3.1 THE BABY'S HYGIENE 3.2 DRESSING THE BABY 3.3 BREAST FEEDING 3.4 ARTIFICIAL NURSING 3.5 MIXED NURSING 3.6 DIGESTIVE PROBLEMS OF THE NURSLING 3.7 THE SLEEP OF THE NEWBORN

The bath

Bathing the baby constitutes a moment of contact, fondness, kisses and amusement, besides guaranteeing the baby's well-being and health.

In this activity first time mothers usually feel inexperienced, but in little time they will handle it well and use loving words and affective expressions that the baby is charmed to receive.

The newborn enjoys his bath, let us not forget that he has lived during nine months in the aquatic means of the uterus.

In the first hour after being born, the baby receives his first bath in the hospital. In some centers they allow the father to be present in those moments if he has attended the childbirth.

Once at home, it is advisable to bathe the baby daily even if the umbilical cord has not healed yet.

There is no specific time for the bath but it is necessary to avoid the moments after the taking because he could regurgitate the milk, it would not be pleasant for the baby if he is given a bath when he is hungry or uncomfortable. It is convenient that the schedule of the bath remains regular to help the baby to have a point of reference that provides him with a feeling of security.

The bathroom or the room selected for this activity should be warm, between 22º C and 25º C, without drafts of air and with space to have at hand all the necessary things.

Before taking the baby from the cradle it is necessary to have everything ready, for the bath and for after the bath, because we should not leave the baby alone for even a second under any circumstance.

We should fill the bathtub with lukewarm water, around 37º C, we should check the temperature with a bath thermometer, with the back of the hand or with the elbow.

When undressing the baby in the dressing area, we should clean his buttocks before putting him in the water, to avoid getting it dirty. To clean this area you can use a wet towel and after, some lukewarm water and mild soap.

Still in the dressing area, the baby's body is lathered with a wet mitten, mainly in the skin folds and the genitals. The head is also lathered to avoid that scabs appear due to the secretion of fat. It is not necessary to be worried when we lather the area of the fontanelles because, although it is not ossified, it is resistant. If they are scabs we can put on almond oils at night and wash the baby's head in the morning, this way they will come off.

Once we have lathered the whole body, the mother or the father places the arm under the baby's armpit, so that he rests his head on the forearm, and with the hand we hold the baby's shoulder to place him little by little in the water, trying that the water doesn't go in his fragile eyes. In the water we rotate him holding him below the chest to cleanse the buttocks and the back.

When the baby is more used to the bath, we can place him in the water first and then lather him.

To leave the bathroom, the mother or the father should make sure that the hands don't have any soap that may make the baby makes baby when holding him. When leaving he is immediately covered because he cools down very quickly and next we dry off the different parts of the body giving soft touches with the towel, without rubbing, from the head down, giving special attention to some delicate areas.

The anus

The baby's genital organs require special cares because they can be irritated causing nuisances to the baby.

Apart from the toilet of the bathroom, the change of diapers will be a daily activity for the parents. In the first months the baby defecates often, even more if he is breastfed, and it is necessary to frequently change him because his skin is very delicate and it can be irritated when being in contact with the urine and the faeces.

The diaper should be changed when the baby wakes up, we should check if it is dry and clean before each taking and review the state of the diaper regularly, mainly if the baby is annoyed.

The wet towels are more hygienic and when sponges are used it is necessary to sterilize them frequently. It is not advisable to put talcum powders, although the grandmothers suggest it, and it is necessary to choose the diapers according to the baby's characteristics.

The change of diapers is a suitable moment to strengthen the affective bonds: to play with the baby, to caress him, to speak to him with sweetness or to tickle him, this time offers him the security that his parents love him.

Cleaning the girl's genital area.

The vulva is an area of secretions and it is necessary to carry out a meticulous cleaning.

If there are depositions, they are wiped off from the abdomen and the thighs with a wet towel or a sponge, and after we clean the genitals from the front to the back so that the germs of the anus don't reach the vagina. The labia are cleaned without rubbing and then we move on to the buttocks and the back part of the thighs holding the baby by the ankles to lift the back side smoothly. With a soft towel we dry off the skin and mainly the folds. Then we can apply a protecting cream in the external area of the genitals, taking care that no remains enter in the vagina.

Cleaning the genital area of the boy.

The steps to follow are similar to the girls' with some small changes.

When the boys urinate they usually stain the gut, the thighs and the buttocks, so it is necessary to extend the cleaning to these areas. It is necessary to wash him from the thighs toward the penis paying special attention to the folds and the surroundings of the testicles. We can softly move the foreskin that is the skin that covers the glans, and return it to its place after cleaning the area, but if the skin doesn't give, it is not necessary to insist since, at the moment, there is not infection risk in the event of phimosis.

After drying the skin we can apply protecting cream on the testicles, the anus and the penis, but only on the outside. It is important to watch that there is no reddening, inflammation or abnormal heat.

Cleaning the face

At first, we can clean the baby's face and neck with lukewarm water, previously boiled or bottled water to avoid germs and other substances.

With a sterile gauze soaked in the water or in physiologic serum we can cleanse the area of the eye from the lachrymal towards the outside, using a different gauze for each eye.

To clean the ears we can use a small stick for each ear, wetting it in boiled water or in physiologic serum, taking care not to injure the baby's ear, to avoid it we turn his head towards one side and, holding him gently, we pass the small stick over all the folds, including the back part of the ear. We should clean the external part because when introducing the small stick in the ear the wax is pushed towards the eardrum with the risk of forming a plug.

The baby's nose doesn't usually require specific care because it already has the hairiness that repel the dirt toward the nose holes provoking sneezing until they are expelled. We can clean the dry small mucosities on the border of the nose holes with a small cane impregnated in physiologic serum without introducing it too much.

Throughout the first two months it is not necessary to cut the baby's fingernails because they are very fine and the skin of the fingers could be damaged, but we should watch that he does not scratch his face when the fingernails are very long, although they usually break alone. After this time, we can cut them with rounded tip scissors, without leaving them too short.

The umbilical cord

Right after being born, the midwife clips and cuts the umbilical cord to a couple of centimeters of the baby's body. The small portion that is in the navel is taken out progressively until it comes off spontaneously in the first two weeks of life.

Until the cord remains fall off, the parents should carry out several cures daily to guarantee that there is no infection. If we observe reddening, suppuration, inflammation, unpleasant scent, or if it doesn't come off after 15 days, it is necessary to go to the pediatrician.

The cares of the cord can be carried out when changing the diaper and after the bath, making sure that the area is dry and they are no remains of humidity. In the hospital they will indicate the parents the steps to follow, and although they can vary the orientations, in general, are:

• We wash the cord and the surrounding area with a sterile gauze soaked in boiled water and mild soap. With another gauze we dry it off touching carefully.

