Baby care

 

Introduction

This factsheet is aimed at providing basic information for new parents on some of the most common childhood complaints they may experience with their children, such as nappy rash, oral thrush, wind, constipation, crying, colic and teething as well as information on how to reduce the risk of cot death.

 

What is nappy rash?

Nappy rash is any skin reaction appearing in a baby’s nappy (diaper) area. The rash usually makes the buttocks very red and sore; the baby may cry every time when filling or wetting their nappy.  Nappy rash can also involve the genital area but tends not to affect the skin creases.

What causes it?

Nappy rash is caused by contact between urine and skin.  A rash is almost inevitable if there is prolonged wetness of the baby’s skin.  Allergy is not thought to be important, simple irritation by urine and stools is the main factor.

Babies with eczema tend to have more alarming-looking nappy rashes with a shiny appearance, while those with a family history of psoriasis can have scaly rashes resembling psoriasis.

In any nappy rash there can be added infection by bacteria or by a yeast called Candida (which causes thrush - see below).  These infections need specific treatment.

What can be done?

Many nappy rashes can be prevented by frequent changes of nappy, and ensuring adequate cleaning and drying of the skin prior to application of the nappy.  It is a good idea to take a spare nappy on shopping trips and other outings.

Once present, nappy rash usually responds to letting the air get to the area as much as possible.  When changing, it is important to clean the nappy area gently (warm water and cotton wool are ideal), dry it thoroughly and then leave the baby’s bottom bare for a long as possible before putting on a fresh nappy.  Even three sessions a day, each of 15 minutes, of “nappy-free” playtime can be effective in rapidly reducing redness and discomfort.

Just before putting on a clean nappy (but not earlier); apply a thin even layer of barrier cream.  Your local pharmacist can advise you about an appropriate cream to use.

Are Terry nappies better?

This is a matter of personal preference. Terry nappies are often used with plastic pants and could cause rashes because the baby would have moisture direct on their skin for longer periods.  The elasticated legs of plastic pants can also chafe the skin.  

However, if nappies fit well and are changed often, it does not matter whether they are disposable or not.  Present day disposable nappies contain a gel that absorbs urine and takes the moisture away from the baby’s skin.

When should one see the doctor about nappy rash?

Consult the doctor or health visitor for further advice if:

•    the baby seems unwell or very uncomfortable
•    the baby has diarrhoea or is off their feed
•    a nappy rash fails to improve with the simple measures given above
    there are distinct spots within the rash or spreading out from its edges or bleeding.
•    If your baby is unwell and has a rash which does not blanch (fade) when pressed.

These symptoms require a proper diagnosis from your GP so that appropriate treatment can be started.

 

What is oral thrush?

Oral thrush (also called monilia) is a mouth infection caused by the yeast Candida albicans.  It tends to cause discomfort when feeding, and may produce visible white patches on the gums and the inside of the cheeks.  The patches resemble milky curds but unlike milk cannot be wiped or rubbed off.

What causes it?

A baby can catch thrush from a mother who has it, either from her vagina during labour or from her nipples when breastfeeding.  It can also indicate poor hygiene techniques in sterilising bottles, dummies, etc.  

A child on antibiotics may also be predisposed to thrush.  To some extent all humans carry this yeast, but only in small quantities because the normal balance of bacteria in the body is enough to prevent Candida from multiplying rapidly and causing symptoms.

Adults too can develop oral thrush, but babies are especially prone to it because their mouths are delicate and they spend so much time sucking.  Babies with oral thrush may have thrush elsewhere as well, particularly in the nappy area.  This is because the warm moist conditions under the nappy encourage the growth of Candida.

If the mother is taking certain antibiotics and breast-feeding, or if the baby is taking antibiotics orally, then these can trigger an attack of thrush.  This is because they kill off some of the body’s beneficial bacteria along with the harmful ones.  In someone with an immune deficiency, whether adult or child, thrush can invade other parts of the body, but this is rare.

What can be done for oral thrush?

Upon suspecting their baby has oral thrush, parents may wish to speak to the health visitor who will be able to advise if a visit to the GP is required.  The GP will be able to make a definite diagnosis.  The usual treatment is a prescription for anti-fungal drops or a gel, used several times a day.  

It is also important to control thrush in the mother if she has it, and to sterilise teats, bottles, teething rings and dummies properly.  Any object a baby can put in his mouth could carry the yeast, but rubber items, which are beginning to perish or crack, are especially prone to harbouring Candida and should be replaced.

