Caring for your newborn (Myanmar Recommendations), Part II

Living Well in Myanmar

Managing the health of your newborn in Myanmar

In previous editions of Myanmar Times Weekend we have presented columns offering advice on caring for your new baby.  We covered newborn behaviors and gave suggestions on how to manage your baby’s different body parts.  Those ideas are applicable to babies regardless of where they live.

Today I’ll offer some thoughts that are specific to Myanmar.  New parents that visit my clinic in Yangon are typically interested in vaccinations, safety and emergency interventions.  While every family situation is unique and decisions have to be tailored to personal priorities and access to resources, the following are some generalizations that might smooth the job of being a new mom or day in Yangon.

Standard vaccinations

Globally, different countries have different vaccination schedules.  The Myanmar recommendations roughly conform to global standards, but miss some important vaccines known to prevent disease in kids.  In my practice I ask parents to pursue an accelerated schedule of the fundamental potentially life saving vaccinations at 6 weeks and 3 months (rather than the Euro-American standard of 2 months and 4 months.  This allows us to complete the first two doses, which are the ones that establish immunity, a bit more quickly.  The rationale for this approach is based on trying to reduce the likelihood of a sickness that might require interaction with a hospital.

Optional vaccinations 

Western medicine has a marginally effective vaccine against tuberculosis called BCG.  It provides some protection, but its utility really depends on how much exposure to tuberculosis you think your child will have.  Much of that risk is based on social and economic status.  Also administration of BCG will affect the accuracy of the skin test that is commonly done to screen for tuberculosis.  The decision to get the BCG vaccine needs to be made in consultation with your doctor.  Raising a baby in Burma also means you should consider the rabies vaccine.  In this column I’ve written previously about the variables to think about in vaccinating against rabies (hyperlink).  My conclusion is that any kid who will be living in Burma for more than six months should be vaccinated, although this doesn’t need to happen until 1 year of age.

Safety

Interestingly, living in Rangoon, the biggest risk to your new baby may be car accidents and poor urban infrastructure.  The medical evidence to support car seats is incontrovertible.  Car seats have clearly been shown to save babies lives.  The reality of using a car seat in Myanmar is difficult to reconcile with the objective evidence.  If you’re getting into a car with no seat belt to restrain the car seat there is no reason to use it.  If the price of a car seat and taxi ride exceed your discretionary income then you must think carefully about whom you ride with and when it happens.  Easier to address is the risk of falling into a hole while walking around town with your new baby.  Take common-sense steps such as moving slowly, having someone walk in front of you, and carrying a flashlight at night.

Bug bites

Best to avoid them.  For babies living in Burma we worry about dengue and malaria.  Both are transmitted by mosquitoes, so the basic rule is to reduce exposure to bites in the household.  In Yangon dengue is the greater threat, and we’ve recently completed a particular heavy dengue season.  While adult populations overwhelmingly survive dengue infections, children don’t always do so well.  Newborns should sleep under mosquito nets.  The home and surrounding yard can be cleared of standing water and if possible screens can be fixed to the windows.

Sickness

Since newborns can’t tell us when they’re sick, we have to rely on other observations to decide if they’re unwell.  The things to look for include:

·      Changes in feeding habits.  If a normally happy baby becomes fussy with breastfeeding over the course of several attempts, it may mean an illness is arriving.

·      A decrease in urination.  A normal baby makes 4-6 wet diapers per day.  If that number is declining it may be an indication of dehydration.

·      Difficulty breathing.  This doesn’t mean loud breathing or a stuffy nose.  Instead it means a baby that is struggling to get enough air.  You can often know this is happening if the nostrils are flaring out or the skin on the chest is retracting into the ribs.

·      A temperature higher than 38 degrees.  For all kids less than 3 months old, your doctor wants to know about a temperature that is higher than 38 (100.4 fahrenheit). 

Emergency Hospital Planning

The decision of where to take your baby in the event of a life-threatening injury is a difficult one.  The specifics should be discussed with your doctor around the time of birth.  There are several private hospitals providing pediatric care in Yangon. However because of the national policy requiring specialist doctors to be government employees, most private hospitals do not have a full-time pediatrician on staff.  This can make those locations unreliable for emergency care.  I recommend all parents know the location of the closest government pediatric hospital.  The two primary city facilities are the Yangon Children’s Hospital in Ahlone and the Children’s Hospital in Yankin.

Mom’s emotional state

A special note on the psychological state of new mothers.  The sudden change in hormone levels after giving birth, combined with the strong emotions associated with a new person in the family, can result in feelings of sadness, frustration and confusion.  These sensations are typical and usually temporary.  In mom’s who are geographic transplants to Myanmar, I’ve noticed both improvement and worsening of emotional state.  Regardless, normalizing these feelings for mom and her partner, along with a bit of time, is usually sufficient for feeling better.  A doctor should become involved if down feelings persist or result in an inability to effectively care for baby 

References:  “Newborn Care”.  Elissa Rubin, Deborah Saunders, Sharon Somek

gelsdorfMD@gmail.com  © Christoph Gelsdorf 2013