• Some doctors recommend applying 60º alcohol with a small cane or an antiseptic product.

• We should leave a while the gut uncovered, so that it dries off totally.

• Some professionals recommend to cover the end of the cord with a sterile gauze and to hold the dressing with special tape. Others advise to leave the clip free, without any dressing.

• Lastly, the diaper is placed folding the top part so that it is below the cord and we can then dress the baby.

SELF CHECK QUIZ
SECTION 2 - BLOCK 3	CHAPTER 1	Date:
1. The baby should not be placed in the water until the clip of the umbilical cord falls off. T r F r
2. The genital area of the girl is cleaned differently from the boy's.   T r F r
3. We should not apply protecting cream on the testicles and penis of the baby because the remains can create infections. T r F r
4. In the hygiene of the baby's eyes, we should use a different sterile gauze for each eye. T r F r
5. We have to keep the area surrounding the umbilical cord damp with boiled water. T r F r

 

After the bath, of the careful toilet of the delicate areas and of the cure of the umbilical cord, comes the moment to dress the baby.

The dressing table is the most comfortable place to change his clothes or to dress him after the bath, until the year and half of age approximately .

We can choose anyone of those available in the market but keeping in mind that it should be solid and stable. It is preferable that the mattress lacks rigid borders that it can be easily cleaned and is not over the 12 or 15 centimeters of height. To guarantee the security, it is better to place the dressing table next to the wall so that there is less risk than the baby can turn over and fall.

We can choose a warm corner, without drafts of air, and to have always handy everything that we will use because, once we set down the baby, we should not go away from him for any reason; if at any time the adult needs to turn around, he can do so while grabbing the baby with his hand.

If we use a folding dressing table, when opening it we should always verify the locks to prevent it from folding when we are dressing the baby.

The baby's clothes. It is not good to accumulate too many clothes because the newborn grows quickly and the clothes will soon be small. It is better to buy clothes for three or four months and to later purchase for a similar period, this way it is easier to calculate the size and the necessary number of garments.

Another factor to keep in mind is the air temperature because, besides being cold, the baby can also be hot.

The garments should be practical and ample so that they allow to change the baby with easiness and that he is comfortable. The one piece suits or night wears are better because they have automatic buttons, Velcro or pressing buttons and they are opened in the chest and the legs. The under garments of one piece allow to cover the baby's belly without the underwear going up under the exterior clothing. While the baby is small, it is important to avoid the garments that are put on over the head.

The skin of the newborn is very sensitive, for that reason, it is not only necessary to take care of the composition of the products for his personal hygiene, it is indispensable to take care that the clothes that are in contact with his skin are made with a hundred per cent natural fabrics to facilitate the perspiration and to avoid irritations. The baby's clothes will always be washed with non aggressive products and will dry off outdoors, if possible exposed in the sun.

To whiten the baby's clothes without using bleach, some mothers soak the garments, during some hours, in a bowl with milk, washing them later with abundant water.

Mohair clothes can be dangerous if the baby swallows some of hair of the garment. Neither they are safe the small buttons that can come off, the safety pins that can open up or ribbons and knots that could coil around the baby's neck.

Steps to follow

So that the baby does not catch cold, first we put on the T-shirt or the bodysuit without adjusting the lower part.

If we are going to put on a garment that opens on the same side as the exterior sweater, we can place the garment or T-shirt inside the sweater and this way we only have to move the arms through the sleeves once. To carry out this action it is better to pick up the sleeve, while we grab with a hand the baby's fist and we introduce the folded up sleeve while with the other hand the adult slips the garment smoothly towards the armpit.

Next we put on the diaper following some simple steps.

1. We place the baby face up.

2. We grab the ankles gently, lift the buttocks and slip half of the diaper underneath.

3. We pass the other half between the legs. If the navel is not healed, we fold the part of up of the diaper so that it is below the clip.

•  We fix the two sides of the diaper with the adhesive tapes so that it is adjusted but does not press in excess.

Once we have put on the diaper, we pull the body suit down, we lift the baby's buttocks and, passing the body suit over the diaper, we buckle up the automatic buttons.

To put on the pants we follow the same procedure as with the sleeves of the sweater, a leg is picked up and, once the foot is in, we pull softly the garment towards the groin, repeating the action with the other leg.

When we are using a one piece suit opened in the front, first we introduce the legs, then we lift the baby up a little pulling the suit up and then we introduce the arms in the sleeves.

SELF CHECK QUIZ
SECTION 2 - BLOCK 3	CHAPTER 2	Date:
1. When we use a folding dressing table, we have to verify the locks to prevent it from folding when the baby is placed on it. T r F r
2. We have to plan ahead and buy the clothes for the baby's first year before he is born. T r F r
3. One piece undergarments are more comfortable for the baby. T r F r
4. The baby's clothes will always be washed with non aggressive products and will be hung out to dry. T r F r
5. We should avoid small buttons that can become loose. It is better to use safety pins or ribbons. T r F r

 

Feeding is a vital function in the baby's development and growth, for that reason it is usually one of the first concerns of the parents.

The baby's growth is very quick in the first months and his organism doesn't still have any body reserves; for that reason it is necessary that the feeding gives him all the nutritious substances that he requires.

For the baby the feeding time is very pleasant, it satisfies a pressing need, but it also provides a series of sensations that provide him with total well-being. In the mother's arms, he perceives her corporal scent and the sounds of the heart that he finds familiar, he can see her loving face while he listens to tender words of acceptance and affection, he smells and savors the milk that makes him feel well and he discovers an entire world of new sensations when touching his mother's skin and clothes.

To breastfeed the baby means to offer him live food that covers all his nutritious needs and protects him of possible infections and allergies.

Organizations such as the WHO or UNICEF promote nursing around the world because the different investigations that have been carried out confirm the enormous benefits that it contributes, among which we can highlight the following ones:

•  It protects the baby from intestinal, breathing and ear infections until his immunologic system takes charge of this protection.

• It adapts to the baby's nutritious needs and to his digestive system.

• It has the ideal temperature at any time.

• It remains aseptic and it provides the baby with antibodies that will reduce the risk of allergies and intolerances. When the baby suffers some type of allergy, nursing diminishes its seriousness.

The colostrum is the first milk that the breast segregates. This thick, sweet and yellowish liquid is very rich in immunoglobulin and it appears during the first three or four days after giving birth.

The hormones . When the placenta is expelled, the production of estrogens and progesterone diminishes drastically and the mother's body increases the levels of prolactin and oxitocyn.

The prolactin is the hormone responsible for the production of milk and the oxitocyn is in charge of making the liquid come out of the breast.

