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What to do for the baby

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HealthWiki > A Book for Midwives > Chapter 15: The first weeks after the birth > What to do for the baby: The first weeks after the birth

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Encourage the baby to breastfeed and watch how she grows

The baby should breastfeed every few hours, from the first hour after the birth on. A baby who is breastfeeding enough and who is healthy should urinate and pass stool within the first 24 hours after, and regularly after that. She should not have signs of dehydration, and should gain weight. Keep the baby warm and dry, and play with her.

Baby has signs of dehydration

If the baby is not breastfed enough, if she has diarrhea or vomits, or if she has a fever, she can become dehydrated. Dehydration happens when there is not enough water in the body. It is very dangerous, and can kill a baby.

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Signs of dehydration:

  • sunken soft spot
  • sunken eyes
  • dry mouth or cracked lips
  • urinating less than 4 times a day
  • dark-colored urine
  • fast pulse and breathing
  • skin that is not stretchy
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To check the stretchiness of the skin, pinch the skin on your own arm and let it go. Watch how quickly it goes back to normal. Now pinch the skin on the baby's belly and let it go. If the baby's skin goes back to normal more slowly than yours did, she is dehydrated.

To help a dehydrated baby

Encourage the mother to breastfeed often — every 1 to 2 hours. Also give the baby rehydration drink — a few drops each minute until the baby is better.

Dehydration can be caused by infection. If the baby is not better in 4 hours, get medical help.

Baby does not gain weight or grow normally

It is normal for a baby to lose weight for a few days after birth. But she should regain her birth weight by 2 weeks and continue to gain weight steadily. A baby who does not gain weight or grow enough may not be getting enough milk. She may also have an infection, diarrhea, or another health problem.

Watch how often the baby breastfeeds. The mother should feed the baby whenever he wants, for as long as he wants — at least every 2 or 3 hours for at least 20 minutes, until the breast is empty. If the baby does not try to breastfeed often, she may be very sick. Take her to a medical center right away.

Watch the mother's health. If the mother is ill or not getting enough good food or fluids, she may not make enough milk. Encourage the family to care for the mother and give her extra food.

See Chapter 16 to learn more about breastfeeding. If the baby justdoes not grow, get medical advice.

Baby "shoots" vomit

Most babies spit up (vomit a small amount). Usually, the vomit dribbles out of the baby's mouth, especially after eating.

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If vomit "shoots" forcefully out of the baby's mouth each time she eats, she may have an infection or something blocking milk from moving through her body. Get medical advice.

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Encourage immunization

Immunizations (vaccines) protect children from many dangerous diseases. The most important vaccines for young babies are DPT (for diphtheria, whooping cough and tetanus), polio, hepatitis B, Hib (for Haemophilus influenza), PCV (pnuemococcal vaccine), RV (rotavirus), and BCG (for tuberculosis). Each country has its own schedule for giving these vaccines and they are usually free. Most vaccines are started when a baby is about 2 months old. Encourage the mother to take the baby to the nearest health center.

If the mother has HIV

Giving ART medicines will protect a baby from becoming infected with HIV if his mother has HIV. This medicine should be started within 72 hours after the baby is born. When the baby is 6 weeks old, he should also start taking a medicine called cotrimoxazole to prevent infections.

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If you clean the cord,
be gentle.

Care for the cord

To prevent the stump of the baby's cord from getting infected, it should be kept clean and dry. Show the family how to care for it.

  • Always wash your hands before touching the cord.
  • If the cord becomes dirty or has a lot of dried blood on it, clean it with soap and boiled (then cooled) water, medical alcohol, strong drinking alcohol, or with gentian violet. Be gentle with the cord.
  • Do not put anything else on the cord — dirt and dung are especially dangerous.
  • If there are a lot of flies where you live, you may cover the cord stump with a clean dry cloth. But usually you should leave it uncovered.

The cord stump usually falls off 5 to 7 days after the birth. There may be a few drops of blood or smooth mucus when the cord falls off. This is normal. But if there is a lot of blood or any pus, get medical help.

