Umbilical Cord Care.

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Care of the umbilical cord is one of the important things new parents have difficulty with. The delicate nature of the cord, the blood and pus associated with it and the apprehension that the baby any handling is painful for the baby is a major cause of concern.

What is the Umbilical cord? Why is it there in the first place and why the clip over it?

This umbilical cord is what actually connects the mother to the baby during pregnancy. The umbilical cord which originates in the abdomen of the baby is connected to the placenta which in turn is connected to the uterus. This cord contains blood vessels which carry blood containing nutrients and oxygen from the mother to the baby and waste and carbon dioxide from the mother to the baby.

Umbilical Cord Structure

After birth all these functions are done by the baby itself and then there is no requirement of the placenta and the umbilical cord. This cord is clamped so there is no blood oozing for the blood vessels in the cord and is cut. (thereby separating the placenta and the baby). This cord clamp (the clip over your little one’s cord) keeps the vessels closed till the cord does not dry off. The small cord left behind is the cord stump. And the best part is all this is painless.

How long is the umbilical cord stump going to be there?

The umbilical cord usually falls of by 10-14 days of life. In very few babies it may take up to 21 days for the cord to fall off.

How do I take care of the cord stump at home?

You need to take care to keep the cord clean. Antiseptic or alcohol rubs are not required to clean the cord. If your baby has had a bath pat dry the cord. Let the cord be in open air to dry off the water. Unlit and unless you are not rubbing the cord or irritating it, it is completely painless

(You may be interested on the topic: When to give my newborn the first bath?)

Fold the diaper away from the cord and let make sure the cord clamp does not come to lie inside the diaper. It may pull the cord and cause irritation.

Never pull the cord. Resist all temptation to pull and detach the cord even if it is just attached at a point. Let the cord dry off and fall by its self.

What to do after the cord falls off?

Cord fallen with thick yellow fluid. Normal.

After the cord fall you may notice a bit of bleeding of a bit of yellowish fluid over the umbilicus. Clean the blood and any other secretion which may be there and leave it to dry.

When do I consult a doctor if I feel that the cord or my baby does not seem right?

When in doubt its always better to consult your paediatrician/neonatologist

How ever if your baby has any of the danger signs then please contact your paediatrician/neonatologist immediately.

Umbilical cord stump can get infected and you need to look for signs which indicated it and if present consult your paediatrician/neonatologist immediately

What are the signs of stump infection that I can look for?

You need to look for general signs of sepsis such as fever, lethargy, poor feeding, poor muscle tone or any of the danger signs.

Look for foul smelling yellow discharge for the cord stump.

Look for any redness and hardness around the cord stump base.

If your baby cries out when you touch the cord it can be an indication for infection

If any of the above is present, then it could be due to infection and you need to consult your paediatrician/neonatologist immediately.

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Colic... Frustration for the parents.

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Colic. This word itself will bring frustration and frustrated memories to a lot of new and seasoned parents alike. I keep getting worried parents coming over and saying that - our baby has been crying inconsolably all evening. Most often these babies turn out to be quite healthy and have Infantile Colic or Baby Colic or just Colic.

Colic isn’t a disease and does not have any long-term effect on health. Some researchers also believe that colic is a stress reliever for newborns. However, this causes a lot of concern and frustration in the parents.

What is Colic?

Colic is defined as episodes of crying for more than three hours a day, for more than three days a week for a three-week duration (lots of 3s!) in an otherwise healthy child between the ages of two weeks and four months (At least a 3 is left out here!).

It simply means that if your baby is crying a lot and is otherwise healthy i.e. does not have any other problem which could cause crying in your baby then probably your baby has colic.

Does my baby have Colic?

If your baby is otherwise healthy and does the following (Symptoms) then probably your baby has colic:-

1.      Intense crying bouts

2.      Crying in the late afternoon or evening that lasts several hours

3.      Your baby's face being red and flushed when they cry

4.      Your baby clenching their fists, drawing their knees up to their tummy, or arching their back while crying

5.      Your baby is ready to feed, and you feel your baby is overfeeding

6.      Baby is quiet if you hold him straight over your shoulder.

Why is my baby having Colic?

