1
Q
What are the differences between a Newborn Care specialist and other caregivers who work with newborns?
A
A NCS is specially trained to work with newborns. They work independently with families (little guidance), often short term. They are well versed in good sleep practices and breastfeeding. They can recognize and address PPMDs. They often work overnights or around the clock care. Other caregivers working with newborns may or may not have the experience, knowledge, or confidence as a NCS.
2
Q
What are the NCS’ goals?
A
To foster healthy sleep patterns in baby(s), to get baby to sleep through the night as soon as reasonably possible, and to leave parents feeling empowered.
3
Q
What does a NCS understand?
A
How to establish healthy feeding and sleep habits.
How to create structure in baby(s) day.
Understands the special needs of families with multiples and preemies.
Knows various sleep conditioning methods and has a successful plan for baby(s).
Knows the limits of their scope and who to refer to if needed.
Understands the value and can support breastfeeding.
Can recognize PPMD and confidently address them.
Understands and can recognize signs of possible food allergies or intolerances and reflux + knows ways to help.
Keeps up to date with research.
4
Q
What is a night nanny?
A
A nanny who works overnight shifts under the direct guidance and supervision of the parents.
5
Q
What is a postpartum doula?
A
A person who helps provide support to the postpartum family in the first few weeks following birth through education, basic baby care, mother care, and household assistance. The focus is on the whole family with an emphasis on mother, not primarily the newborn.
6
Q
Vernix
A
Newborns are often born with a waxy, cheese-like white substance on their body.
- usually only full term babies.
-Often develops around 18 weeks gestation.
-has antibacterial properties
-absorbs into skin
It is theorized to provide moisture and to facilitate passage through the birth canal.
7
Q
Lanugo
A
Newborns are often born covered in a fine layer of hair.
It is the first hair produced by fetal follicles and often appears around 5 months gestation.
It often disappears before birth, but in babies born with it, it falls out within a few days of birth in most cases.
Its purpose is to hold the Vernix on the skin so they are often seen together.
8
Q
Appearance and care for the newborn head
A
They come in many shapes and sizes.
Usually only come in the pretty round shape form in C-sections.
Can be born with no hair, some hair, or lots of hair.
Their hair does not need to be washed daily!
Only use a soft bristled brush on a baby with hair long enough to need brushing.
9
Q
Cradle cap
A
A common condition in newborns.
Most often presents as greasy skin covered by flaky white or yellow scales - occasionally with mild redness under it.
- often is the first sign of a food intolerance or allergy. (Be aware if cradle cap keeps coming back)
- does not “need” to be treated but parents are often highly disturbed by it.
- can come down to the face.
10
Q
Treatment options for cradle cap.
A
- Need permission from healthcare provider and signed liability form!*
- Washing daily with a mild shampoo, using a gentle washcloth or baby brush to break up scales.
- Soaking babies scalp with olive or coconut oil for 15-30 mins and then exfoliating.
- more aggressive measures like dandruff shampoo are sometimes suggested by healthcare provider.
- Don’t put downwards pressure on head when “treating”.
11
Q
Cradle cap or Exzema?
A
Cradle cap and Eczema have similar appearance.
- cradle cap is rarely itchy or uncomfortable.
- Eczema is often itchy and uncomfortable.
12
Q
Causes of cradle cap?
A
Exact cause is unknown, but most experts suggest it has to do with:
- Hormones passed from the mother.
- Yeast bacteria on the skin.
- Food intolerances or allergies.
13
Q
Cradle cap - it is time to see the doctor when?
A
- self care is not working.
- patches are interfering with babies eyes, nose, or mouth.
- The patches appear to be spreading, either in size or to new locations.
- parents are concerned.
14
Q
The newborn head - how to clean.
A
- Wash babies face with warm water and a soft cloth - soap is not necessary in most instances.
- Wash corners of eyes gently with a soft cloth and water only as needed - the “gunk” in corners of the eyes is a normal part of eye cleaning. Never touch the eyeball!.
- Wash the outside of nose and nostrils with a soft cloth and water. Only use a nasal aspirator when needed for congestion - the nose is designed to flush itself. Saline can be used under the guidance of a healthcare provider.
- Wash the inside of the mouth and gums with a soft cloth or baby “toothbrush”.
- Gently wash outside of ears with a soft cloth and water - do not put anything inside the ear canal!
- Keep the neck area clean with a soft cloth and water - be sure to dry this area gently but well or a yeast infection can develop in skin folds.
15
Q
What conditions are concerning and should be addressed with a healthcare provider?
A
- Thrush
- Torticollis
- plagiocephaly
16
Q
Thrush
A
An oral yeast infection. Often contracted by breastfeeding babies if the mother is on antibiotics. Can be passed back and forth between mother and baby.