Should one see the doctor?

Apart from the initial diagnosis, a baby with thrush will need to see the doctor again if he is too uncomfortable to feed properly.  This is unusual, but can lead to dehydration.  Again, parents may wish to make use of the services of the health visitor in monitoring their child’s progress.

What alternative therapies are there?

There are a number of alternative remedies for thrush in adults.  However for babies most practitioners agree that conventional medicines are the quickest and most effective way to relieve symptoms.  Consult your GP before using complementary therapies on a baby.

 

What is wind?

In a baby, wind is air swallowed when feeding or crying.  Though experts sometimes disagree on how important wind is, it is widely believed to cause discomfort and/or burping.

What causes it?

Younger babies are more prone to wind than older ones, and some babies are more “windy” than others.  A baby who cries a lot is likely to swallow air and this in turn may cause more crying.  It is sometimes thought that wind may be more common in bottle-fed babies, but this is unproven.  However there is little doubt that a bottle held at too low an angle allows more air into the teat and thus causes more wind.  

A teat which is too small, and which makes a baby suck harder, is also likely to cause air swallowing, so it is worth checking the flow from the teat before a feed (for instance at the same time as checking the temperature of the formula).  The milk should drip from the teat, when the bottle is upturned, like a leaking tap.  Teats can block up with use. Despite an adequate hole, old or perishing teats may not let milk out fast enough because the walls of the teat stick together and obstruct the flow.

Sucking from engorged breasts making feeding harder may also cause babies to gulp air.  It is the experience of many mothers that dummies do not cause wind, but some babies do have problems with their feeding techniques which may predispose to wind, eg cleft palate.

What can be done?

It is worth trying to change techniques to see if it will help the problem.  Some bottle-feeding mothers find it helpful to change the type of bottle (to one with a polythene lining bag) or the type of teat (to an “anti-colic” variety).

Wind can also be helped by the technique of winding, either just after a feed or once during it as well.  It is not a good idea to pause during feeds too often, because the baby may just get hungrier and angrier and therefore gulp down more air.

The best-known way of winding a baby is by holding him over your shoulder and rubbing or gently patting his back until he burps (use a towel or clean terry nappy to protect your own clothes).  This is only suitable for babies over six weeks or so, because younger babies cannot control their heads well enough.  

A smaller baby is best winded by holding him upright on your lap; with one of your hands under his chin to support his head while the other hand rub his back gently.  Alternatively, some babies are happily winded lying on their stomachs having their backs rubbed (a good method for twins and higher multiples, as it requires fewer hands for each baby).

Many mothers advocate gripe water but this should not be used in babies under a month old.  Most gripe waters contain bicarbonate and could be harmful in excess, so the stated dose must never be exceeded.  There are anti-colic medications on the market and your local pharmacist or health visitor will be able to advise you.

Although some people advocate them there is no scientific evidence to support the use of fennel and other herbal baby teas for wind.  Warm water alone may help in moving the wind along.

Should one see the doctor?

Check with the GP or health visitor if simple measures do not work, or if the baby continues to be distressed.

 

What is constipation?

Constipation is difficult to define in the very young because babies' bowel habits vary. However stools which seem hard, small, pellety or difficult to pass usually classify as constipation.

What causes it?

Any baby who is short of fluid can become constipated.  On the whole, bottle-fed babies are more likely to get constipated and may require extra fluid such as cool boiled water between feeds.  Having said that, breast-fed babies often pass stools less often than mothers expect.  

For reasons that are unclear, some breast-fed babies pass motions seemingly non-stop while others may only do so every 6 to 10 days; both can be completely normal.
Serious causes of constipation are unusual but include thyroid deficiency and various conditions that result in intestinal obstruction (bowel blockage) such as a rare condition called Hirschsprung’s disease, which tends to cause difficulty in opening the bowels from birth.

A baby who has never opened his bowels from birth may have a condition called imperforate anus in which the anal canal is effectively a dead end. Hospital staff and midwives usually ask the mother/parent to observe and inform them when the baby passes their first stool to rule out imperforate anus.  It is a rare condition, but does require surgery to correct it.

What can be done?

An underfed as well as an overfed baby can become constipated.  If a baby is constipated, it is worth offering bottles of plain boiled (and cooled) water.  This is especially useful in hot weather or if the baby is running a fever since at these times the baby may be slightly dry or dehydrated.  