When the baby sucks, he stimulates the nervous endings of the nipple that send signs to the hypothalamus so that the pituitary gland of the brain releases prolactin. This hormone transfers signs to the alveolus of the breasts in charge of producing the milk. Through the blood comes the oxitocyn that provokes the muscular contraction around the alveolus forcing them to send the milk through the galactophorus ducts to the lactiferous breasts where the baby sucks and obtains the milk.

Maternal milk adapts to the baby's needs throughout each taking. At the beginning it contains more water and lactose and, little by little it thickens, increasing the quantity of fatty substances. If the baby only takes the initial milk, it goes quickly through the intestine and all the nutrients are not absorbed, for that reason it is necessary to wait until one breast empties before changing to the other one. One notices that the breast has emptied when it is not tense, it can empty in about 10 to 20 minutes, according to the suction intensity.

The milk has a different composition in each woman, even the milk of one woman changes its components from one day to the other and during the same day. For example, the fatty content is lower during the night and it increases during the day.

The best thing that the mother can do to guarantee the production of milk it is to make sure that her breasts empty regularly. The milk contains a chemical substance that acts as an inhibitor and, when the milk stays too long in the breast, it provokes a decrease in the production.

There is not a fixed period of time for each breast because each baby sucks in with different intensity. In general, the first day after the childbirth he usually sucks 5 minutes of each breast and the second day he doubles this time. The secretion of milk is not completely regular until after 15 days, so it is better that he suckles of both. Later on, it is possible that he is satiated with one breast and it will be necessary to offer him the other one in the following taking.

At the beginning the baby has short periods of sleep and he usually wakes up being hungry, both by day and at night. It is advisable to space the takings with a minimum of two hours because in a shorter period there is no time to digest the milk and to be hungry again.

The frequency of the takings is marked by the baby and the best thing is to give him the breast when he requests it, this way the feeding adapts to the baby's needs respecting his personal rhythm and his sleep periods.

During the first month he usually makes from 6 to 8 takings a day. As time goes by, they diminish down to 5, and later to 4 daily. It is important to try to have him ingest more quantity at the end of the afternoon so that we can also increase the hours between takings at night. When the baby weights 5 or 6 kilos he can go 6 to 7 hours without taking food because he will already have body reserves. With four months he can sleep the whole night and make four or five takings during the day.

The breastfeeding process

The newly born one has a series of reflexes that help him to best adapt to his new environment. One of these reflexes is that of suction, for that reason the baby sucks as soon as he notices any close touch on his lips. But although he has this reflex, he doesn't eat correctly because he swallows air, lets go of the nipple from time to time without wanting it and leaves milk in the corners of the lips. For this reason it is indispensable to follow some minimum rules so that the nursling eats in an appropriate and pleasant way.

Before beginning the taking we should get ready all that we are going to use and place it near us. The hygiene of the hands and the nipples are indispensable and, if the mother suspects that she can catch a cold, she should wear a handkerchief or mask on her mouth.

It is advisable that the mother rests a while before giving the breast to the baby because any edginess contributes to reduce the production of milk.

It is necessary to avoid that something or somebody interrupts during the breastfeeding that if it is possible should always be carried out in the same place, in a calm and quiet atmosphere. The posture should be comfortable for the mother and for the baby, so that he can easily reach the nipple.

The mother can sit down on the bed or a low seat, with the back straight and the arm that holds the baby supported on some cushions. The feet can be placed on a low stool and she should place another cushion on the knees so that the baby is comfortable.

Once sitting, the mother holds the baby in her lap so that the mouth is to the height of the nipple and the head is on her forearm. It is necessary to offer the nipple to the baby without hurries, when the mother touches his cheek he will turn with his open mouth willing to begin the suction.

The baby should embrace with his mouth the nipple and great part of the areola so that the suction is correct. The mother can hold the breast placing the thumb above the breast and the rest of fingers under it, but without touching the areola. With this posture she provides the space between her breast and the baby's nose so that the baby can breathe normally and the exit of the milk is facilitated.

At the beginning of the taking the baby suckles in a regular and continuous way, with short and quick suctions. As he gets satiated, his suctions become more lingering and slower. In occasions he pauses, but it doesn't mean that he has finished, we can use these pauses to help him expel the air. When he feels satisfied, besides stopping the suction, he will withdraw his mouth of the breast.

HOW TO HELP THE BABY TO EXPEL AIR After the taking, or during it, we have to help the baby to expel any air he has ingested. Newborn: we should place his face on our shoulder while we gently rub his back or pat him on the back. After three months: Keep him seated and well held while leaning to the front and while we rub softly his back. Place the baby on the adult's lap with the arm under his chest and the hand under the abdomen while we rub his back or pat him softly on the back

The baby's appetite varies from one taking to the other, but this should not worry the parents, he takes what needs. It is not necessary to weigh him after each taking, once he recovers the weight at birth, during the first month he will gain between 100 and 150 grams per week and about 150 and 200 weekly grams the three following months.

The nursing should begin as soon as possible, if there is the possibility, the best moment it is in the delivery room even if epidural anesthesia has been applied.

The later the breastfeeding begins, the more difficult it will be for the baby to get used to the breast but, even if the feeding is delayed for a few days, the colostrum won't get lost and the baby will be able to suckle with success.

At the beginning of the nursing it is not advisable to use baby bottles and pacifiers because they confuse the newborn. Some babies suckle well although they use them but in many cases the small ones may have difficulties with the nursing when they are given a pacifier or baby bottle.

The breasts during this period

The mother's body gets ready for the nursing throughout the pregnancy and, when she decides to give breast, she should also get ready for the nursing.

During the last month of pregnancy it is important to moisturize and to nurture the skin of the nipples and the aureola and to massage the breast to get them used to the stimulation that they will receive throughout the nursing. The massage should be in circles, soft at the beginning and progressively more intense until a small colostrum secretion takes place.

When the nursing has already begun, the care of the breasts should continue. The skin of the nipple and the aureola should be nurtured and moisturized after the shower and, if needed, between takings. Using an unscented cream that won't bother the baby because the skin absorbs it quickly, however, when washing the area before the taking any remains left should be eliminated. Before the baby suckles, the mother can massage in a circular way the top part of the chest and pull the nipple so that it stands out, mainly when the nipples are very sensitive.

The collection of milk

If the mother has a lot of milk and she needs to avoid that the breast is filled excessively or to empty part of the breast because the baby has not suckled well, she can use protective disks to collect or to extract the milk regularly and to keep it in the refrigerator up to 24 hours in a sterilized baby bottle.

• The protective disks can be used when the milk goes up between takings. They can also be left on to collect the milk when it spurts spontaneously.

It is necessary to clean and sterilize the disks just after using them and the milk should not remain in them more than 30 minutes.

To obtain and to collect the milk with a manual or electric pump is an appropriate measure when the baby doesn't suckle correctly or when he is hospitalized because he is premature or another problem that impedes him from taking the breast normally.