- Requires careful washing and sterilizing of everything that comes in contact with both mother and baby.
Not dangerous, but requires medical assistance from a healthcare provider.
- I do not diagnose - I suggest that it looks like it could be xx but they need a doctor to diagnose and prescribe treatment.
17
Q
Torticollis
A
means “twisted neck” in Latin and can happen because of positioning in the womb, difficult birth or sleep positioning.
- another cause are the use of “containers”/”baby buckets” (carriers, rock & plays, etc)
- can be present at birth or show up in the first few weeks.
- characteristic pulling of the head to one side, difficulty turning of the head, or even a preference to nurse on one side.
- can also present as a small knot or lump on the side of the neck.
- Must be diagnosed by a doctor!
- Can be helped sometimes by repositioning or simple stretches, but PT may be needed.
- Need direct guidance and signed liability form to perform stretches.
18
Q
What is plagiocephaly?
A
It is the flattening of a part of the head. Babies with torticollis often can develop plagiocephaly.
19
Q
What are some in scope practices to help prevent torticollis and plagiocephaly?
A
- Switch which side baby naps on in his crib frequently to naturally help keep head turning balanced.
- Switch which side you feed baby on frequently.
20
Q
Desquamation
A
this is the peeling of the skin of a newborn. Common and usually resolves shortly after birth (within days).
- Healthcare provider may suggest lotions to help.
21
Q
What are some common conditions in newborns?
A
- Cradle cap
- Desquamation
- Milia
- Newborn acne
- Transient Pustular Melanosis
22
Q
Milia
A
Small whit bumps on the head and face that look like small whiteheads. Can be in the mouth as well. They go away on their own within a few days.
23
Q
Newborn acne
A
Fairly common but may or may not go away on its own. Acne pustules should never be popped! Seek medical attention if it is a concern. If it is persistent it could be a sign of an allergy.
24
Q
Transient Pustular Melanosis
A
More common on darker skinned babies, it looks like Milia but often leaves a dark mark on the skin when it disappears.
25
Brachial Plexus injuries
Injury to the Brachial Plexus, the bundle of nerves in the neck that provide signals to the arm and shoulder - sometimes into the chest and leg.
- more common that down syndrome and cerebral palsy combined.
- medical schools teach that these injuries heal but the reality is much different.
- caused by the doctor pulling too hard on the babies head while twisting during delivery in most cases.
- babies with a BP injury often also have a broken clavicle due to shoulder dystocia.
- Babies with a BP injury often have reflux and trouble sleeping because of the nerve pain.
- These babies require referral to a pediatric neurologist and brachial plexus specialist.
- This injury can paralyze them for life, often requires extensive painful surgeries and years of occupational therapy.
26
Characteristics of non-Caucasian babies
- Darker pigmentation of fingers and toes.
- More purple-grey in color (Caucasian babies are usually red)
- Eyes are still often dark blue then change.
- "Mongolian spots" (slate gray nevi or congenital dermal melanocystosis) on back and extremities in many cases.
* People (parents, physicians, anyone) can wrongly assume that Mongolian spots are bruises and accusations of abuse have occurred towards caregivers by parents and from physicians towards parents* Be prepared to educate people on them.
27
How to care for a newborn's skin?
With warm water, mild soap and a soft wash cloth.
- until umbilical cord (and circumcision if appropriate) has healed, clean using the "top and tail" method.
* umbilical cord and circumcisions cannot be submerged in water - sponge bathe until it is safe to give "real bath"
- be sure to dry baby well under the arms and in any skin folds to minimize risk of irritation and yeast infection development.
- keep baby covered as much as possible while cleaning.
- Clean around the penis - Do not pull on it! If circumcised, scabbing is not a good sign.
28
How to care for the umbilical cord?
Follow the instructions from the doctor. Some recommend:
- rubbing alcohol.
- doing nothing except keeping it dry.
29
How to care for a cicumcision?
Follow the instructions from the doctor. Some recommend:
- white petroleum jelly.
- antibiotic ointment.
- nothing but gauze.
30
Signs of an infection in an umbilical cord or circumcision?
- redness
- warmth
- inflammation
- oozing or puss
* requires medical attention*
31
Signs of adhesion with a circumcision?
- difficulty pulling the foreskin back.
- redness under edge of the foreskin after the circumcision has healed.
- little white "bumps" under the skin along circumcision edge.
32
How to care for a non-circumcised penis?
- It simply needs to be kept clean.
| - no pulling of the foreskin required. Damage can be caused by pulling.
33
Vaginal care?
- Always wipe front to back.
- Make sure to clean in between the labial folds.
