OBSERVATIONS OF THE NEONATE

The first week of the infant's extra-uterine existence permits an opportunity to evaluate the human
organism in its first major adjustment, that of survival, utilizing his own resources. Physical
reorganization needs to be well-nigh complete (Smith, 1953), and the physiological variations in this
adjustment between infants are numerous. The condition of the infant at birth as well as the changes
which ensue in the first week may reflect the infant's intra-uterine experience, and certainly give us a
clue as to the extent of stress experienced by him in the birth process. The individual variations in
physical equipment at birth may be an indication of his future physical potential.

The psychophysiological homeostatic mechanisms which can be observed in this first week
may also be of value in predicting and understanding the infant's adaptation to his environment and to
future stress. Phyllis Greenacre (1945) feels that each infant reacts in a characteristic way to the stress
of the birth process, and that a prototype for future anxiety is established at this time. Since physical
reorganization must take precedence in this period, physiological changes dominate the observable
reactions of the infant. Methods which account for physical variables are necessary in order to uncover
the subtler innate individual differences which may point to future personality potential. Repeated
observations in the first week, accounting for day-to-day physiological variations, are valuable in
uncovering

the neonate's individual style of adaptation to his new environment. As a pediatrician, I am impressed
by the innate strengths of the human neonate which come to the fore in adjusting to birth and extra-
uterine existence. But almost as apparent is the strength of the inborn individual characteristics in each
newborn. These traits influence the environment's reaction to him from the start, and one feels that he
has a powerful effect on determining the kind of motherinfant relationship which is likely to persist.
The role of environmental influence in determining the child's personality is well outlined in
psychoanalytic literature. There is a need for methods of evaluating individual capacities at birth which
might reflect
(1) the infant's influence on the kind of environmental stimuli with which he will be presented, as well
as
(2) his ability to receive and utilize these stimuli for future personality development

THE INFLUENCE OF THE NEONATE ON THE MOTHER-CHILD

RELATIONSHIP
The following example is presented to demonstrate the influence of a difficult neonate on an already
disturbed young mother.

1 The extent of any organic central nervous system deficit could not be determined by our available
methods, but his observable behaviour suggested a kind of hypersensitivity and withdrawal which may
lend itself to the kind of all-or-none Défense mechanisms seen later in the atypical development of
severe functional disorders in small children.

2Although the baby never showed any clinical distress, he exhibited two striking, characteristic
behavioral states on repeated day-to-day observations. His spontaneous behavior was limited to these
two states throughout his eight-day hospital course, after the effects of the delivery should have worn
off. A neurologist3 examined him, found no clinical evidence of central-nervous-system damage, but
was also impressed by these extreme states. A lumbar puncture was performed and was also within
normal limits. The first state4 appeared to be a deep sleep in which he was quite floppy, his muscle
tone was poor, with little spontaneous movement or startling present. He was difficult to rouse; stimuli
caused little reaction other than brief respiratory changes, mild startles or blinks, but no change in
alertness. When picked up and held in this state, he adjusted briefly with some muscle tone, his eyes
opened briefly, then he resumed his limp original state. Talking to him, stroking him, even undressing
him, had little but a transient effect on him, and one was struck by his refractoriness and his capacity
to maintain this flaccid, relatively unresponsive state. The second state was as extreme and consisted
ofscreaming, hyperactivity, and hypersensitivity to stim
•
Observed behavior throughout this period consisted of
(1) the same screaming, thrashing pattern seen in the hospital in which he seemed unaware of external
stimuli; and
(2) long periods of staring at a mobile or his hands in his crib. The mother tended to leave him alone
at such times, since she claimed he did not "want her" to hold him. On repeated physical and
neurological examinations, he seemed to be gaining and developing normally