The collectors stimulate the ascent of the milk and they favor the continuity of the production. The collection in the sterilized baby bottle should be made following rigorous hygienic conditions.

Possible complications

•  Aching nipples

The nipples usually ache frequently, these nuisances can appear in the first days or after the second or third week.

In general, this is because the posture adopted during the takings is not the correct one. The nipple should be centered in the baby's mouth so that it occupies, besides the nipple, great part of the aureola. If the suction is too quick, one can make it slower holding the baby's chin smoothly. Also to avoid the aggressive suction at the beginning of the taking, the mother can extract some milk before beginning.

The hypersensitivity of the nipples usually diminishes as the baby learns how to suckle correctly, nevertheless, it is important that the nipples stay clean and dry besides using some lanolin cream with vitamins A and D.

•  Cracks

As in the previous case, they are usually due to the baby's bad posture when he only catches the tip of the nipple and suctions without taking any milk irritating the skin. When the irritation is strong, the nipples crack and they begin to bleed, which requires a suspension of the nursing until they close. In the meantime the mother can extract the milk every three hours and offer it to the baby in a baby bottle.

It is necessary to maintain total hygiene in the area, to dry the injuries well and to apply moisturizing cream, vitamin E in oil or some cream that the doctor recommends.

•  Flat nipple

When the nipples are sunken down, the baby has difficulty in suckling efficiently, but we should not give up on breastfeeding because the nipple helps in this process but is not indispensable to breast feed.

Normally, the doctor will recommend specific exercises during the pregnancy before giving breast to prepare the nipples. When the nursing has begun, the massages are indispensable and the use of silicon nipple covers may assist in the suckling.

• Infection by sores

It can happen that in the baby's mouth there is a fungus called Candida albicans is located that produces an infection or sore causing reddening, flaking and ache in the nipples.

The origin of these nuisances is proven if the baby has white stains inside the mouth, mainly in the tongue or the gums. It is indispensable to maintain the nipples dry and to ask the doctor to prescribes some antifungal cream. Some homemade remedy, as applying natural yogurt, alleviates the problem because it contains bacteria that combats this fungus.

• Mastitis

It is an infection of the breasts and it requires the consultation with the doctor so that he prescribes an antibiotic. This infection provokes reddening, pain and hypersensitivity of the area, it also causes high fever, muscular pains and even nauseas and vomits.

Unless the doctor indicates it so for some complication, it is not necessary to interrupt the nursing because the problem is located in the breast without affecting the milk.

• Obstructed conduits

This problem occurs when one or several conduits are blocked and they don't let the milk to go through. A hard and painful bump can appear that is noticed when touching.

The mother has to avoid the retention of milk giving breast frequently and beginning the taking with the aching breast. When there is a longer time between takings, she can extract the milk to empty the breast. It is advisable to apply humid heat and to massage the breast softly before beginning the taking.

• Lymphangitis

It is an inflammation of the mammary glands that provokes the appearance of a red and painful area in the breast that is quite tense.

It usually produces fever and it requires a medical consultation so that he prescribes a treatment. The baby can continue suckling of the other breast during the 3 or 4 days that the problem usually lasts.

Basic norms for breastfeeding

So that the nursing is successful in the short and medium term, it is indispensable that the mother follows some basic norms:

? To maintain a healthy, balanced and complete diet, rich in vitamins and minerals.

? To rest and to sleep as necessary, avoiding stressing situations.

? To take liquids, mainly water.

? To avoid tobacco, alcohol, caffeine and other harmful substances for the baby and the mother.

? To consult to the doctor before taking a medication.

The mother's diet during the nursing should be very similar to that of the last months of pregnancy, including a larger amount of milk products that are easy to digest.

She should eat three main meals plus a mid morning and a mid afternoon snack.

Eggs, meat and fish supply proteins, the fruit and the greens mainly provide vitamins and mineral salts and the starches supply vitamin B.

In each meal she can eat fruit without abusing of the citrics, plums, pineapple, etc., as they can have laxative effects.

It is good to take liquids (milk, teas, natural juices, etc.) mainly water to facilitate the nursing, to calm the thirst and to eliminate the sensation of dryness in the mouth.

In the first weeks of nursing it is necessary to moderate the consumption of some foods such as vegetables, peas or cabbages because they can hinder the baby's digestion.

The flavor of foods such as leek, garlic, onion, celery, pepper or asparagus passes on to the milk and it can displease the baby. In many occasions, the gases or the too liquid faeces of the baby are corrected by diminishing the quantity of salads, of vegetables, of juices and fruits in the mother's diet.

After the first weeks, the mother's diet can contain all type of foods, trying to moderate the consumption of those mentioned previously.

The mother, in no case, should take medications without a medical prescription. Tranquilizers, sleeping pills, pain relievers or laxatives pass their effects to the milk and they harm the baby.

Also alcohol and noxious substances of tobacco, coffee or tea provoke in the baby from colic or excitability to breathing difficulties and other alterations in his health.

Nursing after a Caesarean operation

Although it has been necessary to carry out a Caesarean operation, the mother can breastfeed the baby as soon as her general evolution allows it. The sooner she begins, the more the mother and the baby will benefit.

The doctor will inform the mother of the effects of the sedatives in the baby. Many pediatricians, even the American Academy of Pediatrics, recommend the nursing from the first moment because the benefits are bigger than the effects of these substances that are usually limited to a possible state of drowsiness.

In the event of Caesarean operation the position during the taking should vary because the weight and the baby's movements can bother the mother.

The mother can choose one of these postures:

? To sit down with a big pillow in the lap and to place on it the baby.

? Lying on the bed so that the baby's legs don't press in the area of the incision.

? Placing the baby on a pillow so that the head is on the mother's lap and the legs under her armpit towards her back.

Weaning the baby

There are mothers that make the decision of not giving breast to their babies, in these cases the doctor administers a medicine shortly after of the childbirth to interrupt the production of milk.

However the most frequent thing is that the maternal nursing is suppressed in a progressive way by adding a feeding with the help of adapted milk in a baby bottle.

To begin the weaning, the first step should be to help the baby to get used to the contact of the bottle nipple and the suction that it is different to that of the breast, besides adapting to the flavor of the artificial milk. We will do this at a time when the baby is in good health, and the baby bottles will supplement the taking of the breast substituting them little by little. The last takings to suppress will be that of the morning because the breasts are full with milk and that of the night because it is necessary to empty them.

The father's collaboration in the weaning process is very important since he can take charge of giving the adapted milk and to serve as an affective support for the mother and the baby that will go through a difficult separation for both.

The choice of the moment for weaning belongs to the mother and all the reasons that move her to make the decision are valid.

