Shaken Baby Syndrome

A large number of child deaths are reported in South Africa each year. A lot of deaths relate to neglect, abuse or murder. Despite this, there's a knowledge gap in relation to understanding the issue....

Amniotic fluid problems

The importance of amniotic fluid Amniotic fluid is essential for pregnancy and foetal development. Amniotic fluid is a watery substances residing inside a casing called the amniotic membrane or sac. ...

Choosing a pre-school

Becoming a parent is a momentous; life-changing event filled with hopes, expectations and naturally some fears. Parents often learn and grow alongside their children, as they face the challenges of pa...

Newborn reflexes

Although newborn babies are physically helpless and vulnerable at birth, they have a number of amazing innate abilities or reflexes. Reflexes are involuntary movements or actions, designed to protect ...

Mastitis

Mastitis is an inflammation of the breast that can lead to infection. The word “mastitis” is derived from the Greek word “mastos” meaning “breasts”, while the suffix “-itis” denotes “inflammation”. Ma...

Pelvic floor exercises

Although your new baby will probably bring you immense emotional satisfaction, physically you may feel uncomfortable and strange in your own skin. After 9 months of pregnancy and hormonal changes, you...

Colic

Babies cry because they need to communicate something and most parents, especially new moms, find it distressing to see or hear an unhappy baby. In time, you will learn to recognize the various causes...

Antenatal Classes

Antenatal classes are informative sessions provided to prepare expecting parents for the birth of their child and the early days of being a parent.Most antenatal classes are run by Midwives and occasi...

Strap-in-the-Future

The Decade of Action for Road Safety 2011-2020 was launched on the 11 May 2011. It is a global declaration of war against road crashes and fatalities. According to Mr Sibusiso Ndebele, MP Minister of ...

  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Why babies cry and how to soothe them

Babies cry as a means of communication, to indicate that they are hungry, tired, scared, in pain, and more. Even entirely healthy newborns will cry for between 1 to 3 hours per day, because they are reliant on other people to meet their basic needs. ....

Toddler Sleep

Do toddlers really need naps? Yes. Naps are essential for your toddler's good health until the age of 4 years. Research suggests that naps are crucial to a baby's brain development. Without them, a child's physical and mental development can suffer. ....

Toddler eating

Is it normal for my toddler to eat less than she did when she was an infant? Because growth slows after the first birthday, it is normal for a toddler's appetite to decrease. Why does her appetite vary so much day to day? Because toddlers are eager ....

Will I hurt my baby’s soft spot if I rub it when I wash his hair?

The medical name for a baby’s soft spot is called the anterior fontanelle. This is an opening in the bones of the skull that allows the cranium to grow. The fontanelle is covered with a very tough membrane so you will not hurt it when washing or br....

What’s the best way to clean the whitish material that builds up between a baby girl’s outside and inside vaginal lips?

Cleaning the discharge that accumulates between the labia majora (outside vaginal lips) and labia minora (inside vaginal lips) bother parents as much as cleaning a little boy’s testicles. A girl is often born with this discharge and it protects the....

I’m worried that I will hurt my son’s testicles when I clean him up after a poo.

Before puberty, it does not hurt if a boy’s testicles are manipulated. Although it’s logical to be gentle, don’t worry about causing your son any pain when you clean him up after a bowel movement.

When I’m changing my baby, I notice tiny opalescent beads around her anus and vagina. If I rub them between my fingers, they have a slight waxy feel. What is this?

It’s called an Epstein’s Pearl and is nothing to worry about. The pearl is composed of mucus cells trapped under a thin membrane. It will go away in the first few weeks of life. Babies often have two variations of this lesion that you may see in ....

Why does my baby get hiccups after she feeds?

Breastfed and bottle fed babies can often get hiccups after feeding. This happens because they reflux some stomach contents into their oesophagus after eating and the acid stimulates a nerve that causes the hiccups. Hiccups generally resolve after a ....

Although my baby takes her bottle without any problems, she spits her pacifier out. Why doesn’t she like it?

Babies don’t suck on things the way we do. Instead of creating negative pressure with their cheeks (that’s what kids and adults do), they lick with their tongues at the same time they work their jaws. Therefore, when a baby sucks on a pacifier, s....

When will I be able to tell the colour of my baby’s eyes?

Babies of European descent usually have dark, slate blue eyes at birth. Babies of Asian or African descent usually have brown eyes at birth. Final eye colour is usually apparent by six months of age, but occasionally remains a mystery until a baby is....

The whites of my baby’s eyes are blue. Is that normal?