EFFECT OF MATERNAL PREMEDICATION ON THE INFANT'S

BEHAVIOR
One of the major difficulties confronting the investigator of neonatal behavior is that there are many
variables which obscure the inborn characteristic behavior of the infant. Anesthetic agents given the
mother during delivery may have an effect on the baby. They may have both an immediate depressing
effect, and a delayed one. The infant appears alert and stimulated at delivery, but may sink into a
deeply depressed state soon thereafter. The stimulation of the birth process serves to break through the
anesthetic effect for the period of delivery, but as soon as external

stimuli diminish, these babies can become depressed to such an extent that even circulatory collapse
may ensue. However, in carefully controlled maternal anesthesia, the anesthetic effects seem to be
transient ones in the neonate, and the controlled studies on normal and traumatized newborns by
Graham et al. (1956) seem to indicate that placental anoxia associated with large doses of anesthesia
given to the mother is the traumatic factor in resultant central-nervous-system damage of the
previously normal newborn, rather than the medication itself. The depressing effects of short-acting
inhalants seem to be relatively short-lived in the infant, compared to longer-acting sedatives given as
premedication to the mother. One of the most striking effects on individual responses to the
environment in the first week seems to be the effect of drug levels in the infant as a result of
premedication given the mother. When the dose is large enough, and sufficiently ahead of delivery, an
effective level of medication is transmitted via the placenta to the infant. The drug level in the infant
at the time of separation from his mother seems to be the effective one (Ploman & Persson, 1957). His
immature liver and kidneys cannot effectively detoxify the drug (Jondorf et al., 1958), and drug
circulates for as much as a week in the newborn. Also there is a storage of drug in the fluid bathing the
brain (Fouts & Adamson, 1959). The immature brain is particularly susceptible to these drugs. The
neonate seems physiologically set up for an immediate and a more prolonged effect of depressant drugs
on his immature central nervous system. Comparing a population of infants whose mothers were given
a large dose of premedication with those of mothers who had little medication prior to delivery led me
to some questions and generalizations based on clinical observations:
1. All babies seem quite alert and responsive to stimuli for a few hours after delivery; e.g.,
(a) they fix and follow a red ring visually for several minutes at a time;
(b) they hear, attend, often even turn their heads to auditory stimuli;
(c) they quiet quickly to warmth orchanges in position, etc.
 2. There follows a relative state of disorganization which seems to last twenty-four to forty-eight hours
in babies whose mothers are unmedicated, but three to four days in the babies of heavily medicated
mothers. The extent of relative central-nervous-system disorganized

tion or depression seems positively correlated with the type, amount, and timing of the medication
given the mother. Anesthesia has a more transient effect than premedication such as barbiturates.
Hence this effect seems to occur as a result of the birth and recovery processes normally, but this may
be accentuated and prolonged by medication. A typically affected baby may lie quietly for relatively
long periods in a flexed position, eyes closed, breathing slowly, regularly, and deeply. Respiratory
irregularities from time to time reflect external or internal stimuli received. Skin color is affected by
reduced cardiovascular activity and extremities are mottled. This state resembles the regular sleep
described by Peter Wolff (1959), but there are fewer, less generalized startles, and spontaneous activity
or responsiveness may be confined to brief respiratory changes, or to isolated movements of small
body segments-facial grimaces, twitching of fingers, toes, etc. Moderate stimuli, such as auditory or
visual, may penetrate this sleep state, but with some latency, and with a diminished response. Stronger
stimuli or tactile and temperature changes disturb the baby more quickly, and there is a rapid spread
to all parts of the body. There is a lack of modulation or suppression of cyclic general movement in
this state. The movements themselves are jerkier, are often restricted, and have more of the snapback
which is characteristic of immature babies. In most babies this depressed state is intermingled with
periods of alertness and more responsiveness to the new environment. The extremes of state described
in George's case given above are pertinent to this transient disorganized period, although they are
usually more transient and less fixed than in his case. This disorganization must affect the mother-
infant interaction in many cases, although to a less extent than it did with George's mother. The
implications of having such a baby are different for each mother. One mother expressed her positive
feelings about such a baby, saying, "Thank goodness she's such a good baby. I was afraid I'd have a
demanding one." By the time the baby began to rouse, this mother's forces were mobilized to adjust to
her demands. The effect of this period on breast feeding was registered by fortyone multiparas
(Brazelton, 1961), who were nursing for the second or third time. They recorded their impressions of
how alert and easy to get to breast their infants appeared in the first week. Their subjective impressions
were evaluated on the basis of
(1) how long an interval of stimulation was necessary to alert the baby,
(2) howeffectively alert they were during the nursing period. These forty-one mothers were multiparas
who had nursed babies before, since it was felt that this might eliminate some of the contamination of
"first-baby" apprehension. The mothers were told that this was a study to determine the amount of
assistance from the nursing staff required to enable a new mother to start her baby nursing. They were
asked to record at each feeding their impressions of