The pediatrician will guide the parents on the adapted milk to use and the steps to follow in terms of the baby's evolution.

The doctor can also prescribe the mother a medicine to reduce the production of milk, besides recommending the reduction of liquids in her diet.

SELF CHECK QUIZ
SECTION 2 - BLOCK 3	CHAPTER 3	Date:
1. The maternal milk is a live food because it contains germs that have not been included in adapted milks. T r F r
2. Maternal milk changes its composition during the day and even during a taking. T r F r
3. The more the baby suckles, the more he stimulates the inhibition of milk production. T r F r
4. After gaining some weight, the baby usually gains between 100 and 150 grams every week during the first month. T r F r
5. Many nursing failures are due to a bad posture during breastfeeding. T r F r
6. The mother should pay special care to her breasts during the pregnancy and after the childbirth. T r F r
7. The maternal milk can be collected with disks or a manual or electric pump. T r F r
8. While the baby is being breastfed, the mother should avoid smoking and drinking coffee, alcohol and other liquids. T r F r
9. It is necessary that the mother eats well during the whole nursing period. T r F r
10. After a Cesarean, nursing should start when the tissue has healed because the baby's weight can open the wound. T r F r
11. If the parents want to wean the baby before the third month, it is best to give him adapted milk since he is born. T r F r

 

Nowadays, artificial nursing is safe option for the baby's feeding since all the adapted formulas cover his nutritional necessities because they have a similar composition.

The mother can also transmit all her love when she feeds the baby with a baby bottle because the truly important thing is the attitude that she maintains in those moments, the affective expressions of her face, the loving looks and the affectionate words. If the baby is not distracted and he stops suckling, this is the best moment to speak to him, to sing softly to him, to caress him, to give him kisses and to cuddle him up.

Even if the mother opts to use a baby bottle from the beginning, it is very important that she considers the possibility to breastfeed the baby the first days to offer him the colostrum that, as has been explained before, besides the necessary nutrients, contains immunoglobulin to protect the baby until his immunologic system matures enough. At the present time, in spite of the constants advances in baby feeding, no laboratory has been able to include at least partly in the milk artificial antibodies that could substitute those offered by the colostrum.

The adapted formula milk

These milks are obtained starting from the cow milk and modifying it until getting a composition that is the most approximate thing possible to maternal milk.

The pediatrician is the most expert person to be able to recommend the most suitable milk for the baby at all times and she will advise a change of product if the factors of growth don't progress as expected or if the baby doesn't tolerate it.

The pediatrician also establishes the quantity of mixture to prepare the baby bottle and the number of takings in terms of the baby's characteristics and the evolution of his growth.

 Special milks

When problems come up, the pediatrician can recommend the use of a type of special milk of adapted formula. The most habitual cases are the following ones:

• Formula for premature babies.

In the event of premature birth, the maternal milk continues to be the best food. But if it is not possible because the mother produces an insufficient quantity or some problem arises, there is an adapted milk of special formula, richer in glucose and with less quantity of lactose than the normal ones. Also the content in vitamins is higher, but the pediatricians usually recommend also vitamins and iron supplements.

• Allergy to the proteins of the cow milk.

For these cases there is milk of vegetable origin, for example soy, although it is necessary to watch for any allergy symptoms to soy.

• Metabolic illnesses.

When the baby's metabolism suffers some congenital defect it lacks the enzymes in charge of metabolizing some essential nutrients. Depending on the problem, the pediatrician indicates the special formula for each case.

• Diarrheas.

After the baby has suffered a diarrhea, the pediatrician recommends a formula without lactose because the intestinal mucous cannot digest this substance during a time due to the inflammation that it has suffered.

Sterilizing the baby bottles

At least until the baby is 8 or 9 months old, we should follow some strict sterilization norms to avoid the proliferation of bacteria that could cause serious illnesses for the newborn such as gastroenteritis and other digestive dysfunctions for the nursling of a few months of age.

When we are going to sterilize the bottles, the first thing we should do is wash our hands with water and soap and later, with the same ingredients, wash the baby bottle, the nipple, the thread, the lids and all the elements that will be in contact with the milk and the baby. We should use special brushes that are sold for this purpose and turn upside down the nipple to clean it in depth. Once clean and rinsed all the elements, we proceed to the sterilization.

Nowadays, some pediatricians consider it is enough to carry to an extreme the hygiene without having to sterilize the bottle. Our advice is to follow this process until the baby is 6 or 8 months old because it doesn't require too much effort and it allows the parents to be calm in this respect.

 

We can sterilize in the morning the baby bottles that we will use during the day, keeping them in the sterilizer or keeping them in the refrigerator, never on the counter, where they could receive germs. If a single baby bottle is used, it is necessary to proceed to wash it and sterilize it before each taking.

If the formula is mixed in the baby bottle and we want to maintain it so for some time before giving it to the baby, it is necessary to keep the baby bottle in the refrigerator. If the milk is kept in a thermos, the bacteria could proliferate in it.

When we plan to spend the day outside of the house, it is better to take bottled water with low mineral contents and to mix the formula right before the taking. If the prepared baby bottle is taken, it will be necessary to keep it in a refrigerator or a thermos bag with some ice. We can also use the formula milk sold in tetra-bricks.

How to give the bottle

Just as with maternal feeding, the comfort and the mother's or the father's serenity is important so that the taking is carried out successfully.

- It is necessary to look for a calm and comfortable place, using some cushions as support, with the baby's back on the adult's forearm and his head in the gap formed by the elbow, with the baby leaning slightly to the back and looking towards the father or the mother.

We should bring the bottle's nipple close to the baby without putting it in the baby's mouth. We should not expect that he will immediately begins to suckle, especially in the first takings. We can touch the baby's cheek with the nipple so that the suction reflection makes him turn towards it and open his mouth.

When the nipple is in the mouth, the adult will incline the baby bottle to guarantee that the milk comes without swallowing air. If the baby bottle leans too much it can make the baby choke.

If we wants to ensure that the flow of the milk is the appropriate one for the baby, a we can used a baby bottle with three different speeds and regulate the base of the nipple according to the baby's suction. There are also in the market nipples with adjustable holes that allow a bigger or smaller exit of milk according to the position in which we administer the milk.

Of the wide range of nipples in the market, we will have to choose the model that is more comfortable for the baby.

The silicone nipples endure high temperatures and the chemical solutions used in sterilization well. They are appropriate for the first months, but when the baby has teeth, he can bite and tear the nipple, so it is better to substitute it for another of different composition because he could swallow a torn piece.

The rubber nipples are softer but they do not endure the sterilization process well and it is necessary to change them often.

There are also special nipples for premature babies that should not be used with the babies born to term because they are very fine and they could break up with a forceful suckling.

