Baby's first days

Babys first days
Your baby’s appearance can change quickly in the first days and internal changes also occur to adapt to life outside the womb. Her head may have been squeezed and will look quite different in a day or so. Vital breathing, circulation and other internal changes happen at birth and in the following days

Newborn Examination
An initial check straight after birth should confirm that breathing is established and that all the external features look normal. Your baby should receive another full check within the first 24 hours by your LMC.

This examination checks for any problems with all parts of the body, and especially the heart and circulation, eyes, palate, anus and hips. Some problems can need early intervention, others just need reassurance and observation as they correct themselves. Newborn babies can be deficient in vitamin K (which is important in the control of bleeding). You will be asked whether you want your baby to have an injection of Vitamin K, or three oral doses of vitamin K. This is to prevent a rare but potentially dangerous form of haemorrhage which affects a small number of babies.
If your LMC detects any concerns your baby will be referred to a Paediatrician.

Your Baby’s Skin
At birth babies are covered with a creamy substance (vernix). This protected the skin from the amniotic fluid in the uterus and will come off without help in the first few days.

Dry Skin
Babies who were overdue can have dry cracked skin after birth but this soon becomes normal soft skin. Dry skin is very common in the first few weeks. Soap or baby bathing liquid can sometimes dry baby’s skin even more. Bathing without soap is fi ne – warm water alone is enough. It may help to lightly rub a small amount of a baby moisturising cream or baby oil on her skin, or use a few drops of baby oil in the bath. Oil will make her skin slippery and require extra care when holding in the bath.

Hormonal Spots (Baby Acne)
Most babies get spots that look like acne on their face, head and upper body between 3 to 6 weeks of age. They can last for a few weeks. They are caused by baby’s hormone levels settling down from the high levels received from mum before birth.
No treatment or creams are needed. They are best left alone as they do not scar or become infected. If squeezed they can become infected. If they become crusty or weepy see your midwife or doctor.

Septic spots
These are white or yellow pus filled spots that look like small blisters. The skin around them is often red and maybe weepy. They can be difficult to tell apart from hormonal spots. They can occur around the nappy area or in neck, arm or leg creases. Antibiotics may be needed to clear the infection and stop it spreading. Discuss any concerns with your midwife, or other health professional.



Chapped skin
A dry rash on the face can be caused by dribbling saliva (for an older baby).This generally clears on its own but may be helped with a little baby moisturising cream.

Birthmarks
Many babies are born with a birthmark (naevus). Some different birthmarks are:
• Dark red or pink patches (often called ‘stork bites’) on the eyelids, top of the nose and back of the neck. These are very common and usually fade over the first few months.
• ‘Strawberry’ naevus - more correctly called vascular malformations. These birthmarks grow from red dots to form reddish or bluish lumps which rarely grow large and need treatment. Most grow without harm before fading in the second year, occasionally not fading completely.
• Flat purple birthmarks (often called port wine stains) - are present at birth and are permanent. They can be treated with laser treatment by a skin specialist.

Jaundice
Many healthy babies develop a yellowish colour of their skin a few days after birth. This usually goes by 7- 10 days. It is due to a temporary build up of yellow pigment (bilirubin) until the liver matures enough to get rid of it. Sometimes jaundice can be a sign of underlying problems such as blood group differences, infection or liver problems. If you notice yellow colour of your baby’s skin and eyes, tell your midwife. A blood test can check the level of jaundice. If the level is high your baby may need further checking and may also need phototherapy (using special lights) to help reduce the jaundice level.

Blood Tests
Around the second day, babies can have a small blood specimen taken by a ‘heel prick’ for the ‘Guthrie test’. This test screens for over twenty rare metabolic disorders which can all be treated early before babies get sick or have irreversible damage. They are detected when the card is posted to the National Testing Centre. Your LMC will be notified if any abnormal result is found and should provide you with information about the conditions tested for (which range from thyroid and adrenal abnormalities to cystic fibrosis) prior to getting your consent. www.nsu.govt.nz/Current-NSU-Programmes/914.asp

Umbilical Cord/Tummy Button
Soon after birth, the umbilical cord is clamped and cut.
• The plastic clamp is usually removed 24-48 hours after birth.
• The remaining stump usually shrivels and separates within 7-10 days. It may ooze or bleed slightly for a few days afterwards.
• Keep the area clean and dry and free from any creams or powder, to avoid infection.
• If it bleeds often, is red, sticky or smelly it may be infected. Talk to your midwife or doctor about this. Rarely a bleeding stump can indicate Vitamin K deficiency or another bleeding disorder.
• Some tummy buttons stick out. This is called an umbilical hernia. The bulge is soft and does not cause any pain or bowel problems. It can take up to five years to disappear as the muscles around them tighten slowly. Very rarely do they need surgery, and early surgery can do more damage than good.