- Never put anything into the vaginal opening.
- Do watch that the vaginal opening does not appear red or inflamed as this may be a sign of infection.
- Uncommon but watch for closing of the vaginal opening. Requires medical attention (usually a hormone cream is prescribed).
- Tip: Fold up wipe to create a gentle but firm wipe to clean inside labia folds.
34
Anus care?
- Requires no special care unless their is a sign of infection.
- A red ring around the anal opening can be an early sign of a food allergy (most often dairy).
- Red, scaling skin or weepy skin indicate a strep infection.
* both require medical attention*
35
How to care for the nails and toes?
* It is recommended that an NCS not trim babies nails for liability reasons.*
- can still support and walk parent through the process.
- Be aware of small threads and any hair that may get into the babies clothing, blankets, or bed. - these can get wrapped around their fingers/toes creating a dangerous loss of circulation very quickly and could result in amputation.
36
What are the different types of diaper rash that can occur?
- Wet contact rash
- Yeast
- Acidic poop rash
- Allergic rash
- Impetigo
- Psoriasis
- Eczema
37
Wet contact rash
Just a redness or slight irritation.
| - usually simply treated with OTC diaper rash cream (or homemade by parent)
38
Yeast
A raised, prickly red rash.
- usually starts in the folds of the skin.
- requires medical attention.
- if cloth diapering, requires switching to disposables and treating cloth diapers once the rash is cleared.
39
Acidic poop rash
Looks and feels like a sunburn.
- can turn into burning open sores.
- Seek medical advice.
- Butt paste and sometimes antibiotic cream works well in most cases.
40
Allergic rash
- Could be from something in the diaper, detergent, environment, or diet.
- Usually covers the entire diapered area and sometimes beyond.
- requires medical attention (preferably from a pediatric allergist)
41
Impetigo
Caused by staph or strep and appears as an open, weeping, crusty sore.
- Requires immediate medical treatment.
- highly contagious.
42
psoriasis
inflamed, scaly red patches of skin which can become infected.
- requires the care of a dermatologist.
43
eczema
Red, itchy, scaly rash that can blister and weep.
- looks a lot like cradle cap.
- Often an early first sign of a food intolerance or allergy.
- if mom is breastfeeding, a diet log is needed to try an identify associations with certain foods.
- if formula feeding, a medical professional should be consulted about the possibility of a food allergy (most often a milk protein issue)
44
Bathing baby once the umbilical cord (and circumcision) is healed.
Baby can now safely take a full bath.
- ideally it will not be daily as it can dry out baby's skin.
- Warm water in an infant tub or lined sink, put a warm wet wash cloth or hand towel over exposed skin areas.
- Bathe from top to bottom.
- Ideally bathe at the same time daily.
- With medical provider approval, lavender oil in the bath water or massaged on baby following bath (in a carrier oil) can be extremely soothing and benefit sleep. Or diffuse lavender oil in the bathing area and/or nursery (with medical approval).
- Don't fight with parents if they want to bathe their baby(s) daily. Can inform them that it's not necessary but don't insist otherwise if they continue to want to.
* babies lose heat fast so be quick to cover hair/head right after cleaning it while you clean the rest of baby.*
45
Feeding a newborn - Breast or bottle?
- In most cases, breastfeeding is the healthiest option for the baby, assuming mom is relatively healthy, both physically and mentally.
- bottle feeding breastmilk is the next healthiest option.
- Bottle feeding formula or specialized formula is the least healthy option.
* but what is best for the whole family?*
46
Feeding a newborn - Why is breast sometimes not best?
- Mom has a medical condition that makes it hard or impossible for her to breastfeed.
- Thyroid disease, pituitary disease, PCOS, medication that passes through the breastmilk that is dangerous to baby.
- When mom is struggling emotionally postpartum and it is just "one more thing" that adds stress to her life.
- When baby has a medical condition (rare) that makes breastfeeding incompatible-called galactosemia and makes baby unable to digest sugars (requires immediate medical attention/specialized formula)
47
Signs of galactosemia (rare condition that prevents baby from digesting sugar)?
- lethargy
- diarrhea
- vomiting
48
How to help baby find mothers nipple if breastfeeding?
Put baby's saliva on mom's nipples.
| - acts as a messaging service for mom and baby.
49
Breastfeeding - Does mom's diet matter?
- Many foods/chemicals pass through breastmilk.
- Mom's diet can produce gas, constipation, diaper rash, and more in a newborn.
- Mom can also pass potential allergens through to baby (cows milk protein intolerance, etc).
- Baby cause an unhappy baby and disrupt sleep.