If the baby suckles too quickly we should interrupt him so that he doesn't choke. It is also not advisable that he keeps the nipple in his mouth if he falls asleep.Each baby has his own suction rhythm, for that reason the time that they take for the taking varies from some babies to others.

If the baby lets go of the baby bottle during the taking it can be because he has swallowed air and he needs to expel him, to help him we should observe the same indications than for the maternal nursing: to place the baby upright on the adult's shoulder while we gently rub his back, to sit him down on our lap with a hand holding the head while the other one rubs his back or to place him face down on the adult's knees holding him with an arm for the chest and the abdomen while with the other hand we rub his back or give him soft pats.

We should not force the baby to finish the baby bottle if he is not hungry, there are more obese boys and girls that were raised with baby formula than with maternal milk. The milk that the baby has not used in a taking should be thrown and never kept to be reheated later.

When it seems that the baby is still hungry after completing the taking it is necessary to comment it with the pediatrician so that he recommends the changes that should be made in his feeding.

If the baby has snots it will be difficult for him to breathe and to swallow the milk. In this case it is necessary to use physiologic serum or some saline solution recommended by the pediatrician and to extract the mucosity with a pear before beginning the taking.

The preparation of the baby bottle.

•  The first step consists on washing the hands with water and soap, also the baby bottle, the thread, the nipple and the lid. We then sterilize all the elements.

•  We boil the water to prepare the mix during 10 minutes until it starts to boil.

We cover the bowl and leave it until the water is lukewarm.

•  We pour in the baby bottle the amount of water indicated by the pediatrician.

•  We fill the measuring cup that comes with the milk can, without compressing the milk powder and we level the measuring cup with a knife or another element.

•  We put in the baby bottle the number of cups advised by the maker or by the pediatrician. We cover the baby bottle with the disk and the hoop and we shake it so that we dissolve the powder totally and there are no clots.

•  We remove the protective disk and place the nipple adjusting the thread plug, without forcing it.

•  We check the temperature by putting some drops in the hand's inner side or in the back of the hand.

When we feed the baby with artificial milk, as with maternal milk, it is not necessary to maintain rigid schedules. It is possible that the baby doesn't request the baby bottle until after three and a half hours or four from the last taking. The adapted milk contains more proteins than the maternal one, therefore, it provides more calories and the baby makes less takings than of breast milk.

Although it may not seem important, it is necessary to avoid putting more milk than the indicated amount in the water of the baby bottle because it is harmful for the baby's organism, the baby bottles that are too concentrated can provoke digestive or renal dysfunctions and also dehydration. It is not necessary to insist so that he takes the whole content, not all the babies have exactly the same feeding needs.

Between takings we can offer a little bit of water to the baby, it will help the intestinal traffic because the adapted milk lacks the substances of the maternal milk that stimulate the intestine. For this reason, constipation is frequent in the nurslings fed with baby formula and practically nonexistent in the babies that take maternal milk.

The babies that take baby formula cry at times, because they are thirsty, not hungry.

SELF CHECK QUIZ
SECTION 2 - BLOCK 3	CHAPTER 4	Date:
1. The adapted formulas are manufactured in laboratories starting from cow's milk. T r F r
2. The baby should take initiation milk during his first semester and continuation milk during the second semester. T r F r
3. There are special formulas for premature babies, for babies allergic to the proteins in cow's milk, for those with metabolic illnesses or for those with diarrhea. T r F r
4. For correct feeding, we have to carefully follow the rules for sterilization, adopt correct postures, use an adequate nipple and prepare the bottle following the instructions of the pediatrician or the manufacturer. T r F r

With this type of feeding type, besides the maternal milk, the baby takes supplements of adapted milk.

This nursing is advised when there is an insufficient production or secretion of maternal milk that can be provoked by general or mammary illnesses, for psychological reasons, for social or work reasons or in the case of twins that, although the production of milk is normal, it will be insufficient for the two babies.

The pediatrician usually recommends the method to follow for a mixed nursing. We can alternate breast takings and baby bottle but this implies that, when not stimulating enough the breast, the production of milk diminishes and it ends up disappearing. It is better to begin the taking with the breast and to supplement it later with the adapted milk.

It is important to keep in mind that if a baby bottle is used, one runs the risk that the baby prefers to obtain the milk through the nipple because it requires less effort. One can try to administer the formula with a tablespoon.

SELF CHECK QUIZ
SECTION 2 - BLOCK 3	CHAPTER 5	Date:
1. In mixed nursing, the mother should only breastfeed in the mornings and evenings. T r F r
2. Mixed nursing is advised when the production of maternal milk is insufficient. T r F r
3. The pediatrician recommends the method to be followed when breast feeding should be supplemented with formula. T r F r
4. Some babies prefer the bottle because it is easier to suckle and they may end up rejecting the breast. T r F r

In the first four months of life the baby should double his weight from birth, for that reason he needs to eat a lot and often. Each baby follows his own rhythms of sleep and feeding, even if it is done by breastfeeding or with a baby bottle.

Although the baby has a great capacity to adapt, it is possible that he may have some digestive problems:

•  Trush

This fungal affection (mycosis) is characterized because the baby will have some whitish points, similar to milk sediments, in the lips and the inside of the mouth (gums, tongue, palate or inside of the cheeks). This mycosis irritates and provokes nuisances in the mouth impeding the normal feeding.

In these cases, the pediatrician prescribes a treatment with the help of local or general antifungal substances because the trush can extend to the buttocks. It is also very important to follow some strict corporal strict hygiene during the 10 or 15 days that the problem can persist.

•  Regurgitation and vomit

The baby regurgitates and spits small quantities of milk coming from the esophagus or of the stomach without there being nauseas or contractions of the muscles of the abdomen. It is habitual in the first weeks of life and it doesn't usually influence in the gain of weight. The regurgitation usually diminishes with the age and they disappear around the eight months.

The regurgitation doesn't have anything in common with the vomit of great quantity of food accompanied by nauseas in babies that have not vomited before. This problem requires a consultation with the doctor.

•  Pain in the esophagus

When this happens, the baby refuses to take food, he writhes and regurgitates easily. He can have abdominal pains while he eats and, when finishing the taking, his burps are sour and they irritate the mucous of the esophagus.

The pediatrician prescribes a treatment to be administered before or after the takings and she will advise the parents to hold the baby in vertical position after ingesting the food while we hold his head and back. It is also advisable to put to him to bed with the head a little higher than the rest of the body.

•  Hiccups

This usually shows up after the taking and lasts a few minutes. It does not entail any danger. It can happen that, when the food reaches the stomach, this is loosened and provokes a reflex movement of the diaphragm that is the separation muscle between the thorax and the abdomen.

•  Sudden refusal to eat and drink

The baby rejects the breast or the baby bottle. He cries, writhes shaking the legs and vomits. When it seems that he has calmed down, he turns pale and he writhes with pain again. With these symptoms, it is necessary to go to the doctor urgently because it could be about an acute intestine invagination.

