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Questions which you certainly need to ask when your pediatrician comes to visit your newborn baby for the first time.

The birth of a baby is an important and a happy event, but for every young mother it erases a lot of uneasy questions: would she manage to cope with her new task? Your baby will be initially examined in the maternity hospital by a neonatologist, and then a pediatrician will visit them at home. The questions you need to ask during this visit are very important and fining their answers will make you feel more confident in taking care of the little child.

Which are these questions? I will try to give you some short answers that can help you.

Which is the relevant air temperature that you need to maintain in the baby’s room and how this room should look like?

The body of a healthy newborn baby maintains normal temperature and there is no need of extra worming.

The air temperature should be 22-23 ºC maximum. There shouldn’t be flowers, TV set or a computer or shelves with lots of books there. Do not put carpet on the floor, because you should clean its surface with a damp cloth every day to prevent dusting. The baby should have their own bed and you have to change the bed sheets daily. Babies do not need a pillow to sleep on but it is good if you put a pillow case or a diaper instead: in case the child regurgitates you can easily change it.

You must air the room for 10 minutes periods every 2 to 3 hours. This reduces the bacterial level in the air and prevents the risk of infection.

When should you bathe your baby, how many times and at what temperature of water and air?

You must bathe your baby daily, but you may use just water every second day. The temperature of the bathing premises normally is 2-30С higher than that of the room. Water temperature must be 370С. First wash the body and the head last. As the head is the most vascular part if you wash it first the baby can feel cold. After bathing coat thoroughly the body and the face of the baby with cleansing milk or cream. Baby’s eyes should be cleaned with saline or boiled water: each eye with separate pad from the outer to the inner corner of the eye. Dry the ears using baby cotton buds.

What should you do if the navel of your baby has not fallen off yet?

If the navel of your baby has not fallen off yet you can bathe the child but after the bath you must clean the umbilical cord stump with alcohol and put antibiotic powder or spray with Eosin, which helps a lot the navel to fall off. For best results you need to spray it 2-3 times daily.

How often should I change diapers of the baby and when?

Diapers must be changed before each feeding, and the seat is washed in tap water 370С, well dried and smeared with cream or baby oil. During the 1-2 month from birth it’s highly recommended the baby’s seat to be washed and wipes to be used as an exception only, because their skin is very delicate and if not washed regularly and smeared with cream it often cracks. If the baby defecates during the nutrition it is better to wait at least 30 minutes before changing the diaper, because otherwise the child may throw up.

How to dress your babies when they are in the room?

During the first month after birth babies sleep most of the time. So a cotton body suit and a union suit or rompers from thicker fabric, booties for the legs and a thin but warm blanket are suitable in this case. Polar blankets are most suitable, but they must be wrapped in a blanket case. You have to change the blanket case every 48 hours.

When your baby is in the room, no baby hat is needed.

Shall we take the baby out for a walk in the first month after birth?

It is of a great importance to prepare the baby for walks in fresh air. We need to start preparing the “winter” babies after the 15th day after birth, and all the rest – 3 to 5 days after birth. We begin with opening widely the window of baby’s room for 10-15 min. and increase this duration in the next 2-3 days till the airing reaches up to 1 hour. Then you can take your baby out on the terrace: initially for 15-20 min. and after that you can increase this duration up to 1 hour. Just then the baby is prepared to be taken out for a walk.

The most appropriate hours of the day are those around lunch time: it is when the temperatures are higher (especially for the babies who were born in the winter, early spring and late autumn). For the babies who were born during the rest time of the year it is recommended the walks to finish till 11 o’clock and to start after 16 in the afternoon. Do not expose your baby to direct sunlight, keep them in the shade, use UV protection creams for uncovered parts of the baby’s body and face. Use a sunscreen with an SPF (sun protection factor) of at least 20.

Is it necessary for the newborn baby to take any preventive medication?

Healthy newborn babies do not need their immune system to be stimulated and they do not need any preventive medication. The only support their system needs is taking vitamin D3 /500 units daily as a prevention of rickets after the 20th day after birth. On the course of time the pediatrician may reconsider the need of D3: to reduce the daily dose or even to stop it depending on baby’s health condition and their diet.

How many times should baby be examined by a doctor?

It will be good a pediatrician to examine your baby twice in the first month: on the 15th day after birth and then at the end of the month. This will help you to feel more confident. Pediatrician will check the weight of the baby and you can ask them any questions you have regarding the upbringing of your child.

How can I tell whether my baby's getting enough breast milk?

This is quite an issue for all the mothers of young babies. Babies who are breast fed must suckle 15-20 minutes and at the end of the first month – up to 30 minutes. Actually the active suckling lasts for at about 10 minutes, then the baby takes rest and after that they suckle again to add the quantity they need. If the baby sleeps without waking up for 2.5 – 3 hours this shows that they have had enough. Particularly important is the Weight/ Growth Chart. Every baby’s need of food is individual. What is the 'normal' growth rate for babies? If your baby gains weight about 700-900 grams a month in the first 3 months, this is a good indicator.

As for the children fed with Baby Formula, they can gain more weight. This is because in some cases they actually suckle more than they need. You give them one and the same dose and they suckle the whole of it as it is easer for them to eat from the baby bottle then from mom’s breast. You wouldn’t like to eat one and the same portions of food every time, would you!?

What vaccines and medical tests the baby needs?

Right after the birth, in the maternity hospital the babies are vaccinated as prevention from common diseases. 48 hours after birth baby is treated with BCG vaccine. It is for protection against tuberculosis. It is given over the left arm.

In the first 24 hours after birth your baby will be immunized with ENGERIX-B against infections caused by all known subtypes of hepatitis B virus. It is administered by intramuscular injection. It is synthetic, with no side effects and it is compatible with all vaccines. The baby needs to be immunized with it three times – while in maternity hospital after birth, during the first month and in the sixth month. It protects your baby from the infection, which is complicated by cirrhosis of the liver.

In the maternity hospital, when a baby is about five days old, a midwife will collect a sample of blood by pricking the baby’s heel using a special device and squeezing out a few drops of blood on to a card. This is called screening test. All babies in Europe, the USA, and Canada etc. have it. The blood spot screening test helps to identify a range of health conditions, including: underactive thyroid (Congenital hypothyroidism), disorder in the metabolism of proteins (Phenylketonuria), adrenal dysfunction. Early diagnosis of these medical problems and early treatment can improve the baby's health and prevent severe disability.

Assoc. Prof. Dr. B. Slancheva
Pediatrician, neonatologist
Head of Neonatology Clinic
University Hospital Obstetrics and Gynecology
“Maichin Dom”