Q & A with Midwife Heather Winter

Why does my baby seem to cry so much?

Babies cry for various reasons. This is the way they communicate their needs. They can be hungry, tired, may need a nappy change or need to be cuddled or burped.

During the first few months of life crying is common and it can be more noticeable in the late afternoon or evening. Crying times peak between 6-8 weeks of age.

Sometimes you will notice that babies will draw their legs up to their tummies and appear to be unsettled, and this may indicate they have wind. A warm bath and a cuddle may help to alleviate this problem. If you are experiencing frustration or anxiety over your baby, place baby in their cot, take some deep breaths to try and calm yourself and seek help and support from family or friends.

If you have any health concerns regarding your baby you will need to contact your GP for advice. Parents who are experiencing difficulties with uncontrollable crying in an otherwise healthy baby can seek help from their Early Childhood Centre, Tresillian, or Karitane.

How long is it ok for my baby to cry?

Remember babies cry to communicate. Consider if this is normal for your baby or is it a sign of baby being unwell. Seek medical advice if you have any concerns.

In the first few months babies cries should be answered promptly, since it’s normally a sign they need attention or affection – they might be hungry, tired, wet or have wind pain. A parent’s quick and effective response to their needs helps to promote parent and child bonding. What is often helpful is the establishment of a good routine so that baby learns it is time to sleep. A bath, massage, feed, low lights, placement in the crib and quiet time can all help with this. Routines take time to develop and babies learn to self-settle at different stages in their development.

Parents who are experiencing difficulties with uncontrollable crying in an otherwise healthy baby can seek help from their Early Childhood Centre, Tresillian or Karitane.

Is it necessary to swaddle a baby, and for how long?

Your baby will love it.

Swaddling reminds baby of being in mummy’s tummy when with little room to stretch, baby was being tightly held as mum walked, talked and lulled baby to sleep.

Wrapping is great for settling babies for up to three months, and for newborns with the moro reflex, who if not swaddled, may startle and wake themselves up. Once the Moro reflex (startle reflex) disappears baby’s arms can be left uncovered.

Most babies will eventually resist being wrapped particularly once they start to roll onto their tummy’s and roll back again onto their backs.

There are alternatives to swaddling on the market in the form of safe infant sleeping bags that can be used instead.

Until then - happy swaddling!

What can I expect as normal newborn behaviour?

My husband and I are expecting our first child and I’m a little daunted by the day we bring our baby home and fend for ourselves! What can I expect as normal newborn behaviour?

How exiting! It’s perfectly normal to be nervous, but do remember, midwifery and medical staff will do a thorough assessment of your newborn and help you learn what’s normal with your baby before you leave their care.

Here are a few tips:

• Umbilical cords will dry into a scale and usually fall off after about 7-10 days.
• Small spits or vomits (called posseting) are normal for newborns as their tummies are still small and the valve that empties milk into their stomach is quite loose. This can often take a few months to tighten and as your baby becomes more upright, the problem will usually go away.
• Babies’ poo changes in the first few weeks from black, to greeny brown while milk is coming in and, when the milk is in, to yellow with little “curds” (small white flecks). Babies’ poo when yellow is quite watery, but if yellow, is a positive indication that your baby is getting fat in the milk. If babies’ poo is persistently green, seek advice. The number of poo’s your baby does per day will vary and they may not necessarily poo every day.
• Similarly, urine output can vary, but a good guide is approximately six wet nappies per day.
• Babies’ will take several weeks to adjust their circadian rhythm (the adjustment between night and day). Babies’ develop their own pattern naturally if their needs of feeding and comforting are met frequently.
• Bathing doesn’t always have to be attended every day - cleaning of the head, face and bottom will be sufficient at times.

The first few weeks are a unique opportunity for you and your newborn to bond, love and learn about each other!

Q & A with San Obstetrician & Gynaecologist Dr Peter Wood

My child is one - is it too late to do Kegel pelvic floor exercises now?

Throughout my pregnancy, I had been a little forgetful about doing Kegel (pelvic floor) exercises. My child is now 1 - is it too late?

It is never too late to do Kegel pelvic floor muscle exercises regardless how long it is since you had your bundle of joy.

With up to 30% of all women experiencing slight bladder leakage when they sneeze, cough or laugh at sometimes in their life, thanks to pregnancy and childbirth, surgery, ageing or obesity, getting into the habit of doing these pelvic floor exercises regularly can be a great preventative measure.

Repeatedly contracting and relaxing the pelvic floor muscles (the muscles that you contract to hold urine in when you’re busting to go) can be done discreetly while sitting at work, watching TV or even while standing in the checkout queue. 1 set of exercises includes 10 quick contract and release and 5 contractions that hold for 10 seconds. Repeating each set 3 times a day will soon lead to improvements.

