Introduction:

“God could not be everywhere and therefore he made mother.” (Jewish proverb)
The birth of a child is significant event in any family. A child is a precious gift, which has lot of potentials
within. The health of a growing child is always a matter of great concern, because a healthy child can
become healthy citizen in future. Most of children have not been protected over years and they remain
adaptation to the new environment, as nursing professionals it is one of our responsibilities to impart
knowledge to mothers about the minor disorders of newborn and its management. The mother’s
responsibility is to provide necessary facilities and care to the newborns and enjoy their life.

Background:
Indian statistical reports say 50% deaths occurs below 5 years. 33% of all deaths occurs below 1year. 20%
of all death occurs below 1 month. 10% of all death occurs below 1 week. Indian academy of pediatrics
reports states that approximately 22.01% newborns were affected with minor disorders. In that Physiological
jaundice is contributing 78.25%, and vomiting is 80.6%, diarrhea is 79.5% and others contributes 40%. The
minor disorders are most common in newborn, neglecting the minor health problem is the one of the factors
contributing to the newborn mortality rate. In India most the mothers are not aware of management
regarding minor disorders of newborn.

Definition:
Newborn or Neonate: From birth to till 28 days the baby is called newborn or neonate.
Minor Disorder of Newborn: Minor disorder is a physical condition in which there is a disturbance of
normal functioning.
Minor disorders of newborn:
Neonates may develop some physical or physiological problems after birth and they can be easily treated
and bears no significance. These problems are discussed here as follows:
 Ophthalmia neonatorum
 Oral thrush and perianal thrush
 Paronychia
 Omphalitis
 Neonatal mastitis
 Nasopharyngitis
 Rhinitis
 Urinary tract infection
 Vomiting
 Excessive crying in infant
 Abdominal distention
 Constipation
 Diarrhea
 Pain in infants
Feeding related problem:
 Posseting
 Gastroesophageal reflux
 Evening colic
 Breast milk jaundice
 Dehydration fever
Respiratory problem:
 Blocked nose
 Hiccups, sneezing, yawning
  Umbilical granuloma
Miscellaneous problem:
 Excessive sleepiness
 Vaginal bleeding
 Mucoid vaginal secretion
 Cradle cap
 Craniotabes
 The setting sun sign
 Obstructed nasolacrimal duct
 Physiological phimosis

 Ophthalmia neonatorum:
Ophthalmia neonatorum is defined as any purulent discharge from the eyes of an infant within 21 days of
birth. There are many possible causes of ophthalmia neonatorum including Staphylococcus albus or aureus,
E. coli, Bacillus proteus, Pseudomonas aeruginosa, Chlamydia trachomatis and Neisseria gonorrhoeae. If
Gonococcal ophthalmia is a dreaded infection because of its destructive nature. It is caused by direct contact
of eyes with infected material in the birth passage of the es mother, during the birth process.
Diagnosis: A swab must be taken from the discharge of eye, for culture and sensitivity.
Treatment: Depending on the result, the doctor will prescribe antibiotic eye drops or ointments.
Chloramphenicol is commonly used but erythromycin or gentamicin should be used for chlamydial infection
and polymyxin for P. aeruginosa.
Eye Care: The infected eye or eyes are cleaned with sterile swabs, moistened with normal saline. Each swab
must be used once only, wiping from inner canthus outward. The appropriate antibiotic drops or ointments
are instilled. This should be repeated at least 4 hourly.
Prevention: The mother should be free from gonorrhea infection. Prophylactic eye drops should be used in
suspected cases.
 Oral and Perianal Thrush:
A thrush is a fungal infection caused by Candida albicans. It is characterized by white patches on the
mucous membrane of the mouth; which may bleed if an attempt is made to wipe off.
The infection usually occurs during birth from maternal vaginal infection, or it can occur after birth through
contact with infected infants, contaminated bottle teats and contaminated hands of those who give care to the
neonates.
Perianal thrush may cause soreness of the buttocks and is secondary to oral infection. The skin is extremely
red and affected area may extend as far as the umbilicus.
Treatment: Topical application of nystatin or amphotericin cream, clotrimazole or miconazole suspension
is done as prescribed by the physician. The suspension is swabbed inside the infant's mouth three times a
day for 4-5 days.
 Omphalitis:
Omphalitis is the infection of umbilicus. It is suspected if there is any inflammation, discharge or offensive
odor from the umbilicus. There is possibility of cellulitis developing around the base of the cord and also of
spread via umbilical vein to the liver causing hepatitis and septicemia.
Treatment:
A discharge from umbilical lesion should be sent for culture, to determine the organism and its sensitivity.
On the basis of the report, antibiotics are started. Neomycin-bacitracin (Cicatrin) powder is applied locally.