(I) initial alertness on the part of their babies;

(2) the difficulty involved in awakening them, i.e., how long it was necessary to stimulate them, how
much stimulation was necessary to institute active nursing;
(3) how long during the feeding this state could be maintained with usual stimulation. The babies were
grouped in four groups according to the amount of medication and anesthesia given to their mothers
during labor.
I. Anesthesia-none affecting the baby, i.e., spinal, saddle, or pudenal block, or none. Barbiturates-not
exceeding 50 mgm. given during the oneto four-hour period prior to delivery.

II. Anesthesia-Inhalantswhich effectively anesthetize the mother so that she could not remember the
delivery. Premedication-none except as above in I.

III. Anesthesia-none affecting the baby. Premedication-300 mgm. of barbiturates or like substances
given as early as one hour and not more than four hours prior to delivery.
 IV. Anesthesia-ether, gas-Oz, or other inhalants with which the mother was noted on her chart to be
anesthetized at the time of delivery. Premedication of III.
The grouping was based on the feeling that premedication in groups I and II would
not greatly affect the reactions of the infants, but would in III and IV, and that anesthesia in groups II
and IV would affect them also but not in I and III.
An effective feeding was one in which not more than five minutes ofstimulation was
necessary to rouse the baby, and in which he nursed for three minutes day I and 2, and five
minutes days 3, 4, 5, and 6. The results as recorded by the mothers were based on subjective
evaluations-even wishes-and there are many important contaminants for which we did not
attempt to account-such as duration of labor and its effect on baby and mother, how the
anesthesia and medication

FUTURE AREAS OF INVESTIGATION

With this marked difference due to drug effect in alertness for feeding in mind, we hope that more
detailed evaluation of day-to-day changes in the neonate may lead us even closer to an understanding

of the uses of adaptive equipment. We further wonder whether the sort of depression that was caused
by these drugs might not accentuate the whole recovery process and make it more available to scrutiny.
Thus, individual differences as well as day-to-day differences might be more easily discernible. As a
result, we are attempting to observe three groups of babies.
1. Babies whose mothers have no effective anaesthesia or premedication.
2. Babies whose mothers have large effective doses.
3. Elective Caesarean section babies who have not been influenced by any effective labour. These
mothers are not premedicated, and spinal anaesthesia is used so that these babies are comparable in all
ways to group 1 except that they have not been through any labour.
We hope from these groups to be able to compare the effects of normal labour and delivery with those
of Caesarean section, as well as to see some of the effects of drugs on these babies

Our observations in the first week of the neonatal period are set up in three areas, in order to
evaluate the ranges within these groups.
1. Unstructured observations6 once a day for one-and-a-half- to two-hour period preceding
a feeding, and for two hours after feeding. At least two feedings in the week are observed. We record
spontaneous behavioral reactions and state changes in response to
(a) internal stimuli (when possible to estimate);
(b) random external stimuli from the nursery; and
(c) certain structured external stimuli, such as a rattle, bell, voice (male and female), light
changes, handling touch, warmth, restraints, etc.-some of the elements of a mother's handling.
2. A daily structured behavioural. neurological test situation in which the structure is
flexible but is based on an attempt to bring the baby through a gamut of responses and state changes
based on Frances Graham's test (1956) designed to test grossly the infant's physiological, neurological,
adaptive capacities, and when possible, some estimation of his characteristic style of moving from one
responsive state to another.
3. A daily test period to evaluate autonomic responses7 in a highly structured situation-
recording cardiac rate by an EKG, respirations with an accordion respirometer, and EEG responses on
an Offer Polygraph, recording observed behaviour simultaneously. This is designed to test the infant's
autonomic responses within quiet states, and to observe the effect on these responses of the
presentation of a series of repeated sensory stimuli-viz., strong light, and sound. We present twenty
stimuli of each kind at one-minute intervals with a five- to fifteen-minute unstimulated period before
and after each series. The baby is quieted by lactose prior to the period of observation, is dressed,
lightly covered and lying on its side, as it is under normal conditions in the newborn nursery. Since we
are unable with our present equipment to record these parameters with a very active, thrashing baby,
our experience is confined to the quieter states, viz., the regular and irregular sleep states described by
Wolff (1959), as

