It's Your Baby

By Dr Saroja Balan

Becoming a parent can be both terrifying and exciting. You will have a million questions, from how to prepare for the birth to how to feed your baby to what to expect in terms of growth and what vaccines the baby needs. It can all be overwhelming. 'Helpful advice' often ends up being confusing, and the internet can be a source of panic.

During her thirty years of practice, paediatrician Dr Saroja Balan has met thousands of parents and found herself answering the same questions. While she firmly believes parenting is mostly learning on the job, she knows a little help goes a long way. Written specifically for Indian parents, It's Your Baby is the best support to accompany you on your journey.

It is meant to help you figure out when your child needs to see a doctor and when you can handle things on your own. Covering basics such as sleep, breastfeeding and common ailments, it also includes all you need to know about screen time, childhood obesity, pollution and parenting styles, helping you navigate the first two years of parenthood.

Dr Balan's reassuring, no-nonsense approach makes this the essential guide for a safe and healthy child - and a more confident you!

• Language: English
• Publisher: HarperCollins
• Release date: Jan 27, 2022
• ISBN: 9789354892028

Dr Saroja Balan

Dr Saroja Balan is Senior Consultant Neonatologist at the Indraprastha Apollo Hospital, New Delhi, specialising in neonatal intensive care as well as paediatric outpatient practice. She graduated from Madras Medical College, trained in paediatrics and neonatology in the UK, and is a Fellow at the Royal College of Physicians, Glasgow. Dr Balan consults as a paediatrician at BabyCenter, the go-to online platform for new parents. She has contributed several articles to medical journals and publications.

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Introduction

Being a parent is both terrifying and exciting – this is parenthood in a nutshell. You’ll soon find that your time is no longer your own and you are now responsible for this creature, 24 hours a day, 7 days a week, with no time off for good behaviour. Now if that thought does not frighten you and have you running for the hills, then you are made of sterner stuff than most people I know. Having been there, I know what this feels like and I hope to guide you through the next 2 years of your baby’s life with detailed and up-to-date information backed by science. You may have many questions, ranging from why is my baby’s potty green in colour to why is my baby crying unconsolably, and I am hoping this book will answer most of them.

Take a look at the parenting section of any bookstore and you’ll notice two things – lots of prettily coloured, voluminous books, and a cluster of confused and increasingly overwhelmed parents. The sheer number of books and movies, and additional support that new parents are offered, can have the opposite effect: Rather than equip parents, they inundate them with ‘helpful advice’ that tends to forgo simplicity and conciseness at the expense of ease of access to first-time parents. For instance, if you were to have a child-related emergency in the middle of the night – or at any point – when you have only yourself to rely on, leafing through pages and pages of repetitive and hard-to-locate information is of little use. I have been practising paediatrics for nearly 30 years, and after each outpatient clinic I realise that I’ve been answering the same questions day in and day out. There are times when I’ve felt that I should just make a small pamphlet regarding common ailments and dosages of medicines like paracetamol – just so that patients are able to access this information regardless of whether they come to see me.

It wasn’t until the mother of one of my patients approached me, saying that I should write a book that would make life easier for new parents, did I really consider it. I’ll admit, I’ve never thought of writing as my strength. I’m usually quite terse and blunt, which often scares a lot of my patients’ parents away (usually, though, this helps get straight to the point and allays their fears), and that is why the prospect of writing a parenting guide was quite daunting. Could I promise to be exhaustive and understandable at the same time? My excuses were many and varied – until I realised that this book, were I to write it, would be exactly what my patients needed.

When a baby is brought into the room for an examination right after birth, most doctors, after years of practice, are quite adept at assessing whether the baby requires careful examination or not, and can accordingly reassure the worried parents. Health visitors – trained staff equipped to answer most questions that new parents have – are incredibly helpful in these situations. They attend to the parenting emergencies and direct parents with medical questions to paediatricians. Unfortunately, there aren’t any health visitors in India and paediatricians, such as myself, have garnered years of experience attending to these queries, enabling us to address the dual concerns of new parents. My hope is that most parents, after reading this book, will not have to wake up their paediatrician at 1 a.m. to ask whether green potty is normal for a two-month-old and if anything should be done about it. I could write a whole book on midnight calls that have kept me awake wondering if I have chosen the right speciality. Although, I must admit, it all feels worth it when you see children recovering quickly or even forgiving you quite easily after a painful vaccination.