- ideally we like to see a non-gmo, organic and balanced diet heavy in most fruits and veggies, lean healthy protein and healthy fats and minimally processes grains.
- Avoiding most processed foods is highly beneficial and most babies do better when mom avoids dairy, particularly uncooked dairy.
- Studies show that organic foods have more beneficial nutrients than non organic foods.
- Studies show that THC passes through breastmilk in small quantities but we don't know the long term effects.
50
Formula feeding - What are the options?
- Conventionally made dairy and soy based formulas (most derive sugar from corn syrup).
- Organic dairy and soy based formulas.
- Goats milk (Hipp and Holle Baby are the most common)
- Homemade formula options (caution - never make yourself!)
51
Formula feeding - DHA/ARA controversy
- DHA / ARA are naturally found in breastmilk and studies show that it helps preemie brain development.
- Formula companies capitalized off this by adding DHA/ARA to formulas and upping prices.
- No studies had indicated that the DHA/ARA added in formulas is beneficial for healthy term babies.
- DHA/ ARA in formulas is from low quality sources.
52
Which animal's milk is closest to human milk?
Camels
53
Medications and newborns
- Never dispense medication of any kind to a baby in your care without specific instructions from the parents and the child's healthcare provider and a medical liability release. You never want to assume responsibility for a medical decision!
- Always double or triple check medication dispensing information and keep a written log or any medications administered and the dosage.
- insist parents also keep track in the written log so that everyone is on the same page.
54
Diapering a newborn - Cloth vs disposable.
- Cloth is considered better by most because there is less environmental damage and a smaller carbon foot print.
- Cloth diapers tend to have less diaper rash because of less chemical exposure and more frequent changings.
- Cloth at night can lead to more wakefulness at night in sensitive babies so diaper doublers are helpful.
- Disposable is more convenient but has greater environmental impact both in production and disposal.
- Disposables are easier for travel and overnights.
- If disposable is chosen, go with a healthier option. (mammanatural.com has a great review of many brands)
55
Diapering newborns - wipes
- Most baby wipes are loaded with chemical cleaners; not great for using in the genital area and directly on the skin (we absorb toxins through our skin).
- Safest is a soft cloth, water and gentle soap.
- Wet water wipes are a great option as well.
- Can find safer brands (safemama.com) or homemade green "recipes"
56
Cancers, illnesses, and diapering
More and more research is showing the correlation between reproductive issues and cancers, and what products (diapers, wipes, etc) are being used near or on the genitals.
57
Special needs of preemies
- May need a specialized car seat.
- Need smaller clothing.
- Preemie sized diapers if using disposables.
- May come home on a variety of monitors or with special medical devices. (be sure to attend any trainings on how to use with parents)
- may need specialized high calorie formula.
- Very likely to have reflux (90% of preemies do)
- Nervous system is not as developed (much more sensitive to touch, light, smell, and sudden or loud sounds).
- They don't eat much.
- They sleep more than term babies.
- They are more vulnerable to illnesses, RSV in particular.
- Their skin is very thin and scratches/tears easily.
- Often struggle with wakefulness because their primary need is growth (babies grow while they sleep).
- Often struggle with feeding (their sucking reflex is not yet fully developed).
- May "appear" to have sleep issues because they are so very tired and do not yet have night and day rhythms.
- must eat as directed by their doctor (wake if necessary)
- Their lower esophageal sphincter is not fully developed which often results in reflux.
- often later have slight development issues.
- Are usually later to reach milestones in the first year to 18 months of life. Usually by 18 months or 2 years they have caught up to term babies.
- Stimuli sensitivity generally resolves around baby's due date.
- Parent(s) may be more likely to have PPMD.
58
RSV
Respiratory syncytail virus.
- MEDICAL EMERGENCY
- most infants get it from a toddler who seemingly "just has the common cold".
- looks exactly like a common cold in older children and adults.
- Insist family have a plan for visitors to wash hands before handling a baby, especially a preemie.
59
What is adjusted age?
A term to describe the adjusted age of a preemie.
- Example:
If born 3 weeks premature, a 4 week old baby would have an adjusted age of 1 week.
- Developmental milestones follow adjusted age up to around 2 years.
60
late preterm babies are how many gestational weeks old when delivered?
34-36 weeks
61
Moderately preterm babies are how many gestational weeks old when delivered?
32-34 weeks
62
Very premature babies are how many gestational weeks old when delivered?
25-32 weeks
63
Extremely premature babies are how many gestational weeks old when delivered?
At or before 25 weeks.
64
Swaddling a preemie
- Should be swaddled with arms up before 37 weeks, so either swaddle with arms up or use a swaddle designed specifically for this purpose.
