn usually tells the pediatrician, "My baby is passing gas." It is normal, and babies sometimes even cry while releasing gas. Is there any link between the mother’s diet and the infant’s stool habits? It is quite common for mothers to discuss this topic. They usually feel that their diet content often causes discomfort or change in the baby's stool consistency, leading to diet restrictions being imposed on the mother. However, this is more of a myth. The mother should eat a balanced diet with fruits, vegetables, cereals, grains, and protein, and drink clean water. This will lead to adequate milk production.

37 An imbalanced, poor-quality diet may affect the mother's health adversely. When should I worry about the baby's stools and stool habits? You may need to be vigilant in the following situations: » The baby has not passed stool in the first 48 hours. » The baby is passing meconium even at the end of the first week. » The stool is pale whitish gray in color. » There is associated abdominal fullness with the delayed or infrequent passage of stools. » There is vomiting, especially yellowish or greenish, associated with the infrequent passage of stools. » There is blood in the stool. » The baby is not feeding well, and there is increased yellowness (jaundice). » There is a significant loss (more than 15-20%) of weight after birth. » The stool is very watery, and the frequency is more than 10-12 times per day. All the above will warrant seeking advice and help from a healthcare provider for obtaining guidance regarding the further action.

38 Y E L L O W B A B Y Jaundice in the Newborn Jaundice is a common condition seen in newborns during the first few days after birth. Although many myths are associated with jaundice, it is generally a transient condition in most newborns. What is the reason for jaundice? Jaundice presents with yellowish discoloration of the sclera of the eyes and the skin of the baby. It results from too much bilirubin in the body. Bilirubin is a yellow pigment that is made during the normal breakdown of red blood cells. The liver

39 recycles this after processing and eliminates it in the urine and stool. If there is excessive breakdown of the red blood cells, as is normal in the newborn period, this pigment gets deposited in the skin and mucous membranes and presents as jaundice. The appearance of jaundice could also mean that the liver is not processing the bilirubin normally. By early and adequate breastfeeding, it may be possible to reduce the effects of jaundice. Is jaundice harmful to my newborn? Most babies develop jaundice during the first 3-5 days after birth; this is usually mild and reduces over the next 4-5 days without any treatment. However, the bilirubin level may be very high sometimes, and the baby appears extremely yellow. The baby may not be adequately active and will pass very dark-colored urine. This is harmful, as it can affect the baby's brain and result in deafness, seizures, and brain damage. However, it is not very common unless there is some underlying disorder. How is the extent of jaundice diagnosed? Jaundice is diagnosed by measuring the level of bilirubin in the blood. A blood sample is collected from the baby and tested in the laboratory. The level can also be tested using an instrument placed over the baby's forehead, which reads the amount of bilirubin in the body. This level is then plotted on a

40 graph that illustrates the level based on your baby's age to detect whether the levels can be managed as such or will require some treatment. What is the treatment available in case jaundice becomes too high? Once the bilirubin levels go beyond a certain level, the doctor will decide to initiate some treatment. Generally, double-surface phototherapy is given. The therapy involves exposing the naked baby to blue light, which effectively neutralizes the bilirubin in the body. The baby is placed under this light Can sunlight help in reducing jaundice in my baby? An old concept was that by exposing the baby to early morning sunlight, it is possible to decrease jaundice. However, just by exposing the baby to sunlight, the bilirubin does not decrease. Bilirubin, at lower levels, is eliminated from the body without any active treatment.

41 When is jaundice more dangerous? Jaundice, even at lower levels, may cause problems in some babies. These include: » Preterm babies born before 37 weeks of gestation » Babies weighing less than 2500 g at birth » Babies whose blood group is incompatible with their mother's blood group » Babies who develop jaundice early, particularly during the initial 24 hours » Babies with jaundice on the arms, legs, and face » Babies with infection » Babies with bruises and a difficult delivery » Babies whose siblings had jaundice at birth and required treatment continuously and can be moved out only for feeding. As the levels reduce, the duration of placing under the blue light gradually reduces. While under the light, the baby's eyes and genital area are kept covered. This can also be done using a ‘biliblanket’ in smaller babies. Sometimes, the levels of bilirubin rise dangerously high. At this time, the doctor may decide to do an exchange transfusion for your baby. Here, the baby's blood is replaced by fresh matching blood so the bilirubin levels can rapidly decrease.