 Neonatal Mastitis:
Mastitis neonatorum occurs due to squeezing of the newborn's breasts, which are enlarged due to the effect
of maternal hormones. Due to lack of inactivation of progesterone and estrogen after birth, breast
engorgement occurs in both sexes after 3-4 days of life and may last for few days.
Treatment:
- Local heat application.
- expression of milk should be avoided.
- Reassurance of parents should be done.
- If an abscess forms, incision and drainage are done and antibiotic therapy is given.

 Nasopharyngitis:
It causes snuffles in the baby. If it spreads downward in the respiratory tract, the cry becomes hoarse.
It is the infection of the respiratory tract which is usually caused by airborne organisms transmitted by
parents, visitors or staff to the baby.

Management:
1. Mother and baby should be nursed in a single room and the baby should be given extra fluid.
2. Nostrils cleaned by cotton wool soaked with normal saline and nasal spray or drops can be used.
 Rhinitis:
It is an inflammation of the mucous membrane of nose, caused by usually Staphylococcus. Nose and throat
swabs should be taken for culture and sensitivity prior to commencing the appropriate antibiotic therapy.
The nasal passage should be kept clear, if necessary, by administering ephedrine nasal drops 0.25%, as
babies are compulsive nose breathers.

 Vomiting:
Vomiting is a forcible ejection of the gastric contents.
Causes:
- Gastric irritation
- Toxic effect on vomiting center
- Reflex vomiting
- Obstruction to the digestive tract
- Metabolic disorders
- Emotional disturbances
Types of Vomitus:
Bile-stained contents are seen in:
- Distal duodenal obstruction
- Malrotation of intestines
- Intestinal obstruction
Nonbile-stained contents with nonprojectile vomiting are seen in:
- Infection
- Increased intracranial pressure Proximal duodenal atresia
- Feeding problems
- The vomiting may or may not contain bile.
- Increased intracranial tension
- There are several causes of vomiting like:
- Uremia

Management:
  The cause of vomiting should be found and appropriate treatment should be given:
 Antiemetic medications should be administered as prescribed.
 Fluid and electrolyte balance should be maintained by monitoring the intake and output.
 In case of obstruction of digestive tract, the child should not be given anything by mouth and
nasogastric aspiration may be done.
 In case of intestinal obstruction, surgery may be required.

 Excessive Crying in Infants:

Infants cry very often due to a number of reasons. If they cry due to some unusual cause, they cry with a
nonstop scream.
Causes of Cry:
 Hunger and thirst or discomfort due to soiled linen.
 Illness with intestinal colic
 Acute otitis media
 Hyperpyrexia
 Distention of abdomen
 Retention of urine
 Severe respiratory tract infection Fall or sprains
 Poliomyelitis
 Itching dermatitis
Assessment:
If children do not stop crying then medical advice is necessary. The following assessment may be done by
the physician to detect the cause of crying:
 History of bowel movements and history of micturition, sucking reflex, and feeding ability.
 History of falls
 Vital signs
 Abdominal examination, to find out any abdominal distention
 Ear, nose, and throat (ENT) examination
Care of Crying Infants:
 Find out if the baby is hungry and feed is required.
 If the infants are uncomfortable, their clothes should be changed.
 Doctor's advice or surgical opinion may be required to find out the cause. The prescribed
medications should be given and the infant should be observed.
 The infant should not be left alone.

