Neonates & infants

Information for the little ones

Prolonged bottle feeding

A very common ‘problem’ seen in children is that they are ‘bottle fed’ forever.

It’s because both the child and the parents find it very ‘convenient’. (more…)

Please give Paracetamol AFTER vaccination.

From BNF for children Post-immunisation pyrexia in infants (see also Post-immunisation pyrexia in infants)

  • Paracetamol by mouth

  • Child 2–3 months 60 mg as a single dose repeated once after 4–6 hours if necessary
    (dose can be repeated twice for meningococcal B vaccine)
    Child 4 months 60 mg as a single dose repeated after 4–6 hours (max. 4 doses in 24 hours)

(more…)

Tongue tie

Tongue tie or ankyloglossia is a common condition in babies. But the fact is that it rarely causes any problem for the baby in feeding or speaking when they are older. (more…)

Faltering growth (Failure to thrive)

Many babies fail to gain weight as expected during the first few days of life. Newborns are expected to loose up-to 10% of their birthweight by Day 5-7 after birth. If they are exclusively breastfed, the breast milk starts to come from Day 2-3 onwards. They then start to gain weight from Day 5-7 and usually regain their birth weight by Day 10.

Most common cause of excessive weight loss is inadequate milk supply in mother, for various reasons. The mother should drink plenty of fluids, eat a healthy diet, try to get adequate rest and put the baby to breast at regular intervals. The technique is also very important and midwives are a great help with that. All these factors help increase breast milk production.

A small percentage of babies may need some top up formula milk or Expressed breast milk if the milk supply does not improve despite the above measures. A health professional should be involved and monitor the weight carefully at regular intervals and ensure that the baby is otherwise well and there is no other factor influencing the feeding and weight.

ODD shaped heads in babies

It’s called Plagiocephaly in medical terminologyPlagiocephaly is a disorder that affects the skull, making the back or side of a baby’s head appear flattened. It is sometimes called deformational plagiocephaly.

There are no symptoms associated with plagiocephaly other than the flattened appearance of the back of the head – either evenly across the back or more on one side. It does not cause any pressure on the baby’s brain and development will not be affected by it in later life. 

Its importance is entirely cosmetic. Nevertheless, if you are worried about any aspect of a baby’s health and are concerned that it might be connected with their head shape, you should always check with a doctor.

Excessive crying in babies

  • Excessive crying in the first months of life is usually benign and self limiting, although in a minority of babies it may be linked with more long term and serious problems. No routine investigations are needed for an afebrile child with no signs of illness on a thorough history and examination.

Reflux (Gastroesophageal Reflux Disease)

Many babies cry a lot specially after the feeds. This could be Gastroesophageal  reflux.

Gastroesophageal reflux (GOR), the passage of gastric contents into the oesophagus, occurs commonly in newborn infants, especially those born prematurely. Physiologic GER typically is a developmental process that resolves with maturation. GER generally resolves on its own by one year of age. In infants who remain asymptomatic, no further evaluation or intervention is typically required.

In contrast, GOR disease (GORD), is clinically significant GER that causes problems. In infants they include frequent vomiting, aspiration pneumonia, irritability, failure to thrive, and exacerbation of respiratory symptoms, including chronic lung disease and most commonly excessive crying.

I see many babies who have been suffering as the reflux is undiagnosed or untreated. Diagnosis is usually clinical indicated by poor feeding, possetting/vomiting a lot, crying, arching of the back, unsettled babies. Treatment is by burping them after each feed for 15-20 min, sleeping them at an angle by raising the head end of mattress, feed thickeners like Gaviscon Infant/Carolbel and some medications which can be prescribed by doctors.

Babies who are breastfed, can be tried on feed thickeners like Gaviscon Infant or Carobel. They do tend to constipate the child, so dose may have to be adjusted.

There are some pre thickened formulas available now like Aptamil Anti Reflux (AR), Cow & Gate AR, SMA Staydown etc. They can be tried if the baby is formula fed and see if that helps. If the simple measures are not working then professional advice should be sought.