Baby Check-up – Two Weeks After Delivery

IMMEDIATELY a baby is born, the doctor or nurse who conducted the delivery must take an Apgar score. This refers to a scoring system used to assess the well being of the baby during its first minutes of life after delivery. It is done in every hospital in the country, be it public or private.

The best delivery is when the baby comes out crying or screaming. The baby’s effort in breathing is checked: the heart rate should ideally be above 100. The colour of the body—does the baby look blue—and the muscle tone are also examined. Ideally, a healthy baby should have flexed its limbs on the body. A baby who is folding her hands on the body shows a good tone but a baby born with the hands straight does not give a good sign.

The last part of the Apgar involves pushing a special tube through the nose and to observe how the baby reacts. A good baby should pull up the face and maybe move the limbs like it is fighting. If the baby reacts violently, it is a good sign but when is just passive, it is worrying. The best Apgar score is above six.

Two weeks after delivery a mother will be requested to take her infant to a post-natal clinic for review. What is checked during this first visit to the clinic?

□ The child’s ability to breastfeed and any breast infections which need to be addressed. It is important to monitor feeding especially for first time mothers, because while in the hospital the mother may appear to cope but when at home by herself she may develop some difficulties like cracked nipples or engorgement of the breast and therefore fear or hesitate to breastfeed. It is also necessary to find out if the mother has introduced other feeds or she is still exclusively breastfeeding.

□ The baby is also examined for any illnesses, for example, infections of the skin, eyes and ears. The umbilical cord stump is checked to determine if it has dropped off and the umbilicus has healed well. If an infection is noted, it is addressed immediately. The healing of the umbilical cord varies with children.

For some, it might actually drop off even before discharge front the hospital but in majority of cases it heals within the first two weeks as long as it is kept clean and dry. A small percentage of babies have what is known as ‘call gradinoma,’ where the stump tends to hang on for a longer period but eventually drops off.

□ The doctor will also check if the child is passing stool well: that is, if is it too frequent or not as frequent as it is expected to be. There are some babies who, in the first few weeks of life, pass stool with every feeding and some mothers may view this as abnormal. It is advisable to assess, and establish if it is actually the normal pattern of passing stool or the baby has got some infections.

□ It is important to establish the baby’s sleeping pattern. Does the baby sleep well or is she staying awake most of the time? One of the factors that may result to a baby being sleepless or waking up frequently is inadequate feeding. If a baby feeds a little and then falls asleep, within a short while she will be awake, but if a baby is breastfeeding adequately, she should he able to sleep for almost three hours before waking up again to feed.

Babies’ normal sleeping pattern is that they sleep a lot during the day, they just wake up to breastfeed and then sleep again and at night they stay awake. A child can sleep for even five hours during the day but will have to wake up because of the need to feed.

□ At two weeks, the baby’s growth and development is checked. It is expected that a baby will lose some weight in the first few days after delivery. This is because when babies are born they have meconium (first newborn stool; which they lose and then they also have a lot of fluid in their tissues and a little bit of that is also lost. By the time they leave the hospital, most of them would have dropped a small percentage of their birth weight.

A review of the baby’s weight trend should indicate that she has started re-gaining weight alter this initial drop. Ordinarily it is expected that by the 10th day of life, the baby will have at least regained her birth weight.

□ Any abnormal problems not detected at birth, for example congenital abnormalities such as problems of the heart, will be diagnosed. At times a baby can be born and while still in the hospital ones does not notice any abnormal heart sound but after some time you can be able to pick this up. it is not obvious that all the congenital heart problems will definitely be picked at birth: some can be picked much later, even beyond the two weeks.

□ The doctor will also check the capability of the mother to cope with the child. This involves simply finding out how the mother is coping. It can be assumed that being a mother is a natural process but at times, it can be quite difficult for some mothers. The doctor will assess her and find out if she is able to handle the baby or she needs assistance.

In some cases a mother may be found to have depression. Some mothers have actually had to go back to their mother’s home, after delivery, to be assisted in their first few weeks, especially mothers who have had C-section and have babies who cry the whole night, keeping them awake.

□ The mother is advised on when to start immunisation, which might not have been given at birth. Ideally, the basic vaccinations like the BCG for tuberculosis and the first polio drops should be given soon after birth or before the mother leaves the hospital.

However, some hospitals have particular days when they give those immunisations and if a baby is born before or after the days of immunisation, it would be important for the mother to go back. When such a mother comes after the two weeks visit, it is important to find out if they actually took the babies back for immunisation.

What happens during the visit?

□ The child is weighed and vital signs like pulse rate and respiratory rate are taken. The weight will tell if the baby is feeding adequately and if the weight of the baby seems to be going down an assessment is made on how the mother is feeding the baby.

Pulse rate and respiratory rate will normally point out if the baby is unwell. If the breathing rate is abnormal, the doctor will try finding out what could be the cause.

□ The baby is examined from head to toe to find out if there is any defect which might have gone unnoticed at birth. For example, a baby might have been born with a head circumference that looks normal but when examined after two weeks, the baby’s head looks a bit bigger than normal.

The doctor should measure the circumference and find out if there is any increase in the size of the head, to rule out hydrocephalus (water in the brain).

□ The mother is given a special growth and development chart (clinic card) to monitor the development of her baby and she is advised on clinic follow up in order to maintain the health of the baby. The mother should also be educated about the vaccines that the baby is expected to get, because apart from the standard schedule there are additional vaccines like Rotavirus, which is given from 10 weeks up to 14 weeks.

Two doses are given four weeks apart, that is, before the baby is six months. Rotavirus is a common cause of diarrhoea and vomiting especially in infancy.

Dr Adelaide Kituyi is a Consultant Paediatrician practising in Kenya.

END: BL 09/58-59

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