 Abdominal Distention:
Children with periodic abdominal distension should be referred to pediatrician.
The common causes of abdominal distention in babies are:
- Constipation with ineffective peristalsis
- Complications Paralytic ileus with acute septicemia of severe gastroenteritis
- Visceral stage of poliomyelitis
- Intestinal obstruction
Associated Clinical Features:
- Children may have excessive salivation
- High fever
- Vomiting
- Refusal of feeds Visible peristalsis
- Crying with a scream
 - Increased respiration
Assessment:
- The history of passing stools and urine should be found out.
- X-ray of the abdomen may be taken.
Management:
- A flatus tube may be inserted to remove excessive gas, if present.
- An oil enema or rectal suppository may be administered. In case of obstruction, nasogastric tube
aspiration and continuous drainage may help to decompress the stomach.
- Dehydration should be treated.

 Constipation:
Prolonged straining and forceful effort at defecation with passage of hard stools is called constipation. Many
symptoms may accompany constipation such as irritability, lack of sleep, nausea, refusal of feeds,
abdominal distention, and abdominal pain.
Classification:
Constipation may be acute or chronic. If the child has had normal bowel movements before and late
develops constipation, it is known as acute constipation If constipation occurs frequently, it is called chroni
constipation.
Causes:
- It may occur due to: Lack of fluids and roughage.
- An acute constipation is seen in most of the febrile cases.
- Lack of exercise in bedridden patients.
- If the food is changed from breastfeeding to formula. Consumption of fruits like apples, banana.
- Painful conditions such as perianal abscess, fissure in anus and piles.
- Prolonged use of drugs given to control diarrhea.
- Children with polio may have constipation.
- Alteration in toilet habits.
- Surgical conditions like intestinal obstruction.
Management:
- The doctor may prescribe laxatives, suppositories or enema.
Preventive Measures:
- An adequate amount of food should be provided if the child is starved.
- Sufficient roughage should be present in diet. Encourage children to have enough fluid intake.
- Painful conditions of anus should be treated.
- Children should be encouraged to have regular toilet habits.
- During diarrhea, drugs should be given in proper dosage according to doctor's order.