- Arms up is the natural position they hold most in utero and since they were born early, it helps with proper development of the arms and shoulders and with feeding cues/alertness until at least 37 weeks.
- If the arms still feel "stiff" or "tight" then continue to swaddle with arms up until you feel arms naturally soften and not resist when gently brought to babies side.
65
Scheduling for multiples
- Get babies and parents used to a schedule as soon as possible.
- Begin by writing it out and sharing.
- Remember/remind parents that it will change as babies get older.
- Decide with parents what they want.
66
Homecoming of multiples
- Have the fridge well stocked.
- have 2 weeks stocked worth of everything needed to stay home.
- Have nursery set for all babies coming home at once.
- Plan for both situations (1 or more babies not coming home with the others) and discuss with parents.
- If babies come home separately, expect it to effect parent's emotions.
- Be prepared to be flexible as parents may be going back and forth from the hospitals.
- Be prepared for strong emotions if there are siblings.
- Have scheduling plan ready!
67
Vehicles and car seats - Multiples
- Discuss this with parents in advance, particularly if triplets or more as special car beds or car seats may need to be obtained.
- Have contact with a local CPST who can advise parents on choosing proper car seats and helping parents learn how to install them.
- Never install a car seat for a client or tell them their car install looks great (refer them to a CPST)
- If using your own car still have parent install car seat.
- Become a certified CPST if you want.
68
Sleep for multiples
- Probably one of the most critical elements for family sanity.
- Scheduling is key.
- Good sleep habits during the day are key.
- Critical to discuss this with family prior to babies arrival or your start date.
- Everyone needs to be on the same page.
- If there are extra hands, develop a written plan and ask parents to ensure everyone follows it.
- appeal to parental emotions.
69
Feeding multiples
- research different methods.
- be well-prepared in advance.
- be sure all caregivers are following the same plan.
- be prepared to be flexible.
- have a labeling system.
- If babies are on different formulas or medications, be extra cautious.
- Hold babies as much as possible while feeding.
70
Feeding devices for multiples
- Pacifeeder
- Podee
- Bebe bottle sling
- Bottle snuggler
- Bottle genie
* Don't recommend for long term use.
* *Often does not work well with preemies.
71
Multiples - Everyone is crying!
- Discuss that this will happen with parents in advance. Reassure them they aren't doing anything wrong.
- Assess the situation and see whose need is greatest:
1. Safety
2. Health
3. Food, sleep
4. diaper, etc
- Keep yourself calm; babies will know if you get stressed and it will increase their stress level and responses.
- Parents will have a physiological response to their babies needs. Encourage them to be calm but know they may not be able to.
- Get parent's help, wake if necessary (inform them of this possibility beforehand) if unable to soothe multiple babies.
72
Symptoms of reflux
- Acidy smelling bowel movements (very common. Sour orange juice smell)
- Frequent spitting up or regurgitating (not necessary for reflux)
- Frequent choking episodes.
- Often fighting the feeds.
- Unexplainable cough not related to illness.
- Unexplainable crying (often misdiagnosed as colic).
- Irritability.
- Not content, always moving.
- Frequent upper respiratory colds.
- Chronic or frequent ear infections.
- Vomiting frequently (more than normal spit-up)
- hiccups
- appears really hungry but pulls away during feedings.
- arching of the neck and back.
- bad or sour breath
- sticking fingers or fist into the back of the throat (may be a sign of Esophagitis).
- Gagging themselves (may be a sign of Esophagitis).
- Hoarse voice.
- full feeling belly.
- excessive gas.
- wheezy breathing sound
- may have poor weight gain.
- failure to thrive or losing weight.
- unexplained nasal congestion.
- Heartburn.
- Indigestion
- Apnea spells (severe cases)
* baby may have 1 or more of the symptoms*
* *often misdiagnosed as colic or other illnesses**
73
Infantile Anorexia
Can develop if baby associates eating with pain and chronically refuses to feed.
74
Reflux and baby's lungs
can asperate acid into lungs causing wheezing sound. Over time this can lead to permanent damage.
- Direct correlation between children who develop asthma and had untreated reflux as a baby.
75
How to help relieve reflux
- Get instructions from doctor and have liability form signed.
- Keep baby upright for about 30-45 minutes after a feeding. can use a bouncy chair, swing, hold or wear baby or put them in a boppy type pillow.
- Avoid laying the child flat. For sleeping try elevating the head of the crib to a 30 degree angle; or try using a Tucker sling or Baby Stay Asleep
- Create a reflux "nest" in the crib to support the child on the elevated surface.
* liability release required anytime parents want to have baby sleep in a way outside of AAP guidelines*
- If using Baby Stay Asleep ask doctor if they want us to use bolsters or not. If yes, makes sure they are below armpit level.