Despite decades of research, the cause of infantile colic is not known. Various causes which are thought to cause colic include: -

1.      Immature Intestines: The intestines of baby may not be able to fully breakdown and handle the nutrient load. Leading to gas and pain.

2.      Food allergy and sensitivity: Some researcher feel that in a breastfed baby some food in the mother’s diet can cause colic. In formula fed babies lactose intolerance could be the possible cause.

3.      Maternal Smoking: Some studies have associated colic with mothers smoking during or after pregnancy

4.      Increased Serotonin: Serotonin is a chemical formed in our body. An increased level has been seen in the evening. This serotonin causes the intestines to contract and could possibly cause colic.

5.      Altered Intestinal Microorganisms: Some studies have reported colicky babies to have a different intestinal microflora as compared to non-colicky ones.

6.      Stress reliever response: Some researcher feel that towards the end of first month babies have increased stimulation from sound and light. Towards the end of day when they are over-stimulated by this increased sound and light the cry to relieve the stress out.

OK. My baby has colic. What should I do?

First and foremost, visit you Paediatrician/Neonatologist. He will thoroughly check and rule out if there could be other cause for excessive crying.

Watch out for Danger Signs

Don’t panic or feel guilty about it. It is nothing you could have done or averted to prevent colic. It is estimated that 10-40% babies worldwide have colic. So, you are not alone.

Calm the baby. Take the baby away from too much noises, light and people. Some babies like it to be taken out of the house so a drive or strolling in the garden might help.

Humming to baby or slow soothing music can also be tried. Swaddling of the baby has shown to soothe babies. A pressure applied on the abdomen (as in “colic carry”) may help babies with intestinal cause. A “colic carry” – where the baby lies with his/her abdomen rested over you arm -  may help.

Colic Carry

Burp the baby. Antigas medication (Semithicone) can be tried, however research has not shown very promising results. However, a trial would not harm (Please consult Paediatrician for dosage)

Mothers should stop smoking. A change in mother’s diet can also help in breastfed babies hence, it is worth a try. Babies on formula feeds may be given a trial of hydrolysed milk. Pacifiers may help and can be tried.

Probiotic correct the microflora of the intestine and may help reduce symptoms of colic. Consult your paediatrician for type and dosage.

Gripe Water: I don’t advice as there are no shown benefits in babies. There are also no safety studies for it. So better avoided.

Again, Colic isn’t a disease and does not have any long-term effect on health. Don’t panic and feel guilty or depressed about it. Colic is usually relieved in most babies by the end of 5 months and in a few by end of six month. Be patient.

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When to give my newborn the first bath?

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The most common question I come across on the first day I get to see a new born is “When can I bathe my baby?” or “Is it necessary to bathe my baby” or “Can I wet or pour water over the umbilical cord” or a worried mother may ask “I mistakenly put water over my newborns umbilical cord. what do I do?”

The first bath of the baby is one of the most awaited moments that new parents look forward to. All credit to all the baby toiletries companies who make these fabulous cute advertisements.

Anyway, the intension of the first bath of the newborn is remove unwanted dirt from your baby which in the first few days would by blood (which the baby has got during delivery) and sometimes meconium. However, that cheesy, white material vernix should be left. This vernix helps creates a barrier for microorganisms and protect your baby.

 Firstly, bathing should only be considered if the vital i.e. temperature, heart rate and other parameters are normal for the baby.

Second, bathing your baby can cause to temperature of your baby to fall and cause hypothermia. So, you need to be watchful of this.

The world health organization advocates that bathing the baby should be differed till at least 24 hours of birth. If this is not possible due to cultural reasons, bathing should be delayed for at least 6 hours. American Academy of Pediatrics and many neonatologists usually advice to withhold bathing till the umbilical fall off, which may take up to 7-10 days.

I prefer advising babies to be given a sponge bath -which excludes the umbilical cord- after 24 hours of birth. A proper bath differed till the baby is 3 days old. This gives us the benefit to clean blood and meconium and gives the newborn enough time to stabilize his/her vitals.

Whether to pour water over umbilical cord during bathing or not does not make any difference. If you have poured it, then relax. It’s safe as long as the water was clean. The AWHONN guidelines state that there is no difference umbilical cord healing. However, you should pat dry the cord and leave it open to air-dry after bathing the baby.

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Danger Signs to look out for in your newborn

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First thing first. Your baby is pink and warm but you should know when to seek medical attention for your baby. You should be aware of these 10 so called “Danger Signs’ for your baby and seek consultation with a medical practitioner immediately if any of these 10 signs are present.

1.       Not Feeding Well. This is the most common sign that mothers observe. Complains like my baby is not sucking well or my baby is taking longer time to complete his bottle are common. If the baby was previously taking feeds well and has stopped doing so then it is time that you take the baby for a proper examination by a medical practitioner preferably by a paediatrician/ neonatologist.

2.       Drowsy/ Unconscious/ Lethargic. Babies normally sleep for 2-4 hours after an adequate feed. If the baby does not wake up after 4 hours of feed then you should wake the baby up to feed the baby. If your baby does not wake up after continuously trying to wake the baby up even 4 hours after feeds then you should immediately get medical attention. Reduced activity of the baby or movement only when stimulated as compared to previous also should make you cautions of an upcoming problem so be aware.

3.       Breathing Fast or Grunting while   breathing. Babies normally have a      respiratory rate (Number of breaths taken in one minute) of around 30-60 per minute. Anything which goes above 60 is abnormal. If your baby is breathing more than 60 times in a minute then a medical checkup definitely required. You should also see for other signs of labored breathing such as grunting, move of nostrils or chest in-drawings while breathing are also signs when medical attention may be required.   

4.       Temperature Instability (Fever/ Hypothermia). Any temperature above 38 degree Celsius (100.4 Degree F) should alert you for medical attention. Fever can also be caused due to poor feeding or over clothing. You may try to adequately feed the baby and remove extra clothing from the baby. But still if fever persists then do visit a doctor immediately. Hypothermia means low body temperature. Any temperature below 35.5 degree Celsius (96 Degree F) should alert you for medical attention. Again poor clothing and cool ambient temperature can result in hypothermia. Adequate clothing is considered that a baby is given an extra layer of clothing when you feel comfortable to just warm. However, if you feel temperature of you baby going down then try increasing the clothing and if not corrected then do seek medical advice.

5.       Cyanosis or Baby turning blue. Babies turn blue when the oxygen of blood falls below a certain level. This usually indicates a heart or respiratory disease. Hands and feet of a few hours old baby may appear blue normally (Called Acrocyanosis). However, if your baby is gone completely blue especially in the lips and tongue and hands and feet after few days of life then you need immediate medical advice.

6.       Seizure. Abnormal jerky movements of any limb requires immediate medical attention. New-born’s do not have seizure like adults as you may have seen them to be. Any jerky movements should be brought to the attention of medical practitioners.

7.       Vomiting. Vomiting is a very common complaint by mother of new born babies. First of all you need to differentiate vomiting from regurgitation. As the valve which prevent feed/milk to come out of babies stomach is not well developed babies may have regurgitation. Curdy milk of small quantity indicates regurgitation and is absolutely normal in a new born up to few times a day. Grossly vomiting out fresh feeds and in full or large quantities many times a day is a danger sign and need examination of the bay. Green or red coloured vomitus required immediate medical attention.

      8.       Jaundice. Jaundice (Yellowish colouration of skin) appearing in 3-5 days of life is normal and called physiological jaundice and in most babies don’t require any treatment. However jaundice in first day of life and after 3-5 days of life requires medical attention. It is still advisable to get jaundice at any day of life to get it checked from a paediatrician/ neonatologist to differentiate physiological from non-physiological jaundice.

       9.       Not passing urine or stool. New born babies should start passing urine and stool in the first 48 hours of life. And then continue to pass urine once in 2-3 hours and stool at least 1-2 times a day. A new born not passing urine for 6-10 times a day should alert the mother to seek medical advice.

10.   Loose Stools. A baby may normally pass small quantity yellow colour stools after every feed. However, a recent change in consistency and increase I frequency of stools requires medical attention. During the process to seek medical attention however feeding must continue.

As stated above if any of these danger signs are present then do not hesitate to seek medical advice. An observant mother/ attendant can prevent a life threating condition much before it happens.

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