Infant, Toddler, and Child Health Sourcebook, 1st Ed.

By Omnigraphics

Provides consumer health information about the physical, mental, and developmental health of infants, toddlers, and children including facts about the diseases and conditions that affect them and tips to bring them up in a healthy way. Includes glossary, index, and other resources.

• Language: English
• Publisher: Omnigraphics
• Release date: Aug 1, 2020
• ISBN: 9780780818132

Book preview

Preface

ABOUT THIS BOOK

The early years of a child’s life plays a vital role in determining her or his physical, mental, and social well-being. In spite of the advancements in medical science and technology, critical threats to infant, toddler, and child health exist in the United States. According to the Centers for Disease Control and Prevention (CDC), about 22,000 infants died in the United States in 2017. Birth defects are considered to be one of the major causes of infant mortality. The other causes include sudden infant death syndrome (SIDS), injuries, preterm birth, and maternal pregnancy complications. The well-being of infants, toddlers, and children determine the future of the nation. So, it is important to ensure that every child grows in a safe, secure, and healthy environment.

Infant, Toddler and Child Health Sourcebook, First Edition discusses the basics of newborn health. It provides information about child development milestones and explains how to seek medical help when a child faces developmental concerns. It also provides information about the several birth defects and how they are diagnosed. Various illnesses and conditions that affect infants, toddlers, and children are discussed in detail along with their causes, symptoms, diagnosis, and treatment. It talks about nutrients required for the healthy weight gain and the mealtime routine for infants and toddlers. Information about medicines and vaccines is provided and commonly asked questions about the vaccines are answered. It explains how physical activities can help children stay healthy. It also provides tips for the safety of children in home and community. The book concludes with a glossary of terms related to infant, toddler, and child health and a directory of resources for further help and support.

HOW TO USE THIS BOOK

This book is divided into parts and chapters. Parts focus on broad areas of interest. Chapters are devoted to single topics within a part.

Part 1: Healthcare Overview of the Newborn discusses the basics of newborn health and explains how the health and vital signs of a newborn are assessed. It highlights the importance of early initiation of breastfeeding and provides information on how to care for a premature infant.

Part 2: Child Development Milestones discusses the basics of development in children. It provides an overview of speech, language, social, and emotional developments. It also explains how to seek medical help when a child faces developmental concerns.

Part 3: Birth Defects and Developmental Disabilities provides information about the various birth defects and how they are diagnosed. It provides detailed insight into the various intellectual and developmental disabilities such as Down syndrome, cerebral palsy, autism spectrum disorder, and so on.

Part 4: Childhood Illnesses and Conditions offers information about the various illnesses that children are prone to. It covers various respiratory illnesses such as common cold, flu, asthma, whooping cough, etc. and other infections such as ear infection, pink eye, sinus, chickenpox, etc. It also addresses some common medical problems in children namely obesity, diabetes, and constipation. The part includes information on growth-related issues and acquired childhood injuries. There is also detailed information on childhood mental disorders.

Part 5: Bringing Up Healthy Infants and Toddlers (Ages 0 to 3) explains how to take care of infants and toddlers of 0 to 3 years of age. The nutrients required for the healthy weight gain and the mealtime routine for infants and toddlers are discussed. Information about vaccination is provided and commonly asked questions about the vaccines are answered. Further details on sleep patterns and infant’s hygiene are also included.

Part 6: Bringing Up Healthy Children (Ages 4 to 11) focuses on the health and welfare of children of 4 to 11 years of age. It gives information on how to keep children away from oral health issues and food allergy. It gives an insight into the vaccines and immunizations required for children of this age. It also explains how physical activities can help children stay healthy along with providing tips on personal hygiene and positive parenting.

Part 7: Safety in the Home and Community explains how to provide a safe environment for infants, toddlers, and children. It talks about child abuse and explains how to prevent it. It also explains how to protect children from preventable injuries. Details about food safety, road safety, sun safety, and water safety are provided.

Part 8: Additional Help and Information includes a glossary of terms related to infant, toddler, and child health and a directory of resources for further help and support.

BIBLIOGRAPHIC NOTE

This volume contains documents and excerpts from publications issued by the following U.S. government agencies: Agency for Healthcare Research and Quality (AHRQ); Center for Parent Information and Resources (CPIR); Centers for Disease Control and Prevention (CDC); ChildCare.gov; Early Childhood Learning and Knowledge Center (ECLKC); Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); Food and Nutrition Service (FNS); Health Resources and Services Administration (HRSA); National Cancer Institute (NCI); National Heart, Lung, and Blood Institute (NHLBI); National Institute on Deafness and Other Communication Disorders (NIDCD); National Institute of Dental and Craniofacial Research (NIDCR); National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Institute of Environmental Health Sciences (NIEHS); National Institute of Neurological Disorders and Stroke (NINDS); National Institutes of Health (NIH); NIH News in Health; Office of Juvenile Justice and Delinquency Prevention (OJJDP); Office on Women’s Health (OWH); U.S. Department of Education (ED); and U.S. Department of Health and Human Services (HHS).

It may also contain original material produced by Omnigraphics and reviewed by medical consultants.