well as the drowsy and alert but inactive states. This confines our results to reactions within
these states. If the baby becomes active and does not quiet spontaneously for a long period, we stop
the observation, offer him lactose and calm him before proceeding again. Other external stimuli such
as random noise, light or temperature changes, are confined to an absolute minimum. This is an effort
to test the repeated stimuli on one modality under comparable conditions.

One extremely interesting reaction of the neonate that we have observed with our repeated
stimuli is his capacity to defend himself from them after a period. This process is akin to the habituation
studies in animals by various workers such as Sharpless and Jasper (1959). In quiet, alert states, there
seems to be progressive decrease in the duration and amount of activity caused by the repetition of a
moderately disturbing stimulus, such as light or sound. The reaction caused initially decreases or is
postponed after a period, and frequently drops out entirely for the remaining period of stimulation .
Along with the decrease and/or postponement of general motor reactivity and startle, there is a gradual
decrease in respiratory change

Finally, all behavioral change, including respiratory, may cease except for irregular blinks,
often almost imperceptible, or random, spontaneous muscular activity which may not be in direct
association with the stimulus. Cardiac rate changes also decrease and may become imperceptible. Air
blast, as opposed to light and auditory stimuli, seems to be more continuously disturbing, and
habituation seems less potent in dealing with this stimulus.

The baby who was initially alert, receptive, and who is still receivingstimuli-as evidenced by
(1) blinks;
(2) effects on the EEGsuch as alerting responses, evoked potentials, and vertex responses; or
(3) an immediate active response to a different stimulus, or to a marked change in the intensity or
frequency of the original stimulus-now gives the behavioral appearance of a state which can be equated
behaviorally to a deep sleep. There is regular discharge of accumulated tension, in spontaneous startles
or movements, during the period of stimulation. These startle and startle equivalents are short-lived,
and do not seem to be directly correlated with presented stimuli. Respirations and behavior as well as
the infant's appearance and his reaction to this stimulus are equatable to what is seen in deep sleep
Even electroencephalographic changes of sleep are seen-the spindles of fast activity and high voltage
followed by slow, low voltage activity described by PeterTizzard (1959).

This state can be maintained in many babies for relatively long periods. Babies remain in this
state continuously for fifteen, even thirty minutes of an experimental period. It is disturbed by
(1) internal or external stimuli of other kinds which are intense enough to penetrate this apparent
barrier;
(2) a marked change in intensity or speed of presentation of original stimulus; or by
(3) cessation of this repeated stimulus. There is a variable period after cessation of stimulation in
which the immobile state is maintained, then the baby begins to arouse, and discharges accumulated
tension. He may become active with thrashing, reflexlike activity. If he does not change to a tense state
after a period, he rouses to the more alerted irregular kind of sleep state as described by Wolff (1959),
 with frequent startles and spontaneous movements, and is quite receptive to all stimuli with motor
reactivity as a stimulus response
. The baby shown in Figure 9 is a good example of the use and usefulness of this kind of
barrieragainst external stimulation. This baby was being given a routine EEG at a nearby institution.
Their babies were reported to produce "sleep records" despite their state of alertness prior to the test
situation.