The white part of the eye is called the sclera and the tissue inside the sclera is called the choroid. The choroid is bluish in colour and it can be seen through the sclera in the first few months of life because the sclera is thin. If an older baby ....

Can I take my baby out?

Of course. Going out for a walk is a great activity. If the baby is in a pram, protect them from direct sunlight and dress them warmly enough. If carrying them in a pouch, protect their head and face from the sun or wind. Take care not to overdress t....

Is it safe to leave my baby alone?

As long as the baby is in his cot, you can hear your child if he cries (get a monitor if necessary), the room is a comfortable temperature and he isn’t too hot then you can leave your baby to sleep alone. Do not leave a baby unattended on a couch, ....

How can I tell if my baby’s bowel movements normal?

When your baby is born his first bowel movements will be dark green or black and sticky, this is called meconium. They will then change to a mustardy yellow colour with small bits, often described as bird-seed like. A formula fed baby will have soft ....

Is my baby too hot?

Overheating is a recognized sign of Cot Death or Sudden Infant Death Syndrome (SIDS). To avoid overheating, place the back of your hand on the tummy or the neck, if it is damp or sweaty then your child is too hot, and you need to cool the baby down b....

Why does my baby cry all the time?

Crying is your baby’s only means of communicating. As you get to know your baby, so too will you get to know variances in his cries. He may just want attention or be lonely. He may also be uncomfortable, have a wind, be hungry, feel cold or hot. A ....

Is my child gaining enough weight?

Average, weekly weight gain is 200gms. Some babies only gain 100gms, some as much as 300gms. One week there might be a gain of about a 150 gm and the next will be about a 250gm weight gain. Bottle fed babies tend to start gaining weight from birth, w....

Can I really keep expressed breast milk in the freezer for 3 months?

Yes. Expressed breast milk can stay in the fridge for a maximum of 24hrs and in a good quality freezer for a maximum of 3 months. Frozen breast milk can be defrosted in the fridge or at room temperature. It should be warmed up to body temperature in ....

Do I need to clean my baby’s nose?

It is only necessary to clean baby’s nose if there is some congestion that may be interfering with feeding or sleeping. Saline nasal spray or drops are often sufficient to “wash” the congestion away. If it is thick nasal mucous, an aspirator ma....

Why must my baby face backwards in the car seat?

A baby should face backwards in their car seat for the first 9 months or until they weigh 9 kg. For the first 9 months, their head is approximately 1/3 of their body weight and if there is an impact it could cause a forward facing baby to be propelle....

My baby has crusty eyes in the morning, what can I do?

Newborn babies can get excessive “sleep” in the corners of their eyes due to an immaturity of the tear ducts. This can easily be wiped with moist cotton wool and it resolves itself by about 2 months. There can be an excessive amount of discharge,....

My baby just cries all the time, what can I do?

This depends very much on the circumstances behind the crying. (Read more: crying) or send me an e-mail: Elizabeth@tum2mom.co.za for a personal answer.

Do I need to give my baby water to drink?

Most babies under 5 months, drinking either breastmilk or formula do not require extra water to drink. One usually starts introducing cool, boiled water when introducing solid foods.

Can I travel with my little baby?

This depends on where, how and how long the journey will take. Send me an e-mail: Elizabeth@tum2mom.co.za for a specific answer.

Is it Ok for my baby to suck his thumb?

Yes. A lot of babies need to soothe themselves by sucking on their fists, which can become thumb-sucking as they get older. It is your choice if you wish to encourage this or the use of a dummy.

Can I feed my baby both breastmilk and formula?

This can be done and in various ways, however expressed breast milk and formula should not be mixed in the same bottle. Seek guidance from your clinic nurse or send an e-mail to Elizabeth@tum2mom.co.za for specific advice.

What is the difference between a posset and a vomit?

Bringing up a small amount of milk when a baby burps is called a posset. This is quite common, especially with breast fed babies. If the baby is healthy and gaining weight, there is no reason for concern. Larger amounts would be considered to be vomi....

When will my baby sleep through the night?

This is a difficult question to answer as there are many variables to the concept of “sleeping through”. Some parents see having 12 hours uninterrupted sleep as the goal, others only expect 8 hours uninterrupted sleep as ideal. Most understand it....

Can I use soap on my baby’s skin when I wash her?

It is advisable to use a very mild soap or aqueous cream when bathing baby for the first few weeks. Avoid soap on their face. If there is a reaction to any product that is used, seek medical advice to find a cleanser that is best for your baby’s sk....

My 3-month-old is drooling a lot and chewing on things. Does that mean she’s teething?