ABOUT THE HEALTH REFERENCE SERIES

The Health Reference Series is designed to provide basic medical information for patients, families, caregivers, and the general public. Each volume provides comprehensive coverage on a particular topic. This is especially important for people who may be dealing with a newly diagnosed disease or a chronic disorder in themselves or in a family member. People looking for preventive guidance, information about disease warning signs, medical statistics, and risk factors for health problems will also find answers to their questions in the Health Reference Series. The Series, however, is not intended to serve as a tool for diagnosing illness, in prescribing treatments, or as a substitute for the physician–patient relationship. All people concerned about medical symptoms or the possibility of disease are encouraged to seek professional care from an appropriate healthcare provider.

A NOTE ABOUT SPELLING AND STYLE

Health Reference Series editors use Stedman’s Medical Dictionary as an authority for questions related to the spelling of medical terms and The Chicago Manual of Style for questions related to grammatical structures, punctuation, and other editorial concerns. Consistent adherence is not always possible, however, because the individual volumes within the Series include many documents from a wide variety of different producers, and the editor’s primary goal is to present material from each source as accurately as is possible. This sometimes means that information in different chapters or sections may follow other guidelines and alternate spelling authorities. For example, occasionally a copyright holder may require that eponymous terms be shown in possessive forms (Crohn’s disease vs. Crohn disease) or that British spelling norms be retained (leukaemia vs. leukemia).

MEDICAL REVIEW

Omnigraphics contracts with a team of qualified, senior medical professionals who serve as medical consultants for the Health Reference Series. As necessary, medical consultants review reprinted and originally written material for currency and accuracy. Citations including the phrase Reviewed (month, year) indicate material reviewed by this team. Medical consultation services are provided to the Health Reference Series editors by:

Dr. Vijayalakshmi, MBBS, DGO, MD

Dr. Senthil Selvan, MBBS, DCH, MD

Dr. K. Sivanandham, MBBS, DCH, MS (Research), PhD

OUR ADVISORY BOARD

We would like to thank the following board members for providing initial guidance on the development of this series:

Dr. Lynda Baker, Associate Professor of Library and Information Science, Wayne State University, Detroit, MI

Nancy Bulgarelli, William Beaumont Hospital Library, Royal Oak, MI

Karen Imarisio, Bloomfield Township Public Library, Bloomfield Township, MI

Karen Morgan, Mardigian Library, University of Michigan-Dearborn, Dearborn, MI

Rosemary Orlando, St. Clair Shores Public Library, St. Clair Shores, MI

HEALTH REFERENCE SERIES UPDATE POLICY

The inaugural book in the Health Reference Series was the first edition of Cancer Sourcebook published in 1989. Since then, the Series has been enthusiastically received by librarians and in the medical community. In order to maintain the standard of providing high-quality health information for the layperson the editorial staff at Omnigraphics felt it was necessary to implement a policy of updating volumes when warranted.

Medical researchers have been making tremendous strides, and it is the purpose of the Health Reference Series to stay current with the most recent advances. Each decision to update a volume is made on an individual basis. Some of the considerations include how much new information is available and the feedback we receive from people who use the books. If there is a topic you would like to see added to the update list, or an area of medical concern you feel has not been adequately addressed, please write to:

Managing Editor

Health Reference Series

Omnigraphics

615 Griswold St., Ste. 520

Detroit, MI 48226

Part 1 | Healthcare Overview of the Newborn

Chapter 1 | Basics of Newborn Health

Chapter Contents

Section 1.1—Your Baby’s First Hours of Life

Section 1.2—Adapting to Life outside Womb

Section 1.3—Thermal Care

Section 1.4—Respiratory Effort and Resuscitation

Section 1.1 | Your Baby’s First Hours of Life

This section includes text excerpted from Your Baby’s First Hours of Life, Office on Women’s Health (OWH), U.S. Department of Health and Human Services (HHS), June 6, 2018.

After months of waiting, finally, your new baby has arrived! Mothers-to-be often spend so much time in anticipation of labor, they do not think about or even know what to expect during the first hours after delivery. Read on so you will be ready to bond with your new bundle of joy.

What Newborns Look Like

You might be surprised by how your newborn looks at birth. If you had a vaginal delivery, your baby entered this world through a narrow and boney passage. It is not uncommon for newborns to be born bluish, bruised, and with a misshapen head. An ear might be folded over. Your baby may have a complete head of hair or be bald. Your baby also will have a thick, pasty, whitish coating, which protected the skin in the womb. This will wash away during the first bathing.

Once your baby is placed into your arms, your gaze will go right to her or his eyes. Most newborns open their eyes soon after birth. Eyes will be brown or bluish-gray at first. Looking over your baby, you might notice that the face is a little puffy. You might notice small white bumps inside your baby’s mouth or on her or his tongue. Your baby might be very wrinkly. Some babies, especially those born early, are covered in soft, fine hair, which will come off in a couple of weeks. Your baby’s skin might have various colored marks, blotches, or rashes, and fingernails could be long. You might also notice that your baby’s breasts and penis or vulva are a bit swollen.

How your baby looks will change from day to day, and many of the early marks of childbirth go away with time. If you have any concerns about something you see, talk to your doctor. After a few weeks, your newborn will look more and more like the baby you pictured in your dreams.

Bonding with Your Baby

Spending time with your baby in those first hours of life is very special. Although you might be tired, your newborn could be quite alert after birth. Cuddle your baby skin-to-skin. Let your baby get to know your voice and study your face. Your baby can see up to about two feet away. You might notice that your baby throws her or his arms out if someone turns on a light or makes a sudden noise. This is called the startle response. Babies also are born with grasp and sucking reflexes. Put your finger in your baby’s palm and watch how she or he knows to squeeze it. Feed your baby when she or he shows signs of hunger.

Medical Care for Your Newborn

Right after birth, babies need many important tests and procedures to ensure their health. Some of these are even required by law. But as long as the baby is healthy, everything but the Apgar test can wait for at least an hour. Delaying further medical care will preserve the precious first moments of life for you, your partner, and the baby. A baby who has not been poked and prodded may be more willing to nurse and cuddle. So before delivery, talk to your doctor or midwife about delaying shots, medicine, and tests. At the same time, please do not assume everything is being taken care of. As a parent, it is your job to make sure your newborn gets all the necessary and appropriate vaccines and tests in a timely manner.

The following tests and procedures are recommended or required in most hospitals in the United States:

Apgar Evaluation

The Apgar test is a quick way for doctors to figure out if the baby is healthy or needs extra medical care. Apgar tests are usually done twice: one minute after birth and again five minutes after birth. Doctors and nurses measure five signs of the baby’s condition. These are:

Heart rate

Breathing

Activity and muscle tone

Reflexes

Skin color

Apgar scores range from 0 to 10. A baby who scores seven or more is considered very healthy. But, a lower score does not always mean there is something wrong. Perfectly healthy babies often have low Apgar scores in the first minute of life.

In more than 98 percent of cases, the Apgar score reaches seven after five minutes of life. When it does not, the baby needs medical care and close monitoring.

Eye Care

Your baby may receive eye drops or ointment to prevent eye infections they can get during delivery. Sexually transmitted infections (STIs), including gonorrhea and chlamydia, are a main cause of newborn eye infections. These infections can cause blindness if not treated.

Medicines used can sting and/or blur the baby’s vision. So you may want to postpone this treatment for a little while.

Some parents question whether this treatment is really necessary. Many women at low risk for STIs do not want their newborns to receive eye medicine. But, there is no evidence to suggest that this medicine harms the baby.

It is important to note that even pregnant women who test negative for STIs may get an infection by the time of delivery. Plus, most women with gonorrhea and/or chlamydia do not know it because they have no symptoms.

Vitamin K Shot

The American Academy of Pediatrics (AAP) recommends that all newborns receive a shot of vitamin K in the upper leg. Newborns usually have low levels of vitamin K in their bodies. This vitamin is needed for the blood to clot. Low levels of vitamin K can cause a rare but serious bleeding problem. Research shows that vitamin K shots prevent dangerous bleeding in newborns.

Newborns probably feel pain when the shot is given. But afterwards babies do not seem to have any discomfort. Since it may be uncomfortable for the baby, you may want to postpone this shot for a little while.

Newborn Metabolic Screening

Doctors or nurses prick your baby’s heel to take a tiny sample of blood. They use this blood to test for many diseases. All babies should be tested because a few babies may look healthy but have a rare health problem. A blood test is the only way to find out about these problems. If found right away, serious problems such as developmental disabilities, organ damage, blindness, and even death might be prevented.

All 50 states and the U.S. territories screen newborns for phenylketonuria (PKU), hypothyroidism, galactosemia, and sickle cell disease (SCD). But, many states routinely test for up to 30 different diseases. The March of Dimes recommends that all newborns be tested for at least 29 diseases.

You can find out what tests are offered in your state by contacting your state’s health department or newborn screening program. Or, you can contact the National Newborn Screening and Genetics Resource Center (NNSGRC).

Hearing Test

Most babies have a hearing screening soon after birth, usually before they leave the hospital. Tiny earphones or microphones are used to see how the baby reacts to sounds. All newborns need a hearing screening because hearing defects are not uncommon and hearing loss can be hard to detect in babies and young children. When problems are found early, children can get the services they need at an early age. This might prevent delays in speech, language, and thinking. Ask your hospital or your baby’s doctor about newborn hearing screening.

Hepatitis B Vaccine

All newborns should get a vaccine to protect against the hepatitis B virus (HBV) before leaving the hospital. Sadly, 1 in 5 babies at risk of HBV infection leaves the hospital without receiving the vaccine and treatment shown to protect newborns, even if exposed to HBV at birth. HBV can cause a lifelong infection, serious liver damage, and even death.

The hepatitis B vaccine (HepB) is a series of three different shots. The American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) recommend that all newborns get the first HepB shot before leaving the hospital. If the mother has HBV, her baby should also get a HBIG shot within 12 hours of birth. The second HepB shot should be given one to two months after birth. The third HepB shot should be given no earlier than 24 weeks of age, but before 18 months of age.

Complete Checkup

Soon after delivery most doctors or nurses also:

Measure the newborn’s weight, length, and head

Take the baby’s temperature

Measure that baby’s breathing and heart rate

Give the baby a bath and clean the umbilical cord stump

Section 1.2 | Adapting to Life outside Womb

Adapting to Life outside Womb, © 2020 Omnigraphics. Reviewed July 2020.

Most people would be aware of the three trimesters of pregnancy. However, very little information is available about what the mother and child experience after birth. This phase after childbirth is called the fourth trimester.

Arrival into the World

In the warmth of the womb, all the needs of the fetus are easily met from eating to sleeping. However, after birth, the whole environment changes for both the mother and child. After being in darkness, the baby is suddenly faced with bright lights, movements, and shapes. Though right after birth the baby’s ears are filled with fluid, she or he will still be aware of the noises since it is louder than they were used to inside the womb.

When a baby is born, its first instinct is to breath, which is done with a loud and healthy cry usually in response to the noise, light, and cold air that they are new to.

The parents can equally be shocked and overwhelmed upon the arrival of their baby. The usual environment of the house is suddenly changed where the schedule evolves into feeding, changing the nappies, and soothing.

The Fourth Trimester: First Three Months outside the Womb

The fourth trimester is considered the last stage of a baby’s fetal development. During the first three days of life, the baby goes through a phase called behavioral disorganization, meaning they need to adjust to the new surrounding that is alien to them. In the first 12 weeks of birth, the baby will develop from being disoriented to being able to respond and interact.

There are various ways through which the parents can help the baby and themselves adapt to the new setting. Following are some tips:

Recreate Life inside the Womb

Since the baby is used to the life inside the womb for the past nine months, it is helpful to recreate her or his vibe. Some ways to do this are:

Inside the womb, the baby is used to being in motion. It is good to use a cradle or bouncer that moves back and forth, or side to side to match the movements experienced inside the womb.

Babies listen to the sounds the mother’s body makes. Shushing or heartbeat sounds help them fall asleep easily.

Skin-to-Skin Contact

The biggest change for the baby is being physically separated from its mother as they have had constant contact and comfort inside the womb. This is why the baby needs to be immediately reunited with the mother after birth (if there are no medical emergencies) as holding the baby close to the mother’s skin keeps the baby warm and stimulates her or his sense of touch. The familiar smell will help calm the baby and regulate the breathing and heartbeat. This is important right after birth and for the next few months to come.

Feeding

Inside the womb, the baby is easily fed as per the mother’s routine; hence, they do not face hunger or thirst. However, now the baby has to signal when she or he is hungry. Some of these cues can be sucking, and putting their fingers in their mouth. Follow these leads that the baby gives and feed them for as long as they need. It is important to remember that no two babies are alike and they do not have a circadian rhythm (a daily sleep-wake cycle) in position for the first few months. Therefore, do not compare your baby to someone else’s or with the previous experience with your older child for that matter.

Other Tips to Help Adapt to Life outside Womb

During the first few months of birth, the baby experience a lot that keeps them occupied. For example, tasting and smelling different flavors, and adjusting their eyes to see people and objects. Hence, they do not require much playtime. Instead, use this time to bond by sleeping when they sleep, or making eye contact, or do get some fresh air by taking the baby with you while going for a walk.

Help the baby to learn how to self-soothe by recognizing their body language.

Offer your little finger for the baby to hold or your pinkie-knuckle to suck.

It is important to place support to her or his back and bottom. Place your hand, a rolled blanket, or any soft doll.

When to Worry

When the baby does not learn some of the mentioned adaptations, there may be an underlying problem that is undiagnosed. Sooner the problem is recognized and addressed, the better the outcome of the treatment will be. Do not ignore the subtle symptoms that the baby shows. A pediatrician should check on a baby if she or he is often disturbed by normal household noises or if she or he does not respond to sensory simulations.

Though a few ups and downs during the first three months outside the womb are inevitable, use this time as an opportunity for getting to know the baby, spending time, and singing to her or him.

References

This Is How to Help Your Baby Adapt to Life outside the Womb, Everymum, June 9, 2020.

6 Tips to Help Your Newborn Adapt to Life outside the Womb, Living and Loving, October 25, 2018.

The Fourth Trimester: Adjusting to Life outside the Womb, Boot Camp, June 27, 2016.

Womb to World: Helping Your Newborn Adapt to Life outside the Womb, BabyCenter, June 24, 2016.

Section 1.3 | Thermal Care

Thermal Care, © 2020 Omnigraphics. Reviewed July 2020.

Thermal care or thermal protection of a newborn involves various procedures that ensure the protection of a newborn from hypothermia (extreme cold) or hyperthermia (extreme heat). This also ensures that the infant maintains a normal body temperature of 36.5–37.5 °C (97.7–99.5 °F). Warmth is vital for survival and is very essential for a newborn baby; the thermal stability of an infant improves with increase in weight. Therefore, thermal care is essential for reducing morbidity and mortality in newborns.

Thermal Control

Inside the womb, heat produced by the fetus is transferred to the mother through the placenta. The ability of an infant to control heat production is not fully developed after birth and they experience a sudden decrease in body temperature. During the first half hour after the delivery, heat loss occurs mostly due to evaporation of the amniotic fluid from the infant’s body. Newborns also lose heat due to the following factors:

Conduction. Being in contact with cold objects such as a table or weighing scale.

Convection. Warm air replaced by cold air around the baby due to air currents.

Radiation from the baby’s body to colder objects in the vicinity including cold walls or windows.

These mechanisms that cause heat loss in an infant may act in reverse, causing the baby to become too warm, which results in hyperthermia. For instance, if the baby is kept in hot surroundings, or is exposed to heating devices for a long period.

Hypothermia in Infants

When a newborn baby loses the ability to produce heat, hypothermia occurs due to a sudden dip in body temperature. This can occur due to several characteristics, such as a large body surface of the newborn in relation to weight and less amount of subcutaneous fat, especially in low-weight babies. Infants with temperature between 36.0 to 6.4 °C (96.8 to 97.5 °F) may be under cold stress, which should be a cause for concern.

Signs of Hypothermia

Early clinical indications of cold stress due to hypothermia in an infant are:

The feet are cold to the touch

Inability to nurse due to weak suckling ability

Lethargy or reduction in activity

Weak cry

Prevention of Hypothermia

A concept that describes a set of interlinked measures taken to minimize the risk of hypothermia is known as warm chain. These are a series of 10 steps, most of which are achievable, derived by the World Health Organization (WHO) to prevent hypothermia:

Delivery room. It should be kept warm (at least > 25 °C) and free from draught.

Drying. The newborn must be immediately dried and wrapped using warm towels.

Skin-to-skin contact. Place the baby on the mother’s chest or abdomen (Kangaroo care).

Breastfeeding. This should be initiated within one hour of the delivery to provide enough calories for the infant to produce heat.

Mother and baby together. The newborn should be kept with the mother 24 hours a day (rooming-in) so the baby can be breastfed on demand.

Bathing and weighing. These should be postponed to avoid a drop in body temperature and should be considered only after the vital signs are stable.

Appropriate clothing and bedding. Loose clothing, warm cap, and blankets should be used according to the environment.

Warm transportation. The baby should be kept warm during transportation by using extra clothes or blankets and skin-to-skin contact.

Warm resuscitation. Use additional sources of heat when a baby is being resuscitated to recover from respiratory distress. For example, a radiant heater or focusing heating lamp.

Training/Awareness. Healthcare providers should be aware of the risks of hypothermia and hyperthermia, and they must be trained in the procedures of warm chain.

Hyperthermia in Infants

When the surrounding environment is too hot, the baby’s temperature increases above 37.5 °C (99.5 °F) and it causes hyperthermia. Hyperthermia is different from fever, which is caused due to infectious microorganisms. However, infections should be checked first unless there are very apparent external reasons for overheating. Hyperthermia can sometimes lead to severe complications such as shock, convulsions, and coma; and a core body temperature above 42 °C (107.6 °F) can result in neurological damage.

Signs of Hyperthermia

The common symptoms of hyperthermia include the following:

Increase in heart rate, breathing, and respiratory distress

Warm extremities, flushing, and perspiration

Weak muscle activity and poor feeding

Irritability and weak cry

Dehydration

Treatment of Hyperthermia

Hyperthermia in a newborn baby can be treated using the following steps:

The cause of higher temperature should be identified, including maternal pyrexia (fever) or sepsis, which is caused by the body’s reaction to an infection. Overheating can also be caused due to rewarming or overwrapping with blankets of clothes.

Clinical concerns or risk factors for any infection should be considered and discussed with the pediatrician.

The environment should be modified by moving the infant to a cooler area and external sources of heat should be removed or reduced.

The newborn’s temperature should be rechecked every 15 to 30 minutes after the intervention and the above steps can be repeated if required.

Babies can change temperature rather quickly than adults; therefore, the temperature should be closely monitored and every article of clothing need not be removed.

References

Newborn Thermoregulation, Champlain Maternal Newborn Regional Program (CMNRP), June 15, 2013.

Thermal Protection of the Newborn: a practical guide, World Health Organization (WHO), May 20, 2017.

Management of Thermal Care in Newborn Babies, United Kingdom National Health Service, May 1, 2015.

Section 1.4 | Respiratory Effort and Resuscitation

Respiratory Effort and Resuscitation, © 2020 Omnigraphics. Reviewed July 2020.

Newborns have heads that are larger in relation to the size of their body, which causes the head to flex in a supine (upward facing) position. Also, newborn infants have small mouths containing a large tongue, airways and lungs that are not fully matured and a short, pliable trachea. These differences in physiology, along with soft ribs that are not fully developed makes it easier for a baby’s airway to be obstructed. This makes them susceptible to respiratory problems even if there is a slight injury or inflammation.