This baby was brought in screaming just prior to a feeding. He was fed several ounces of
lactose, which did not seem to satisfy him, he was not bubbled, and he con
tinued to scream lustily. A tight elastic band to hold EEG electrodes in place was put on his
head, tight elastic to hold EKG leads on his ankle and wrists. They were tight enough in each case to
cause vascular stasis and some edema below them. Within a matter of one to two minutes, the baby's
crying ceased entirely, he assumed a rigid, flexed, restricted posture with eyes tightly closed.

He maintained this posture through a forty-minute period of stimulation-with no observed

spontaneous activity or startles, rare, whimpering, high-pitched cries, but little other perceptible
movement. The technician said, "You see, he's asleep" and pointed out to us that this EEG had a great
deal of the "episodic sleep activity" reported by Ellingson (1958) and Tizzard (1959) as associated
with spontaneous sleep in newborns. This EEG activity is also equatable in part to that seen in adult
sleep records. She used repeated strong light as a stimulus, as well as loud bangs on a metal bell. These
were often recorded on the occipital EEG as evoked potentials.

They caused a brief startle in the infant at first, who immediately returned to his original
restricted state. After the first few of each of these, he showed no behavioral changes, no respiratory
or EEG changes. After the forty-minute session, she removed the headband, the arm and leg bands.
The inert, quiet, "asleep" baby "woke up" with a piercing scream, and screamed continuously
thereafter. He did not accept the bottle again, and thrashed constantly for the many minutes that
remained. One was tremendously impressed by the ability of this infant to handle these continuous,
apparently painful stimuli. The fact that he assumed what could be mistaken for sleep-With EEG
confirmation-raises many questions as to the nature and meaning ofsleep in the newborn.

We have not yet had enough experience to do more than speculate about this mechanism of
adaptation, its usefulness and meaning as a stimulus barrier, and we have wondered about its meaning
as an Anlage of future mechanisms of defense. There is increasing literature concerning its evaluation
in animals and adults, some suggestions as to its mechanism in infants. We have wondered further
about the effects on itof
(1) medication,
(2) central-nervous-system maturity and intactness at birth,
(3) day-to-day habituation, and of
(4) learning and experience as accumulated in the first few days. We hope that there may be
patterns of responsiveness and habituation which will

show significant individual differences and lend themselves to prediction of future personality
potentials

Observation:
 The baby should be kept in continuous observation twice daily for detection of any abnormalities.
Anthropometric measurement:
Measure weight
length
 Head circumference
Chest circumference

WEIGHT:

 The average daily wt gain for healthy term babies is about 30gm/day in the first month of life
 It is about 20gm/day in second month
 10gm per day afterwards during the first year of life.LENGTH: (from top of head to the heel with
the leg fully extended)
 Average range: 18-22 inches (46-56 cm)

Head circumference:
Head circumference (repeat after molding and caput succedaneum are resolved).
Average range: 33 to 35 cm (13-14 inches) Normally, 2 cm larger than chest circumference Place tape
measure above eyebrows and stretch around fullest part of occipital at posterior fontanel.

Chest circumference
(at the nipple line): Average range: 30-33 cm (12-13 inches) Normally, 2 cm smaller than head
circumference Stretch tape measure around scapulae and over nipple line.Immunization: Newborn
should be immunized with BCG vaccine & ‘0’ dose of ‘OPV’. Hepatitis ‘B’ vaccine can be
administered at birth as first dose & other two doses in one month & 6 months of age.

Follow up & Advice: Each infant should be followed up, at least once every month for first 3
months & subsequently 3 month interval till one year of age.

HARMFUL TRADITIONAL PRACTICES FOR THE CARE OF NEONATES

o use of unclean substance such as cow dung, mud on umbilical card,

o immediate bathing,
o use of prelacteal feeds,
o application of kajal in the newborn eyes,
o instillation of oil drops into ears & nostrils,
 during bathing the baby use of unhygienic herbal water,
 use of pacifiers,
 introduction of artificial feeding with diluted milk,
 giving opium & brandy to neonates
 use of readymade expensive formula foods.