- Change feeding schedule to give child smaller meals more frequently.
- Avoid tight clothing especially around the belly.
- Avoid holding baby in a way that puts pressure on the belly.
76
How to create a reflux "nest"?
- Take a large bath towel and roll into a cylinder lengthwise. Then fold it into a "U" shape.
- Place on top of the crib mattress, but under the sheet, with the bottom of the "U" where the baby's bottom will rest with his legs going over the top of the bump from the towel.
- The ends of the towel come up on either side of the baby to prevent them from rolling.
- They should come no higher than the baby's armpit to avoid baby getting their face against the towel and smothering.
77
How to help reflux - sleep positions?
Refluxers often reflux less when sleeping on their tummy versus their back.
- However, this can increase the risk of SIDS and families should always contact their doctor before trying it.
- Obtain a liability release form if they plan to tummy sleep.
78
How to help reflux - Thickeners
Some doctors recommend thickening the feeds with cereal or trying a thicker formula such as Enfamil AR (designed for refluxers).
- Starting recommendation is rice cereal and 1 teaspoon per ounce.
- Start slow and work up as it is harder to suck thick formula.
- There are special nipples made that are silicone and cut in a "Y" shape that helps with thick formulas.
- If rice is too constipating, oatmeal is suggested (it is high fiber and helps even things out)
- Premix cereal bottles. It absorbs better and thickens evenly.
* consult pediatrician first*
79
How to help relieve reflux - special bottles?
- Playtex bottles or
- Dr. Brown's bottles.
Both do more than other to prevent air from getting into baby's tummy, which seems to aggravate the gag reflex for those reflux babies that spit up or projectile vomit.
80
How to help relieve reflux - DHA/ARA formula
- If using, consider switching to a non DHA/ARA formula as the ARA can often irritate the stomach and make reflux worse.
- ARA can cause inflammation of the stomach lining and intestinal tract.
* discuss with pediatrician first*
81
How to help relieve reflux - Soy or hypo-allergenic formulas
- Can be a great help but,
- Soy is not recommended except as a last resort.
* Soy mimics estrogen in the body. A baby only drinking soy formula takes in as much estrogen as a woman taking 5 birth control pills. Other concerns about carcinogens and GMOs*
- If reflux is resolved this way, the reflux was is likely due to food allergies.
- If baby needs the hypo-allergenic formulas, with a note from their doctor, families can sometimes get their insurance company to cover the cost (may have to fight but could be worth it)
82
What is tongue tie?
an abnormal attachment of the lingual frenulum that can interfere with a proper latch and impede breastfeeding and speech.
83
What is lip tie?
an abnormal attachment of the upper frenulum that impedes movement of the upper lip.
84
Signs of tongue or lip tie - mom
- nipple pain and/or erosions
- nipple looks pinched, creased, bruised, or abraded after feeds.
- white stripe at the end of nipple.
- painful breast/vasospasm
- low milk supply
- plugged ducts
- mastitis
- recurring thrush
- frustration, disappointment, and discouragement with breastfeeding.
- weaning before mom is ready
85
Signs of tongue or lip tie - baby
* Not always visible but still exist; sometimes it may just be the tongue appears shorter or that the whole floor of the mouth raises with the tongue movements.
- poor latch and suck
- unusually strong suck due to baby using excess vacuum to remove milk.
- Clicking sound while nursing (poor suction)
- ineffective milk transfer
- infrequent swallowing after initial let-down
- inadequate weight gain or weight loss
- irritability or colic
- gas and reflux
- fussiness within one to two minutes of beginning to nurse.
- difficulty establishing suction to maintain a deep grasp on the breast.
- breast tissue sliding in and out of baby's mouth while feeding.
- gradual sliding off the breast
- chewing or biting on the nipple
- falling asleep at the breast without taking in a full feed
- coughing, choking, gulping, or squeaking when feeding.
- spilling milk during feeds
- jaw quivering after or between feeds.
86
Assessing for possible tongue tie
* baby may not have every sign
- Does baby's tongue rise less than half-way to the palate when crying?
- Do the sides of the tongue lift but not the center?
- Can you see a dip in the tongue in the center of the mouth?
- Does tongue have a heart shaped tip?
- Does baby have a high, narrow, or bubble palate?
- Can you see or feel a tight frenulum?
87
Describe the "Murphy Maneuver"
- Used to feel for a tight frenulum in assessing tongue tie.
- Use medical grade gloves (non-latex).
- Put your little finger at the base of baby's tongue and draw across the floor of the mouth.
- If you feel a resistance in the center of baby's mouth, that is the frenulum.
- If you cannot get past this frenulum without going around it, then it may be restrictive enough to affect baby's ability to breastfeed.