Respiratory Effort of a Newborn Infant

There are considerable physiological changes affecting the newborn infant’s respiration process that happen during the transition from fetal to extrauterine life. This includes the role of the placenta in gas exchange being taken over by the lungs and it changes the fluid-filled lungs to become air-filled lungs. The respiratory efforts taken by a baby to breathe can be assessed by observing the following signs:

Flaring of nostrils

Tracheal tug

Intercostal/subcostal (muscles above and below the ribs) recession

Abdominal breathing

Neonatal Resuscitation

In a newborn infant with reduced vital signs, a series of emergency procedures are carried out by neonatal healthcare professionals to establish normal breathing, heart rate, color, muscle tone, and activity. This emergency procedure is known as neonatal (infant) resuscitation. This is done to prevent newborn infant deaths and long-term neurodevelopmental conditions caused by perinatal asphyxia (suffocation).

Simulating Respiration after Birth

The umbilical cord is usually clamped one minute after the complete delivery unless the baby is in need of immediate resuscitation. The baby should be kept warm and dry during this period. If apnea (gasping) persists after drying the baby, intervention is required. A healthy baby takes its first breath within 60 to 90 seconds of clamping the umbilical cord. Babies usually begin spontaneous regular breathing within 3 minutes of birth to sustain the heart rate above 100 beats per minute, and this improves the skin color. Tactile stimulation such as warming, drying, and rubbing the back or the soles of the baby’s feet is recommended to stimulate spontaneous breathing.

Resuscitation Process

If the stimulation of drying does not receive a response from the newborn infant, efforts should be taken to actively resuscitate the newborn. The four major steps involved in neonatal resuscitation are:

Clearing the airway. The airway of a newborn infant can be cleared by using the following steps:

The baby should be placed on its back and the head should be kept in a neutral position with the neck (cervix) flexed a little (sniffing position). A 2-cm towel should be placed under the neck and shoulders to maintain a neutral airway and care should be taken to not flex or overextend the neck.

Blockage of the airway can also be caused by materials such as meconium or blood. The airway can be cleared by gently suctioning the back of the mouth and throat using a catheter.

Improving breathing efforts. Adequate ventilation should be provided within one minute if the baby is failing to breathe well after birth.

In order to replace the lung fluid with air, the first five breaths in a newborn infant should be inflation breaths. This can be done using a continuous gas supply such as a pressure limiting device and a mask.

Newborn infants who fail to respond to mask ventilation must be intubated with an endotracheal tube. Ventilation is usually given with room air but sometimes it may be required to give supplementary oxygen until good respiratory efforts and heart rate are established.

Enhancing circulation. In spite of adequate ventilation for 30 seconds, if the heartbeat remains low or absent, chest compressions should be started.

This is done to transport oxygenated blood from the lungs to the coronary arteries to improve cardiac function.

Chest compression for newborn infants is done by gripping the chest with both hands and using the two thumbs to press down on the lower third sternum (breast bone), with the rest of the fingers over the spine on the baby’s back.

The chest should be compressed quickly and firmly and the compressions can be stopped once the heart rate reaches 60 beats/minute and the newborn is carefully monitored for any fluctuations.

Utilizing drugs. Adrenaline (epinephrine) should be given to stimulate the heart if the heart rate has not increased beyond 60 beats per minute.

Before proceeding to drug therapy, airway and breathing must be reassessed as adequate since heartbeat failure is due to lack of lung inflation.

An umbilical venous (UV) catheter is used to administer medications such as sodium bicarbonate or glucose. Naloxone is given to reverse pethidine or morphine that was administered to the mother as an analgesic, which causes respiratory distress in the baby.

Response to Resuscitation

The three indications that confirm a successful neonatal resuscitation are:

An increased pulse rate of above 100 beats/minute

Good respiratory efforts or a good cry ensuring adequate breathing

A pink tongue indicating proper oxygen supply to the brain

If prolonged ventilation is required by the newborn infant, they must be carefully observed after the delivery for at least 4 hours in the nursery. However, if there is no detectable cardiac activity in the baby for 10 minutes, resuscitation should be stopped.

References

Resuscitation and Support of Transition of Babies at Birth, Resuscitation Council, October 15, 2015.

Failure to Breathe at Birth and Resuscitation, Bettercare, December 22, 2017.

The Paediatric Assessment Triangle, Don’t Forget The Bubbles, April 30, 2019.

Resuscitation of the Baby at Birth, Advanced Life Support Group (ALSG), January 15, 2011.

Chapter 2 | Assessing Health and Vital Signs of a Newborn

Chapter Contents

Section 2.1—What Is the Apgar Score?

Section 2.2—Important Measurements of a Newborn

Section 2.1 | What Is the Apgar Score?

What Is the Apgar Score? © 2018 Omnigraphics. Reviewed July 2020.

The Apgar test is the first test given to infants after their birth. It is given at the first minute and, again, at the fifth minute. Developed in 1952 by Virginia Apgar, an anesthesiologist, the test is designed to evaluate the physical condition of an infant right after birth and suggest if emergency care or medical attention is necessary. The first-minute test score determines how well the child has endured the birthing process, and the fifth-minute test score determines how well the infant adapts to life outside the womb.