NEW BORN CARE

INTRODUCTION
At one and five minutes after birth, babies are assessed and given an Apgar score. This scoring system assesses
new born babies’ well-being using five different factors: heart rate, respiratory effort, muscle tone, reflex
ability, and colour.

Principles of care at birth

 Establishment of respiration
 Prevention of hypothermia
 Establishment of breastfeeding
 Prevention of infection
 Identification of at-risk neonates

15 Steps of New-born Baby Care Immediately after Birth

The first 24 hours of a new born baby are the most overwhelming. Your hormones are having a ride of their
own, and your emotions are all over the place. Taking care of a tiny human that looks so fragile and beautiful
is a big responsibility.

New-born Care Immediately After Birth

Immediate care of a new born following delivery is a must. There are a lot of things that go into the care of
the child when just born the breathing of the child, sleeping, baby’s first breath and more. Here are some of
the most immediate requirements that you need to take care of as soon as your baby is born.

1. Umbilical Cord Care

Through the nine months of your pregnancy, the umbilical cord was a lifeline that connected you to your baby,
providing your loved one with all the oxygen and nourishment that was needed. Once the baby is all set to
face the world, the umbilical cord is cut, as it isn’t required anymore. Cutting the umbilical cord looks and
sounds painful, but it isn’t. You’ll see that a stump of the umbilical cord remains in the navel of your child.
This stump usually falls off anywhere between a week to a month. Once it falls, the belly button of the child
might look sore – this takes a few more to heal. If you see traces of blood – calm down, it’s normal. You might
also see some yellow fluid, that’s normal too. As far as care for the umbilical cord is concerned, make sure
you keep the area dry and clean at all times. Don’t try to pull out or remove the stump off; it must fall off on
its own.

2. Breastfeeding

your child is a necessary, but challenging milestone; it can sometimes leave you frustrate, sore, and even
angry. Your milk is the best, most nutritious food that you can give to your infant, and breastfeeding your
child is great for your health as well. You can start breastfeeding your baby about an hour or two after birth.
At first, you’ll see that the milk is thick and yellowish – that’s some extremely rich, healthy milk called
colostrum. Filled with antioxidants and protein, colostrum is extremely beneficial for your baby. Make sure
you have good back support and position yourself comfortably. Most mothers bring the breast to their baby –
don’t do that. Instead, bring the baby to your breasts, so that he or she knows how to attach. A lot of women
suffer from cracked nipples and hardening of breasts, for which there are ointments available that can provide
relief

3. Baby’s First Breath

Your baby, in the womb, didn’t have to worry about breathing. However, post birth, the baby’s lungs which
were previously filled with fluid, are now filled with air. This sudden shift is bound to be difficult for a
newborn baby, so the first few breaths of your infant are usually hard, laboured, shallow and irregular. This
isn’t a cause for concern as long as the baby’s breathing steadies up and becomes normal.

A newborn baby’s breathing is usually irregular. While this is not a cause for alarm, do monitor the baby; if
you think the breathing is too noisy, consult a doctor.

4. APGAR Test

The APGAR test is the first test that the doctor will perform on your child to make sure that your baby is
normal. APGAR stands for appearance, pulse, grimace, activity and respiration. All of this is tested, and the
child is given a score accordingly. This score, which is called the APGAR score, will tell you if everything is
normal with the child or if there is a cause for concern. A score of 7 and above is considered normal, a score
of 4 to 6 is considered relatively low, while anything below 3 is claimed critically low.
If the doctor determines that the score is too low at the 5-minute mark, he/she may need to provide medical
attention immediately.

5. Weighing Your Baby

Most newborns weigh between 2 kgs to 4 kgs. The weight of your child is an indicator of how your baby is
doing, so it is imperative that you keep a tab on it. A newborn baby is bound to lose weight during the first
week post birth, as a lot of body fluid is lost during this time. However, you will see an increase in the weight
of your child after a week or so.

Adequate weight gain is important for a baby’s physical and mental development. If you feel the required gain
is not taking place, do consult a paediatrician and plan a diet which provides all the nutrients with which the
baby needs to thrive.