Himalaya & the Science of BabyCare Bringing the best of Nature's care for babies by contemporizing Ayurveda with modern technology

44 T E M P E R A T U R E M A N A G E M E N T of the Baby The baby should ideally be warm, neither too hot nor too cold. You should feel warm if you touch the baby with the back of your hand. There is no need to check the baby's temperature every now and then. The normal body temperature of a newborn is between 36.5°C and 37.4°C. Preterm babies tend to get cold more quickly as their body surface area is more in comparison to their weight. Hence, if not covered properly, they tend to lose heat. Therefore, avoid placing the baby on cold surfaces, do not allow the cold breeze to enter the baby's room, and do not leave a wet baby exposed. However, allow for cross ventilation and good light in the baby's room.

If the baby is not kept warm, she/he must spend energy to produce heat and will have less energy for weight gain. The head is the part from where maximum heat is lost. Hence, a baby should wear a cap. Palms and soles are the other areas from where heat is lost. Therefore, in cold weather, using mittens and socks is advised. However, in hot weather, the layers of clothes can be reduced, and a thin, light vest should suffice. It is alarming if a baby is cold to touch, especially during the first few hours of life. Newborn babies during this period should not be allowed to get cold because newborn babies' response to any stress, such as low sugar or infection, increases by lowering the temperature, placing them at higher risk. Keep babies warm by layering clothes and swaddling them with a blanket. However, if they continue to be cold, advice from healthcare providers should be sought. Skin-to-skin care, also called "kangaroo mother care," can be provided following the right steps, which will be taught before discharge in case of preterm or low birth weight babies. Perhaps, it will be practiced for many days before discharge. Mothers should continue this even at home. 45

46 Other than the above measures, room heaters can be used. It is better to use a good quality heater with enough protection to avoid accidents. Do not keep it too close to the baby. It is good to humidify the room air by keeping a bowl of cold water in front of the heater. As the baby grows, she/he can maintain the body temperature in a better way. While buying thermometers, avoid the glass mercury thermometers, as they are prone to breaking and mercury spillage is dangerous. Digital thermometers can take a long time to arrive at the correct temperature. Non-touch thermometers are ideal. Finally, a reminder: let the baby be warm but neither too hot nor too cold.

47 W E I G H T M A T T E R S What is the normal birth weight of a newborn baby? The average birth weight of newborns in India is considerably lesser than their European counterparts; this holds true for babies born in other Asian countries, probably related to the inherent genetic constitution. The average birth weight of a newborn in India is around 2.8 kg. Male babies tend to be a bit heavier than female babies; however, the exact reason for this is not scientifically enumerated. What You Need to Know

48 Is there a change in weight soon after birth? In the first 24-48 hours after birth, there are significant changes in the body. The body needs to adjust to the environment outside the uterus. Hence, fluids are adjusted in different parts of the newborn's body. As a result, body weight is lost in the first few days after birth (almost 8-10% of the birth weight). This is a normal physiological change in the body and usually gets corrected after a few days. When does the baby regain the birthweight? Usually, a baby loses body weight in the initial days after birth; this may last up to a week after delivery. During this period, breastfeeding may not be completely initiated and could add to the baby's weight loss.

49 Are there any reasons why some babies are heavier at birth? There are many reasons for varying birth weight. Apart from the genetic factors, there are other reasons why some babies are born with higher birth weights. Everything that happens dur ing pregnancy affects the baby's weight at birth. If the mother had health issues, anemia, high blood pressure, kidney ailments, or did not gain adequate weight during pregnancy, the baby tends to have a lower birth weight. These infants are called small for date babies. If the mother had diabetes mellitus during pregnancy or gained a large amount of weight, the infant's birth weight tends to be higher. These are called as large for date babies. However, by the end of the first week, the weight stabilizes, and the baby begins to gain weight. By the 10th day after birth, the baby's birth weight is generally regained.