Are there side effects linked with birth control?

Information about the different side effects of birth control can be overwhelming.

Hormone influencing contraceptives, such as the combined oral contraceptive pill, vaginal rings, hormone impregnated intrauterine devices, and implantable birth control and injections can have some advantages including treating irregular menstruation, painful periods, acne, endometriosis and premenstrual syndrome. Disadvantages can be inter-menstrual spotting, mood changes, weight gain, headaches or migraines, nausea, missed periods, breast tenderness and possible decreased libido.

Other non-hormonal options include condoms, copper intrauterine devices and diaphragms. Side effects from these are less common than hormonal contraception, and use of these is up to the individual. Non reversible options include vasectomy, and tubal ligation both of which require surgery and possible associated complications.

Discussion with your doctor about what might suit you best is the place to start.

Is it safe to get dental work done when pregnant?

Is it safe to get dental work done when pregnant? I'm five weeks pregnant and have to get a filling done.

Dental health during pregnancy is very important. Pregnancy issues like changing hormones, gastric reflux or repeated vomiting due to morning sickness can affect your teeth enamel and can cause decay.

Dental work like fillings and crowns can be carried out at any time.

However it is important to alert your dentist as some medications may be inappropriate for example Tetracycline which can stain the baby’s developing teeth. Similarly if x-rays are required, they should provide a lead apron to wear around your waist.

We do generally suggest that you postpone other teeth whitening or cosmetic treatments until after birth.

So good luck with the pregnancy and keep smiling!

What do I need to watch out for travelling overseas if I'm pregnant?

I’m currently pregnant and am travelling overseas soon. What do I need to watch out for?

Unless you are travelling to a developing nation, it is safe to travel during a healthy pregnancy however you should always alert your doctor or midwife since they know the specifics of your pregnancy.

Generally speaking, the risks of miscarriage in the 1st trimester or early birth in the 3rd trimester do mean the 2nd trimester is generally considered the best time to travel.

However women with gestational diabetes, carrying multiple babies, or more than 34 weeks pregnant are generally not advised to fly.

Women with pregnancies with more serious complications are not advised to travel due to the specific conditions, risk of early labour or access to services they might need.

Specifically, for all pregnant women the risk of Deep Vein Thrombosis is increased, and travel is not recommended to developing countries which require immunisation against diseases like Typhoid, or drugs to prevent Malaria, as these put babies at risk.

Q & A with San Paediatrician Dr Neil Ginsberg

Are there certain medicines my children should avoid?

No one feels pressure like a parent of a sick child to relieve pain or discomfort fast, however, too little or too much or the wrong medication could have serious side effects.

A few key rules apply: see your doctor for an accurate diagnosis, never use left-over medications or give a child something prescribed for an adult. Always read the instructions regarding weight, size, dose, how and when to dispense, date of expiry and potential interactions with other medications.

Specifically, aspirin should never be given to children, especially during viral illnesses, as it can cause a potentially life threatening disease. Over-the-counter cold and cough medications have little therapeutic value in children, and are definitely not recommended for children under 6. Paracetamol and ibuprofen should be used cautiously, however medical review is recommended if there is any deterioration. Antibiotics should only be used on your doctor’s advice.

Equally importantly is monitoring for possible adverse reactions like rashes, hives, wheezing or difficulty breathing. Please also ensure safe storage and disposal of any unused medications.

When it comes to circumcising my baby, what should I consider?

Circumcision of your baby boy really requires careful consideration of the benefits and risks as well as your cultural and religious influences.

The practice of the surgical removal of the foreskin covering the head of the penis dates back thousands of years.

Benefits of circumcision include a reduced risk of urinary tract infections, as well as offering some protection in adulthood against sexually transmitted infections such as genital herpes, hepatitis C and HIV.

Immediate risks, although minimal when performed by appropriately trained practitioners, include pain, bleeding and infection. There are some suggestions that function may be affected, and in extreme cases anatomical damage may occur. There are conflicting suggestions regarding the hard to measure pain of the procedure and the long term psychological impact, and appropriate pain relief measures should be utilised at all times.

How do I know if my baby is getting enough Vitamin D?

Vitamin D, the ‘sunshine vitamin’, plays an essential role in the growth and development of healthy babies helping to build strong, healthy bones and teeth. Symptoms of insufficient Vitamin D include dental deformities, impaired growth or rickets.

Babies at risk of deficiency include babies who are only breast fed, particularly if the mother has low vitamin D. In addition, those infants with dark skin, those born premature, and babies who spend most of their time inside have an increased risk of deficiency.

Babies get about 80% of their vitamin D from the sun. The body uses sunlight on the skin to make vitamin D. Sunscreens will reduce the effectiveness of this process, so it is recommended that babies get brief, early morning unprotected sun exposure to ensure maximum benefit.