Look for signs of infection

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  • The baby seems very weak or tired, or stops breastfeeding.
  • The baby has diarrhea.
  • The baby cannot keep warm, even when wrapped in blankets.
  • The baby has a fever above 38°C (100.4°F).
  • The baby has a weak, fast heartbeat.
  • The baby breathes with difficulty, more than 60 breaths a minute.
  • The baby seems ill.
Cord infection

Infection in a baby is most often caused by germs getting into the cord stump. When the cord is infected, the area around the cord usually becomes red, drains pus, feels hot, or smells bad. If signs are mild, start by cleaning and putting gentian violet on 2 times a day. If it does not improve or gets worse after 1 or 2 days, give medicines or get medical help.

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If the cord was cut with something that was not sterilized, or if someone put dirt or dung on the cord stump, the baby can get tetanus. Even with good care and medicine, most babies who get tetanus will die.

To prevent tetanus, pregnant women must be vaccinated, and the cord must be kept clean.

A baby with tetanus will usually be stiff, with her head bent back, and will have very brisk (strong) reflexes. Check the baby's reflexes for signs of tetanus:

Let the leg hang freely and tap it just below the kneecap with your knuckle or finger. If the leg jumps a little bit, the reaction is normal. If it jumps a lot, the baby may have tetanus.
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If you see signs of tetanus, get medical help immediately.

If medical help is more than 2 hours away
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  • inject 100,000 Units benzylpenicillin
on the outside of the baby's thigh muscle,
1 time only
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Pneumonia (lung infection)

Infection can also happen in the baby's lungs (pneumonia). This is most common if the mother's water broke more than 24 hours before the birth, or if she had a fever during labor.

Signs of a lung infection in a baby are: breathing fast (more than 60 breaths a minute) grunting when she breathes, or sucking in the skin between her ribs as she breathes. Get medical help, especially if the baby is small or was born early. On the way, give antibiotics.

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Meningitis (brain infection)

Rarely, a baby becomes infected in the brain (meningitis). A baby with an infection in the brain will have a stiff neck and lie with her head bent back. She may vomit, the soft spot on her head will bulge, and she may become unconscious. A baby with an infection of the brain can quickly die. Take the baby to a hospital immediately.

If you have antibiotics, give them on the way to the hospital.

Antibiotics for infections in a newborn
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such as pneumonia, meningitis, infections of the blood (sepsis) and others
  • inject ampicillin
in the outside of the baby's thigh muscle,
2 times a day for for a baby up to 6 days old
3 times a day for a baby 1 week old or more
for a 2 kg or smaller baby: inject 80 mg
for a 3 kg baby: inject 150 mg
for a 4 kg or bigger baby: inject 200 mg
  • inject gentamicin
in the outside of the baby's thigh muscle,
once a day
for a 2 kg or smaller baby: inject 8 mg
for a 3 kg baby: inject 12 mg
for a 4 kg or bigger baby: inject 16 mg
Take the baby to a hospital. If this is not possible, give ampicillin and gentamicin for at least 5 days.

Watch the color of the baby's skin and eyes

Many babies have a yellow color to their skin or eyes a few days after birth. This is called jaundice. Jaundice is caused when a yellow substance called bilirubin builds up in the baby's body. Normally, a new baby's body breaks the bilirubin down in a few days, and the yellow color goes away.

Rarely, the baby can have severe jaundice, which is dangerous. Signs are:

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Put a yellow baby in the sun for a few minutes every day.
  • The yellow color starts on the first day of the baby's life.
  • The yellow color lasts for more than 2 weeks.
  • The yellow color extends to the baby's hands or feet.
  • The baby seems very sleepy or does not wake up to breastfeed.
  • The baby does not stay warm.

If the baby shows any of these signs, get medical help immediately.

Otherwise, help the baby breastfeed often, and give the baby some sun. The sun helps break down the bilirubin. If it is warm enough, take off the baby's clothes, cover her eyes, and put her in the sun for 5 minutes once or twice a day. (Too long will burn the baby's skin.)

This page was updated:11 Sep 2019