•  Rejection of the food

This behavior should always be a reason of concern, mainly if there is no normal weight gain. It is necessary to consult with the pediatrician to rule out the existence of any illness and, in case the baby is healthy, he will give you some advice (to avoid putting too many clothes on him so that he doesn't get drowsy, to follow a more rigid feeding schedule, etc.).

•  Intolerance to milk

The baby seems to be excessively apathetic or irritable and presents other symptoms such as vomits, skin eruptions, diarrhea or very little gain of weight. With one, or several or these symptoms, the pediatrician should rule out the possibility of an allergy to milk or metabolic congenital dysfunctions. In any of the two cases it will be necessary to use special formulas for the feeding.

•  Jaundice provoked by maternal milk

Jaundice after the childbirth can persist for 10 to 15 days. After this time, if the baby is being breastfed, it is very possible that the jaundice may be caused by the maternal milk. This dysfunction occurs because the content in fatty acid of the milk inhibits the normal metabolism of the bilirubin. In these cases the urine is clear and there is no blood incompatibility with the mother. It is important to see the pediatrician, although this jaundice doesn't entail any risks. Only if it was very intense, the mother would have to interrupt the feeding for a few days but, in general, it is not necessary.

•  Constipation

The babies with maternal feeding rarely suffer from constipation.

The number of depositions varies a lot, usually between 1 and 8 daily depositions, or every time that he has a taking.

The frequency of the depositions usually diminishes progressively starting from the first month, independently of the type of feeding. At three months, some babies suffer constipation, mainly if they take formulas, it is possible that they make a deposition every three or four days. The evacuation of the intestine starts becoming regular when we introduce other foods such as fruit and vegetables.

When the faeces are very hard and it is a true effort for the baby to evacuate them, it is necessary to see the pediatrician although it is possible that he only advises to introduce orange or grape juices in the diet.

•  Diarrheas

After being born, the baby expels the meconium through the first depositions,. These depositions are greenish and blackish, sticky and odorless. Some days later the baby expels the transition faeces that are more and more yellowish and less abundant, until the elimination of normal faeces begins.

The diarrhea is very rare in the babies that are breastfed. These nurslings usually make a semi liquid deposition after each taking, the color is yellowish, it has an acid smell sour and small whitish clots.

True diarrhea is usually accompanied by uneasiness, abdominal distension, stagnation or loss in weight and, in occasions, fever or vomits.

If we observe a sudden variation in the characteristics of the deposition or the number of times that the baby defecates increases without having changed the feeding, it is necessary to go to the pediatrician.

The colic of the nursling

At times, mainly at the end of the afternoon, the baby feels bad although he has eaten until being satiated, he has burped and there are no apparent symptoms of illness. The baby cries in a periodic way, some times violently, because he has feeling of uneasiness due to digestive problems that also prevent him to establish his sleep patterns. The colic of the nursling are a very frequent dysfunction that usually disappears before the three months.

The episodes of loud crying can be repeated several times throughout a period of time that can last for 3 or 4 hours. The most frequent symptoms in this dysfunction are the following ones:

• The baby is not able to fall asleep or he wakes up screaming suddenly and crying, while he writhes, reddens or turns pale.

• His gut is tense and inflamed, he looses gases is and his gut makes sounds.

• The depositions can have a sweet and sour smell, a greenish color, little consistency, and there can be Jacquet dermatitis due to the high acidity of the faeces.

• He is constipated, blushes, cries and writhes because it is a great effort for him to defecate. The depositions are dry, as pellets and not very frequent.

When the colic are light, we can soothe the baby by holding him in our arms and rocking him softly, but if they are intense, the pediatrician can indicate the medication to alleviate the problem.

 

SELF CHECK QUIZ
SECTION 2 - BLOCK 3	CHAPTER 6	Date:
1. Trush is a fungal infection that can affect the buttocks of the baby. T r F r
2. When the baby regurgitates we should give him more milk to compensate what he has spit. T r F r
3. Hiccups can irritate the mucous of the baby's esophagus. T r F r
4. When the baby suffers an acute intestine invagination, he refuses to eat. T r F r
5. If the baby suffers jaundice due to the maternal milk, we have to definitively suspend the nursing. T r F r
6. Adapted milk formulas guarantee that the baby will not suffer from constipation. T r F r
7. Diarrhea rarely occurs in breast fed babies. T r F r
8. The nursling's colic are frequent during the first trimester and come up, especially at the end of the afternoon. T r F r
9. Rotating massage in the gut area help ease the colic. T r F r

 

The sleep process, together with that of the feeding, are primordial functions for the baby. During the first weeks it seems that he doesn't do any another thing than to eat, sleep and cry without following a concrete order. To establish a routine so that the newborn adapts these processes will depend on the sleep habits that he acquires.

To try to "educate" the sleep rhythms of the newborn is a useless effort, only he will be able to find his own rhythms and, after several months, reach a balance. So that he can get it, it is necessary that we do not alter his sleep cycles.

The first four months are a complicated period for the baby because he continually has to adapt to an environment that, he is discovering little by little. In this stage, the adaptation is dominated by his biological rhythms and the natural functions of sleep and feeding that are related because the supraquiasmatic nucleus of the hypothalamus controls them.

Most newborns sleep between 16 and 20 hours a day. They usually sleep in cycles of 3 or 4 hours coinciding with the takings. During the first weeks they don't distinguish between day and night and, up to the third or fourth month they only wake up if they are hungry, cold or hot, if they have soiled the diaper, if they feel some nuisance or when they have already slept enough.

Each baby has his own physiology and this marks to a great extent the rules of vigil and dream. Underweight babies usually demand food more frequently and their periods of sleep are shorter.

The stages of sleep

When we sleep we go through a succession of several cycles, from superficial sleep until the deepest that can be summed up in two periods: paradoxical active sleep or REM and slow dream or non-REM, in the baby under four months we also add the period of drowsiness. To know these periods allows the parents to understand the baby's reactions and to respect his rhythms.

•  Phase of drowsiness

Although he is sleeping, it seems like the baby is in a state of drowsiness. If in this phase the parents speak to him or pick him up in their arms he can wake up and later he will find it difficult to go back to sleep.

•  Phase of paradoxical active sleep or REM

This period occupies at least 50% of the time that the baby is sleeping, the percentage decreases progressively, being about 25% when the boy or girl is 2 years old.

In this phase the dreams or oneiric manifestations and plenty of animation take place in the baby's body. The muscular tone diminishes, there is an increase of the electric resistance of the skin, the pulse and the breathing are altered and the electric cerebral activity is more intense.

In this phase he registers in his memory the experiences he has lived while he was awake.