I have, since, found myself looking forward to writing this book because it really feels like a step in the right direction: To set up a community that helps new parents navigate this tricky terrain. Most of parenting is a learning on the job, and this book strives to be the best support to accompany you on your journey. The main goal of this book is to help you figure out when your child is sick and needs a doctor’s visit, so that you can handle the smaller illnesses on your own. I believe that most childhood illnesses need only symptomatic treatment, and less medicine is the way to go (lest these babies turn into pill-popping adults).

When I became a mother for the first time, despite having a degree in paediatrics, simple things like how much to feed, how to bathe, and how to clean the baby, were things that I had to learn on my own since they weren’t mentioned in any of my textbooks. While parents in India usually have a family support system to help them raise a child, this trend is changing, given the increasing number of nuclear families. And though parents these days have access to more information, there is a problem in discerning the quality of the information that they are receiving. Very often, the primary source of information for parents is the internet. While this is a helpful resource, it may also be a source of confusion or panic for new parents. Take, for example, the hapless mother who called me at midnight about green potty. She may have googled and found out ten different reasons for it, which would have frightened her. The information age can leave parents with more questions than answers and, in my practice as well as in this book, I try to answer questions that new parents have.

Raising a child is a huge responsibility and it can drive even the best of us up the wall, or reduce us to an anxious mess. But in time you will hit your stride.

This book does not claim to replace your doctor, but is meant to be a guide to help you navigate the first two years of your baby’s life – and, in turn, yours.

The initial chapters are arranged in order of what to expect after the birth of your baby. Following that, it is arranged topic-wise – sleep, growth, development, and so on. Given that we are amid a pandemic, I have included a section on Covid-19. Currently, in some parts of the word, the vaccine is licensed to be used on children 2 to 18 years of age. India has licensed Covaxin to be used for children 2–18 years while Zydus Cadila will soon be available for children 12–18 years.

At the end of the book, you will find recipes that should help you with your growing child. I have been handing out these recipes since I started my practice 30 years ago. Parents have found them useful over the years. I hope you do too.

1

Parturition. The Birthday. Term Birth

As the day that you are waiting for draws closer, I’m sure you feel nervous. Though your excitement knows no bounds, it is only natural that it is tempered by the fear of the unknown. You have taken classes, you have read books, but are you ready for the birth of your child? Are you really ready to be a parent?

It’s no secret that many first-time parents find the delivery of their baby to be most daunting. Choosing between a vaginal birth and a caesarean section (C-section), managing post-op care and understanding postpartum depression can be quite overwhelming for a first-time parent. That’s where I come in: to filter and refine the barrage of information that will be thrown your way. I shall try to break down the entire first two years of your baby’s life into individual, manageable stages. For example, what happens after birth, how to manage breastfeeding, your baby’s development, vaccination, and so on. Think of it as a set of ‘parenting training wheels’ that come off in time for your child’s second birthday. By which point, you will be more than equipped to take on any parenting challenge that comes your way.

Through the next few pages, I will try my best to simplify any and all ambiguous information that is available regarding childcare, and address all the common concerns.

The Hospital Bag: A Checklist

Around 36 weeks is a good time for you to start packing your bag, as some mothers go into labour well before the due date and you don’t want to be scrambling around then.

Even if you are having an elective C-section and have chosen a date, you could still go into labour before the date. So, it’s a good idea to have your bag ready. I am going to suggest some essential items for both you and your newborn baby.

FOR THE MOTHER

All your outpatient papers, including all the antenatal scans and blood reports. Carry your insurance papers that the hospital will need. If you have a birth plan, make sure that goes into the bag. A notepad and pen are a good idea so that you can write down all the questions you may have for the relevant doctors when they come on the rounds.

Toiletries like toothbrush and paste, your favourite soap and shampoo, things like lip balm and deodorant, and anything else that might make you feel better. Though hospitals may provide all this, you may be happier using your own.

Your night gown and some loose-fitting clothes so that you are comfortable before and after delivery. Make sure you have some comfortable slippers and a robe, as you may want to walk around when you are in labour. You may need a few sets of clothes, as your clothes may get stained during labour and even after delivery.

Your glasses are a better idea than carrying contact lenses, but if you prefer your contacts, then be sure to carry the case and solution – you will want to be able to see your baby clearly.

Your phone (a very important gadget!). Also, the phone charger and even a multi-pin plug.

To try and make the room as comfortable as possible, you can carry your own pillow and blanket or comforter; any photos that you would like close to your bed and some music that you enjoy.