A few interesting things happen at three months of age: (1) a baby has enough motor skills to confidently grab objects and pull them to her mouth, (2) a baby likes chewing on things more than before, and (3) a baby’s major salivary gland (the parot....

My 6-week-old has a soft bowel movement twice a day. However, before she goes, she strains real hard and gets red in the face. What should I do to treat her constipation?

If your baby is feeding well and gaining weight, I don’t think she is actually constipated—the definition of constipation is producing hard, dry stools. Babies sometimes grunt and strain when having a bowel movement because of a reflex that tells....

My 2-month-old is losing her hair. When will it grow back?

It’s common for babies to lose their hair in the first few months of life. For some infants, the hair grows back quickly. For others, they may look like little old men until they are 9- to 12-months of age.

My 2-month-old baby hasn’t made a poo all week?

It depends on what baby is drinking. A baby drinking purely breastmilk can occasionally have no bowel movement due to growth spurts and as their digestive system matures. If there are plenty of wet nappies and the baby is comfortable give it another ....

What is the rash my 6 week baby has all over its face?

This is quite possibly millia, small tiny white spots usually spreading across the nose and cheeks and up onto the forehead and in severe cases over the whole face and into the neck. They can appear worse if the baby has very fair skin or is too warm....

My 3 week old is stuffy all the time and sneezes a lot. Isn’t he too young to have a cold?

Although your 3 week old is not too young to have a cold, the chances are he doesn’t. Babies have to breathe through their noses for the first few months of life. Their nasal passages are small, however, which explains the “stuffy” sound you he....

My son was circumcised three days ago. His penis was red at first, but now there’s some yellow pus on the head. What should we do?

Right after a newborn is circumcised; the head of the penis is bright red and has a “wet” look. Over the next few days, the head becomes drier and takes on a dull red appearance. The head returns to its normal skin colour about a week after the c....

My 3-week-old’s big toenails are in-grown. Is this normal?

Although this is a common observation, it is not usually due to truly ingrown nails. A newborn’s toenails have the consistency of parchment and because of intrauterine positioning; the nail may grow up against the fleshy part of the toe. The reason....

My 2-week-old has a small amount of milk coming from his nipples. Is this normal?

Male and female infants can be born with swollen breasts, due to the effect of maternal hormones on their breast tissue. A small percentage of babies also get a milky discharge from their nipples which resolves in a few days. You should not squeeze t....

My 10-day-old still has his umbilical cord. It’s gooey and smells bad. What should I do?

It is not unusual for the cord area to have an unpleasant smell a few days before it falls off. The reason for this is because the cord remnant is actually decaying, i.e., the umbilical stump does not have a blood supply and the body’s immune syste....

If I carry my newborn in a carry pouch, will it hurt his back?

Infants are very flexible and carrying them in an infant carrier will not cause back pain. The main thing to be concerned about when you use an infant carrier is that their head is well supported and that they don’t get too hot.

My newborn has overlapping toes. Should I tape them to straighten them out?

Things are pretty tight in the uterus and babies have a few “problems” because of this. Their shins are bowed because their legs were crossed in-utero, and their toes may overlap as well. If your newborn has overlapping toes because of these intr....

For the first week of my son’s life, I kept finding a pink stain in his nappy. Does he have blood in his urine?

Your baby was excreting uric acid crystals in his urine. This is a common finding in the first week or two of life. Although parents often report seeing “blood” in their baby’s urine, on further questioning we find out that there is a pink or s....

This morning I saw some blood coming from my 5-day-old’s vagina. Should I worry?

Baby girls commonly have a small amount of whitish discharge from their vagina. In some cases, this discharge turns bright red—it happens because the baby is shedding the lining of her uterus just like women do when they have their periods. This is....

My 1-week-old is peeling and has very dry skin around his wrists and ankles. What should I do about this?

During the pregnancy, babies are floating in amniotic fluid. For most of this time, they are covered with a greasy white material called vernix caseosa. Unfortunately, by the end of the pregnancy, the concentration of vernix lessens and the baby’s ....

My 3-day-old has a blister on her upper lip. Do you know where this came from and when it will go away?

This is called a sucking blister. It doesn’t bother the baby and usually falls off in a few days. Often a baby will get more than one in the first few weeks of life.

Is it normal to have piles after giving birth?

One third of women can develop piles during pregnancy. They are swollen veins around the rectum that may itch and ache or cause extreme discomfort. Ice packs can be applied to reduce the swelling as well as specific topical haemorrhoid ointments. Ple....