* Do not diagnose. Refer to a doctor if suspicious.
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Tongue & lip tie - To clip or not to clip?
- It is a personal decision between the family and their healthcare provider.
- The current trend is swinging back towards not clipping.
- Dr. Agarwal of AZ and Dr. Gaheri or PDX are leading experts.
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Pyloric Stenosis
- Narrowing or restriction (stenosis) of the pylorus, the muscular lower part of the stomach.
- Prevents food from properly emptying into the intestines.
- Usually shows up between 3-5 weeks post birth.
- Genetic component
- More common in first born males
- More common in Caucasian babies than others.
- Use of the antibiotic Erythromycin by the mother late in pregnancy, while breastfeeding or in the baby during the first weeks of life is a factor.
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Signs of pyloric stenosis
- vomiting: seems like spit up at first but becomes projectile, usually soon after eating.
- It may be curdled from stomach acid, but will not contain bile.
- Babies have fewer, smaller, sometimes mucousy stools because little food is actually reaching the intestine.
- babies will fail to gain weight, become lethargic and possibly dehydrated from lack of food.
- Waves of peristalsis, or left to right rippling or waves of movement across the babies abdomen as the stomach tries to empty itself after feeding.
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Treatment of pyloric stenosis
- immediate referral to healthcare provider
- proper logging of feeds/reactions will help diagnose quicker
- ultrasound of babies stomach/intestines
- barium swallow
- blood test for salt imbalance from dehydration
- pyloromyotomy - muscles are cut around and relaxed to allow the foods to pass into the intestines properly.
- Most babies can begin to feed normally within a few hours post surgery.
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Cleft lip and Cleft palate
Birth defects that happen while a baby is developing in the uterus. During the 6th to 10th week of pregnancy, the bones and tissues of a baby's upper jaw, nose, and mouth normally come together (fuse) to form the roof of the mouth and the upper lip. An interruption of this process can cause cleft lip or palate.
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Feeding a baby with cleft lip or palate - breastfeeding
- Can be successful if infant has a cleft lip but no cleft palate but, sometimes requires a changed feeding position so that mother's breast tissue fills the gap in the lip or gum.
- Breastfeeding an infant with a cleft palate is quite challenging unless the infant's cleft palate is very far back in the mouth and very small. Nursing at the breast is best limited to 10 minute sessions, and supplemental bottles will be needed if breastfeeding alone does not supply enough food for adequate satisfaction and growth.
- For most mothers of infants with cleft palate, breast pumping should begin in the birth hospital using a high quality electric pup and continue after each feeding.
- Refer to a lactation consultant.
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Feeding a baby with cleft lip or palate - bottles
- small, frequent feedings
- semi upright feeding position to limit milk going into nasal passage.
- Head, neck and shoulders in straight line or tilted forward (not back).
- Pull lower jaw down and out of the way if needed to get nipple in properly.
- Watch for signs of distress (no breathing in 3-4 sucks, squirming, ect) and remove bottle, calm baby and begin again.
- Use specialized bottle systems such as a cleft palate nurser, pigeon nipple or Haberman.
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Food allergies and intolerances
- Earliest signs can be seen within just a couple weeks of birth, but most don't appear until around 6 weeks-- the same time as reflux.
- cradle cap
- acne
- red ring around anal opening
- hives or rash
- vomiting after eating
- loose. acidic stools (can even "burn" the skin)
- Cramping and pain following a feeding
- Crying, often about an hour post feeding
- blood or mucous in stools
- anaphylaxis--swelling of the mouth or tongue or inability to breathe.
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What's the difference between an allergy and intolerance?
- intolerance causes discomfort and some physical symptoms.
- A true allergy produces a histamine response either intestinally, externally (hives, rash) or anaphylactic shock.
- This must be evaluated by a proper healthcare provider--often times a standard pediatrician does not recognize the signs and many signs mimic reflux (which often goes hand in hand).
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Treatment of food allergies or intolerance?
- Avoidance of foods by mother if breastfeeding or specialty formulas if bottle feeding.
- administering an antihistamine if needed, epi pen, auvi-q.
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What are the big 8 allergens?
- milk
- eggs
- fish
- crustacean shellfish
- tree nuts
- peanuts
- wheat
- soya
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What are the AAP's guidelines for safe sleep?
- back to sleep
- no loose blankets
- crib free of bumpers, soft bedding, wedges, toys, pillows and positioners.
- Crib or bassinet, not the parents bed.
- avoid over heating
- use a pacifier (offer at time of sleep but do not replace it if it falls out of baby's mouth)
- smoke free area.