6. Baby’s First Poop

Your baby’s first poop is called meconium. This looks very different from faeces, but that is completely
normal. You baby, when in your womb, has ingested a lot of fluids, so the first few faecal discharges might
look different. Give it a week or two, and you’ll see that the baby’s poop is relatively normal.

If you do not see meconium pass in 24 hours, it may be because of an intestinal obstruction, and you must
consult a doctor immediately.

7. Skin-to-Skin Contact

Skin-to-skin contact is very important for your child. Throughout the pregnancy, the baby is in the comfort of
your womb, but all of a sudden during birth, this isn’t the case, and this is why skin to skin contact is necessary.
Your baby is placed naked, against your naked skin, and a blanket is wrapped around the both you and your
child. You’ll see the baby relax almost instantly. This also makes the baby familiar with you.

8. Vitamin K

Vitamin K is administered to newborn to prevent any bleeding. Vitamin K helps in clotting of blood, so should
there be any bleeding, Vitamin K can help clot this and prevent bleeding.

9. Eye Care

Your baby’s eyes are extremely delicate and sensitive. Almost within an hour after birth, the doctor will put
some eye drops to ensure that the baby’s eyes are free from any infection. Make sure you keep the baby’s eyes
clean at all times. Use a damp cloth and some clean water to wipe your baby’s eyes.
 10. Hepatitis B Vaccination

Every vaccination is important for your child, so mark the dates and make sure you get your child vaccinated.
The Hepatitis B vaccination is extremely important, as the disease is fatal.

11. Sleeping

Say goodbye to sleep after the birth of your newborn. You’ll see that newborn babies never sleep when you
want them to, and always sleep when you don’t want them to. Most of the time, their sleeping cycle will leave
you vexed and annoyed, but that is part of what motherhood is. Be patient; your child will sleep as and when
he feels like it. If your child isn’t getting enough sleep, your child is probably in distress. Check the diapers,
and see if he is hungry. Swaddling the baby and ensuring the house is calm are ways of helping your little one
sleep well.

12. Bathing

It is recommended that for the first week and a half, you give your child a sponge bath. Use a soft cloth and
some warm water and wipe your baby clean. However, you can wash your baby’s face, hands and genital area
thoroughly with warm water, especially after a change of diapers.

The reason it is recommended that you wait for a week or so before bathing your baby is for the umbilical
cord to dry. Once this has dried, it usually falls off. This is your cue to start giving your newborn baby a nice
warm bath in a tub.
A lot of people bathe their babies on a daily basis, which is alright, but three days a week is more than enough
as well. Keep in mind that your baby’s skin is extremely sensitive, and it is prone to dryness. So, excessive
bathing can dry the baby’s skin.

Make sure the water is lukewarm, warm enough to soothe your baby, but cool enough not to burn. You can
use a gentle soap that is mild enough, without the fear of causing an allergy or a negative reaction. You can
ask your doctor for a recommendation on this one.

Make sure you keep an eye on your baby at all times, as your baby can slip in the bathtub. It is extremely easy
for a baby to drown in a bathtub – less than sixty seconds is all it takes.

You don’t have to wash your baby’s hair every day; twice or thrice a week should suffice. Make sure you use
a mild shampoo.

13. Physical Examination

Like APGAR, a physical examination after birth is necessary. The doctor will examine the child, to see if your
baby is healthy.

14. Providing Warmth to Baby

Swaddling your baby is more important than you think. Keeping your baby warm helps in regulating the body
temperature. A newborn child does not have as much fat as an adult or a grown-up kid has, and this is the case
especially with premature kids as well as kids who are underweight. Make sure you wrap your child in warm
clothes, especially if the climate in your area and the environment is cold. Wipe your child dry immediately
after a bath, and make sure the baby is kept warm after this as wel

15. Circulatory & Physiological Respiratory Changes at Birth

While the baby is in the mother’s womb, the respiratory, as well as the circulatory systems, operate in a way
which is very different from the way they will function after birth. The baby is dependent on the umbilical
cord for the supply of oxygen. Circulatory modification and respiratory gas exchange take place rapidly during
the process of labour and birth so that the baby can breathe outside the womb, and the heart functions normally.