Bottle-fed babies who do not respond to extra water can benefit from a change of formula; talk to your health visitor about this. As an alternative, some health visitors suggest offering a teaspoon of freshly squeezed orange juice, diluted with two teaspoons of water.

Should one see the doctor?

See the doctor if the baby:

  • vomits
  • seems to be in pain
  • continues to have constipation despite the suggestions above
  • has a hard distended stomach with constipation
 

What is abnormal crying?

All babies cry, but they differ as to how much they do of it. Some seem more placid and contented while others are very vocal. When crying, newborn babies do not shed tears, but older babies can cry with or without tears. Both are normal.

What causes it?

Babies probably do not cry just to "exercise their lungs", as some suggest. They can cry for a variety of causes, such as

  • hunger (a cry parents soon recognise)
  • thirst (it is unusual, but can occur in hot weather)
  • discomfort or pain (including colic - see below)
  • boredom or loneliness
  • tiredness
  • illness
  • a dirty or wet nappy (probably)
  • fear

You should suspect a baby is ill if they are drowsy, feverish, off their feeds, unusually irritable, if they have diarrhoea or an odd shrill cry, or is snuffly or chesty. If any of these applies, or your instinct tells you your baby is unwell, always consult your GP or the out of hours medical service which can usually be accessed via NHS Direct on 0845 46 47.

What can be done?

When a baby is crying, picking them up may be enough to pacify them, or they may need feeding and/or changing - these procedures should be tried first. Check too that their clothes aren't too tight, especially around toes and wrists, as sometimes a loose thread, ribbon or tight cuff can cause pain.

Some very young babies just need comfort or wrapping more snuggly (as long as they can't overheat) while others need more attention, especially if over two months. Many babies are soothed by being sung to, by soft music, by a tape of "womb" noises, or even by the sound of a nearby vacuum cleaner or tumble dryer.

Taking a baby out in their pram or in the car often works, but some may cry on returning home. In practice, dummies are very useful for many crying babies, as long as the parents are scrupulous about hygiene and do not use a dummy constantly.

Picking up and rocking a baby and talking to them is often the most effective pacifier, but obviously a mother can't do this 24 hours a day.

A baby who cries a lot puts enormous pressure on the parent and the whole household. A mother may feel inadequate if she believes people who tell her the baby's crying is somehow her fault (which is unlikely to be true).

Getting away from a crying baby is sometimes essential for a parent's sanity. Even leaving the room can work wonders if it puts a mother out of earshot for 15 minutes (but first she has to make sure that the baby can't come to any harm and is not showing signs of illness such as a high temperature, unusual drowsiness, persistent vomiting).

With a demanding baby, a parent just has to accept that less will get done. Things will improve, but for the time being it is best to be realistic about chores and aim to do the minimum necessary for safety and hygiene. Many household tasks can be postponed. When a crying baby does stop, a harassed parent is better off lying down for a rest rather than catching up on housework.

Some babies cry mainly at night instead of sleeping and letting their parents do the same. There are a number of ways one can help a baby sleep at night - from having a peaceful sleeping place to instituting a calm and predictable night-time routine.

Some of the resources at the end of this information sheet are also useful for sleeplessness.

What complementary methods are there?

Some advocate techniques such as baby massage and cranial osteopathy for babies who cry a lot. There is no very convincing evidence for cranial osteopathy, but massage may help both parent and baby relax.

When should one see the doctor?

Consider seeing the doctor if you think your baby might be ill (see symptoms above).

In the case of a constantly crying baby, seek help from your doctor or health visitor before you reach the end of your tether. This is for you and your baby's well-being: a difficult infant can make the most devoted parent lose control.

Your GP and health visitor can provide valuable emotional and practical assistance. There are further sources of help and support listed at the end of this factsheet.

 

What is colic?

In babies, colic is abdominal pain that occurs on and off, causing bouts of intense crying especially in the evenings. The baby may pull his legs up as if in pain. Colic (also known as evening colic and three-month colic) often starts at the age of two weeks and stops at three or four months of age, sometimes as suddenly as it began.

What causes it?

Nobody really knows what causes colic and there is considerable debate about various theories. Perhaps the most plausible is that the baby's bowel is somehow immature, which explains the effects of certain foods and the fact that babies outgrow colic. Sometimes the cause is trapped wind (see above).

Some breast-fed babies may become colicky when their mother eats certain foods such as oranges or strong tasting foods such as garlic. A few are intolerant of milk, so changing a bottle-fed baby to a dairy-free formula may help (but check with the GP or health visitor first).