Why am I still bleeding a month after the birth?

Vaginal bleeding after the birth of your baby is from the uterus at the area where the placenta was attached. It can take up to six weeks for the uterus to return to its normal size and for the bleeding to stop. The blood should be dark in colour and....

Mastitis

mastitisMastitis is an inflammation of the breast that can lead to infection. The word “mastitis” is derived from the Greek word “mastos” meaning “breasts”, while the suffix “-itis” denotes “inflammation”. Mastitis can occur at any time but is most common in breastfeeding women, particularly in the second and sixth week postpartum. Mastitis tends to emerge in the first three months after giving birth but can occur up to two years later. The condition can leave you feeling rundown and exhausted, making it difficult to care for your baby. In rare cases, non-lactating women develop mastitis.

There are two types of mastitis. Non-infectious mastitis, which usually occurs when milk remains within the breast tissue (called milk stasis) because it has not been properly drained, due to a blocked milk duct or feeding problem. The second type, infectious mastitis is caused by a bacterial infection. Although painful and potentially upsetting for breastfeeding moms, mastitis is relatively easy to treat. Prompt medical treatment is essential to avoid recurrence and complications.

Symptoms

The most common symptoms of mastitis include:

  • Redness or reddish streaks
  • Breast pain or sensitivity
  • Heat and swelling
  • A hard area on your breast
  • A burning sensation in the breast that persists or is present during breastfeeding
  • Nipple discharge, which is usually white but may be streaked with blood

Other symptoms may include:

  • Feelings of stress or anxiety
  • Chills
  • Elevated body temperature
  • Shivering
  • General aches and pains
  • Feelings of malaise

Cause

Mastitis can be caused by several factors, including:

  • Poor attachment to the breast
  • Nipple damage
  • Long breaks between feeds or infrequent breastfeeding
  • Breasts that are too full
  • Blocked milk ducts
  • Weaning too soon
  • Pressure from an overly tight bra or baby carrier
  • A baby who is having latching difficulties (for example, due to tongue tie)
  • Being overtired or rundown

During lactation, anything that prevents milk from being properly expressed tends to result in milk stasis, which often leads to blocked milk ducts. In general, bacteria do not thrive in fresh human milk. However, if the milk ducts are blocked and the milk stagnates, there is a greater chance of bacterial infection. It is believed that bacteria exist on the surface of the breast skin. If the skin becomes cracked or broken, bacteria can enter the milk ducts. It has also been suggested that bacteria from the baby’s mouth can enter the mother’s breast during breastfeeding.

The breast tissue can also become inflamed due to the presence of cytokines in the breast milk. Cytokines are special proteins that the immune system uses and are passed on to your baby, to help them resist infection. If breast milk is not properly drained, the mother’s immune system may mistakenly attack these cytokines as if they were viruses or bacteria. This process, results in inflammation of the breast tissue to stop the spread of a supposed infection.

Although less common, non-lactating women can develop infectious mastitis. Regular smoking in the late 20’s and early 30’s is thought to contribute to the development of the condition. It is believed that smoking damages the milk ducts making them more prone to infection.

Nipple piercing can also increase the risk of developing mastitis.

Risk factors

  • Breast-feeding during the first few weeks after childbirth (postpartum)
  • Broken skin or cracked nipple
  • Using only one position to breast-feed, may result in your breast not being fully drained
  • Wearing a tight-fitting bra or clothing, may restrict the flow of milk
  • Overtiredness or fatigue
  • Previous bouts of mastitis while breastfeeding

Diagnosis

Mastitis is fairly easy to diagnose on the basis of symptoms and a physical examination. If the condition is unresponsive to treatment or the symptoms are severe, your doctor may take a small sample of breast milk for testing. Tests are able to detect the presence of a bacterial infection and the type of bacteria responsible for the condition. Bacteria identification helps your doctor select the most appropriate treatment.

If your doctor suspects a feeding problem, you may be asked to demonstrate how you breastfeed. Although breastfeeding is natural, it is not necessarily instinctive, requiring time, effort and adjustment for both mother and baby. You may need to experiment with feeding positions to find the most comfortable option. Stimulating the rooting reflex and establishing correct latching techniques take patience and practice.


Treatment

It is recommended and safe to continue breastfeeding or expressing milk from the affected breast if you have mastitis. Although frequent nursing or pumping may be painful, it is essential to keep the milk flowing and avoid clogging.

This is not the time to wean. It is crucial to keep your breasts as empty as possible. Your baby’s sucking is the best way to do this. You may be worried about feeding your baby from the affected breast but this is what you need to do, and it poses them no harm whatsoever.

There are a number of ways to help the breast empty or drain more easily:

  • Make sure your baby is attached well and that you are feeling comfortable. Breathe deeply and evenly. Make a special effort to relax as this will help your milk flow.
  • Check that your let-down reflex is working as your baby begins to suck and that they are receiving sufficient milk. When your let-down happens, you will experience tingling in your breasts, a sudden feeling of fullness or milk leaking from your other breast. You will also notice changes in your baby’s sucking pattern, such as more frequent gulping or swallowing.
  • Hand express or use a breast pump if necessary, before, after and between feeds. If you have mastitis, your milk may taste salty and although not harmful, your baby may refuse to suck. A good place to hand express is under a warm shower.
  • Gently massage the sore breast while your baby feeds. You can also massage the affected area towards the nipple while in the bath or shower. Gentle pressure behind the lumpy area may help move the blockage.
  • Change feeding positions to help shift the blockage. For example, feeding while lying on your left side may help clear a blockage on the right side of either breast. If the blockage is under the nipple, raise the breast with your hand while feeding. Another option is to feed “on all fours” while kneeling over your baby.
  • Ensure that you are well hydrated by drinking water frequently throughout the day.
  • Enlist the support of family and friends so that you are able to rest or sleep as much as possible. Resting allows your body to recover between feeds.
  • Place a cold pack (such as frozen vegetables placed in a cloth) on the affected area, twenty minutes on, twenty minutes off, to reduce the inflammation and relieve pain.
  • Use warmth sparingly, preferably 10 minutes before a feed, to help trigger your let-down. This may help clear the blockage and soothe pain. Sources of heat include a warm shower, immersing your breasts in warm water in a bath or basin, water bottles or microwavable heat packs, or a hand towel wrung out in hot water.
  • Consult your doctor immediately if you develop a fever, feel unwell or are unable to clear the blockage within 12 hours. Infectious mastitis may require antibiotic treatment. Take your medication as directed and finish the course. Antibiotics make mother and baby more susceptible to thrush. If you or your baby develops any side effects, contact your doctor straight away.
  • Over-the-counter painkillers, such as paracetamol or ibuprofen may be necessary or prescribed to reduce pain and fever.
  • Severe and recurrent mastitis or delayed treatment may result in the development of a breast abscess (a collection of pus). An abscess needs to be drained under local anaesthetic. Healing takes 5-7 days. With your doctor’s approval, you can continue feeding, while covering the affected area with light gauze dressing. If you are advised to stop feeding from this breast during the healing process, ensure that you pump or express milk regularly.

Prevention

  • Breastfeeding exposes the skin around the nipples to excess milk. Moisture together with vigorous sucking makes this sensitive area prone to damage. There are a number of preventative measures you can take to minimize your chances of developing mastitis.
  • Gently dab your nipples clean after each feed.
  • Breastfeed frequently. Newborns generally feed 8-12 times in a 24-hour period.
  • Breastfeed your baby as often as your baby wants to feed.
  • Don’t miss or put off breastfeeds.
  • If your breasts become too full, wake your baby for a feed.
  • If your baby doesn’t want to nurse, you may need to express some milk for comfort.
  • Seek help to ensure that your baby is latching and feeding well at your breast. It is important to get advice on how to position baby on your breast. A baby who is properly latched will not need to suck hard to feed well. Taking baby off your nipple is also important to prevent irritation. This can be done by gently pushing down on your baby’s chin, to break the airtight seal between her mouth and the nipple.
  • Offer both breasts at each feed. If your baby only feeds from one breast, alternate by offering the other breast first at the next feed.
  • If you need to start a feed on the right breast, place your feeding cushion to your right, as a reminder. Alternatively use a wristwatch or elastic band.
  • If your breasts still feel full after feeds, express a small amount of milk until you feel comfortable.
  • Avoid excess pressure on your breasts from clothing or from your fingers when feeding. Make sure your bra is very loose or take it off.
  • Avoid mixed feeds, including formula or other fluids, unless advised by your health care provider.
  • If your nipples are cracked, swollen or sore seek treatment immediately, as they are prone to infection.

Complications

Delayed treatment of mastitis can lead to the development of a breast abscess, resulting in excruciating, throbbing pain, swelling, heat and tenderness in the affected area, and high fevers. Treatment generally includes antibiotics and drainage of the abscess under local anesthesia. You may need to halt breastfeeding from the affected breast temporarily. However, it is recommended that you continue to empty the breast with a pump until healing has occurred and nursing can resume.