Checking up on Baby

The first few days and weeks at home with a newborn baby can be a real test for the new parents’ nerves: is the new addition to the family sleeping too much? Or eating enough? Is it normal for three hours of crying at a time? Why didn’t anyone tell me the poo would be black? But regular checks by the midwife, the health visitor and your GP can do much to set your mind at rest.

For the first ten days or so (and, if you’re really struggling, up to 28 days), the midwife will visit every couple of days to make sure that you and your baby are both well, that the baby is feeding well and gaining weight and that any problems which arise (such as jaundice) are monitored and, if necessary, treated. This is enormously helpful and can be a real godsend in those early days when you’re so crazed with lack of sleep that the smallest milk spot on your new baby’s face can have you fretting for hours.

As well as weighing the baby and checking on feeding, around the sixth or seventh day the midwife will also carry out the Guthrie test. This involves taking a few drops of blood from your baby’s heel, and tests for thyroid deficiency and a rare condition called PKU (phenylketonuria), which, if left untreated, would result in a severe mental disability, but if detected shortly after birth is completely curable.

At about day 10, if all is well, the midwife will sign you over to the health visitor who, in partnership with your GP, is responsible for your child’s health up to the age of 5. She will be your first port of call if you have any queries about your baby’s feeding, sleep and physical and emotional safety. In most areas the local health visitor will run a regular (usually weekly) baby clinic, to which you can take your baby to check her weight and have a general chat about her progress.

The 6-week check
The first formal baby check-up comes at about six weeks, when you’ll be invited to bring your baby to see the GP. Here, your doctor will repeat many of the checks that were done in the hospital following the birth. Your baby will be undressed, weighed and thoroughly examined. Checks will include:

  • Measurement of head circumference and the baby’s length
  • Heart rate and lung function •Abdominal organs
  • Sight and hearing
  • Manipulation of the hip joints to look for signs of dislocation
  • Head control and limb tone
  • Genitals (in boys, the GP will check to see that both testicles have descended)

It’s important to remember that the 6-week check is not a test that your baby has to pass, and that in any case the vast majority of babies will sail through with no problems. But if something should crop up, you can feel reassured that it’s being addressed from an early stage and will most likely be easily corrected.

In the UK babies are routinely immunised against diphtheria, whooping cough (pertussis), Hib (a form of influenza), tetanus and polio (the DtaP/IPV/Hib vaccine) and meningitis C at 2, 3 and 4 months. These important immunisations build up your child’s immunity to once-frequent childhood illnesses, which have now been all but eradicated. This round of injections is followed by the MMR vaccine at around 13 months, which protects against measles, mumps and rubella (see box). For the immunisations at 2, 3, and 4 months, two injections are given at each visit to the GP’s surgery (one each of Dtap/IPV/Hib and meningitis C).

The first immunisation in particular can be stressful for parents but try to relax; generally the worst you’ll get will be 5 minutes of indignant screaming, and possibly a bit of grizzly behaviour for the next couple of days. You may be asked to stay at the surgery for at least 10 minutes or so after each appointment, to make sure that the baby does not have a reaction to the vaccine (although the risks of a serious reaction are tiny – fewer than 3 per million vaccinations).

Over the next 24 – 36 hours, you may find that your baby has a slightly raised temperature, and is grumpier than usual. Sometimes a small swelling will develop around the site of the injection – this is normal, and quite often takes several weeks to subside, but shouldn’t cause the baby any discomfort after the first day or two. Generally the practice nurse will advise you to give the baby infant paracetamol which, given in the correct (tiny) dose, is effective at lowering temperature and reducing swelling.

The measles, mumps and rubella (MMR) vaccination is generally given at 13 months, and then a booster given before starting school. This ensures that the few children who do not develop immunity after the first jab are given a second chance. Your baby may suffer mild symptoms of each of the diseases in the few weeks after the vaccine is given, but serious side-effects are rare.

Ask the Professionals
First checks and immunisations can be daunting, but ensure your baby’s good health. Use your midwife, health visitor and GP; they should be pleased to answer any questions you may have.

Why immunise?
The illnesses that these vaccines are designed to prevent can be life threatening in babies and small children. Before the immunisation programme was introduced, there were up to 5,000 deaths a year from diphtheria alone, and cases of whooping cough (which can be fatal in babies under one year old) ran at around 120,000 a year. By vaccinating all children against these diseases, so-called ‘herd immunity’ is maintained, whereby the fact that all children have immunity from a given illness prevents any outbreaks from occurring. With the much lower take-up of the MMR vaccine (as low as 70% in some parts of the country), herd immunity (which requires 90-95% take-up) has been compromised and cases of mumps and measles have risen over the past few years (in 2004, the number of mumps cases rose to 16,436 from 4,204 in 2003).
The very small risks associated with vaccination are greatly outweighed by the risks of serious complications from the natural infections.

MMR – the latest information
The MMR vaccine has been beset by controversy since the publication of a report in The Lancet in 1998 that claimed a link between the vaccine and a significant rise in cases of autism in the UK. This report has now been widely discredited and the latest reports suggest that there is no such link. A study published in the New Scientist in March 2005 focused on Japan, where the number of cases of autism has continued to rise despite the withdrawal of the MMR vaccine in 1993. Concern has also been raised about a possible link between the measles element of the vaccine and the development of Crohn’s disease, which affects the gastrointestina tract. However, The National Association for Colitis and Crohn’s has reviewed the available evidence and fully supports the UK’s MMR programme. No research has ever proved a link between MMR and autism or Crohn’s disease and the overwhelming majority of experts believe that the vaccine is safe.

If your baby is ill on the date of the appointment (particularly if she has a fever), the vaccination should be postponed until she has recovered. The only reason for withholding vaccines permanently is if your baby has a confirmed anaphylactic reaction to a previous dose of vaccine.

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