The Apgar test uses five factors to evaluate the baby’s condition. Apgar scores range from 0 to 2 for each condition, with 2 being the best score and 0 indicating a need for immediate medical care. A doctor, midwife, or nurse would do the tests and combine the five factors for the final score between 0 and 10—10 being the highest score possible, indicating the baby is very healthy. The factors taken into consideration for Apgar scoring are as follows:

Skin color (appearance)

Heart rate (pulse)

Reflexes (grimace response)

Muscle tone (activity)

Breathing effort (respiration)

What Do the APGAR Scores Mean?

Each of the five factors is scored with a 0, 1, or 2 based on observations. The following are the interpretations for the score:

Skin Color (Appearance)

If the skin is bluish-gray or pale on the entire body, the test score is 0.

If the hands and feet are bluish and the rest of the body is in normal color (pink), the test score is 1.

If the entire body is in normal color (pink), the test score is 2.

Heart Rate (Pulse)

The most important assessment, the heartbeat is evaluated by a stethoscope.

The test score is 0 if there is no heartbeat.

The test score is 1 if the heart rate is less than 100 beats per minute.

The test score is 2 if the heart rate is greater than 100 beats per minute.

Reflexes (Grimace response)

Grimace response refers to response toward stimulation, such as a mild pinch:

The test score is 0 if there is no response to airways being suctioned.

The test score is 1 if there is a grimace during suction.

The test score is 2 if there a grimace, cough, sneeze, or vigorous cry.

Muscle Tone Activity

The test score is 0 if there is no movement and the muscles are loose and floppy.

The test score is 1 if there is some bending of arms and legs.

The test score is 2 if there is active movement.

Breathing Effort (Respiration)

The test score is 0 if no breathing takes place.

The test score is 1 if slow or irregular respiration takes place.

The test score is 2 if there is a strong cry.

An infant who has a test score of 8 or above is considered a healthy baby. However, a score below 8 may require medical attention such as helping her or him breathe through suction. It does not mean the baby is unhealthy or has major health issues. Some infants are born with a medical condition that needs to be treated; others may just need time to get accustomed to the new environment outside the womb.

If the scores of the test given at the first minute are low or do not look good, another test is given at the fifth minute and the scores are recalculated. The doctors and nurses will continue to monitor the baby and give the needed medical care and treatment. Very rarely, a test is given in the 10th minute of birth. Most of the infants score low in the first minute and eventually, the scores are higher at the fifth-minute test.

The test does not predict a child’s long-term health, intellectual status, behavior, or personality. Only few infants score a perfect 10. A slightly lower Apgar score is common for some newborns who are born after a complicated labor, cesarean delivery, or high-risk pregnancy. If the healthcare provider has concerns about the baby’s Apgar score, she or he will let the parent know about the baby’s present health condition, cause of the problem, and the treatment administrated. As time progresses, most babies do well with necessary medical attention.

References

Hirsch, Larissa. What Is the Apgar Score? Kidshealth, July 2014.

Apgar Score, U.S. National Library of Medicine (NLM), November 6, 2017.

Your Child’s First Test: The APGAR, American Pregnancy Association (APA), August 2015.

The Apgar score, BabyCenter, n.d.

Section 2.2 | Important Measurements of a Newborn

Important Measurements of a Newborn, © 2020 Omnigraphics. Reviewed July 2020.

Newborn babies are carefully checked at birth by performing a complete physical assessment of every body part for signs of problems or complications. During the hospital stay, the baby’s health is constantly evaluated and a comprehensive physical examination of the baby is done within 72 hours of giving birth. Assessment may include birthweight, body measurements, and a physical exam that involves checking the neuromuscular and physical maturity of the baby.

The hospital staff takes measurements of each baby, including the length and head circumference to help get an idea of her or his overall health. These may be measured using the metric units, centimeters (cm) or inches (in).

Head circumference. The average newborn baby’s head measures 35 cm and is slightly bigger than half the body length of the baby.

Length. The length is measured from top of the head to the heel of the foot. The average length of a newborn baby is about 50 cm long.

Abdominal circumference. The circumference around the baby’s belly.

The staff also checks for vital signs such as:

Temperature. The stable body temperature of a newborn baby is 97.0 °F to 98.6 °F (36.1 °C to 37 °C) in a normal room.

Breathing rate. A newborn’s breathing rate is normally 40 to 60 breaths per minute, and is much lower when the infant is asleep.

Pulse. The pulse of a newborn baby varies typically from 120 to 160 beats per minute.

Blood pressure. A newborn baby’s blood pressure is generally an upper number (systolic) between 60 and 80, and a lower number (diastolic) between 30 and 45.

Oxygen saturation. This should be around 95 to 100 percent on room air.

Birthweight

The birth weight of a baby is an important indicator of health, therefore, infants in the nursery are weighed daily to determine the growth, fluid, and nutrition requirements. The mean weight for term babies (born between 37- and 41-weeks’ gestation) is about 7 lbs. (3.2 kilograms). Small babies and very large babies are generally at greater risk for problems. Newborn babies can also lose their birth weight by 5 to 7 percent and then gain the weight back when they reach 2 weeks of age. However, premature and sick babies may not gain weight immediately.