50 Are there any standard weight differences that can be anticipated? Usually, parents with higher body weights have larger babies. The incidence shows that the weight increases as the birth order increases, and the firstborns are usually the lightest. Male babies tend to be heavier than female babies, although the females are sturdier and more tolerant to stress during the newborn period. How much weight does a newborn gain after birth? The rule of thumb is that the infant gains 15-30 g daily. Thus, the baby would double the birth weight by the age of five months and triple the birth weight at age one. By age two years, the weight would be four times the birth weight. When do we need to worry about the weight gain of the baby? You must be concerned if your baby has not gained the desired weight every month, as this can be due to various factors. It is good to consult your doctor when your baby is not feeding or sleeping well enough and is not putting on sufficient weight.

51 I N F A N T Do babies need any supplements? Breast milk is the best nutrition for every baby. Ideally, this is complete and wholesome nutrition that should provide all the required nutrients for baby's growth and development. However, mother's milk may sometimes not contain all the nutrients in the desired proportions needed for the baby's proper growth and development. Hence, supplements may be necessary for the baby. Does a breastfed baby get adequate amount of nutritional factors and supplements? Ideally, breast milk is the most appropriate infant food providing all the nutrients required for Supplements

52 proper growth. The mother sometimes does not consume a diet that can provide all these nutrients. Breast milk then draws these nutrients, like iron and calcium, from the mother's body and provides them to the baby to some extent. As a result, the mother's body tends to develop deficiencies, and the baby too may not have adequate amounts of all the nutrients. How is vitamin D beneficial for the baby? Vitamin D is produced in the body upon exposure to sunlight. It is also obtained from certain foods like oily fish. However, if the mother is not exposed to sunlight adequately or does not consume fish, the vitamin D levels in her body can be low. Thus, breast milk will not contain enough vitamin D. This vitamin is required for the growth and strength of the bones and muscles. Vitamin D is also linked to the prevention of rickets in infants.

53 What is the daily requirement of vitamin D for infants? The American Academy of Pediatrics has recommended a daily intake of 400 IU of vitamin D supplementation for all infants. This is due to the decreased exposure to sunlight. This supplementation must be started soon after birth and continued for the first year of life. Is iron supplementation needed for infants? Iron is an essential micronutrient critical for the infant's motor and cognitive development. Infants and young children with iron deficiency or anemia are at risk of developmental difficulties involving cognitive, social-emotional, and adaptive functions. It has been found that a large proportion of pregnant women and lactating mothers have low iron stores in their bodies. Thus, breast milk may be deficient in iron, and the infant will not receive an adequate amount of this micronutrient from breast milk. Supplementation of iron may be needed under these circumstances.

54 What vitamins and minerals are needed for infant supplementation? All vitamins are needed in an optimal amount to ensure the proper growth and development of the infant. Vitamin A is needed to support healthy eyesight and the normal immune functions of the infant. It has been found that a vast majority of pregnant women are deficient in vitamin A and hence, cannot provide the required amounts for their infants.

55 Zinc is a mineral known to promote resistance to infections, improve immunity, and help in the proper growth and development of the nervous system. It can also help in protecting against diarrheal diseases by improving the gut barrier, as well as maintenance of other mucosal linings. Zinc supplementation can be invaluable in ensuring the health of an infant. The B-complex vitamins, like B1, B6, and B12, are essential for normal neurodevelopment and maintaining the red blood cells in the body. Vitamin C in adequate amounts will protect against infections and help heal wounds. Supplementation of all these vitamins and minerals may be needed when the mother is deficient. Are supplements needed for infants given formula feeds? Most infant formulas are already fortified with all the required vitamins and minerals. Usually, this is adequate for the daily requirements. However, vitamin D supplements may be given after checking the amount that is provided by the supplement formula.

56 C R Y I N G What is the normal crying time of a newborn baby? It is essential to know what is normal before discussing excessive crying in a newborn baby. A baby's normal cry time may vary from baby to baby, day to day, and at different times. However, the average crying time of the infant may be around two hours daily. From birth to six weeks of age, the crying time may be higher, about three hours daily. So, on average, the crying time may extend from one to three hours in the newborn period. Are there any common and usual causes of excessive crying? Babies may cry for many reasons. As the baby cannot express her/his needs in any other possible method, she/he resorts to crying. Hence, it is vital Baby