If the parents, thinking that he is awake and uncomfortable hold him or speak to him it is very possible that he will wake up and he will have a hard time falling asleep again.

•  Phase of slow sleep or non-REM

In this phase the baby usually sleeps with the fists closed, the muscles maintain their tonicity and no agitation is visible.

During the slow sleep, the organism segregates the growth hormone (GH), mainly in the first hours of the night for that reason, if the baby sleeps little, or he doesn't habitually reach this phase, the physical (including weight and size) development and that of his cerebral functions would not benefit. This fact explains why babies sleep so many hours per day during the first three months, when their bodies are developing so rapidly.

The baby goes from the phase of slow sleep or non-REM to the paradoxical active sleep or REM (let us say from deep sleep to light sleep) in an abrupt way rather frequently (every half hour approximately) and in this transition he can wake up, but if he doesn't receive any stimuli at that time, such as being held in his mother's arms, he goes back to sleep again.

 

 

The first four months

The baby needs a lot of understanding from his parents in the first weeks of his life. During this time the most frequent and lingering phases are those of paradoxical active sleep and agitated vigil. He needs the attention and fondness of the adults to acquire the security he needs.

• It is necessary to maintain a calm, harmonious and affective environment around him, trying to avoid loud noises, but without seeking an absolute silence.

• We should not alter the rhythms of the baby's sleep confusing the phases of vigil with that of paradoxical active dream. If, when observing that he becomes agitated, he opens the eyes or he whimpers while sleeping and the parents take him in their arms, he will find it difficult to go back to sleep again. Whenever the baby cries, it is necessary to check what happens, but if everything is well, it is better to wait to make sure that he is awake and in the phase of vigil. If every time that he protests or whimpers, he is held in arms or fed, it will be more difficult to establishes his own rhythms of sleep and the over eating will only increase the problem.

• We should choose a basket or adapted cradle that guarantees the baby's comfort. In the first months he spends many hours in it, the basket can very pleasant and loving at the beginning it will be left small very soon.

Once the baby is moved to a cradle it is necessary to try not to change him. If the cradle is a folding one, it can be taken in our trips so that, although he changes rooms, the familiar elements of his cradle offer him tranquility and security. The cradle can be changed of location in the room because this way the baby can receive more varied stimuli, but if he is moved to another room, so should his cradle.

The baby will love to have some stimulating elements in the cradle such as mobiles, lamps that project figures while playing a melody, baby rattles or stuffed animals.

• After the takings and before entering in the drowsiness phase, the baby goes through a period of calm vigil that the parents can take advantage to play with him and to cuddle him but, when they suspect that he begins to get tired, they should take him to the cradle so that he learns how to fall asleep alone. It is possible that he whimpers a little because it is his form of catching sleep, but the parents should not take him in arms, some soft caresses or a cradle song will help him to fall asleep.

• So that he learns how to differentiate the day from the night we should follow different rituals.

During the day he can sleep with the habitual sounds of a house, we can dim the intensity of the light a little and, if it is possible, put him to bed in his basket or in the pram so that he learns to associate the cradle with the night sleep, and differentiate the day from the night.

When the baby is in a phase of vigil, the parents can and should take advantage to offer him stimulation and to cuddle him. These are the best moments to present him colorful objects and objects that make sounds, to speak to him, to caress him and to cuddle him. Besides transmitting him all their love, this way the parents help him to develop his physical and intellectual potential and the baby learns to associate being awake with different activities.

At night there should be silence and darkness in his room. The last hour of the afternoon can be a good moment for the bathroom and, after the taking, we follow the ritual that we will use every night. For example, to burp him, to change his diaper, to put him to bed in the cradle, to sing a lullaby and to turn off the light. Always in the same order.

For the night taking we will choose a place with little intensity of light, almost in dimness. We should not talk with him or play with him and when he has burped, we should put him to bed again.

We can progressively reduce the night takings. If the baby whimpers at night it is not necessary to hurry to hold him so that he makes a taking. After checking that everything is well, it is wiser to let him cry a little, he will possibly fall asleep after a soothing caresses. When the baby weighs around 5 kilos he can do without the night taking because he already has enough reserves, but the parents should keep in mind that until 4 months the baby doesn't usually sleep 8 or 10 full hours.

At nights we will have to use all our patience, not lose our nerves and offer to the baby a big dose of sweetness, but with stability, in our actions.

• It is not advisable to take the baby to bed with the parents, much less if the mattress is soft or if there are too many bed clothes that generate a lot of heat. The father or the mother could rotate when they are sound asleep and injure the baby. Although it mat be more comfortable for the mother to feed the baby without getting out of the bed, it is completely inadvisable to sleep with the baby in the parent's bed.

During the first month you can place the cradle in a comfortable place in the bedroom of the parents, but after this period, the ideal thing is that the cradle is located in room for the baby.

• After the first 15 days of life, in the afternoon, many babies cry and writhe although there is no physical cause for these signs of uneasiness. Pediatricians call these episodes evening dysrhythmia (evening anxiety) that is due to the discharge of the tension that the baby has accumulated throughout the day. This problem usually reaches its maximum intensity towards the sixth week, it diminishes progressively and it usually disappears around the third month.

Parents will have to apply all their patience and love as the baby is trying to adapt to the rhythms of the day and night and he needs the understanding and calmness of the parents.

Of course it is inadvisable to administer sleeping pills or tranquilizers that, besides not solving the problems of the baby's sleep, they can harm the development and the maturation of his nervous system.

The baby's sleep position

Nowadays pediatricians recommend that the baby sleeps face up because it seems to be that the risks of temperature elevation (hyperthermia) diminish in that position, the baby also has a bigger area to breathe well without the risk of asphyxia that exists when the baby places his nose and mouth in the pillow.

To avoid the risk of regurgitation, he can go to bed on one of his sides, placing a towel or blanket on his back so that he maintains that posture.

The mattress of the cradle should be firm and it is not necessary to use a pillow. It is more practical to dress the baby in a nightwear blanket than to place sheet, blanket and quilt or comforter in the cradle because all this clothes can bother the baby. It is necessary to always have present that cold and heat can bother the baby, both situations can provoke his uneasiness and interrupt his phases of sleep.

SELF CHECK QUIZ
SECTION 2 - BLOCK 3	CHAPTER 7	Date:
1. Most newborns sleep between 16 and 20 hours per day. T r F r
2. If the baby is in the active sleep phase and cries because he is having a nightmare, we should hold him in our arms and get him to calm down or he will not fall asleep again. T r F r
3. The growth hormone is produce during the drowsiness phase. T r F r
4. If the parents want to stimulate and play with the baby, the best times are those of active vigil. T r F r
5. To help the baby learn to differentiate between day and night, we have to follow different rituals when putting him to bed. T r F r