Food sources of vitamin D include salmon, herring, mackerel, trout, sardines and fresh tuna, canned tuna, red meat and egg yolks. Also, fortified foods such as breakfast cereals, some milks and spreads. Vitamin D supplement drops can be given to babies at high risk of deficiency.

Should I wake my sleeping newborn if it’s meant to be feedtime?

Generally sleeping newborns are a good sign, however on average babies should feed every three to four hours since babies lose 5-7% of their body weight in the first week and thus need to feed regularly. Once they are gaining weight then they can be left longer overnight if they are settled. Feed according to your babies signs: once they’ve had enough they will get sleepy fidgety or distracted. Generally, they will remain unsettled if still hungry.

What’s a normal feed? For formula-fed newborns its 60–90 ml per feed every three to four hours while if on the breast quantities will be smaller but more frequent. By six months, it’s 180–240 ml 4 or 5 times a day.

Unless ill or premature most babies regain lost weight by 14 days and will have doubled their birth weight by about three to four months. Just remember average 12 year olds are taller than their parents…so enjoy this baby phase while you can!

My eight-month-old grinds his teeth - what can I do to stop this?

My eight-month-old has seven teeth and he’s started grinding them—so much so that I can see his jaw going back and forth! Is this bad and what can I do to stop it?

That’s a great question. Nearly one-third of children grind their teeth, often during their sleep. This is called bruxism and is generally a behavioural pattern rather than a pathological problem. This will often happen in deep phases of sleep and may be aggravated in children where the top and bottom teeth are not properly aligned. It is not worrying in an 8 month old and most babies will grow out of this habit. If it persists, see your GP or dentist for reassurance, and if they are concerned then a paediatric referral may be needed.

Is it OK to use a nasal aspirator to clear my child’s stuffy nose?

Is it OK to use a nasal aspirator to clear my child’s stuffy nose? I’ve heard it can hurt his nasal lining and cause other problems?

Well, doing this task for our babies is just another joy of parenthood, isn’t it?

For adults who can blow their nose life is so much simpler… however for babies with colds who are congested, a nasal aspirator can help remove mucous and make breathing and sleeping easier. Saline drops however, are usually good enough without the need for aspiration.

If you do need to resort to aspirating, please remember that babies have sensitive noses and being too aggressive can irritate your baby’s nasal passage, whilst using it too often can also swell the lining of the nose. So, I would only be aspirating if they were really struggling.

Assess the need, be gentle, don’t use it too often. That way everyone will breathe easy!

How can I stop my baby from rolling over and waking himself up?

How can I stop my baby from rolling over? My baby is seven months old and wakes himself up every time he rolls over.

What great news that you’ve got an active developing baby reaching the milestones that show muscle development.

Babies usually attempt to roll over from three to four months and generally by six months the arms and neck muscles are strong enough to roll left or right. This is at a similar time to gaining head control and often around the same time as learning to sit on their own. They flip from lying on their back to their tummy and back again.

I agree that it may be frustrating if this causes him to awaken, but it is a crucial milestone, and in time he should work it out and stop waking himself up. It is very important not to put anything into the crib that might increase the risk of suffocation or SIDS.

I know it’s a small consolation but your son developing the skill of rolling means that he’s on his way to crawling, walking and running…something to really look forward to!

How can I tell if my baby’s mild fevers are teething-related or something else?

Fevers in babies are certainly scary for parents and especially so when the baby is a newborn. A fever is normally an indication that the body is fighting illness and the baby’s immune system is functioning. Most commonly it is caused by a cold or other viral infection, but it may be a more severe infection such as pneumonia, a urinary tract infection, ear infection, or even meningitis. You can’t be too careful so a quick trip to your doctor is wise.

Most importantly, please go to the doctor as soon as possible in the following situations: if your baby looks unwell, if the fever lasts for more than 3 days, and in particular, if a fever occurs in a baby under 3 months of age. Remember also, teething does NOT cause a significant fever, so don’t blame teething and ignore a genuine infection!

My child is two and still has a stork bite mark on the back of her head. Is this normal?

A stork bite, also called nevus simplex, is a common birthmark affecting one in three new-borns, and is mostly temporary. This often occurs with a similar mark on the eyelids and/or forehead. Because these birthmarks are as a result of tiny blood vessels under the skin, the colour can deepen when a baby cries or gets hot. These birthmarks are cosmetic alone, and the facial marks in particular usually disappear by about 12-18 months. The neck marks, as in your child, can remain but are generally hidden under the hairline and therefore of little concern. Whilst those that persist can be laser removed, this is very rarely needed. To be certain, let your GP see your child and discuss the options available if indeed treatment is needed at all.