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Swaddling - AAP
AAP recommends as long as you follow safe sleep guidelines:
- back to sleep
- know when to stop
- know the risks
- keep the hip area looser--baby should be able to bend hips up and out.
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Swaddling tips
1. Keep blanket at shoulder level around baby's body.
2. Snug around the chest but not too tight. Should be able to put a finger between blanket and chest.
3. Hips need to be loose--helps their belly breathe and move.
4. Make sure baby is not overheating. Room temp should be 68-72F. At higher end you can swaddle baby in just a diaper.
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When do you stop swaddling a baby?
As soon as they can roll over by themselves. Start weaning them from swaddling as soon as you see them trying to roll over by themselves (can make changes to daytime sleep before night-sleep).
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Signs baby is learning to roll over?
- Moro reflex starts to lessen.
- Body is becoming physically capable.
- Lifting legs off ground more during tummy time.
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Swaddle weaning
- start by taking one arm out
- assess for startle response
- Take other arm out
- be gradual and make intermittent changes.
- once baby is comfortably sleeping with just legs swaddled you can remove the swaddle all together.
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Swaddling mistakes
1. not swaddling tight enough.
2. swaddling with arms up near the face and bent. Preemies are the exception.
3. making assumptions about how the baby 'feels' about swaddling based on adult feelings.
4. allowing blanket to touch the cheek.
5. allowing the end of the swaddle blanket to come loose.
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Non REM sleep
- what we most closely associate with sleep, meaning that there is very little movement during this time, our breathing and heart rate is slow and steady, and there is very little, if any dreaming during this stage.
- it is believed that most of our restorative sleep comes during this stage.
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REM sleep
- Body is much more active and this is when we actually dream.
- 4 distinct phases that we go through as we progress from being drowsy to deep sleep.
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sleep cycle length
45 mins for babies, 90 minutes for adults.
| - we transition to adult circadian rhythm around age 3.
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sleep development
- REM sleep begins to develop at approximately 6 months gestation.
- Non-REM around 7 months gestation.
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When to put baby down to sleep?
Watch for tiredness cues. Yawning is a late stage cue and ideally baby will already by swaddled and ready for sleep at that point.
- looking at you smiling then suddenly looking away
- rubbing eyes.
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How much sleep does a newborn (up to 3 months) need?
16-22 hours a day.
* a newly circumcised baby may sleep for an extended period, possibly up to 12 hours immediately following the procedure*
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How much sleep does a 3-6 month old baby need?
15-18 hours
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How much sleep does a 6-12 month old baby need?
14-16 hours
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How much sleep does a 12-18 month old baby need?
14-15 hours
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How much sleep does a 18-24 month old baby need?
13-15 hours
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Sleep patterns - Birth to 4 months
- Sleep will be random, but will start to work itself into a pattern or waking in the AM and going back down for a nap 1-2 hours after waking.
- Sleeping for 1.5 - 3 hours, then waking again for 1-2 hours, and back down for an afternoon nap.
- waking again, up for 1-2 hours, another nap.
- Up again for another 1-2 hours and then into bed for the night, with possible wakings depending on age and size.
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Sleep patterns - between 4 and 6 months
- Most babies are capable of sleeping at least an 8 hour stretch at night and many can sleep up to 12 hours.
- Provided the baby is at least 12lbs, they have no physiological need to eat night (unless health is a problem). Some notice that girls need to double their weight before being able to sleep through the night.
- They move into a daytime pattern at this age of waking, an am nap about 2 hours later, waking, an afternoon nap about 2 hours later, waking, a short late afternoon nap about 1-2 hours later, waking after an hour, then back down for the night 1-2 hours later.
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Patterns of sleep - between 6 and 9 months
most babies will drop the late afternoon nap and move to a schedule or one morning nap and one afternoon nap.
- should easily be sleeping 11-12 hours at night.
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Patterns of sleep - between 15 and 18 months.
AM nap is often dropped and baby can stay awake 4-5 hours between sleep periods.
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Patterns of sleep - 18 months
Usually by this age, most babies are only nap once per day and will stay that way up until 2.5/3 years or older.
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problems you may encounter with sleep?
- Baby may have health issues (reflux, allergies, failure to thrive, pyloric stenosis)
- Parents may not be following through but think they are.
- Parents changed their minds.
- Baby may be more sensitive
- Baby may have undiagnosed (and undetectable) issues such as autism and sensory integration disorder.
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Tips for healthy sleep development
- proper feeding, especially during the day.
- proper scheduling based on age.
- paying attention to sleep cues.
- proper steps
- proper environment
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What is a good environment for baby's sleep?
- dark room
- no tv or screen time
- swaddling
- white noise
- fan
- crib or bassinet in child's room
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