During labour – which may take a few hours if you are induced – you may want to read or watch a movie. So, take what you’d like.

You will need to keep yourself hydrated during labour. If there is something special that you like to drink – like coconut water or lime juice – carry it with you. However, if you have a C-section, you may not be allowed to eat or drink for a few hours according to the hospital policy. Especially with food – some hospitals may not allow you to eat while in labour, so please check with the relevant person before you grab a snack.

After the delivery, you will want loose, comfortable clothes, especially around your C-section wound. You may be given an abdominal binder to wear for a few days after the delivery. Make sure you are carrying enough underwear and feeding bras if you’re going to use them.

FOR THE FATHER

Dads-to-be should also carry comfortable clothes, shoes, books, snacks and – the most important – a cell phone to take pictures.

Carry your wallet with both credit/debit cards and cash.

Carry your insurance papers or card.

FOR THE BABY

For the new arrival, it is best to pack a separate bag.

A car seat is a good idea. Make sure you have done adequate research and learnt how to use it. You will need a rear-facing car seat for the newborn.

Carry a few sets of baby clothes and a going-home outfit. Depending on the weather, use caps and socks. Carry mittens, as most term babies have long nails and tend to scratch themselves.

Take a baby blanket that you can use when you bring the baby home.

Most hospitals these days provide diapers. But you may want to carry some, depending on where you are having the baby.

This is by no means a comprehensive list and you can add or subtract, as the case may be. Now go ahead and pack your bag if you are nearly 36 weeks!

Inside the Delivery Room

The end of the third trimester of pregnancy is typically full of both excitement and anxiety as mothers await their baby’s arrival and the baby inside is trying to make its way out. This is what you have been looking forward to over these past months. At the same time, it can also be physically uncomfortable and emotionally draining. Pregnant mothers might be experiencing swollen ankles and increased pressure in their lower abdomen, and wondering when they will go into labour.

A full-term pregnancy is 40 weeks. At 37 weeks, labour induction might seem tempting – like a gift from the Gods – but we recommend that you wait till your baby is full term. The last few weeks are important as it is during this time that the mother’s body makes final preparations for the arrival of the baby. The baby also does most of its growing, especially the lungs, in the last few weeks. The risk of neonatal complications is the least if babies are delivered between 39 and 41 weeks. However, no two pregnancies are similar, and one might deliver a 37-week baby who is absolutely healthy, with no complications.

Some women choose to go through labour without any pain-relief medication and instead rely on relaxation techniques to alleviate the pain. For most mothers, vaginal delivery is about treating labour as a natural event. This can be done even in a hospital setting with minimal monitoring. Most hospitals now permit your partner/husband into the delivery room, so that both of you can share that first moment. If they would like to cut the umbilical cord, your obstetrician might allow them to do so, and give them a pair of scissors at the right time.

Some of you may have an elective C-section because you may not be able to have a vaginal delivery due to many reasons, one of them being a breech presentation where the baby comes down bottom first, while others may end up with an emergency C-section after going through labour, due to certain complications.

You might have heard about delayed cord clamping. There is a lot of literature advising that doctors delay cord clamping for up to a minute after the delivery of the baby. This is done to ensure more blood to the newborn from the placenta, so that your baby gets more iron, preventing anaemia in the coming months. Anaemia is a condition where you have low haemoglobin (iron is an important component in the formation of this haemoglobin). When you delay the cutting of the cord by a minute, the baby gets extra blood through the umbilical cord. Following delivery, over the course of next 4 to 6 weeks, the haemoglobin steadily falls and can even come down to as low as 8 gm/dl. Breast milk is not a great source of iron for the baby, so most paediatricians give iron supplements to exclusively breastfed babies because it takes longer to correct the anaemia if babies are iron deficient. So delayed cord clamping helps. Occasionally, due to this delay in cord clamping, the baby might receive more than the required blood, leading to polycythaemia, ultimately resulting in prolonged or early jaundice (see p. 16). The jaundice may be exaggerated because of polycythaemia. In case there is any problem with the baby, the obstetrician may decide to clamp the cord earlier, and hand the baby over to the neonatologist.

Some people decide to do cord-blood banking. This must be planned with the obstetrician and the cord-blood bank before delivery. In this case, the umbilical cord may be cut earlier, and the obstetrician will insert a needle into a large vein in the umbilical cord from the mother’s side. The blood is collected in a special bag – this must be done quickly, before the placenta separates and the cord blood stops flowing. The blood which is collected is around 80–120 ml. Usually, this takes only a couple of minutes.