What can be done?

Firstly if breastfeeding one can avoid foods which are known to cause a baby's colic.

During a bout of crying, cuddling the baby may be enough to stop the crying. Drinks of warm (cooled boiled) water can help. Winding the baby, or holding him in a different position can also relieve the pain of colic.

A baby may improve by lying on his stomach (babies should not be put to sleep on their fronts) but they can be held draped over a parent's forearm, with the head supported, and walked around, and you can rub the baby's back gently at the same time.

Various medicines like gripe water and specially formulated anti-colic medicines can ease colic, but you should check with your doctor if your baby needs these more than occasionally.

 

What is teething?

Teething is the process of a tooth emerging through the gum. The first tooth is usually a lower incisor and comes through at five to six months of age, but it can appear at almost any time in the first year.

Experts sometimes say that teething produces nothing but teeth. It is not true that it causes high fever, convulsions, coughs or many of the other symptoms that have over the years been put down to teething. However most mothers and GPs would agree that teething can cause:

  • Pain.
  • Dribbling.
  • Frantic chewing.
  • Red cheeks.
  • Crying.
  • Possibly diarrhoea.
  • Nappy rash.
  • Strong smelling urine.
  • Exacerbation of eczema.
  • A slightly increase temperature.

What can be done?

Something to chew, be it a teething ring or a rusk, often satisfies a teething baby. A teether, which is kept in the fridge can be especially soothing.

Simply rubbing the sore gum may bring relief, as can various teething gels that contain local anaesthetic. Babies who are particularly fractious from teething benefit from paracetamol syrup for pain relief. Your health visitor or local pharmacist will be able to advise you.

 

Sudden Infant Death Syndrome (SIDS/ Cot Death)

Sudden Infant Death Syndrome (also known as SIDS or Cot Death) is defined as the unexpected death of a baby less than one year old, often occurring during sleep and for which no obvious cause can be found even after death. About 500 cot deaths occur a year and so far no cause has been established for SIDS although there are many theories including that some babies in certain situations may find that they have problems controlling their own temperature or have problems regulating their breathing.

Most cot deaths occur under the age of 6 months and are more common in babies who have a brother or sister who died of SIDS, babies born prematurely or of low birth weight and those in families with low incomes or to mothers who smoked in pregnancy or after the birth of the child. 690,013 live births in 2007


There are a number of measures parents can take to reduce the risk of their baby dying of cot death. These are:

•    Placing the baby on its back when laying it down to sleep. It is thought that this simple advice has reduced the number of cot deaths by 70%.

•    Both mother and father should stop smoking from the moment the mother realises that she is pregnant. This is because the risk of cot death has been shown to increase with the length of the baby’s exposure to cigarette smoke both when it is inside the womb and after it is born.

•    Keep the baby at a normal temperature i.e. avoid overheating the baby. A room or cot which is too hot may cause overheating in a susceptible baby so the room temperature should be kept at around 18ْC and parents should avoid sharing their bed with their baby until they are at least 8 weeks’ old and preferably longer. This includes not falling asleep with the baby on the sofa.

•    Keep the baby’s head uncovered and make sure that as far as possible the baby’s head is uncovered before they go to sleep and that their feet are towards the foot of the cot to avoid them wriggling under the sheets.

 

Where can I get further information?

Apart from contacting your GP or health visitor, the following organisations may offer further help and information:

SERENE and the CRY-SIS Helpline
BM Crysis
London
WC1N 3XX
Telephone: 0845 1228 669 (9am-10pm 365 days a years)
Email: cry-sis@our-space.co.uk
Website: www.cry-sis.org.uk

Offers telephone support from parents who have themselves coped with crying babies.

National Childbirth Trust
Alexandra House
Oldham Terrace
Acton
London
W3 6NH
Telephone: 0300 3300770 (enquiry)
Telephone: 0844 243 700 (members)
Telephone: 0870 444 8708 (breastfeeding)
Website: www.nct.org.uk

Parentline Plus
520 Highgate studios
53-79 Highgate Road
Kentish Town
London
NW5 1TL
Helpline: 0808 800 2222
Email: admin@parentline.co.uk
Website: www.parentlineplus.org.uk

Help for parents under stress.

Foundation for Sudden Infant Deaths
11 Belgrave Road
London
SW1V 1RB
Telephone: 020 7802 3200 (general enquiries)
Website: www.fsid.org.uk