The doctor slaps the baby’s bottom at birth to help clear the airways and encourage breathing. It is important
to monitor the baby for 6 – 10 hours after birth, as several changes take place in the major organ systems in
this period.

Motherhood is beautiful, but there is no denying the fact that it is tiresome, frustrating, and sometimes scary.
Just give your baby all the love and care, and make sure you take good care of yourself too, and you are sure
to have a memorable journey

BIBLIOGRAPHY
Book references
1. Dutta. Parul. “ PEDIATRIC NURSING “, edition : 3rd edition ; publication : Jaypee brothers medical
publishers ; new delhi, 2014.
Pp : 214
 2. Marlow. Dorothy. R, Redding. Barbara. A. “ TEXTBOOK OF PEDIATRIC NURSING ―,
Edition : 6th edition; publication : Elsevier india private limited; south asia, 2013. Pp : 315

3. Sharma rimple, ―ESSENTIAL OF PEDIATRIC NURSING‖ jaypee brother medical publisher

WEB REFERANCE
https://parenting.firstcry.com/articles/immediate-care-of-your-newborn-baby/
 MANIBA BHULA NURSING COLLAGE
BARDOLI

SUB OBSTRATIC AND GYNAECOLOGY NURSING

TOPIC IMMEDIATE CARE OF NEW BORN AT BIRTH

SUBMITED TO SUBMITED BY
HIRAL MAM KINJAL TANDEL
LACTURER FYMSC NSG
MBNC MBNC
DATE:
 MANIBA BHULA NURSING COLLAGE
BARDOLI

SUB OBSTRATIC AND GYNAECOLOGY NURSING

TOPIC IMMEDIATE CARE OF NEW BORN AT BIRTH

SUBMITED TO SUBMITED BY
HIRAL MAM MANISHA RATHVA
LACTURER FYMSC NSG
MBNC MBNC
DATE:
 MANIBA BHULA NURSING COLLAGE
BARDOLI

SUB OBSTRATIC AND GYNAECOLOGY NURSING

TOPIC IMMEDIATE CARE OF NEW BORN AT BIRTH

SUBMITED TO SUBMITED BY
HIRAL MAM DIVYA PATEL
LACTURER FYMSC NSG
MBNC MBNC
DATE:
 MANIBA BHULA NURSING COLLAGE
BARDOLI

SUB OBSTRATIC AND GYNAECOLOGY NURSING

TOPIC IMMEDIATE CARE OF NEW BORN AT BIRTH

SUBMITED TO SUBMITED BY
HIRAL MAM ANKITA KHER
LACTURER FYMSC NSG
MBNC MBNC
DATE:
 MANIBA BHULA NURSING COLLAGE
BARDOLI

SUB OBSTRATIC AND GYNAECOLOGY NURSING

TOPIC

SUBMITED TO SUBMITED BY
HIRAL MAM KINJAL TANDEL
LACTURER FYMSC NSG
MBNC MBNC
 DATE:

MANIBA BHULA NURSING COLLAGE

BARDOLI

SUB OBSTRATIC AND GYNAECOLOGY NURSING

TOPIC

SUBMITED TO SUBMITED BY
HIRAL MAM MANISHA RATHVA
LACTURER FYMSC NSG
MBNC MBNC
DATE:
 MANIBA BHULA NURSING COLLAGE
BARDOLI

SUB OBSTRATIC AND GYNAECOLOGY NURSING

TOPIC

SUBMITED TO SUBMITED BY
HIRAL MAM ANKITA KHER
LACTURER FYMSC NSG
MBNC MBNC
DATE:

MANIBA BHULA NURSING COLLAGE

BARDOLI

SUB OBSTRATIC AND GYNAECOLOGY NURSING

TOPIC

SUBMITED TO SUBMITED BY
HIRAL MAM DIVYA PATEL
LACTURER FYMSC NSG
MBNC MBNC
DATE: