Caring for your newborn, Part I

Living Well in Myanmar


Newborn Care in Myanmar

Thinking about or getting close to having a baby in Yangon?  Congratulations!  Lucky for you, with the right amount of attention, love, and knowledge, babies will naturally achieve what they need to grow up healthy.  Having a newborn in Burma is unique in some ways, but most of the recommendation doctors give internationally apply here as well. 

The parents I meet in my clinic in Yangon have a variety of questions, some of which can be answered in general terms and some of which are particular to our setting.  This week I’ll give some thoughts on the basics of newborn care.  Next week I’ll review some specifics that apply to Myanmar, such as vaccine schedules, child safety, bug bites, and how to know if a baby needs to see the doctor.  The following is a list of common and practical ideas that might make your job as new parent a little bit easier.

Sleep.  All babies should sleep on their back, never on their stomach.  If you use a crib no other pillows, blankets, positioners or bumbers should be placed inside the crib as they can cause suffocation.  Co-sleeping with your baby in your bed also poses a risk for injury, so if you decide to do this please be very careful.  Everyday alternate the side to which you place baby’s head in order to prevent it from becoming flat in the back.  Newborns sleep up to 22 hours per day in the first weeks of life.  They tend to make a lot of noise when they sleep – grunting and moving around.  This is normal and doesn’t mean the baby is uncomfortable or suffering from stomach gas.  When humans are born they need some time to become diurnal.  This means your baby does not differentiate between day and night.  The best advice is to do the same as much as possible during the first few weeks of parenting.  Try to nap and sleep when baby sleeps.

Weight and breastfeeding.  Babies can loose up to 10% of their birth weight in first days of life.  While you’re waiting for baby to get back to its birth weight, usually about 2 weeks, you can wake baby for breastfeeding every three hours.  After the birth weight is regained you should avoid waking up a sleeping baby.

Crying.  Perhaps you’ve noticed that babies seem to cry often.  This is normal, and happens even if you’ve tried everything from feeding to diaper change to temperature adjustment.  Often parents will then blame gas, but crying, particularly at night, is part of good neurological development.  If the crying becomes too much for you to bear you can of course hold and cuddle them.  Babies want to be held and they have no memory so it’s not possible to spoil them.  Also you can try pacifiers which soothe lots of infants effectively.  Pacifiers don’t negatively impact breast feeding and may actually prevent again SIDS.  Don’t tie the pacifier to anything as it can get tangled around baby parts and cause injury.

Spitting, burping, and farting.  Babies are experts in doing these things.  As parents we like to help them out by holding them up, patting them, and saying nice things.  After a breast feed you can try to help baby burp for 5 minutes.  If it doesn’t happen, don’t worry about it.  Gas finds its way out the top or bottom, and different babies do it differently.

Poops.  Perhaps the most frequent topic parents like to talk to their doctor about.  If you have a new baby, please read this statement:  poop can vary from once every time you breast feed to once a week.  As long as the poop is soft, the frequency doesn’t matter.  In the first days of life poops are thick, sticky and black.  After that, the color can be varied:  orange, yellow, green, brown.  Often there are small seeds in the poop which is also normal.  If you think your baby has hard, dry, pebble poop, please call me.  Otherwise poop can be soft, smooshy, watery, or stinky-explosive to the point where my brother-in-law would declare it to be ‘hazardous material’.

Bathing.  Nothing more than a wet washcloth every 2-3 or days is necessary to keep a baby clean.  Newborn skin is dry and flaky, and regenerates itself every few days.  Therefore no soap is required.  If any area is cracked you can use some Vaseline, but otherwise all you need is water!

Diaper care.  After baby poops or pees, wipe down the area with a towel that is unscented and alcohol free.  If it looks like there is a rash developing, send me an email so we can decide if a treatment is necessary.  Normally all you need is Vaseline.  Products that contain Zinc Oxide, which provides an extra level of protection are available in Myanmar.

Clothes.  Big topic in Myanmar.  Most parents overdress their baby.  While the kids often look stylish, sometimes they get misdiagnosed as having a fever.  It’s easy enough to choose clothes for your baby that you would choose for yourself.  If you feel confused, wait 15 minutes then touch your baby’s chest – if it’s cold add a layer, if it’s hot take off a layer.  Don’t judge your baby’s temperature by the hands and feet, as they’re usually colder than normal.

The ‘belly button’ area.  Keep the area dry, but don’t try to clean it or use alcohol.  It will be fine by itself.  Keep the diaper below the area so it is open to the air.  The stump will fall off in 1-2 weeks, and might bleed a little or have some yellow discharge.  Just wipe that away with a dry towel.  It doesn’t hurt the baby at all so don’t be afraid to touch it.

Fingernails.  Newborn nails grow very quickly.  If fancy baby fingernail clippers are difficult to find or financially out of reach, I think it’s safer to file them gently rather than use scissors.  In much of the developing world, such as Myanmar, many parents bite off the nails, which seems to be just fine as well 

Eyes. Often the eyelids are swollen in the days after birth, which is normal and gets better on its own.  In the first few months of life eye discharge and crustiness is normal.  This is because tear ducts easily get stuck in a newborn.  If your baby has some sticky eyes after waking up just wipe it away with a wet towel.  This can occur repeatedly through the first year of live.  If you feel like the whites of the eyes are turning red or the discharge is happening throughout the day, then please come to see me for an appointment.

Baby’s vagina.  In the first days of their life little girls have swollen skin on the outside of the vagina. Some girls also have a thick white discharge.  This is normal, it comes out on its own, and there is nothing mom and dad need to do about it.  Also, some baby girls have blood that comes out of the vagina in the first days of life.  Also normal.  It’s caused by mom’s hormones circulating in baby’s blood.

Breasts.  Both little boys and little girls may have swollen breasts in the first few weeks of life.  Normal.

Baby sneezing and having hiccups.  These occur frequently in newborns and don’t mean that the baby is sick.  Breast feeding should continue normally. 

Building muscles.  As a babies grow doctors encourage tummy time – putting them stomach and face down several times per day while they’re awake.  This develops arm, neck and trunk strength. 

Stuffy nose.   Both loud sounds in the nose and stuff coming out of the nose are normal in babies.  As they eat breast milk, babies get fluid stuck in the back of the nose.  It sounds very crackly and can be even louder when babies are lying on their back.  Luckily this is normal.  As long as your kid continues to eat, pee, poop and grow, there is nothing to worry about.

Meeting new friends.  For the first 8 weeks of a baby’s life I recommend limiting visitors to family and friends.  For kids in Myanmar please ask me about the accelerated vaccine schedule that can create immunity a bit earlier than what we would do in Europe or America.   Try not to go to places that have may people:  markets, jetties, political rallies, etc.  Ask people to wash their hands before holding baby.  Teach bothers and sisters to touch baby’s feet instead of hands or face.

As a new parent you will continually be amazed at the way your baby grows and develops as a human.  With nurturing and a basic understanding of when to relax and when to be concerned, you are more likely to enjoy the process.

Reference:  Some content adapted from Elissa Rubin, Deborah Saunders, and Sharon Somekh

gelsdorfMD@gmail.com  © Christoph Gelsdorf 2013