What a Newborn Looks Like

You are probably imagining a pink, gurgling, beautiful baby. In reality, many newborns are tiny, wet, odd-looking creatures when they first arrive. Their heads may be pointy and misshapen, especially if you have had a vaginal delivery. This is because the head moulds to pass through the birth canal. This is only temporary and will right itself in a few days. The baby may also look scrunched up since the legs and arms were kept bent in the womb. This is all perfectly normal, and the limbs will straighten over the coming weeks. You may notice that your baby’s fingers and toes are thin and may have long nails.

The skin appears quite red and blotchy, and sometimes even purple. Some babies are born with a white coating, called vernix caseosa, which protects the tender skin while the baby is in the womb. This is usually washed off after the first bath.

Some babies, especially those born prematurely, have a soft furry appearance because they are covered by fine hair called lanugo. This hair usually falls off in a few weeks. Rashes and blotchy skin are normal in the first few days. The baby’s skin colour and tone also change a bit in the coming weeks and months, and take on the natural complexion that the baby inherits from his parents.

Right after birth, an APGAR score evaluates your baby’s health.

What Is an APGAR Score?

An APGAR score determines which babies need extra help after their birth. The score is on a scale of 0 to 10, and the acronym stands for the following:

A: Appearance or colour

P: Pulse/heart rate

G: Grimace (reaction to stimulation)

A: Activity (tone)

R: Respiration (breathing)

A score between 7 and 10 is considered normal. The evaluation is done at 1 minute after birth and again at 5 minutes. The lower the score, the more trouble the baby had during delivery, and some of them may need observation in the nursery. It’s not that if your baby doesn’t score a perfect 10 he’s not going to graduate with honours from college. So, don’t hassle your paediatrician and yourself worrying about it.

After your baby is born, she will need a full examination from head to toe by your neonatologist. This will also include a few procedures like clearing the nasal passages, checking her height and weight, and taking the blood-pressure measurement. This will usually be done in the nursery before the baby comes to you. Let’s look at what this entails:

Your Baby’s First Check-Up before She Comes to You

Head

Some babies have an elongated swelling or bump on their head. This is because the head is moulded to pass through the vaginal canal. The condition is called caput succedaneum, is harmless and affects only the scalp. It settles in 24–48 hours from birth.

Cephalohaematoma, on the other hand, is a condition caused by the collection of blood between the skull bones and the skin above it. It is caused during the delivery process and usually resolves in 6–8 weeks. This is one of the reasons for jaundice in a newborn baby.

There are two soft spots on the newborn’s head. The anterior fontanelle is on top of the head, in the middle of the skull. It usually takes 9–18 months to close and remains open until then so that the brain can grow.

The posterior fontanelle is on the back of the baby’s head. It is smaller and closes around 6–8 weeks from birth.

Eyes

Your baby’s eyes are checked with an ophthalmoscope for a red reflex to rule out cataracts and tumours in the eye. Babies can also get haemorrhages in the eye because of the trauma of the delivery. They go away in a few weeks and can be left well alone to heal on their own.

Some babies are born with a partially blocked tear duct, which can lead to excessive tearing. This only needs cleaning and massaging of the nasolacrimal duct which is situated in the corner of the eye. You may have to do this a few times a day, for a few weeks, to open the duct. Rarely, this condition can lead to conjunctivitis, which results in a yellow pus discharge for which your doctor may prescribe antibiotics.

Ears

Some babies may have skin tags or pits in front of their ears. Sometimes, this can be an indication of kidney problems. So, prior to discharge, your doctor may decide to get an ultrasound of the kidney or bladder.

All babies usually get a hearing test before leaving the hospital or at least within the first month of life. If there is a problem, more complex tests like Brain Stem Evoked Response Audiometry (BERA) may be required.

Nose

Most babies have nasal congestion during the first few weeks of their life as their nasal passages are narrow. They usually need only regular saline drops to clear it.

Mouth

Babies are checked for cleft lip or palate, which is a defect in the lip or palate. Cleft lips are repaired usually between 3 and 6 months of age and palate repaired around 1 year of age. Babies with cleft lip can have difficulty in feeding. You’ll get help from the paediatrician or a breastfeeding advisor, so that you know what to do.  

Epstein’s pearls, white pimples in the roof of the mouth, need no treatment and disappear on their own.

Gums and teeth

Some babies are born with teeth, called natal teeth. Sometimes, if they are loose, the dentist may decide to remove them. If they are very sharp and you find it difficult to breastfeed, they may require smoothening.