 Diarrhea:
Diarrhea Change in a baby's established bowel pattern towards greater frequency and looseness should
be taken seriously. The transitional stools are passed during the third and fourth day after birth.
 These are often semi-loose, and greenish-yellow. Frequency is increased which settles spontaneously
within 24 to 48 hours.
 Many babies pass stools while being fed or soon after the feed due to exaggerated gastrocolic reflex
which may persist for a couple of weeks.
 These infants continue to gain weight satisfactorily though their mothers are often worried.
 The breastfed babies develop increased frequency of stools if the mother is taking ampicillin,
cephalosporins, tetracyclines, certain laxatives and following excessive consumption of foods with
high organic acid content such as oranges, cherries, tomatoes and chilies.
  The intake of glucose water and honey by the baby may result in diarrhea.
 The infective diarrhea is more likely to occur in bottle-fed babies. Stools are watery with mucus and
pus cells. Acute infective diarrheal illness in a newborn baby should preferably be treated with
parenteral fluid therapy and systemic antibiotics.
 Diarrhea may also occur due to overfeeding or serious underfeeding, congenital thyrotoxicosis,
maternal drug addiction, Hirschsprung's disease, metabolic disorders such as salt-losing variety of
adrenal hyperplasia, disaccharidase and enterokinase deficiency.
Management:
1. Avoid bottle feeding maintain hygiene.
2. Wash nipple after each feed.
3. Put on exclusive breastfeed.
4. Mothers who are breastfeeding might need to adjust their own diet to avoid any foods that could trigger
diarrhoea in their babies.
5. Keep the diaper changing area clean and discomfort.
 Physiological jaundice:
The jaundice usually appears on 2nd and 3rd day and disappears by 7th and 10th day, a little later in premature
neonates. In a term infant the level may be 6-8 mg/dL on 3rd day.
A rise of unconjugated serum bilirubin to 10 -12 mg/dL is in the physiological range. In a premature infant
the peak level of 12-15 mg/dL in the 1st week may be without any abnormality.
Causes of excessive bilirubin production are:
(1) Increased red cell volume per kg and increased red cell destruction due to shorter life span (90 days
compared to 120 days in adult) in the neonate;
(2) Transient decreased conjugation of bilirubin due to decreased UDPG-T activity.
(3) Increased enterohepatic circulation due to decreased gut motility and high level of intestinal ẞ
glucuronidase;
(4) Decreased hepatic excretion of bilirubin
(5) Decreased liver cell uptake of bilirubin due to decreased ligandin (transport protein).
Treatment:
No specific treatment is required. The baby is given more frequent feeds. In premature babies, careful
observation is required and evidences of rising bilirubin near critical level need exchange transfusion.
However, use of phenobarbitone or phototherapy is quite useful.
 Pain in Infants
Pain is subjective, personal and causes the sensation of discomfort. It can be classified into three types:
Peripheral pain: Peripheral pain may be superficial, intermediate or deep. It arises from skin, internal
organs, muscles, and tendons.
Central pain: It arises from CNS which is induced by trauma, obstruction in circulation or any tumor.
Psychological pain: It may occur in psychosomatic disorders. Children may suffer from headache which
may be due to anxiety and is relived when anxiety is relieved.
Approach to a Child with Pain:
Reaction to pain depends on age of the children, their previous experience with pain, memory, parental
reaction to pain, physical restraints, child's preparation for painful events and health status of the child.
History is taken. Essential components of history are:
- Time of onset of pain
- Progression of pain
 - Character of pain
- Location of pain, radiation of pain
- Child's activity (severe pain is associated with interference of daily activities.)
- Presence of other symptoms like anorexia, nausea, vomiting, diarrhea, constipation, etc.
- Presence of systemic symptoms
- Family history
Observation of child's behavior also helps to identify pain. The child may be irritable, anxious, shows
withdrawal, lack of interest in surroundings, limitation of movements, and adoption of specific position.
Management:
- Mother's presence with their children is important especially during painful state of their children.
This may help to reduce stress and minimize the discomfort of children.
- Mother's touch, soothing words and cuddling provides a sense of security and love to the child.
Prescribed analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) should be administered
- Children should be watched for side effects of non- narcotic drugs like gastric bleeding, increased
coagulation time, and metabolic changes.
- Look for the side effects of narcotic drugs like respirator depression, nausea, vomiting, and
constipation.
- Local application of soothing lotions, applications heat and cold and local anesthesia may be
prescribed for superficial or peripheral pain.

 Feeding related problem:

