CHARLES & BABY FLORENCE
Action point:
How would you recognise normal “baby blues” at day four over post-partum depression?
Baby or maternity blues are a mild and transitory moodiness suffered by up to 80% of postnatal
women (and in some cases fathers). Symptoms typically last from a few hours to several days, and
include tearfulness, irritability, hypochondriasis, sleeplessness, impairment of concentration,
feelings of isolation and headache. The maternity blues are not the same thing as postpartum
depression, nor are they a precursor to postpartum depression or postnatal psychosi.s
Post-partum depression is more severe than 'the blues'. The blues can leave you feeling tearful,
anxious and experiencing mood swings in the first 2 weeks after your baby's birth.
Feelings of anxiety, irritability, having difficulty sleeping and a reduced appetite are some of the
early signs of post-partum depression, and these symptoms may be noticed before a woman
recognises that she feels depressed.
You may experience feelings of hopelessness and inadequacy that do not seem to improve. Some
women feel angry and irritated and do not understand why, others may feel overly anxious about
their baby, tearful, alone, guilty, unable to cope and unsupported. Each woman’s experience of
postnatal depression is different. Cultural background may also affect a woman’s experience of
postnatal depression.
You may feel that you are being a bad mother and that somehow you have to cope. Postnatal
depression can affect how you feel about, and care for, your baby. Many women do not do not
realise that the feelings they are experiencing could be post-partum depression.
Action point:
Complete the following glossary:
CYFS-
Child Youth& Family Services
Pre conceptual-
Before conception (fertilisation)
Ante natal-
Before birth
NVD-
Natural Vaginal Birth
Postpartum-
After child birth
LMC-
Lead Maternity Carer
Rubella titres-
Measures level of immunity to the rubella virus
Term baby-
Baby delivered after 37 weeks
Fundal height-
Size of the uterus
Meconium-
Earliest stools of new-born, made up of materials that the new-born
ingested in the uterus (tar like)
Foetal alcohol syndrome-
Is a pattern of mental & physical defects that can develop in a fetus
in association with high levels of alcohol consumption during
pregnancy
In utero-
The state of the embryo or fetus
Action point:
Match the discomforts of pregnancy with the associated probable cause and possible treatment
Separate sheet. See PBL3 Pregnancy discomforts.
What will Lisa discover in relation to the initial weight loss?
Every child follows a growth pattern from birth. Usually the first thing they do is lose weight! Many
babies on average lose 5-7% of their weight in the first few days after birth. There are lots of
theories around why babies do this initially, but by about 7- 10 days old they should have started to
put it on again. From then on your baby will gain 120-200g per week.
Charles asks how to best thaw the breast milk? Uncover professional and public opinion on frozen
breast milk including thawing, effectiveness, expiry dates and methods of expressing milk.
Breast milk must be stored in either sterilized bottles or special plastic bags (milk pouches). They are
disposable, sealable and available at chemists.
Be aware that plastic bottles are recommended. The important anti-infection agents in breast milk
can stick to the glass, depriving the baby from having these in their milk.
Also you can put your breast milk into sterilized ice cube trays; this can allow small amounts of milk
to be added to the babies bottle.
Steps to storing milk
1. Express milk into sterilized bottle, bag or ice cube tray.
2. Label, write date and time that the milk was expresses
3.Place milk in fridge to allow to cool.
4. Once cooled you can then put it into freezer.
Fresh breast milk can last:
-
6 to 10 hours at room temp (however it is recommended to always store in the fridge if
available).
3 to 5 days in the fridge (below 4 Degrees Celsius).
3 months in a separate freezer of a fridge (with its own door).
6 months in a deep freezer (less than 0 Degrees Celsius).
Once breast milk is thawed it lasts one hour room temp or 12 to 24 hours in the fridge.
NOTE: Once breast milk has been defrosted it cannot be re-frozen.
Breast milk must be defrosted slowly. This can be done by:
-Placing the frozen milk in the fridge a few hours before it is needed, then warming it up by standing
the bottle in a container of hot (or warm) water for a few minutes. OR
Take the bottle out of the freezer, run some cold water on the outside of the container , gradually
increasing the water temperature until the milk is defrosted and warm.
NOTE: never use a microwave to defrost or heat your breast milk. This affects the properties of
breast milk and unevenly heats the milk, possibly resulting in burning baby’s mouth.
Action point:
Outline the characteristics of a normal, term, four week old baby; include reflexes, measurements
and average weight gain.