Additional Screening Procedures

There are various other screening measures to validate the health of a newborn baby that are usually done within 24 hours following the birth and it includes:

Blood test (or heel stick) to check for medical conditions including rare genetic, hormone-related, or metabolic conditions

Newborn hearing screen to verify auditory functions such as the auditory brain stem response (ABR) test and otoacoustic emissions (OAE) test

Pulse oximetry to determine the measure of oxygen in the blood.

Physical Exam

A complete physical exam is a vital part of newborn care. It involves the healthcare provider carefully checking each body system to see if it is healthy and functioning properly. They also lookout for any signs of illness or birth defects. Physical exam of a newborn often includes:

General appearance. Observing the baby’s posture, the symmetry of limbs, and muscle tone, and examining the spine and level of consciousness (whether the baby is awake and alert).

Skin. Checking the skin color, texture, nails, as well as skin folds and any rashes.

Head and neck. Checking the appearance and formation of the baby’s head from passage through the birth canal (molding), the collar bones (clavicles), and the soft spots (fontanelles) on the skull.

Face. Inspection of the ears, nose, cheeks, and the presence of red reflex in the eyes.

Mouth. Examining the roof of the mouth (palate), tongue, and throat.

Lungs. Observing sounds the baby makes when she/he breathes along with the breathing pattern.

Arms and legs. Monitoring the movement and formation of the baby’s limbs.

Abdomen. Presence of masses or hernias.

Genitals and anus. Verifying that the baby has open passages for urine and stool.

Heartbeat and pulse rate. Sound of the heartbeat and checking for pulses in the groin (femoral) area.

Umbilical cord and placenta. Both are examined and a blood test is done on the umbilical cord to determine the hemoglobin level and blood type.

Reflexes and central nervous system. Observe the infant’s general behavior, movements as well as the grasp, rooting, and sucking reflexes.

The pediatrician regularly takes measurements and checks the weight of the baby at each physical test, starting with the first one after birth, and will plot them on growth charts. These important measurements should significantly rise at a predictable rate in a healthy, well-nourished infant. Any disruption in the pace of growth will help the doctor better diagnose and deal with any eating, developmental, or health concerns.

References

Physical Exam of the Newborn, Stanford Medicine, November 17, 2016.

Newborn Measurements, University of Rochester Medical Center, July 31, 2011.

Assessments for Newborn Babies, Stanford Medicine, November 17, 2016.

Assessments for Newborn Babies, The Children’s Hospital of Philadelphia, February 1, 2001.

Chapter 3 | The Umbilical Cord: Cutting and Aftercare

The umbilical cord is a flexible cord that connects a mother to her fetus in the womb. It attaches the mother’s placenta and the baby’s stomach, which later on is known as the belly button. The cord contains a vein that carries oxygen and nutrient-rich blood to the baby and two arteries that carry deoxygenated blood out from the baby’s body. An average umbilical cord measures 50 centimeters or 20 inches in length. During the last stage of pregnancy, the placenta passes antibodies from the mother to her baby through the umbilical cord. These provide protection for the baby from infections for around three months after birth.

Cutting of the Umbilical Cord

The umbilical cord is clamped and cut off in a painless procedure after the baby is born. The baby is then left with a small stump attached to her or his belly button that would gradually fall off the baby usually between one and three weeks after birth.

Normally, the umbilical cord is cut shortly after birth; nevertheless, recent findings suggest that babies could benefit by having the umbilical cord attached for a longer time. According to a data reported by the Cochrane Library, babies that remain attached to their umbilical cords for a few minutes after birth show higher content of iron accumulation, a higher concentration of hemoglobin, and a higher birth weight, between three and six months.

The Aftercare

Washing the cord stump as part of the usual bath routine for your baby is recommended. Care should be taken to use only pads of cotton along with water for washing the area. Drying of the stump and its area needs to be done with caution. When pee or poo stays on the stump, a mild soap can be used to help scrub it off. Band-aids or bandages are not to be used to protect the stump end, as that would restrict the flow of air.

Keeping the Area Clean and Dry

Pediatricians used to prescribe rubbing alcohol to cleanse the base of the cord. However, several doctors now advocate not to use alcohol as it is believed to irritate the skin and often slows healing. Until adopting one of these options, it is important to contact the child’s pediatrician regarding their advice. The use of newborn diapers with a specific cut out or fold helps to prevent any irritation on the cord. Depending on the weather, it is best to dress the baby in only a t-shirt and a diaper to allow the cord to dry out longer.

Keeping the Area Infection Free

Newborn babies are prone to get infections due to the exposure of the stump. Redness, swelling, yellow discharge, or even foul smell of the umbilical cord indicates an infection and should be cleaned with care.

Diaper Care

When putting on a diaper for the baby, the stump should not be covered, as there are chances that the baby’s urine might be clogged in the stump causing an infection.

Sponge Baths

The baby should only be given sponge baths and not be bathed in a tub until the umbilical cord has fallen off. Care should be taken to fan dry the area and not to rub it with a cloth.

Natural Healing of the Cord

It may seem as though