Posseting:
Neonates spit out milk after feeds spontaneously or after burping. It is of very small quantity and looks
similar to milk curd. It does not require any treatment.
Gastroesophageal reflux:
Neonates sometimes regurgitate large quantities of milk even after long time of feeding. Appropriate feeding
technique should be adopted. Vomiting may be there due to various organic and non- organic causes.
Identification and early treatment of underlying causes is necessary.
Evening colic:
This may occur few weeks after birth. Infant starts screaming suddenly pulling things to abdomen with
flushing of face and frowning specially in the evening. These infants cannot be consoled by feeds, cuddling
or warmth. The crying subsides spontaneously in couple of hours. It may be due to intestinal colic, which
leads to further swallowing of air and the vicious cycle continues.
Breast milk jaundice:
Babies may develop breast milk jaundice, which may last for about 3 months. Serum bilirubin, thyroid
function test are carried out to rule out the congenital hypothyroid. Breastfeeding should not be withheld in
these babies.
The activity of the enzyme-glucuronyl transferase is inhibited by a specific steroid 3α, 203-pregnanediol
and increased fatty acids of breast milk. The bilirubin level rises from the 7th day after birth to a maximum
of 20-30 mg/dL by 14th day.
Jaundice is usually mild and it takes a time (4-12 weeks) to disappear. It rarely causes kernicterus. It requires
no treatment. If the bilirubin level is more, temporary withdrawal of breastfeeding cures jaundice. Breast
milk jaundice may recur in 70% of future pregnancies. Breastfeeding jaundice is due to decreased intake of
milk that leads to increased enterohepatic circulation.
Dehydration fever:
Newborns may develop fever (temperature >39°C) with obvious signs of dehydration during second or third
day of life. It may be due to poor heat dissipation mechanism and inadequate feeding. Close monitoring of
neonate with frequent feeding, loose clothing and hydrotherapy resolves the problem. The fever is
transient and usually disappears after 24-48 hours.
  The baby remains active, alert and cries for feeds.
 The baby should be dressed with light and loose cotton clothes and his environment kept cool in
summer. The newborn babies should never by exposed to direct sunlight during the hot summer
months.
 There is no role of antipyretics in the management of this condition because the set temperature of
the thermostat in the hypothalamus is not altered.
 Hydrotherapy, adequate feeding and nursing in a cool well-ventilated room are enough to
manage such a baby.