Your baby will grow and learn to do things in their own time. Premature babies' developmental
stages, their growing and learning (eg smiling, sitting) are counted from their due date rather than
their birth date. Between one and three months your baby will:
- smile and coo
- watch your face and try to respond to speech
- hold their head up when being held
-lift their head for a short time when lying on the floor on their tummy
-follow gentle movement close to them
- become quieter at the sound of your voice
Your baby’s hearing is fully developed at birth. You may notice your baby:
- cry or startle (jump) when there is a sudden loud noise
- stir in their sleep at sudden noises
- look up or stop sucking when breastfeeding when there is a loud noise
Babies’ eyesight develops gradually. They need to develop strong eye muscles so they can grow up
seeing everything around them and to see things steadily with both eyes.
From birth babies can see most clearly 20–30 cm in front of them. Things closer or further away look
blurred. Babies enjoy looking at faces, contrasting colours (particularly black and white) and bright
colours.
By four weeks, your baby will turn to look at lights and windows.
4week Boy Average weight: 4.7kg
4week Boy Average length: 56cm
4week Girl Average weight: 4.5kg
4week Girl Average height: 55cm
Action point:
Give an overview of what has happened to Florence 's elementary system. Will you be reassuring
Lisa and Charles or rushing Florence to the doctor?
Very pale poo
This can be a sign of jaundice. This is common in newborns and usually clears up within a couple of
weeks of the birth. However, it can be a problem if it lasts longer than this.
Ask your midwife or doctor to check your baby over, even if she doesn't look jaundiced
Neonatal jaundice is usually harmless: this condition is often seen in infants around the second day
after birth, lasting until day 8 in normal births, or to around day 14 in premature births. Serum
bilirubin normally drops to a low level without any intervention required: the jaundice is presumably
a consequence of metabolic and physiological adjustments after birth. In extreme cases, a braindamaging condition known as kernicterus can occur, leading to significant lifelong disability; there
are concerns that this condition has been rising in recent years due to inadequate detection and
treatment of neonatal hyperbilirubinemia. A Bili light is often the tool used for early treatment,
which often consists of exposing the baby to intensive phototherapy. Bilirubin count is lowered
through bowel movements and urination so regular and proper feedings are especially important
Breastfed babies’ bowel motions
Breastfed babies poo at least once a day until 4 weeks of age. After 4 weeks some babies do poos at
every feed, others only every 7–10 days. It is normal for babies to suddenly change their pattern.
Motions are often runny with small lumps.
Formula-fed babies
Formula-fed babies usually poo every day or every second day. They tend to have firmer-formed
motions.
Colour
Colour can vary from yellow to green to brown. Green poos are common in a well baby. However,
sometimes the green colour may be caused by a feeding problem or illness. If you are concerned,
consult your midwife, Plunket nurse, well child health provider or doctor.
Constipation
A baby’s poos should be soft. When your baby is constipated, their poos are hard and difficult to
pass. It is common for babies to go red in the face, push and seem to strain when they are doing
poos even when they are not constipated.
Constipation is rare in breastfed babies. It is normal for breastfed babies over four weeks of age not
to do poos every day. Some babies go only once every 7–10 days. Formula-fed babies usually do
poos every day or every second day.
The most common cause of constipation is not enough fluid. Ask your Plunket nurse, other well child
health provider or doctor about constipation in babies less than three months old.
If your baby has not passed their first poo by 24 hours after birth, you should see your doctor. If you
are using formula, check you are making it correctly. (It is important to put the water in before the
powder and not to add extra scoops of powder or add extra water.)
Action point:
Explain this indentation to Lisette and Franchesca with a full explanation of how long it will be
present and appropriate treatment/handling of the indentation. Include any changes that may be
evident if Florence is unwell and dehydrated.
Fontanelles are soft spots on a baby's head which, during birth, enable the bony plates of the skull to
flex, allowing the child's head to pass through the birth canal. The ossification of the bones of the
skull causes the fontanelles to close over by 18 months up to a child's second birthday.
A sunken fontanelle indicates dehydration, whereas a very tense or bulging anterior fontanelle
indicates raised intracranial pressure.
Parents may worry that their infant may be more prone to injury at the fontanelles. In fact, although
they may colloquially be called "soft-spots", the membrane covering the fontanelles is extremely
tough and difficult to penetrate. However, the fontanelles allow the infant brain to be imaged using
ultrasonography. Once they are closed, most of the brain is inaccessible to ultrasound imaging,
because the bony skull presents an acoustic barrier.
Action point:
Charles is concerned that Florence is not receiving any breast milk. His own mother fed him on
cows milk and he asks you about swapping Florence's infant formula for cows milk.
If you are considering using infant formula, discuss this with your midwife, Plunket staff, other well
child health provider, or lactation consultant.
Use an infant formula that is suitable for your baby’s age. The Ministry of Health advises that
ordinary, unmodified cow’s milk should not be given to babies until they are at least 12 months old.
This is because cow’s milk contains higher levels of protein and salt than are safe for a young baby’s
developing kidneys. It also does not have the vitamins and minerals a growing baby needs, especially
iron.