Hesperian Health Guides

In the Next Few Hours

In this chapter:

About an hour or two after the birth, when the baby has breastfed and you have made sure the mother is not bleeding and is OK, carefully examine the baby from head to toe to see if there are any problems that need attention. Do not let the baby get cold while you examine her.

Medicines for newborns

If the mother has gonorrhea or chlamydia (two infections of the genitals), this can infect the baby's eyes during birth, causing severe eye problems and blindness. It is quite common for a woman to have a genital infection and not know it. The best way to ensure gonorrhea or chlamydia are not spread to the baby’s eyes is for both women and men to be tested and treated for these sexually transmitted infections. To learn about the signs of these infections and their treatments, see Sexually Transmitted Infections. To prevent eye infection from gonorrhea, put a little erythromycin or tetracycline ointment in each of the baby’s eyes within an hour or two after birth.

In places where hepatitis B or liver cancer is common, it is wise to give a hepatitis B vaccination to the baby on the first day after the birth. This will prevent the spread of hepatitis B from the mother to the baby. It is also quite common for a woman to have hepatitis B and not know it.

If the mother has HIV, the baby will need HIV medicines. Also see HIV and AIDS (in development).

Examine the baby

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  • Does this baby look like other babies?
  • Are her body parts on the left and right sides the same size, shape, and position?
  • Is her skin intact? Check especially at the lower back. Sometimes there is a little opening there that needs surgery
    right away.
  • Are her genitals normal? (Swelling on the first day is common and not dangerous.)
  • Has she urinated? A baby might not urinate in the first day. But she should pass urine several times on the second day and every few hours after that. If she does not urinate enough, or if her urine is dark colored and strong smelling, she needs to nurse more. Or rarely, she may have a problem with her kidneys.
  • Has the baby passed stool? If not, wear a glove and gently insert your smallest finger in the anus to make sure it is not closed shut. If there is no hole she needs surgery.

Some differences are not important, and some can be a sign of a serious problem. If a baby has one difference, be aware that there might be others and sometimes they are inside the body. Watch these babies closely for normal breathing, color, and urinating.

Head shape and size

illustration of the above: a baby's swollen head.

Different head shapes and sizes are normal. A baby’s head can be pointy or have a big swelling, especially after a long labor. In a few days the swelling will go away.

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A hematoma

Some babies have bleeding under the scalp, called a hematoma. It feels soft when you press it. These are not dangerous. They may take a month or longer to go away.

Some babies who are born early have smaller heads that will develop normally as the baby grows. But if you are worried that a baby’s head is too small, especially if you live where there is Zika, talk to a health worker to see if it is the right size or what special help the baby might need. To learn more about preventing Zika, see the chapter Malaria, Dengue, and Other Illnesses from Mosquitoes.

Cleft lip and cleft palate

a baby with a cleft lip.

A division in the lip (cleft lip, harelip) is easy to see. A division in the roof of the mouth (cleft palate) is not always obvious. Put a clean finger in the baby's mouth to feel if the top is closed. The danger to a baby of cleft lip and palate is that they can make breastfeeding more difficult.

To breastfeed, try covering the cleft in the lip with a finger, so the mouth can seal around the breast. For a cleft palate, put the nipple and the dark area around it (the areola) deep in the baby's mouth and to one side of the cleft. If the baby still has trouble, give breast milk with a clean spoon or dropper until he grows more able to nurse. Feed him often so he will stay well. See more information on how to remove milk by hand for spoon feeding.

A cleft lip can be repaired with surgery after 3 months. A cleft palate can be repaired with surgery after 1 year. In many countries these surgeries are provided for free and can make a big difference in the child's life. Ask at a clinic or hospital for information.

illustration of the below: checking for a dislocated hip.

Dislocated hip, hip out of joint, dysplasia

Some children are born with a dislocated hip – the leg has slipped out of its joint in the hip bone. Most often, this fixes itself in a few days or weeks.

Bend the legs so you can hold both the thigh and lower leg together. Rest your fingertips on the baby's hips. Then roll one leg at a time in a slow circle – out, around, down, and back up. If one leg stops early, jerks, or “clunks” when you open it wide, it may be dislocated.

a woman carrying a baby in a sling with his legs apart.
Ask the mother to carry her baby with the legs open, like this. Check the baby again in two weeks. If you still feel or hear a jerk or “clunk,” seek help. A simple harness that holds the baby's legs open for a few weeks can prevent life-long disability.

a baby with his foot turned in.
the baby with a cast on his leg.

Club foot

If a newborn’s foot turns inward or is the wrong shape (clubbed), try to bend it into the right position. If you can do this easily, repeat this several times each day. The foot (or feet) should slowly grow to normal. If you cannot easily bend the baby’s foot to normal, take him to a health center within a few days of birth. His foot will need to be straightened with casts. If done early, casting prevents surgery or disability later.

Extra fingers or toes

illustration of the below: a small extra finger with string around it.

A small extra finger or toe, with no bone inside, can be removed by tightly tying a string around it. It will dry and fall off. If the finger or toe is larger or has a bone, it will not cause harm, and you can safely leave it be.

Slight webbing between toes like this is not a problem.
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If two or more fingers are stuck together, they will need surgery to work properly.

Down syndrome

A disability that affects thinking or learning may be obvious soon after birth, or you may not notice until the child is older. Down syndrome is a common cause of mental slowness. Babies with Down syndrome have some or all of these signs:

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Upward tilted eyes
Flat face
Only one line across the palm
Ear small with a fold of skin on top
Less muscle tone

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Wide space
between 1st and
2nd toe
a boy using crutches while holding a girl on his shoulders; the girl holds a sign.
Look for the
in every child.

Down syndrome is not caused by anything the mother or anyone else did. If a woman is over 35 years old when she becomes pregnant, her baby is more likely to have it. These babies need the same love and attention as all babies, and certain simple activities can help them learn. For more information, see Hesperian's book Disabled Village Children, chapter 32.

Caring for children with disabilities

Many physical differences that cause problems for a child can be treated at home by the family with the help of a health worker. Perhaps more important than any medical treatment though, disabled children need love, attention, play time, learning time, and responsibility, like any other child. Look for the gifts and skills each child brings.

The best way to protect children is to take care of their mothers.

More severe birth defects

Some birth defects are so severe they will lead to the death of the baby. This is a very painful time for the family and community. As a health worker, you can help the family to talk about their sadness and loss.

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Cleaning and dressing the baby

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Many mothers want to protect their babies from bad air with lots of clothes or blankets. This can make the baby too hot! One extra layer is enough.

Wipe off any blood and the baby’s first bowel movement (a sticky black stuff called meconium) but do not give a bath. After two or three days, the family should bathe the baby regularly to clean up milk, spit-up, dirt, and feces.

When you dress the baby, use as many clothes as an adult needs, plus 1 layer. For the first week or two, cover the baby’s head – they lose a lot of heat through their heads. Change clothes or diapers as soon as they are wet or dirtied with stool. If the skin gets red or there is a rash under a diaper, leave the clothes or diaper off to help it clear.

This page was updated:05 Jan 2024