 Respiratory Problems
Blocked nose:
Due to small nasal passages newborns develop blocked nose frequently. As newborns are nose breathers,
they feel breathing difficulty and may vomit feeds. Gentle cleaning with soft cloth after instilling saline
drops relieves discomfort.
Hiccups, sneezing, yawning:
These are the positive attributes of healthy infant. Hiccups occur due to spasmodic contraction of diaphragm
immediately after feed. These physiological body responses are common in healthy newborn babies.
Hiccups are produced by spasmodic contractions of diaphragm and are characterized by sudden, noisy and
jerky retractions of suprasternal notch and xiphi-sternal region. They usually occur immediately after a feed
due to distension of stomach and irritation of diaphragm. Sneezing occurs due to nasal irritation of various
secretions and not a sign of common cold. Sneezing occurs due to irritation of the nostrils by secretions and
should not be considered as a sign of upper respiratory infection. Yawning is common before going to sleep
or on waking up. The presence of these physiological responses should be viewed as positive attributes
of a healthy baby.
 Skin Infections:
Most skin infections in newborn babies are staphylococcal in origin. Hygiene measures, which are routine in
neonatal care can combat the spread of this organism.
Septic spots:
Isolated pustules may resolve if swabbed with a cotton wool swab soaked in chlorhexidine 0.5% in spirit. If
these pustules persist or appear in clusters, a swab should by be taken for culture and sensitivity and an
appropriate antibiotic is started.
Paronychia:
Injury to folds of skin surrounding the finger or toenails may result in infection. In the early stages, dabbing
with chlorhexidine 0.5% in spirit may be sufficient to dry up the whitlow. The baby's hand should be
enclosed in a mitten in order to prevent him from touching his eyes with it.
Pemphigus neonatorum:
This is a rare, highly contagious skin disease characterized by watery blisters. If it is suspected, a doctor
should be seen, the baby isolated and swabs taken from the lesions. Antibiotics may be given intravenously.
A very severe form of pemphigus is toxic epidermal necrolysis (Ritter's disease), which results in exfoliation
of skin over a wide area.
Pyoderma:
These are single red lesions seen on the scalp, neck, groin and axilla.
Pseudosclerema (subcutaneous fat necrosis):
These are localized areas of indurations without any over the red, stretched and no pinchable overlying skin.
It resolves spontaneously inflammation.
Acne neonatorum:
Due to transplacental passage of maternal hormones acne lesions are sometimes seen over the forehead,
nose and cheek at birth. It disappears within few days.
 Miscellaneous Problem
Excessive sleepiness:
Babies sleep most of the time during first few days after birth. They should be aroused during feeding.
-Effect of maternal sedation, septicemia or floppiness should be ruled out. Some babies may keep their eyes
closed most of the time during the first 48 hours. This should not be a cause for concern and anxiety.
During first few days of many infants go to sleep after taking only few sucks on the bottle or breast.
They should be kept aroused during feed by tickling on the soles and behind the is ears but it should not be
carried to the point of annoyance or discomfort.
Barbiturates, bromides and opium derivatives when taken by the nursing mother, may cause sleepiness in
her suckling infant.
When a baby is floppy, such as in mongolism and cretinism, there is lack of vigor and desire for feeds.
Lethargy and lack of interest in feeds in a baby, who was alert and active previously, is an important sign of
serious systemic disease and may be the sole manifestation of septicemia.
Umbilical Problems:
Umbilical granuloma: It is a small fleshy mass with persistent discharge at the base of umbilicus developed
few days after separation of cord. Application of common salt everyday till the discharge stops may shrink
the granuloma as salt is hygroscopic.
Vaginal bleeding:
Menstrual like withdrawal bleeding may occur after 3-5 days of life and last for 2-4 days. Hygiene should be
maintained.
Mucoid vaginal secretion:
Due to transplacental passage of hormones, female babies may have thin grayish white mucoid vaginal
secretions. Gentle cleaning should be advised.
Cradle cap:
It is manifested as seborrheic cap with crusting over the scalp. Coconut oil may be applied overnight
followed by shampooing with cetavalon.
Craniotabes:
It is softening of small bones that can be pressed like table tennis ball. It indicates prematurity, congenital
rickets and osteogenesis imperfect.
The setting sun sign:
Transient setting sun sign is normal in newborn. It is rolled down eyes with visible sclera.
Obstructed nasolacrimal duct:
Due to blockage of lacrimal duct, persistent tearing occurs from one or both eyes without any congestion.
This duct usually opens up within 5-6 months of life. Mother is advised to massage the lacrimal sac with
thumb and index finger during feeding or playing with infants; sometimes squeezing of epithelial debris or
syringing may be required.
Diaper dermatitis:
Prolonged use of synthetic, tight wet diapers can cause redness, indurations and excoriation in the perianal
area. Gentle cleaning, application of petroleum jelly and frequent changing of diaper help reducing the
problem.
Physiological phimosis:
In most of the male neonate’s foreskin is not retractable. Effort to retract it, should be avoided.
Conjunctivitis:
Copious discharge in the eyes may be treated with daily cleaning and application of antibiotic eye drop.

NURSES ROLE FOR PREVENTION OF NEONATAL DISOREDERS:

 Screen out high-risk babies.
 In normal delivery the nurses should check the following:
- Continuous foetal monitoring
- Careful episiotomy
 The nurses who have upper respiratory tract infection should not conduct delivery.
 Immediate care of the newborn should be given to prevent from hypothermia/infection.
 Unnecessary exposure of the baby should be prevented.
 Reassurance the parents about the common problems of neonates and its prevention.
Conclusion:
Newborn health problems are frequently found ranging from minor physical and physiological peculiarities
to the serious life-threatening illness. Minor problems should not be ignored lightly without adequate
assessment of the conditions. Early diagnosis and management of the serious problem help to overcome
lifelong disability and to reduce neonatal morbidity and mortality.
Bibliography:
1. Dutta Parul, Paediatric nursing, New Delhi; Jaypee brother’s medical publishers(P) Ltd 3rd edition
2009.
2. Dutta DC, Textbook of Obstetric, New Delhi; Jaypee brother’s medical publishers(P) Ltd 10th
edition 2023, page – 550-551.
3. Pal Panchali, Textbook of paediatric nursing; CBS publishers and distributors (P) Pvt Ltd. 2nd
edition, 2021.