Throat

Laryngomalacia or floppy larynx is heard occasionally in babies. This squeaky noise usually gets worse when the baby is agitated and settles on its own. It’s also the most common reason for noisy breathing in babies. In most cases, it resolves by the time she is a year old.

Chest

The baby’s chest is checked with a stethoscope for breath sounds and babies are examined to see if there is any respiratory distress (fast-breathing and grunting). If they have problems with breathing, they are kept in the nursery for observation.

Mild breathing problem is often seen in babies after a C-section. This is known as transient tachypnoea. It can lead to oxygen requirement or fast breathing. This usually settles within 24 hours, but the baby may have to stay in the intensive care unit (ICU) during that period.

Heart and circulation

The baby is examined for any murmur: extra noises heard in the heart. They are usually present in cases of congenital heart disease. Some babies will need further evaluation by a paediatric cardiologist, a paediatrician specialized in treating children with heart disease. The pulses are carefully checked, especially the femoral pulses in the area where the thigh meets the abdomen. This is to rule out the condition of coarctation (congenital narrowing) of the aorta.

At the time of being discharged, your baby will have her oxygen saturation checked. Some babies may have blue hands and feet, called acrocynosis. This is nothing to worry about, as it will settle in a few weeks as the baby’s circulation improves.

Abdomen

The abdomen is checked to look for any enlargement of the liver or spleen. Some babies have a distended (bulging/swollen) abdomen due to an intestinal problem, which can lead to yellow vomiting (bile). These babies will need further tests to diagnose the problem.

Babies usually pass their first stool within the first 24 hours, called meconium. If this does not happen, they may need further evaluation.

The umbilical cord is checked to see whether there are 3 blood vessels (2 arteries, 1 vein) in it. If there is only 1 artery, your doctor may ask for an ultrasound of the baby’s kidneys because it may be a sign of a kidney problem.

Genitals

BOYS: The doctor will examine your baby boy to make sure both testes are in the scrotum. Undescended testes will need to be followed up on. In most cases, the testes will descend within 1 year of age. If not, you will be referred to a paediatric surgeon. Then, the doctor will check to see if the urethral opening is at the tip of the penis. If it is on the underside, it is called hypospadias; when it is on the top, it’s called epispadias. These may need surgery later on in life. In these cases, you may be counselled not to get your baby circumcised, as the foreskin will be needed later for corrective surgery.

GIRLS: Some baby girls may have labial adhesions where the labia are joined, and there may be some white, mucous-like vaginal discharge. This is normal and can be cleaned when you give the baby a bath or after a diaper change. Occasionally, newborn babies have vaginal bleeding, called a pseudo period. This is caused by the presence of maternal hormones and settles in a few days. For persistent labial adhesions, your paediatrician may recommend an oestrogen cream that you will have to apply over the adhesions. This usually resolves with the cream but may return on discontinuing it. You can repeat the process, and this will eventually settle when the ovaries start making oestrogen, the female hormone.

When baby girls are cleaned, you should wipe from front to back, so that the bacteria from the anal region doesn’t spread to the vagina and cause infections like urinary tract infections (UTIs).

If the clitoris looks too large or the penis looks too small, your doctor may order some extra tests to determine the sex of the baby.

Enlarged breasts

Babies, both boys and girls, can develop mastitis or swollen breasts because of maternal hormones. It is temporary and will go back to normal in a few weeks. The breasts may even produce some milk called ‘witch’s milk’. This is also normal and soon goes away on its own.

Never try to squeeze out any of the milky fluid from your baby’s breasts as it can damage the tissue or lead to infection.

Kidney and bladder

Most babies pass urine in the first 24 hours. If this is not the case, then they need to be investigated.

Spine and nervous system

The baby is turned over and the spine is inspected. Abnormalities over the skin or over the spine may be a clue to inner spinal problems like spina bifida.

Reflexes like rooting (turning the head when a cheek is rubbed), sucking, palmar grasp (closing fingers on objects placed in the palm) and moro (startling of the body when the head is dropped back) are routine reflexes that are checked in the first examination.

Arms and legs

Babies are examined to make sure that their arms and legs move equally. Their hips are checked to rule out congenital dysplasia, a condition where the ‘ball and socket’ joint of the hip has not formed properly.

Some babies may be born with extra fingers (polydactyly), or in certain cases, the fingers may be fused (syndactyly).

Club foot is