57 How to comfort a baby crying excessively The only method to comfort a baby while excessive crying is to remove the cause of disturbance for the baby. It is a good idea to pick up and hold the baby when crying excessively. Hold the baby upright or flat, which will help the baby relax. Rock the baby using a rocking chair or cradle with rapid small vibrations. You could also take the baby out into an open area to make the baby feel relaxed and comfortable. to understand the cause of excessive crying and treat it accordingly. Some of the reasons for which babies may cry often and excessively include the following: » Hunger »Thirst »Loneliness or boredom »Irritation due to a wet diaper »Discomfort from a soiled diaper »Excessive gas or colic » Illness or infection »Pain Is it possible to detect the cause of excessive crying in a baby? It is a difficult problem to solve, as the baby may cry for many reasons, as enumerated above. If it has been over two hours since you fed your baby, the crying may be due to hunger. Offer the baby a feed and see if the crying eases. Also, checking the diaper before beginning the feed is a good idea. Sometimes, the diaper area is irritated due to a rash

58 and must be appropriately treated, or your baby will cry excessively due to the pain. While breastfeeding, it is a good idea to avoid too much caffeine as this can cause excessive fussiness in the baby. Are there any medications that should be given to calm the crying baby? If you can find the cause of excessive crying in your baby, the solution would be to remove the cause. However, the challenge comes when you cannot decipher the cause of excessive crying. In such cases, it is good to check thoroughly to look for any irritants disturbing the baby. In the absence of any detectable cause, it is good to attempt to burp the baby, carry her/him into some fresh air, rock her/him, and, if needed, give a feed. If nothing works, it is better to contact your pediatrician and get an expert opinion.

59 Diapers are an essential part of every baby's clothing.The diaper you use depends on your personal preferences and your baby's comfort. » Cloth diapers are the conventional method used for caring for newborn babies. These are made from soft cotton cloth, which is gentle on the baby's skin. These are re-usable and must be washed and dried well. The disadvantages of these diapers are that they must be cleaned thoroughly, washed, and dried well before use. They can cause skin infections and irritation if they have not been properly cleaned or dried. » Disposable diapers are used in most urban areas for their convenience. These diapers are readily available, can be picked up off the shop shelf, and come in different sizes. These diapers do not need to be washed or cleaned before usage and can be discarded once soiled. However, the disadvantages are that they cannot be reused. A L L Y O U N E E D T O K N OW about Diapers

60 What are disposable diapers made of? Diapers are made using absorbent materials covered in layers of other materials. The absorbent material is usually a polymer and is present in the core of the diaper and does not come in contact with the baby's skin. Some diapers contain certain dyes, which act as wetness indicators. Most of these are safe for infant skin. Some diapers contain volatile organic compounds, like toluene and xylene, used as fragrances in the diaper and may cause some skin irritation. Wood pulp is bleached and used to make diapers, producing dioxins as by-products. These compounds may persist for long in the diaper, but are not at harmful levels in the disposable diapers available in the market.

61 Can I use diapers for my infant? Diapers are said to be safe for babies, including newborn babies. Those manufactured particularly for newborn infants are preferred. » Diapers must not be allowed to stay without change for more than two or three hours; after this time, it is a good idea to change the diaper. » Watch the baby's skin in the diaper area, as the skin is delicate and can be easily irritated and infected. Hence, you must watch out for evidence of any skin irritation, redness, or rashes while changing the diaper. » When your baby passes stool, you must change the diaper immediately to maintain the hygiene of the diaper area.

62 How to clean the diaper area It is a good idea to clean the diaper region with a soft cotton cloth or baby wipes before putting on the new diaper. The correct cleaning method involves cleaning from the front to the back in order to prevent contamination by fecal matter. It also helps ensure that no secondary infection can occur, and contamination and cross infection are avoided. Clean the What precautions must be taken before putting on a diaper? Before putting on a diaper, it is good to practice the following: » Clean the area using a soft, absorbent cotton cloth or baby wipes. » Use warm water to clean the area. » Clean the skin folds of the groin as fecal matter, sweat, and urine tend to collect in these regions and cause skin irritation. » Dry the area with a dry cotton cloth. » Apply diaper cream generously, especially to the groin folds and bottom regions, ensuring that the skin is kept lubricated and does not get damaged. » Use a good quality diaper that is well suited for your baby.